​Meet K.E. Garland of Jacksonville, Fla., a mother of two daughters (ages 19 and 22) and loving wife of 25 years. As if preserving a marriage for a quarter century and raising a family were not enough, K.E. is also a published author, educator and the creator of the menopause awareness site, NavigatingtheChange.

I recently had the privilege of contacting Ms. Garland, who altruistically agreed to answer some behind-the-scenes questions about her experience through “the change.” The 48-year-old Garland is still in perimenopause, not actual menopause, as she has not yet gone a full 12 months in a row without menstruating.

Now for the Q-and-A!

Many people think there’s a connection between when women started their periods and when they go through menopause, though there isn’t much science to back this claim. How old were you when you started your period? And how would you describe your menstrual cycles?

I started my period when I was TEN years old! It took me a while to figure out what was going on, even though my father explained it to me. My periods were always predictable; if I didn’t have a period, it was because I was pregnant.

How would you characterize your pregnancies? Were they uneventful, difficult on in between?

My pregnancies were very normal. For both, I was almost fully dilated and didn’t know it until I went to the last appointment. For my second pregnancy, I had to have a C-section because, instead of feeling the baby’s head, the OB/GYN felt her feet (breech position).

What do you recall experiencing as your earliest perimenopause symptoms, and when?

I think I was around 44 or 45. The biggest issue I had initially were periods every other week! It was the most distressing thing I’ve ever gone through. The first time it happened, I had on white pants and was headed to work, which is 60 miles from my home. I just happened to have to use the bathroom, and that’s when I found out I was having another period, even though I’d just had one two weeks’ prior. This is one of the sure signs of perimenopause – irregular periods.

What have been the most challenging symptoms, and how have you gone about trying to relieve them?

Later, I began having hot flashes, night sweats and insomnia. After doing a little research, I found that drinking alcohol, especially wine, and having sugar at night right before bed increases hot flashes and night sweats, and that can also cause insomnia. I stopped drinking wine or anything right before bed. Also, I’ve switched to a plant-based diet, which includes more vegetables and fruits, and less meat. Some of the meals I enjoy are veggie tacos or coconut curry-chickpea-type recipes.

Is anything off limits, as far as what you will do to get relief for symptoms?

So far, I haven’t had to do anything too crazy, but usually if a new symptom comes up, I try to first do something natural, like change my diet, and then seek other ways.

What have your encounters with the medical community been like, particularly in dealing with perimenopause?

Doctors have been NO HELP to me. My gynecologist told me I was “going through menopause,” and she could prescribe birth control to alleviate the symptoms. I didn’t even understand why she would suggest birth control. But now I do . . . it’s all hormonal. In fact, my experience with doctors is part of the reason I began the website, NavigatingtheChange. I was researching so much that I figured I’d include what I found in order to help other women who may be struggling.

Is your experience of (peri)menopause anything like that of your mother, as far as you know? Have you talked to other female elders or relatives about their experiences?

My mother died when I was 16, and I did talk to my grandmother, who will be 95 in October. She said, “I only had a little sweating!” So, yeah, no one in my family full of women had said a word to me about this very important time period, not one word.

What do you most wish you had known beforehand?

I really wish there would have been some type of ceremony or something. Wouldn’t it be cool if all of the elders would give you one thing that could help you? For example, I’d give my daughters turmeric or ginger tea because it helps settle your stomach and your nerves (bloating and anxiety are symptoms of menopause). It would be a coming-of-age box.

For some women, perimenopause is so hard that it’s difficult to envision the future. If you’re able to think 20 years into the future, what do you envision?
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Twenty years from now, I hope to be done with all this menopause brouhaha! All of the crones say that phase is very liberating, so it sounds like a much more relaxing time. I hope that in 20 years, I’m walking around like one of those so-called crazy-looking women with wild hair, who could care less what others think about anything. I think I’m almost there! 

Kitty Anderson is one of the few nationally Board-certified health coaches in the U.S. specializing in menopause education and recovery. By her count, there are only seven similarly credentialed health coaches in the United States.

When I first stumbled across her YouTube Channel, Create a Menopause Recovery, I knew that Kitty was someone special. As an ardent researcher myself, and as a woman just months into her own HRT treatment and recuperating from interludes with a medical system with few knowledgeable practitioners, I was immediately impressed by Kitty’s comprehensive approach to sharing information, truly helping women and focusing on multifaceted solutions. Kitty is not only a menopause expert, she has also been using hormone replacement therapy (HRT) to address her symptoms and improve her quality of life for 14 years.

Kitty Anderson graduated from The Mayo Clinic College of Science and Medicine’s accredited coaching program and passed the National Board Certification Exam, the same body that licenses physicians. In order to maintain her credentials, Kitty takes continuing education courses and is bound to adhering to precise ethical rules and a defined scope of practice. She has also completed coursework in health, psychology, neuroscience, counseling, wellness and nutrition, among others, at Wright State University and Sinclair College.

Kitty’s current paid offerings include one-on-one consultations and webinars, focusing on HRT, stress reduction, nutrition, relationships, movement, sleep and more.

I recently caught up with Kitty to discuss how women are dealing with – or rather, not really dealing with perimenopause – with a special emphasis on her concept of menopausal care as a social justice issue. While many online menopause evangelists may have a decided bent towards naturopathic or conventional medical remedies, or may seek to abandon to idea of any treatments since menopause is a “natural event,” Kitty is the first I’ve encountered who adds a socio-political and socio-cultural element to her advocacy.

Why do so few women seem to know about HRT, let alone use it, for their perimenopausal and menopausal symptoms?

Hormones do hundreds of things in our bodies, and that's how the body works. Only three percent of American menopausal women are getting HRT. Many women are denied HRT by their (conventional) OB/GYN. It is NOT the standard of care to offer HRT.  That means we can't sue our doctor if they say no. 

What about alternative ways to get HRT?

A functional medicine doctor or a functional pharmacy will be more generous with HRT, but it is more expensive. They may or may not counsel on diet. We pay extra for these services, and the product quality is lower than the FDA-approved products.

It seems like so many women are on various prescriptions, potions, supplements or unproven lifestyle changes to get relief from menopausal symptoms. Why?

Our algorithms make it impossible to find valid consumer-friendly information. Everyone is selling something to replace HRT. There is just not a logical reason to use these other products in my mind. They are not the identical molecule to the hormones you used to make.

And there aren’t many accessible examples of women successfully navigating menopause in real life either, right? At least not in terms of symptomatic women talking openly about their symptoms and sharing what worked?

Women tend to look to other women, and there are few examples of women thriving on HRT. If you don't have a friend using HRT, you don't see the benefit. It seems unnatural. But the identical molecule is natural, right? Replace what's lost -- in a form that your body uses.  

There are various formulations and preparations out here that are all classified as HRT. How can there by so much variability in the market?

The broad category of drugs called HRT don't all perform equally for sleep, mental health and cognitive health. Our menopause society (North American Menopause Society - NAMS) doesn't focus on brain health. The research outcomes are focused on menopause symptoms and future bone health. Doctors treat all drugs in the HRT category as equal, and they are not. Our medical system allows this.

Research shows that women of color, and Black women in particular, may have a more difficult and earlier transition to menopause. How does this factor into your concept of menopause treatment as a social justice issue?

Women of color and low income women are about 30 percent less likely to have an HRT prescription. Health information and products are not as available. I think that the lesser quality and less expensive oral estradiol is available on Medicare as the first line of treatment. I have heard of some women getting transdermal estradiol, which is better. 

What are some other barriers to women’s success with hormone replacement therapy?

Not all women trust the medical industrial complex . . . for good reason, right? We have some drugs that are worse than the disease. It is a for-profit system. This works to our detriment. Seventy percent of women stop their HRT in the first year without talking to their doctor. And 70 percent of women do not read the directions to apply their HRT correctly. They are under-dosing.
 
Even smart, successful women are having a hard time getting quality information and the right treatments. Many end up with cabinets full of supplements, vitamins, tinctures and herbs. Others are prescribed medications that don’t fundamentally address the hormonal loss.

I have talked with extremely educated women who know research inside and out. They did not figure out that HRT was critical. The information never made it to them. I know female health coaches in their 50s and 60s, and they did not know what HRT does. They were not using it. 

How can they lead women to wellness without it? There are currently only seven menopause coaches with the Board Certification of NBHWC. There is no training for our Board-certified coaches. I created my own training from a multitude of sources.

What does this do to women over time, this lack of informational access and proactive engagement from their healthcare providers?

When a woman over 60 years old comes to me to talk about hormones, she is really broken. She has arthritis, she has autoimmune problems, she has fatigue, she lacks confidence and motivation, and she is fearful. Her body has gone without hormones for a decade. It has changed. In some ways, she will not recover. She just didn't get the right information at (or before) menopause. It's so sad. 

It seems like some of this is socially conditioned as well as structurally induced, within the systems of healthcare, education and media, this lack of open treatment discussions and awareness for women. Hence, this is really is a social justice issue, like you said. It involves equity, access, investment and repairing the fissures in our medical system.

Most women just think they should "tough it out" or “not bother anyone.” Women are accustomed to self-sacrifice and giving the doctor control of the outcome. They don't understand how to work the system to get what they want. No one is telling them that they are in charge of their health outcome. Doctors are looking for compliance typically, but they don't talk to us about whether or not we are getting enough HRT. 
They don't ever phrase this as, “HRT is good for you. You should feel really well.” And for some reason, there are no testosterone products off the shelf for women. Testosterone is a controlled substance. NAMS doesn't even cover testosterone in their training. (Editor's note: The International Menopause Society does address supplemental testosterone for women.)

I feel like we have to know more than our doctor to get this to work well. All three hormones – estradiol, progesterone and testosterone – are important and all are low at menopause. You can't expect your body to work with 1/20th the amount of reproductive age hormones at menopause.


You can learn more about Kitty Anderson at https://www.jumpstartaip.com/. She offers paid 1:1 consultations and webinars.

Highlights from her YouTube Channel are:

Perimenopause and Menopause HRT for Infection, Weight Loss, Alzheimer’s, Diabetes
Higher Dose HRT Works Best for Mental Health: How HRT Works
100 Ways Hormone Loss Gets to You: HRT Prevention and Recovery
HRT and Personality Changes: What to Expect – My Story, My Clients and Universal Laws of Hormones
No Rules for Menopause? Well, Guidelines, Yes.

Perimenopause is not a linear experience – that is, its course, symptomatology and severity vary by each individual woman, though there are some common denominators.

However, for years scientists have been investigating many perimenopausal factors, including onset, level of debility and longevity of symptoms by racial groups and ethnicities. One of the most interesting and compelling studies is the SWAN study, also known as the Study of Women’s Health Across the Nation, which first started in 1996.

A subset of this major research study has unearthed race-specific findings, showing that the perimenopause experience may in some ways be associated with ethnicity. Given the diversity of women participating in SWAN over the years, researchers have had the capacity to evaluate women’s experiences from a physical, racial, biological, sociological and psychological lens. At the start of the SWAN study, 28 percent of participants were African-American, 47 percent were White, eight percent were Hispanic, eight percent were Chinese and nine percent were Japanese. Study participants were followed every year during the first 10 years and then every other year subsequently.

Many facts about menopause digest key points into an aggregate, one usually represented by the largest swath of the U.S. female population – white women. But within the predominating factoids about menopause, such as the average age of complete menopause being 51 in the United States, are other layers of nuance and differentiation. For example, the average of menopause for Black women is two years sooner, age 49. (Note: Menopause is defined as going 12 months in a row without a period. By most estimates, perimenopause – the time leading up to menopause when women are often symptomatic – can last 4-12 years).

Key Racial and Ethnicity Findings

• African-American women were more likely to undergo surgical menopause, or hysterectomy. Women whose ovaries have been removed face increased morbidity from strokes, fractures, Parkinsonism, cognitive impairment, dementia, depression and anxiety. These issues are amplified if the ovarian removal occurred before the age of 45.
• Hispanic women were more apt to experience an early or premature natural menopause.
• Black women reported higher incidence of heavy menstrual bleeding, while Hispanic women were more likely to develop type 2 diabetes. White women had the lowest bone density in the cohort.
• Hispanic women are not a monolith. Within this population, there are different nationalities and countries of origin. Puerto Rican women had the highest rate of metabolic syndrome, anxiety, depression and insomnia when compared to other Hispanic women. Yet Central American women reported greater vasomotor (hot flashes and night sweats) symptoms than other Hispanic sub-groups.
• African-American women had the highest BMI in the study, and researchers believe there is a connection between menopausal symptoms and BMI. Hispanic women had the second-highest BMI. Both Black and Hispanic women reported more severe and frequent hot flashes than other women.
• Lower socioeconomic status was related to an earlier menopause. Financial strain, adverse life events, daily stress and inadequate social support correspond with both depressive and menopausal symptoms. In the U.S., Black and Hispanic women as minorities face more race-related disparities in daily life. Some characterize the physiological manifestations of pronounced and ongoing stress as “weathering” that causes medical issues and aging due to an increased allostatic load (wear and tear on the body from chronic stress). Interestingly, Black women report hot flashes for 10 years, Hispanic women for almost nine years, and white women for around six and a half years.