I arrived at my new job during the pandemic. The scheduler placed me on the night shift, isolated and in an alternate location. After about a month of working in that position, I went to the doctor because I wasn’t feeling right. I couldn’t quite put my finger on it; I struggled to sleep, and I was gaining weight, even though I was still exercising and eating a healthy diet. My doctor wanted to prescribe antidepressants, but I wasn’t depressed. He prescribed sleeping pills, but the side effects weren’t optimal for the type of job I held.
Talking with my doctor and getting nowhere MADE me feel burned out. I scheduled a trip home to Virginia for some rest, and I thought about whether or not I wanted to retire sooner rather than later because I was under a tremendous amount of stress on shift duty. Not because of the work per se, but because shift work is stressful to the human body.
While at home, I went to the emergency room, where doctors discovered a blood clot in my leg. As a result, I started seeing different specialists over the next several months. I saw a cardiologist, neurologist, pulmonologist, and hematologist. None of them pinpointed what my issue was. Only the pulmonologist said I needed to watch my stress.
While in the waiting room of the neurologist, I read an article about menopause. Something stood out; the author talked about the changing brain of a woman in menopause. I took the article to the neurologist and told her that I think I’m menopausal. She said, “Oh, I didn’t even consider that. You don’t fit the profile!” She still prescribed an antidepressant, but I never took a single pill. I started reading every book I could about the brain and hormones instead. I felt empowered and became my best expert. This journey led to becoming a sharper thinker, and champion for female wellness in the military.
I am an Air Force senior leader committed to being part of the solution to the retention crisis currently affecting my service. I want to speak to servicewomen ages 35 and beyond (and those who supervise them) about a natural factor that may prevent some women from being their most effective selves. It is menopause, and it affects military women in myriad ways. The truth is that the effects of vaso-motor functions at the neural level are due to the impact of three hormones: estrogen, testosterone, and progesterone. Additionally, research on cortisol and core executive functions shows that the amount of stress a woman is under at around the age of 35 may affect menopausal symptoms starting in perimenopause. Thus, it is an operational imperative to implement menopause awareness in the Department of Defense (DOD).
This article explains the realities of menopause, the different stages—perimenopause, menopause, and post-menopause—why younger women should care, strategies for resilience, and current approaches to address menopause in the DOD.
First, let’s be clear—I am not a medical doctor. As I mentioned, I am an Air Force senior leader. I hold an undergraduate degree in biology, an advanced degree in health psychology, and nutrition and hormone health certifications. I am qualified to speak on this matter because of my educational background and because it affects Airmen.
The reality is that menopause crosses four areas of strategic interest to the DOD:
1. Women’s health
2. Occupational health
3. Mental health
4. Retention
Suppose we are serious about retaining expertise and nurturing our best talent. In that case, it’s best to become aware of menopause. Although women’s health and readiness have gained an increased level of interest—it usually surrounds family planning, pregnancy, and postpartum issues. And among the dozens of pamphlets in the women’s clinics on Air Force installations, there is little information, if any, on menopause. A lack of reference material on the topic is an issue. Because if you intend to work past the age of 40, you will be affected by menopause, even if you don’t have an interest in maternal care.
Menopause Stages
A few years ago, I shared a post on Linked-In about women in the UK leaving the workforce for a little-known reason. It was due to menopause. I shared it on my page and added, “And she faces it while it being largely misunderstood by her doctor, those closest to her, and her boss.” That post resonated with women and men alike. I received several stories in my inbox and even more thanked me for sharing the story. Men committed to a healthy workforce thanked me—most hadn’t considered menopause as an issue in the workplace, or retention for that matter.
I then educated myself on hormone health and interviewed health experts, other senior leaders, and high-performing business owners; the stories were very similar. There was a continual thread—menopause was an issue that affected their perceived bearing, thought processes, sleep, and performance. My mother, an old-school human resources officer who experienced women leaving the workforce due to menopause, told me that women have been dealing with menopausal symptoms forever—it’s always been a problem. Still, no one was committed to providing resources. Women must know that depending on their stress level, perimenopause can start as early as 35, followed by menopause, then post-menopause.
Let’s look at each stage.
Perimenopause
If you think about the average career woman, she’s working hard at her career. Still, it becomes more complex if she decides to marry, have children, deploy, lead large projects, and return to school. She’s flying along in her career, sometimes working long hours and putting her health last. If stressed, her cycle becomes out of sync, a sign that something may be off. Stress management is the healthiest solution to long-term health.
What’s happening is The Change, a euphemism for menopause, but many medical professionals do not help their patients connect stress to menopause. In fact, during my investigative work on professional women and menopause, I discovered that antidepressant use sharply increases in middle age and continues to climb—exceeding the use in men. But what if women understood that some of what they’re feeling is due to hormonal changes and stress? It’s at perimenopause when a professional woman should be looking at timing her life to her luteal cycle; it puts her in synch with the natural aging process and is also mindful. It can serve as a protective factor for the next stage.
In a study on cortisol and executive functions, researchers observed that chronically elevated cortisol levels contribute to adverse effects on the immune system, multiple hormonal systems, and neural function. This study is critical when considering the kind of work military women do because it essentially says that structural alterations in neural systems contribute to cognitive impairments—which is what women experience in menopause.
Perhaps fewer antidepressants and more awareness are in order, as she’s just beginning a journey that can be 20 or more years long.
Menopause
Technically, a woman enters menopause one year after her last cycle. Although this is the formal definition, the truth is that because of declining hormones, she will experience one of the 12 major symptoms of menopause.
The big three symptoms, brain fog, hot flashes, and sleep problems, are what are of the highest concern to professional women because they come suddenly, without warning, and depending on their stress, can be debilitating. I am not in full menopause, but I experienced my first hot flash while at work. I didn’t know what it was, but I soon underwent all of the major symptoms just by being on shift work. Unfortunately for me, I am not a candidate for medical intervention like hormone replacement therapy, so I have to work on more mindfulness training tactics. But for most women, you must communicate these changes with your doctor before considering a total career change.
I hope that our military leaders can follow the path of the prime minister of Scotland, Nicola Sturgeon, who felt it was her duty to openly talk about menopause because it affects all areas of a woman’s life. That is a leader committed to female retention and recruitment. Who wouldn’t want to work for a company that implements actions that increase employee retention over their lifetime?
Post-menopause
After menopause, a woman may feel a little more in control because they no longer have the turbulent hormonal effects. It’s not entirely over because post-menopausal women still contend with a higher risk of disease and joint problems.
At this point, women consider retirement or a second career. However, this demographic is of equal concern because it is almost invisible. Even in my own study, it is difficult to find research on post-menopausal women.
Strategies
Marked by rapid changes that affect performance, symptoms of menopause typically start in women between ages 45-55. Because changes are erratic, symptoms are noticeable by peers and can lead to debilitating effects. Symptoms of menopause that affect workplace performance include hot flashes (75% of women), brain fog (60% of women), sleep problems (26% of women qualify as insomniac), and depression/mood swings/anxiety (23% of women).
Understanding how severe the symptoms are, the good news is that three key strategies may help alleviate symptoms and lead to empowerment, less stress, and improved mental health:
1. Brain health
2. Diet
3. Exercise
Let’s take a brief look at each.
Brain Health
Consider the stress response as it relates to brain health. The stress response occurs when the brain detects a threat. It works a complex dance within the hypothalamus and secretes a hormone that regulates cortisol. Cortisol, the “flight or fight hormone,” is shown to be higher in women, especially as they wake up. Many of us start our day after a cup of coffee and skimp on sleep, burning candles at both ends. It’s imperative that women take their earned Leave on a regular basis and practice daily self-care. Hence most morning wellness strategies for men aren’t as effective for women.
Wellness starts with sleep, being mindful of your stress levels throughout the day, and creating psychological shortcuts where needed, like reading a book, taking a quick nap during your lunch break, and getting lots of sunshine. Take care of your brain!
Diet
Eat for hormone and brain health. A great book I read years ago, long before thinking about menopause, was Grain Brain by Dr David Perlmutter. The concepts made perfect sense as they relate to hormonal health. They change how you think about food during this stage. You must eat to nourish your body, not just give it fuel—which is a different way of thinking about food. Foods that are higher in good fats are key, and avoiding junk food and high sodium are good choices.
Exercise
Believe it or not, walking is the best exercise for a menopausal and post-menopausal woman. Walking outside without sunglasses and showing as much skin as possible for 20 minutes is ideal for hormonal health. For those of us who have to maintain fitness due to our jobs, we have to prepare for the physical fitness test differently; making sure to incorporate more walking and stretching, with a focus on joints when doing weight-bearing exercises. Old-school compound movements are better than some of the newer exercise routines.
Leaders implementing strategies such as physical fitness programs, improving access to healthier meal choices (military installations can do better than Burger King—I’m just saying), and Annual Leave forecasting can expect reduced absenteeism and increased productivity and morale. One military location did just that.
Best Practices
The US Navy Medicine Readiness and Training Command in Naples, Italy, recognized an issue with active-duty women and tied their symptoms and effects to menopause. As a command strategic goal, the researchers and nurses created a condition-based program to improve female force readiness, as they found that 53% of active-duty women ages 45 and older were overweight, and 20% were obese. The program included an eleven-part program to manage menopausal symptoms. Unfortunately, the program was negatively affected by the 2020 pandemic and ended. It’s time to implement this program across all Services. We can do this.
Fostering menopause awareness within the military is not just a matter of health but a strategic imperative for maintaining operational readiness. By acknowledging and addressing the unique challenges female Servicemembers face during service, we not only enhance their well-being but also strengthen the overall effectiveness of our forces. As leaders, it is incumbent upon us to champion this cause, ensuring that military women receive the support and resources they need to thrive. Let us commit to creating an environment where every Servicemember, regardless of age or gender, can perform at their best, contributing to the success of our mission and the welfare of our entire military community.