Sex, Sanity and Sleep!: Everything About Perimenopause and Menopause

By Nadu A. Tuakli MD

“Dr. Tuakli is a wonderful physician, always considering the range of treatment options for her patients. In women’s health she has been particularly open to new advances in care. She was one of the first primary care physicians in our region to recognize the benefits of uterine embolization as an alternative to hysterectomy for women with fibroids. She brings the insights of years in practice as well as the latest research advances to every patient’s care.”

Her podcast is called Wellness and Wisdom with Dr. Nadu Tuakli

James B. Spies MD, MPH
Professor and Chairman, Georgetown University Hospital
Department of Radiology

• Language: English
• Publisher: Xlibris US
• Release date: Apr 27, 2023
• ISBN: 9781669873648

Book preview

Copyright © 2023 by Nadu A. Tuakli MD.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Rev. date: 04/27/2023

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Contents

Abbreviations

Acknowledgements

Chapter 1     Sex, Sanity and Sleep

Chapter 2     Don’t let fear make your decisions for you

Chapter 3     Meet the Pauses: Menopause, Perimenopause, and Postmenopause

Chapter 4     The Role of Hormones in Women

Chapter 5     Symptoms of Hormonal Imbalance

Chapter 6     Sexual Intimacy

Chapter 7     Sanity

Chapter 8     Sleep

Chapter 9     Treatment of Menopause

Chapter 10   Scientific Research On Hormone Replacement Therapy

Chapter 11   Are Hormones Right for Me?

Chapter 12   Interesting Facts

Chapter 13   Male menopause aka Andropause

Chapter 14   Parting words: looking to the future

Contact information

References

Abbreviations

Acknowledgements

T O MY HUSBAND and soul mate, Roberto Sanchez PhD, who quietly puts up with my unending projects which can range from a burning need to write a book to spontaneous volunteer trips to disaster areas and so much more in between. He is my stabilizing rock, more loving and supportive than I could ever dream of. Thank you for taking the cover photograph (autumn in Pompeii).

I would also like to thank my patients. For over 30 years they have trusted me to help them and their families. It has been wonderful to watch children, young couples and mature adults alike, grow and thrive as they have equally enriched my life. My patients have shared their stories and challenged me to keep them in optimal health as I have shown them how to age in the healthiest way possible.

Chapter 1

Sex, Sanity and Sleep

Nadu A. Tuakli MD, MPH

Once you stop learning, you start dying.

-Albert Einstein

S O HERE IT is: the book that I wanted to write for years! I would vow to write this book every time a woman walked into my office suffering needlessly with menopausal symptoms. I vowed to write this book so women could educate themselves and not have to suffer in this way. It took me a while but I finally got it done.

I originally published the book under the title Lifting the Veil of Menopause. When I convinced women to read it I would get tons of positive feedback. Patients thanked me for writing the book and for insisting that they read it. One lady told me she saw herself on every page. The ‘problem’, if there was one, was partly the title. Women do not think menopause is exciting and so they were hesitant to pick it up or even admit that they needed to read it.

This book is about the symptoms of hormone imbalance and how to manage them. ‘Sex, sanity and sleep’ encapsulates some of the major symptoms in terms of extent and severity but as you will discover when you read this book there are many others. Even though this book focuses on the symptoms that you feel, do not lose sight of the absolute health benefits of BHRT including prevention of heart disease, less risk of dementia and prevention of osteoporosis. Remember to always weigh the benefits against the perceived risks which may not even exist.

So, let’s just say it right at the beginning: none of us necessarily want to discuss sex, mental issues, or menopause with our doctors.

Sometimes it is because these topics, quite frankly, can be just a little embarrassing and many times women are in denial about needing help in these areas. It doesn’t help when doctors don’t listen to these women or blow off their concerns as a natural course of events.

An organizer of a women’s conference told me last year, No one wants to hear about menopause. So I did not find it too surprising when I mentioned my previous book, Lifting the Veil of Menopause, and women would say Oh, how in-ter-rest-ing! as they stared blankly over my shoulder into the distance, a polite way of saying "Really, do we have to talk about it?."

The original book was specifically conceived to bring light to the issues of menopause that many women feel uncomfortable mentioning to their healthcare providers. I will discuss this reluctance later in the book and the possible causes. Suffice to say many times women find it easier to read about these issues than to talk about them. Be that as it may, these topics must be discussed one way or the other, if women are to improve their quality of life, and reach their full potential.

So I have taken a new approach: To talk about specific issues while also discussing menopause and perimenopause. Unlike the bored response to ‘menopause’, most women react to the topics of sex, sanity, and sleep with a nod and a knowing smile. These subjects are important to so many of us, and we know we must find balance, something that’s not easy to accomplish with our busy schedules and various daily life crises.

If I told people that I still think of practicing medicine as an art and that I constantly enjoy polishing my craft, they may laugh at me in disbelief. But actually it is true, the hands on wisdom I have acquired during the last thirty years of practicing medicine has fueled my desire to continue making a difference in my patients’ lives, particularly in the area of women’s health and longevity.

So, why did I have to write this book? The answer can be found in the old saying knowledge is power. Never is that more true than for a patient. Often, I find that, even though I am an experienced physician, many of my colleagues are unwilling to engage in a meaningful debate about hormones with me, much less with an inquisitive patient. To put it very simply, I love to teach, and I believe providing my patients with the knowledge I have gained through my experience will only make them more powerful in their own lives. Who couldn’t use a little bit more power in their daily lives?

In addition to my clinical practice, I have always enjoyed teaching. I taught as an assistant professor at Georgetown Medical School as well as under less official hats like preceptor for nurse-practitioner students from Duke, Catholic, Maryland, and Marymount Universities or just as a mentor for high school seniors. Most importantly, I teach my patients. I truly believe that my most essential role as a doctor is to provide my patients with the tools they need to be healthy and that means information and education.

Over the years I have had the opportunity to treat a lot of menopausal patients and have seen, firsthand, the dilemmas that hormone imbalance can create. In writing this book I want to give readers the best medical advice I can about menopause and its symptoms. I aim to show how suffering women can alleviate their symptoms through various therapies, particularly hormone balancing. Better yet, I believe that when you have this information, you will be able to more confidently and knowledgeably discuss the subject with your doctor. Let me mention here that my take on this subject is different from what you may have heard from other doctors or read in the mainstream media; later in the book, I will explain exactly what I mean by this.

Please, before you allow your doctor to refer you to a psychiatrist or hand you pills for anxiety and sleep, read the rest of this book!

I want to spread the word about bioidentical hormones as a viable and likely healthier treatment option in an area of women’s health that has been neglected, dismissed, underreported, and misunderstood for decades. Women need to pay attention to this wonderful and effective treatment option. Also understand the implications for future health if you choose to forgo it.

For centuries, women have accepted that menopause signals the end of a woman’s vitality and desirability, with an inevitable decrease in her quality of life. As a doctor, I’m going to tell you the truth: that is a ridiculous myth! A woman’s quality of life, including her sex life, can continue throughout her lifespan. When most women reach menopause, their lifespan is only at the halfway point. Don’t throw in the towel so soon ladies! An excellent quality of life is available to any woman who wants it. Depending on where you live, it may be a little challenging to find a doctor who will help, when you do, it will be well worthwhile. Don’t give up, but use the information in this book to find the perfect doctor who will help you live your life to the full extent that you deserve.

I find the lack of knowledge regarding hormonal issues in menopausal women to be staggering, which is one of my strongest motivators in writing this book. As the years go by, instead of seeing women become more powerful with knowledge about hormones, I havent seen much change. In my view, many women suffer needlessly from the sheer lack of valid and reliable scientific information. I am determined to help you gain the knowledge and power you need to make your own decisions.

Part of the problem is that the community does not discuss menopause, there is a conspiracy of silence if you will. To put it simply, menopause is often the elephant in the room and the women going through it may feel uncomfortable talking about it.

On the other hand, when menopause is talked about, it’s often with old-fashioned ideas in mind. Well-meaning loved ones will try to convince a professional woman to cut back on her professional activities, a problem men don’t seem to have. Somehow, I don’t think that kind of advice would fly if the lady in question were the First Lady or head of the Reserve Bank.

So many women are making huge strides professionally. Does going through menopause mean they suddenly need to sit at home and accept that their life is winding down? Absolutely not, their life is barely half way through! Just look at the many wonderful examples there are of incredibly successful women such as the head of the IMF and many female heads of state. Women like these, with so much responsibility, should have their menopausal symptoms handled efficiently. They should not merely be overmedicated with drugs; and neither should you!

Having lived and worked professionally all over the world, I am very much aware of the different cultural attitudes toward women and menopause. Although they are gradually changing, none are particularly progressive. We need to change these thoughts and approaches, and the way to do it is by arming ourselves with knowledge then sharing the knowledge with others. I wasn’t exaggerating when I said earlier that knowledge is power.

My passion regarding menopause began around twenty years ago with Mandy (see Mandy’s story on page 24), whose plight so galvanized me that I began to research hormone-replacement therapy (HRT). Furthermore, I regularly began attending conferences on the topic to stay up on the latest scientific information and to compare notes and experiences with like-minded physicians.

Both doctors and patients should learn as much as they can. Every week, a woman comes to my office in a state of emotional crisis because her hormones are out of whack. These women are invariably successful, up-to-date on the latest technology, and often find me after scouring the Internet looking for solutions. They find themselves blindsided, floored, and totally out of control when they hit menopause. Their discourse ranges from, I wish I had known to