Beyond Mainstream Health
Pain Free Menopause: Strategies For Relief
Physical therapist Gabrielle Rathz discusses the important topic of managing pain during menopause. As the number of individuals experiencing menopause is set to rise dramatically, understanding the associated challenges and solutions is crucial.
Join Gabby as she explores effective strategies including:
Hormone Replacement Therapy
Pain medication options
The vital role of physical therapy
Recommended lifestyle modifications
Gabby explains how cardiovascular exercises, strength training, and specific stretching routines can alleviate discomfort and improve overall quality of life during this transitional period. With valuable insights supported by statistics, she emphasizes the need for greater attention and awareness regarding menopause and its effects on health.
Whether you're experiencing menopause or supporting someone who is, this video offers practical advice and encouragement for navigating this stage in life.
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#Menopause #ChronicPain #PhysicalTherapy #HealthAndWellness #GabrielleRathz #MenopauseAwareness #WomenHealth #PainManagement #ExerciseForHealth #WellnessJourney #HealthyAging #Incontinence #MenopauseSymptoms #PhysicalWellness
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hi it's Katie Harris and today we have Gabby rates oh God I'm not gonna start over um it's rates right I said thatly yeah it's rates hi it's Katie Harris and today we have Gabby rates with us she is a physical therapist who works at Invictus here in the city so very excited to talk about pain and menopause because this is a big issue Gabby and I'm so glad you're talking about it so um take it away thank you so much um so again so I'm Gabrielle rates I'm a pelv floor physical therapist at Invictus Physical Therapy um and I'll be discussing pain and menaus just because this is a really important um subject it impacts so many people like according to the North American menopause institute there's 1.1 billion people who are going to be in menopause worldwide by 2025 so like this is clearly a topic that touches a lot of people and I think what's interesting is that AARP did a survey and they found that 84% of people who are going through menopause have menopause um symptoms and have pain but that interfered with their lives and 42% of those went to talk to a clinician about it and of those 42% only one in five were recommended to a menopause specialist so this is definitely a topic that doesn't get enough attention and I think it's really important for us to shed light on it and learn about the different treatment options so in order to like promote overall health and well-being during the stage of life we need to recognize and manage the changes that occur during menopause and per menopause so we need to understand what happens during these times and I sort of want to talk about per menopause and menopause because there's a lot of changes that we can make during per menopause that will impact our aging process process per menopause is this time of transition it's characterized by fluctuating hormones and estrogen excess during this time like your periods will change so they can be longer they can be shorter they can be heavier lighter or less frequent um it's just a time where there's fluctuations in the flow and duration of your period um there's also going to be fluctuations in different things like your mood your sleep this is like you can get hot flashes weight gain memory and also it will impact your heart and Bone physiology so again like the reason I bring up hary menopause is that this is a really good time to make lifestyle changes to ease the transition into menopause and it's something that we can sort of start thinking about in our early 30s or even before so that we know what to expect um one thing I think that is helpful is tracking Cycles so there's different apps that are available on smartphones and like one of them is called flow that's the one I use and that way when you're tracking the cycle you can tell what when the changes are occurring and what changes are taking place and recognize what's going on with our bodies so we can better transition into menopause now most people will go into per menopause about 10 years before menopause and one thing that's like important to note in about per note about per menopause is that sometimes the symptoms can be worse in per menopause than during menopause and sometimes it's vice versa so you don't really know you don't really know what's going to what's going to happen and it's important to know that there can be changes from person to person so that you aren't surprised now menopause is defined as the cessation of menstration for 12 months consecutively um it's the natur biological process of a female's reproductive system shutting down and marking the end of menstrual cycles and fertility the typical age for menopause is between the ages of 45 and 55 with 51 being the average in the US in 2019 and if you think about that the average age of death is 83 and so we're spending an average of like 32 years in menopause meaning that we like need to learn how to manage it um this where this comes into play this is you know another really great opportunity for us to make life choices to like Aid in in aging so the common symptoms of menopause are caused by a decline in the production of female hormones of estrogen and progesterone and this leads to like the changes in ovulation and ministration so the symptoms include night sweats there's sleep disturbances dry vagina eye skin hot flushes temperature swings having like a racing mind at night which I have anyway but you know it's worse and Vena pain during intercourse back or joint pain headaches or migraines and mental fogginess and then there's also a number of health risks that are associated with menopause one of which diabetes there's heart disease having more UTI dementia dis pinia which is p with sex and then osteoporosis and it's good to know all these health risks because there are treatment options available to address them one of which would be physical therapy so intro to menopause pain during Menopause the ovaries stop producing estrogen and and progesterone like we just said um and that leads to hormonal imbalances that can cause various symptoms including pain so estrogen is responsible for a lot of things one of these things is bone growth and so when we have this decline in estrogen this can lead to the Bone architecture being changed and the bone density being lost and that can lead to a decrease in overall strength and now there's like a decrease in in bone strength and there's also a decrease in muscle mass because of the decrease in estrogen and androgens so this could be the primary cause of age related muscle loss and strength and having this muscle muscle long loss and strength deficits and bone loss can lead to pain um and muscular skeletal pain is actually very common in menopause um specifically like muscle sorace and aches are common during menopause and this is because we have the decreased muscle tone from the less having less estrogen um we have reduced flexibility um we have reduced or we have increased muscle tension and this is all because of the hormone changes and all of these things sort of come together to act on your system which is your body and cause imbalances which lead to pain and there's also this thing it's called the genital urinary syndrome of menopause and this sort of encompasses a range of symptoms that related to the um vaginal and urinary tracts um there's decreased estrogen again and so what happens is that the vaginal walls can become thinner they can become drier they're less elastic and this can lead to painful intercourse and other discomfort in the pelvic floor pelvic region and this can also lead to urinary frequency and incontinence and what happens is that there is more vaginal dryness too in the iritation that can occur because of having less estrogen and this can lead to discomfort and pain during menopause and urinary problems so this is also something that can be treated The Laughing is that having like the hormone fluctuation an estrogen decrease during menopause can lead to headaches and migraines and this can cause significant pain and discomfort so there's a number of management strategies um the effective management strategies of chronic pain during menopause may involve hormone replacement therapy pain medication physical therapy and lifestyle modification so some of these I think are better discussed with your primary care dietitian or like other health care providers but I'm going to be discussing the physical therapy and lifestyle modification part of it the role of physical therapy so Physical Therapy can play a really important role in the management of pain and discomfort associated with menopause by addressing the muscular skeletal issues pelvic floor dysfunction and other menopausal symptoms physical therapists can help people find relief and improve their quality of life during this period so the first thing is cardiovascular exercise which we all know um helps increase endorphins and makes us happier but it also can help with pain so like regular cardiovascular exercise like brisk walking swimming cycling doing the elliptical anything that's like raising your heart rate all of these can improve blood circulation and reduce inflammation and also boost endorphins and this can help decrease menopause related pain and I think it's like it can be a catch 22 almost where like you're already in pain so you don't want to do cardiovascular exercise and so you're like what do I I don't want to do cardiovascular exercise to get out of pain so what do I do and this is where seeing PT can be really helpful because the PT can examine you and like figure out the exact mechanism and cause of the pain and get you like a better pain place so that you can start doing cardiovascular exercise and in turn get better blood circulation inflammation reduction and and better pain there's also strength training strength training is um incorporating strength building exercises that Target the major muscle groups and this can help strengthen the body improve posture support joint function um and this can significantly reduce menopausal related aches and pains so one thing that's important to know is that bone is deposited in proportion to the compression load that it has to carry so what that means is that if there's less load being put on your body less bone is going be um deposited and so then if there's more more bone is going to be deposited and we already know that estrogen decreases lead to um loss in bone density and so doing what we can to increase the load on the bone so that they can deposit more more bone is really beneficial so what they found is that resistance training needs to be done two times a week to see benefits specifically at two sets of 8 to 10 two sets of 8 to 10 for each exercise at 80 to 85% of your one rep max and has to include every major muscle group um it should be individualized based on your tolerance and current activity level so you don't want to go from not doing any strength training to you know doing squats with 50 pounds it's we might want to start with just sitting to standing and then sitting to standing holding weights and then maybe then we get to squatting so it really should be individualized to where you are um according to studies the best way to gain strength is to do a combination of high-intensity weightbearing and progressive resistance training this is like most beneficial for improving bone density too and they found that resistance training changes the muscle both in young people which we know but also in older participants um so what we know is that resistance training weightbearing activities and balance are all super important for maintaining bone and muscle a health as we age stretching so it's important you know stretching is important it maintains flexibility especially as we age now we get weaker back muscles because of the changes that happen in the muscular skeletal system and this can be associated with Progressive spine curvature and that's where we start to see that curving in the um the back of the spine back of the neck um a lot of people because of this lose shoulder and thasc Mobility or trunk mobility and another thing that's important is that the most common place for compression fracture is in like the trunk the thoracic area of the spine and so increasing flexibility in that area can be helpful um specifically stretching exercise help improve Mobility they reduce muscle tightness and they alleviate pain in a lot of the different body parts that are affected by menopause and there's a few good stretches that could do one would be a s side lineing thoracic rotation so um let me see tell me if you're able to see I'm gon to move this over so I can show this on the floor yeah absolutely love the interactive interactive so this is a great strategy you would get on your side you can use the B you don't have to and then put the top leg at this like 90 degree angle um it's more comfortable if you use this but you can also do it on floor you can do it on pillow um arms are going to go in front of you and then sort of just going up following your arm with your head and then coming back and that's going to help really increase the rotation and flexibility of these muscles then there's also the angel stretch lying down so laying on the ground arms are going to go to the side can you see that maybe we're going to go up and down so it's sort of show you on the wall and this is what you would be doing on the ground so you're here and just bringing your arms up and down and like if you do it you'll feel a pretty solid stretch and it's good for activating these muscles and just relaxing bring down tension for a dog is great for core it is also really good for range of motion I have enough room for this but we're going to try so one leg goes out and then opposite one goes out usually your leg would be straight and then you would do the opposite so here trying to keep your back as flat as possible and then repeating great for core um also just great for movement and then the thread and needle is on all fours here bringing one arm down under and just holding um I would do these first of all I think it's good for a lot of people to just stretch every day get more blood circulation get more flow um but like 10 seconds 10 times a day to start and then increase um as tolerated or you can even like start with lower sets but getting some sort of stretching in the other thing is that um with yoga like yoga can be a good form of stretching there was this one study and it had like over 700 participants over a 10 year period and they did this 12 minute video with 12 poses and what they found is that well first of all like 83% of them had Osteo oia or osteoporosis and then at the end after the um 10 years there was a small but significant change in bone mineral density in the femur and the spine so going through those yoga poses it doesn't have to be a super long yoga class it can be a 12 minute class with 12 poses and that has been found to have benefits public floor Physical Therapy my favorite um so pelvic floor PT plays a really crucial role in managing the symptoms of menopause including pain and in Cotten what pelvic Flor PT does is IT addresses the muscle tone in the pelvic floor and in other regions along with muscle function and coordination and by addressing all of these things it's like it uses a number of of techniques to optimize pelvic floor health and alleviate symptoms so we're sort of looking at at the actual pelvic floor and take seeing exact what's going on with the with the muscles so let's say like there's vinal dryness with pelv FL physical therapist therapy or we would actually look at the pelvic floor and we can give recommendations on different moisturizers maybe the dryness is leading to some tightness so you can go in and um help loosen up the tissue like yeah so it's going to improve the pelvic muscle strength decrease pelvic muscle tension enhance BL and bow control I feel like as we age we're just told that we're all going to be a continent and that's that and just get used to it and like that's just not the case at all it's something that's very common but it's not normal and in pelvic floor Physical Therapy you can take a look at the muscles themselves and see are they are they really tight is that's what is that what's leading to having cents are they weak you know I think we're told again that like just doing Kel just do you're in continent do Cel um but that's not always the best option so it's good to actually get your pelvic FL muscles looked at to see exactly what would be beneficial for you um it's also really great for the um like we were talking about the J urinary syndrome of metap um there's like these changes in the bulva and the bladder due to less estrogen like and that leads to the vaginal dryness the pain with sex bleeding and disc Comfort urinary frequency in continents pain with urination and this can actually be a progressive thing unless you get effective treatment because as we age like the tissue will continue to break down and become more fril so we want to sort of nip it in the butt and address it right away so like with with GSM with the Geno um urinary syndrome of menopause we would look at your specific symptoms like see what is again what is your skin look like does it look like it's irritated um do we need to recommend moisturizers are the muscles weaker if so can we strengthen them um we want to make sure that we're strengthening them in a way where they're Contracting correctly um there's this study that showed that there's a correlation with incontinence and um incontinence is correlated not only with decreased strength and endurance but tone reaction control and coordination and pelvic floor PT can help regain these also the other great thing about pelvic floor PT is that if you're having a paining with sex um you can not only address the tissues but there's sex education including positions that and support that can make things more enjoyable lifestyle changes so Lifestyle Changes um I would recommend seeing specific specialists for each one of these but I'm just going to give a general overview for um diet and nutrition adopting a balanced diet with increased intake of fruits vegetables and whole grains to improve overal health and wellbeing is important I see nutritionist I feel like knowing exactly what nutrients to put into your body can be really helpful especially as we age especially as there's formal fluctuations and as we see changes in our bone health so finding a nutritionist has been amazing also exercise routine we already sort of talked about cardiovascular exercise and how that increases endorphins and leads to having less pain specifically like the American Heart Association says that you should exercise um do 150 minutes a week of moderate intensity activity or study five of vigorous aerobic activity and like spacing that out throughout the week that can also help you maintain a healthy body weight and help decrease pain Stress Management so I am the biggest fan of Stress Management and like just therapists as we get older I would highly recommend every person get a therapist um there's also stress management techniques that you can do um without a therapist one is like you can do meditation you can do yoga you can engage in the things that make you happy do more um of your hobbies one thing that I do I do this every morning for Stress Management is an alternate nostril breathing so what you do is you take a deep breath in you cover both nostrils you're going to release one breathe out and then breathe in with that same one cover alternate breathe out breathe in cover alternate and I'll just do this like 10 times on each side and it's a great way to just get the nervous system to relax get everything to be in the more relaxed State because when we're stressed our muscles tend up when we're stressed like we're more likely to be in more pain and so just doing things to help alleviate stress can be really helpful and then sleep habits sleep is really important which I'm learning as a new mom now um they found that a cycle less than seven hours is associated with the number number of health risks including higher rate of cardiovascular disease increase in blood pressure increased risk of stroke um higher rate of obesity and type two diabetes and increase risk of certain types of cancers like breast and colorl um and per menopause and menopause are already associated with problems falling asleep and staying asleep and with nighttime Awakening and so having good sleep hygiene is especially important during this time and just a few ations winding down at least 30 minutes before you go to sleep and then unplugging all your devices and get some light exposure during the day when we get light exposure that helps with the Circadian rhythm um and then keeping lights low in the evening keeping your caffeine intake to earlier in the day and the suggestion is to keep caffeine intake up to 400 milligrams and try not to drink caffeine you know six hours before bedtime and then um avoiding alcohol and dinner right before that time and remembering that your bed is for sex and for sleep and that way when you start to go into bed like you're just associating it with those two things and it makes it easier to fall and stay asleep and no one to seek help um no one seek treatment so if you're um in pain and you're trying cardiovascular exercise and you're trying stretches and you're trying moisturizers and you're on horal replacement therapy and you're still having pain that might be a good time to see a specialist um whether it's a pelv Floor specialist or physical therapist it's job and and get the help you need these are all things that can be treated and that we don't have to live with cl jop awesome Gabby that was that was really awesome um and that statistic 84% of women going through menopause um were having pain and 42% seeing somebody and only one in five actually getting a referral that's I mean that's insane it's crazy it's really crazy there's not enough attention being brought to this population right and everyone's GNA go through it so every person with the vagina is gonna go through it so we should it's true we should what's out there right and there's and you made a point too that even when they go like I don't know that clinicians know what to say um or you know and it one of my patients said it um you know she's like my GYN OBGYN doesn't seem to be interested any in me anymore because I can't reproduce so you get like seven minutes of time and they don't have anything to offer I think that's that's problematic and um there's also like been surveys of people in medical school and and people outside of medical school asking how comfortable they are treating menopause and I think there's not as much comfort and knowledge around it um so just raising awareness of menopause and treatments and and knowing that every person at whatever phase of life should be comfortable and happy and to be treated well yeah and you know there's another statistic out there that says um adults buy more diapers for themselves than they do for kids at this point and there's this idea that uh urinary leakage and urinary incontinence is just something that happens to you when you get old they're definitely is it's like you're getting older you're GNA leak just get a diaper and that's just it's just not doesn't have to be the case right there's so many options out there right yeah absolutely I I love those stretches I want to do them right now like that looks so nice they're so comfortable I do at least one of them every single day really too yeah helpful yeah um and how about for like joint pain like stretching for joint pain or any uh I mean you have physical therapy for joint pain right yes so like it depends on the joint it depends on what's going on you would sort of want to figure out what's causing the pain it's um sometimes like we have joint pain because the muscles are really tight sometimes we have joint pain because the muscles are weak um sometimes we're just not moving them a lot enough you know like if if if I like clench my fist and I hold it you know and I'm not moving it like that's going to hurt so we got to figure out what's going on first so like if your muscles are really tight doing a nice stretch so like if you have wrist pain just stretching it out here here same with like shoulder you can go over anything that like helps you feel a stretch in a way that's not painful um and doing it like uh for like 10 seconds at a time so stretching and then also doing progressive resistance training so strengthening if weakness is something that's going on with you and honestly strengthening is just a good idea to do anyway because we do lose muscle mass as we age and again that doesn't have to be the case so gradually incre ining strength training helps to build the muscles and the bones around the joints which helps with pain yeah and I strength training comes up so often whether you're talking about like doing weight loss or menopause or you know old age or U you know whatever the case may be it always seems to come back to uh muscle strength and uh stability as like core factors of how you age it's so true yeah um okay and then so for for joint pain as well because I do get a lot of of women when they come in and they've hit 50 they're you know in in menopause or just about to go into menopause and they do complain of like kind of a generalized joint pain I mean is that something you guys see a lot oh my God all the time all the time and it's that you know the changes in normal levels from one like C less estrogen leads to having again like bone law bone mineral density loss in muscle strength issues which then impacts the joints but I think the other part of it is that like people are because they have less strength they they and they're in more pain they don't exercise as much um to try to avoid pain at least a lot of the people that I see because they're scared of being in more pain by exercising and then so they're more sedentary and then when we're more sedentary there's less blood flow to different joints and when there's less blood flow there's less oxygen and nutrients and so then that to like a general achiness and I found the just encouraging movement motion is lotion um movement of any kind like shoulders hurt move them around you know obviously in a you don't want to do it in a way that makes the pain worse but just moving things around moving your body going on like even a short walk 10 minutes um can really help with the joint achiness and then the other thing is that breathing exercise that sounds silly but it really helps to calm down the nervous system and when the nervous system calms down the muscles can relax a little bit more and now they're pulling less and so then that can lead to less achiness and pain so there's all these really great techniques for it yeah tell us a little bit about how does somebody know when PT would be like the right thing to do that's a great question I I I think if if you're having pain and you've tried moving and you've tried stretching and you've tried um like massage you know um and it's not working for like a period of a week or two it's just a good idea to get checked out um honestly I I'm of the belief that everyone could benefit from Physical Therapy it's one of those things where like you know we get annual exams every year just to make sure that we are healthy and that like to prevent anything from happening I think that the same would go for physical therapy ideally if you're having pain at all or even if you're not having pain and you're like you know I'm getting older and I want to make sure that my my muscles don't become weaker and I want to know that I'm doing the right exercises like I think that's a good time to see a PT um certainly like if you're having any pelvic pain any pain with SE any like incontinence of any kind see a PT right away just you know get get it looked at you don't know what exactly is going on with the mucles and I can't tell you how many times people come in um like within continents and they're like I've been doing Keel nonstop and and I still have and um it turns out their muscles were really tight and that was like putting more pressure on the bladder and that's what was causing the incontinence and so tightening it even more with the cables was making it work and so there's just like no I guess one place with all um and so going in and even seeing someone for one session or for a 15minute talk and they can let you know like hey PT is appropriate for you it's not appropriate for you like a lot of offices at indictus like you can call and ask to talk to one of the pts and I know a lot of PT offices do this like just ask to talk to one of the pts tell them what you're feeling and then you know we can tell you hey you know like I would just go see a personal trainer go to see a massage therapist or or just do movements or like I think that you should come in you know yeah so do people need a referral to go to PT it um depends in Pennsylvania you can see a direct access PT so you have to get your direct um access license um you can see them without a referral for 30 days and then you need a referral after that if um like with certain insurances they will require referral in general like if you're going um outside of insurance though it's that 30-day period and then you do need a referral from a healthcare clinician okay um do they typically get problems or have problems getting referrals from Physicians once they've decided that's what they want I I never had a problem I feel like Physicians have been really really encouraging of PT um they want to help people get moving help people get out of pain I think the only time I've seen any difficulty is if the person hasn't seen their doctor for over a year but in that case the doctor just wants to to see them to make sure that everything's okay and to check in to do that annual exam but other than that there's there has not been a problem okay and insurance pays for PT insurance pays for PT okay again but you can also pay out of pocket you can also pay out of pocket so Insurance depending on the insurance company um they'll give you different amounts of visits for physical therapy so you might get 20 visits you might get 10 visits and then you would work with your PT within that that visit allocation to get a treatment plan that works best for you like um here and I think with most pts will try to try to get you in as little as possible so that you're not spending as much money and as much time but if you go above that allocated amount then you do have to do out a pocket or there can be a peel process use okay um and what about like uh you know I know frozen shoulder gets to be an issue in menopause is that something you guys deal with as well it is yeah so frozen shoulder is there's depending on where you are in the process of of the progression of frozen shoulder there's either lot that you can do or there's less exercises that you can do either way there's a lot that you can do for pain management and so we see people in all different phases of frozen shoulder and are able to help them at least manage the pain okay why does that happen in in is it specific to menopause I mean I know people a lot everybody gets frozen shoulder but it seems like it happens a lot in menopause it does happen a lot in menopause that's a really good question I I don't know that I know the answer to that I think that it is likely more more common in menopause because of the hormonal fluctuations and because of the changes that are happening in the buns and in the joints and because of the inflammation because frozen shoulder can be very inflammatory like it's an inflammatory um diagnosis so I would imagine that menopause would exacerbate those things which would make it more likely with that being said I'm not I don't know know that that's 100% why okay I mean it makes sense absolutely like menopause is also known as inflamma um yeah um but is there any um like urgency with frozen shoulder if you start to get it should you see somebody sooner rather than later or I think with frozen shoulder there's less there's less of an urgency frozen shoulder sort of is going to take its course um no matter what so there's there's different phases of frozen shoulder there's like the freezing stage the Frozen stage the thawing stage and depending on where you are the tissue just sort of has to do its own thing so it's not urgent I do think that it's helpful to come in sooner rather than later because even if you can't like let's say you're in you know the Frozen stage where the shoulders just not going to be moving like you might not be able to get a ton of movement but you can help with pain and you can learn other strategies to use that shoulder use your body to get the things done that you want to be done okay so when they have frozen shoulder they I mean are they just not able to lift it up um or what kind of um limitations do they have so it's lifting it's rotating um mainly lifting and rotating there's just like a the motion is just not not there and you start motion and then it sort of stays in that in that tight State okay so they might you know wake up one morning and feel maybe feel like they slept on their arm wrong or something and it just kind of develops from there then it just sort of develops from there and I don't think they know exactly why frozen shoulder occurs um but once once it's come on it it takes its course and you can do what you can to help allate it as much as possible okay awesome um so what about Invictus can you tell us about what you guys do there so Invictus Physical Therapy we um are um an outpatient like Mom and Pop shop so I started this Clinic with my best friend from PT school and it was sort of like named after my brother Yoni um his favorite poem was Invictus and he wanted to serve the medic Ander surf population in Boston so when he passed away from cancer we were like let's open up something in his name and in his honor we named it indictus and our big goal is to provide like individualized as much one-on-one treatment as possible and we treat um all Orthopedic conditions we treat balance impairments we treat pain I'm a pelvic floor physical therapist so we do pelvic floor PT there's also all the p here are running Specialists and running coaches and they have certifications in vestibular therapy so I think for us we really wanted to to get as much experience as possible and as many certifications as we could so that we could serve all of Philadelphia in the best way possible I love it so if people want to find out more where do they go and how do they find you so you either call 267 548 4476 that's our office number um we also have a website www. Invictus pt.com and there's a form there where you can you can fill it out you'll come straight to us we'll call you to make an appointment um or if you just if you have any questions just give the office a call and anyone will be happy to chat with you awesome well thank you so much for sharing this with us thank you so much for having me I'm so excited that you're doing this I think this is really important stuff and and hopefully it'll help a lot of people yeah absolutely thank you
#Pain #Free #Menopause #Strategies #Relief
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