Beyond the hot flashes: Rethinking menopause and midlife health - Yukon

How Dr.Mahima Gulati uses lifestyle medicine to help women succeed in midlife and beyond.

For many women, midlife health changes can seem sudden, confusing, and deeply personal.Weight gain despite "doing everything right."Sleepless nights that turn into exhausting days.Brain fog, joint pain, and an overwhelming sense of energy depletion.

"These symptoms are real," says Dr. Mahima Gulati, an endocrinologist and leader in lifestyle medicine at UConn Health.

At UConn Health, Gulati works with women across the lifespan, from younger patients with polycystic ovary syndrome (PCOS) to women navigating perimenopause, menopause and postmenopause.His holistic approach is lifestyle medicine, which enhances the specialty of medicine through prescription, evidence-based changes in disease treatment and prevention in daily practice.

Rather than offering quick fixes, lifestyle medicine addresses the fundamentals of health, including how people sleep, eat, move, communicate, manage stress, and avoid harmful substances.

"These six pillars form the core of lifestyle medicine," explains Gulati. "They give us practical, science-backed tools that we can prescribe during visits to help patients change their daily habits in meaningful ways."

Why is lifestyle therapy important during menopause?

Menstruation is often confused with a one-time event, that is, the end of the menstrual cycle.In fact, this is a long transition that sometimes begins ten years before, and sometimes years after, a woman's last menstrual period.

During this time, the drop in estrogen levels removes what Gulati calls the "protective umbrella" that previously helped regulate metabolism, bone density, muscle mass, cholesterol and blood sugar.

"When women enter their 40s, the risk of heart disease can increase rapidly," she says."We see changes in the body, loss of muscle and bones, and negative changes in cholesterol, sugar and blood pressure, sometimes even if the lifestyle does not change."

Research also shows that after menopause, your resting metabolic rate can drop by an average of 100-250 calories per day, making weight gain more likely and weight loss more difficult.Many women gain 10 to 20 pounds during this transition, as body fat increases and muscle mass decreases.

"That's why the life's life is the most important way to be important in the same time," said and gold."She gives women in the opinion of the idea when their body is not feeling of unnecessary or stress."

The first pillar: social communication - not to suffer alone

One of the most powerful and often underestimated tools that Gulati uses is the extension.

At UConn Health, she leads collaborative medicine sessions called group visits.These are doctor-led medical visits where patients receive clinical care, lab tests and expert advice with other women facing similar challenges.Each session covers a different aspect of lifestyle medicine.

“Having women sit in a room and realize they are not alone is incredibly healing,” she says.“The connection itself lessens the burden of chronic illness.”

Patients often find that changes they previously thought were isolated, such as new snoring, sleep disturbances, increased sensitivity to alcohol, or decreased energy, are common experiences during this stage of life.

Group visits are available for people with any type of chronic illness.Doctor-led visits are an opportunity to meet other patients who may have similar problems.

"They learn from each other," says Gulati."This shared understanding creates momentum for change."

Pillar Two: Sleep - Solve the "Energy Crisis"

Sleep disturbances are one of the most common and debilitating symptoms of perimenopause and menopause.

"Estradiol affects REM sleep," Gulati explains."Women often get up at 1 or 2 in the morning, sweat at night and find it difficult to sleep. When it happens from night to night, it is not only exhaustion but also an energy crisis."

Her approach includes both education and practical strategies:

• Establish a consistent sleep routine

• avoid coffee and alcohol in the evening

• Limit exposure to blue light after 19:00.

• Keep devices out of the bedroom if possible

• Practice relaxation practices such as yoga and meditation

Hydration is also important, she explains. "Getting plenty of water during the day can help regulate body temperature at night and reduce hot flashes."

Pillar Three: Stress – Relationship ChangeIt's not just about reducing the relationship.

Instead of trying to eliminate stress, a nearly impossible task, Gulati helps patients redefine their relationship with stress.

"We talk about embracing stress as a sign for growth," she says."What can I let go of? What can I say no to? And for stress I can't avoid, who can I ask for help?"

This reframing helps women shift from a biology of fear to a biology of courage and connection, promoting resilience rather than exhaustion.

Four: Move - Holder than Training

Exercise becomes non-negotiable in middle age, but Gulati emphasizes that movement should be multidimensional.

"The training is necessary," he said."Keeping the flesh and bone is the goal is not a goal of stress."

She also emphasizes the importance of stopping sitting for long periods of time, incorporating balance training as women age, and prioritizing flexibility and mobility.

"This isn't just 30 minutes of exercise," he says."It's how often we move throughout the day."

Pillar five: avoid harmful substances and behaviors

Lifestyle medicine also addresses smoking, drinking, and behavioral addictions.

Alcohol, notes Gulati, is often tolerated differently after menopause.Even small amounts can increase sleepiness, increase visceral fat, and increase the risk of breast cancer and osteoporosis.

She also addresses the issue of digital device overuse, encouraging patients to limit screen time at night and avoid scrolling while awake throughout the night.

“These behavioral changes can dramatically improve sleep and overall well-being,” she says.

Pillar Six: Nutrition – Nourishing the body through transformation

Nutrition is one of the most requested topics in Gulati group interviews.Discussions range from reading food labels to increasing vegetables and protein, improving hydration, and exploring foods to relieve menopause symptoms.

"We focus on improvement, not perfection," he says."And we emphasize celebrating what works, better sleep, better labs, more energy, not just a number on a scale."

Replace disinformation with evidence

As menopause dominates social media feeds, Gulati advises women to find reliable, informed sources.

She recommends organizations such as the American College of Lifestyle Medicine, the Endocrine Society, the North American Menopause Society and trusted health systems such as UConn Health, Mayo Clinic and Cleveland Clinic.

"The only way to combat misinformation is to replace it with good information," he said.

A new story for midlife health

Gulati believes menopause should be defined as a transition, not a decline.

"That's where emotional maturity happens," she said."Women are very clear about their priorities. They save their energy for the things that really matter."

Lifestyle medicine, she says, supports this change not by fighting change, but by helping women move through it with strength, clarity and confidence.

"It's a journey," Gulati says."And it deserves attention, compassion and evidence-based support every step of the way."

Referrals for lifestyle therapy appointments can be directed to Dr. Mahima Gulati, UConn Health, Division of Endocrinology.