Sonia Durairaj of Harbor Health On 5 Things You Need To Thrive Through Perimenopause

An Interview With Shawna Robins

Surround yourself with a supportive community. We all need a tribe of people who radiate positive energy in our lives. Connect with people and things that make you feel healthy and give you joy.

Perimenopause is a significant transitional phase for many women, often accompanied by a variety of physical and emotional symptoms that can impact daily life. However, with the right knowledge and support, it’s possible to thrive through this stage. How can women navigate perimenopause with resilience and a positive outlook? What tips, resources, and lifestyle adjustments can make this transition smoother? As part of this interview series, we are interviewing Sonia Durairaj, MD.

Sonia Durairaj is an internal medicine physician at Harbor Health in Austin, Texas, and a Menopause Society Certified Practitioner. She is dedicated to helping women navigate the natural transitions of perimenopause and menopause and maintain a vibrant quality of life. She is also an affiliate faculty member in the Department of Internal Medicine at the University of Texas at Austin Dell Medical School.

Thank you so much for doing this with us! Before we dig in, our readers would like to ‘get to know you’. Can you tell us a bit about your background and your backstory?

I grew up in a town outside of Columbus, Ohio, and was exposed to medicine early in life. My father is a physician, and my mother was a nutritionist and worked in public health. The summer after my sophomore year in high school, I participated in a public health organization called Amigos De Las Americas. I volunteered in a medical and dental clinic in a rural part of central Mexico and knew immediately I wanted to be a doctor. After working my way through medical school, an internship, and residency, I started practicing medicine as a hospitalist. I was also fortunate to work closely with medical students and residents in Denver, Colorado. After moving to Austin, Texas, I decided to switch to outpatient medicine with a focus on women’s midlife health issues. That led to me becoming a Menopause Society Certified Practitioner to help women thrive through perimenopause and menopause.

Can you share a story with us about what brought you to your particular career path?

During my 25 years of practicing medicine, I discovered a large subset of my female clients were experiencing new concerns and challenges in their health as they went through perimenopause and menopause. I decided to get more training and become a Menopause Society Certified Practitioner. During medical school, the women’s health care topics I learned about included puberty, pregnancy, and postpartum issues. After that, health care for women was the same approach we had for men. I believe some of the findings from the Women’s Health Initiative study in 2002 also put a halt to more training in women’s midlife health issues.

I remember watching my mother live through perimenopause and menopause, and it was a tough transition. I did not know what it was, she did not understand why she felt that way, and her doctor did not know what it was or how to help. My mother suffered in silence for years with no conversation, recognition, or guidance. I am relieved the normal life transitions for women are beginning to get more attention and appropriate care with further training and research in this area.

What are some common misconceptions about perimenopause, and how can debunking these myths empower women going through this stage?

Most people are familiar with menopause as the time a woman has had no menstrual period for at least 12 months. Perimenopause is not as understood and can proceed menopause by 10 years or even more. Perimenopause can be just as challenging as menopause since it can last so long and occur during a time women are raising children, caring for aging parents, and balancing the demands of home and work. An article in Oprah Daily in April 2023 appropriately called perimenopause Puberty 2.0 due to the fact it may cause mood changes, skin breakouts, irregular periods, and hormonal fluctuations.

Perimenopause has been linked to more than 30 symptoms, yet there is no specific lab test for it. It is based on a clinical diagnosis. Now that perimenopause and menopause are elevated in the public eye and more research is being done, I am hopeful more women can feel empowered as they find a trained and certified health provider to help make the life transition smoother.

Many women experience unexpected emotional challenges during perimenopause. How can they develop mental resilience and maintain a positive mindset through this transition?

Women should know they are not alone during perimenopause, and it is not a disease or disorder but part of normal aging. Others are dealing with this chapter in their lives with various symptoms too. Talk to your provider about what you are experiencing. Sometimes just recognizing your concerns and discussing them can be therapeutic. This is a normal life transition, but the key is to do it in a healthy way that keeps you thriving.

What lifestyle adjustments — including diet, exercise, and sleep routines — do you recommend to help alleviate some of the most common symptoms of perimenopause?

The transition into perimenopause is a time to prioritize yourself and your health. It is easy to lose sight of caring for yourself if you are in the “sandwich generation” taking care of children and parents. Be proactive instead of reactive to your health and well-being. Eat a clean, healthy, high-fiber anti-inflammatory diet. Exercise daily with a combination of cardio and weight lifting/resistance training. (Ladies you will not bulk up!) Get enough daily restorative sleep, and develop good sleep hygiene habits that work for you. Cut down on alcohol, since it is a sleep disrupter and a carcinogen. Do not smoke. Finally, ensure you have a tribe of friends and family to help with stress management.

Since women have an increased risk of cardiovascular disease, bone disease like osteoporosis, and dementia during menopause and after, it is imperative to

start focusing on these healthy habits during perimenopause to set a strong foundation for your mind and body as you transition into menopause and postmenopause.

In your experience, what are the most effective natural remedies or alternative treatments for managing symptoms like hot flashes, mood swings, and fatigue?

Evidence mostly supports the use of hormones to help during these erratic hormonal fluctuations we experience during perimenopause. However, for those women who cannot take hormone replacement therapy, there may be other options. Some possible solutions may include focusing on the pillars of well-being (stress, sleep, diet, exercise), non-hormonal medications, and cognitive behavioral therapy (CBT). Collaborating with your health provider to develop a plan that is best for you is important during this transition.

Hormonal changes can impact cognitive function, often referred to as “brain fog.” What advice would you give to women looking to keep their minds sharp and focused during perimenopause?

This is a big area of research by Lisa Mosconi, Ph.D, Director of the Weill Cornell Women’s Brain Initiative. Her research focuses on the interplay of genetics, hormones, environment, and lifestyle in the female brain. I strive to keep up to date on all of the latest research on perimenopause and menopause. I advise women in my care to focus on the well-being pillars and stay engaged in the physical and cognitive activities they love. Some examples may be reading, hiking, tennis, or learning to play a musical instrument.

Ok. Here is the main question of our discussion. Can you please share “5 Things You Need To Thrive Through Perimenopause”? If you can, kindly share a story or example for each.

1. Surround yourself with a supportive community. We all need a tribe of people who radiate positive energy in our lives. Connect with people and things that make you feel healthy and give you joy.
2. Prioritize yourself. Schedule time to take care of yourself by practicing healthy habits and enjoying moments of fun. This is vital behavior in order for you to give the best version of yourself to others.
3. Remember it is okay to say “no.” Women are caregivers, helpers, and doers, but that does not mean we have to do it all for everyone and everything. Consider it a healthy practice to say “no” sometimes.
4. Sleep. Aim for 8 hours of sleep each night and talk to your doctor about treatment for hot flashes and mood swings that may disrupt sleep. Sleep is restorative for your body and mind, and not getting enough of it will only make symptoms of perimenopause worse.
5. Establish a relationship with a primary care provider so you can discuss any health concerns openly. I find women sometimes think they can only talk to a specialist about perimenopause, but a primary care provider should be able to help address your concerns or help you find a specialist if needed. Women’s health issues during this life transition are certainly a part of your overall health, and your primary care clinician should know your complete health history.

What role does community and social support play in navigating perimenopause, and how can women find or create supportive networks during this time?

Begin by not being afraid to talk to your primary care provider about needed support. She or he may have suggestions of community support groups. Talk to your friends who may be going through similar changes. I am glad there is much more attention being given to perimenopause and menopause on social media platforms. You can find physicians who specialize in women’s health talking about the latest research and treatment options. Even though this is long overdue mainstream attention, you should not allow yourself to get overwhelmed with all of the information. You need to make sure the content focuses on evidence-based medicine and research. I recommended finding a provider certified by the Menopause Society to help you sort it all out.

Looking forward, what proactive steps can women take in their 30s and 40s to prepare for peri-menopause and set themselves up for a healthier, smoother transition?

The most important step a woman can take is to find a doctor she can collaborate with to be proactive. Establish your family health history with the doctor and talk openly about your health goals. Implement a plan for habits in your 30s and 40s that will strengthen your four pillars of health — sleep, stress, diet, and exercise. Start working on your cardiovascular, bone, and brain health early, and stay up to date on your preventive care. Talk to your provider about needed pap smears, mammograms, and screenings for blood pressure, blood sugar, and cholesterol.

Wonderful. We are nearly done. Is there a person in the world, or in the US, with whom you would like to have a private breakfast or lunch, and why? He or she might just see this, especially if we tag them. :-)

I would love to have a private breakfast or lunch (or any brief meeting) with Michelle Obama. I admire her intelligence, grace, ambition, dedication, kindness, authenticity, and courage. And I suspect she might have some great advice about perimenopause too!

This was very meaningful, thank you so much. We wish you only continued success on your great work!

About the Interviewer: Shawna Robins is an international best-selling author of two books — Powerful Sleep — Rest Deeply, Repair Your Brain and Restore Your Life, and Irresistibly Healthy — Simple Strategies to Feel Vibrant, Alive, Healthy and Full of Energy Again. Shawna is the founder and CEO of Third Spark, an online wellness hub for women over 40 who want to reignite their sleep, reset healthier habits and respark their lives. Shawna is a sleep expert, hormone health expert, and a National Board-Certified Health and Wellness Coach (NBHWC). She has been featured on many podcasts including Dr. Mindy Pelz’s “The Resetter Podcast” and in Authority Magazine, Thrive Global, and The Huffington Post. A free download of her latest book can be found at www.thirdsparkhealth.com/powerful-sleep/ You can follow her on YouTube, Facebook, Instagram and LinkedIn.