Photo by Stacy Zarin-Goldberg

Five years ago, Dr. Suzan Kovarick couldn’t sleep.

At 54, the Bethesda gynecologist was moody, depressed and had trouble concentrating.  In a matter of months she’d gained weight and her skin had become dry and dull. Then, during lunch one day, an overwhelming, intense heat erupted in her chest.

The hot flash helped confirm Kovarick’s suspicions. She was in menopause—that time of life when a woman’s hormones dip and menstrual periods end. For many, including Kovarick, it can mean suffering from a slew of symptoms, including hot flashes, sleep disturbances and mood changes, which can last months or years.

“Everything was so off,” says Kovarick, who has been treating patients for 30 years as a certified menopause practitioner. “I felt like I lost my way.”

Then she was diagnosed with osteoporosis. Menopausal hormone changes can increase bone loss and the risk of osteoporosis. The risk of heart disease increases, as well.

Kovarick knew she had to make some changes. So she modified her lifestyle and started hormone therapy, which is sometimes prescribed to relieve menopausal symptoms.


These days, the 59-year-old Chevy Chase resident feels great, likes what she sees in the mirror and walks with a skip in her step. Life is “immeasurably better,” she says.

What she does:

Takes Hormones

Through a skin patch, Kovarick receives a daily low dose of estradiol, a plant-based estrogen approved by the Food and Drug Administration. She takes 200 milligrams of a plant-based progesterone, also approved by the FDA, for 14 days every three months.

The Payoff

Almost immediately after starting the hormones, Kovarick’s mood improved and she could sleep again. She never had another hot flash. Her skin became brighter and less dry. Hormone therapy also generally improves sexual function, helping with vaginal dryness, which Kovarick says most menopausal women face. She says there’s some medical evidence that hormones taken early in menopause may decrease the risk of certain diseases and aid bone health, as well. Since starting her regimen, Kovarick’s bone density has remained steady.


Kovarick believes hormone therapy is a good option for her despite a 2002 study linking it with health risks. That study, she says, focused mostly on women well beyond the average age of menopause (51) who were taking oral estrogens that are initially metabolized through the liver, creating more risks.

Kovarick says her regimen has provided great benefits with low risk thanks to several factors: starting hormones in her early 50s, the type and amount of hormones she uses, and her good medical history. She plans to continue taking them.

Exercises Body and Brain

Kovarick takes ballet for 90 minutes three to four times a week at Silver Spring’s Maryland Youth Ballet. She lifts weights with a trainer for an hour twice a week. And she plays mah-jongg, a game similar to gin rummy, with a group at least three times a month.


The Payoff

Increased strength, flexibility and balance from the physical exercise—and a more toned body. “I don’t fall over when I try to put on my pants anymore,” Kovarick says. Strength training also keeps her bones healthy, and the cardio exercise from ballet helps keep her heart in shape. Research shows that complex activities such as ballet and mah-jongg challenge the brain and may aid cognitive function.

Watches Her Diet

Kovarick follows a low-fat, low-carb diet, eating mostly vegetables, fish, chicken and eggs, and drinking unsweetened almond milk instead of sugar-packed cow milk.

Each day she takes 1,500 milligrams of calcium citrate, 1,000 milligrams of vitamin D, 400 milligrams of magnesium, 1,000 milligrams of omega-3s, and 2,000 milligrams of flaxseed oil.


The Payoff

Kovarick dropped the 5 pounds she gained at 54. “The metabolic rate lowers considerably in menopause,” she says, and a vigilant diet and exercise regimen helps counter that. The calcium, vitamin D and magnesium aid bone health. The omega-3s are good for the heart, and the flaxseed oil helps alleviate her dry eyes, another symptom of menopause.

Leah Ariniello is a Bethesda-based writer who frequently writes about health.