Hi! I’m Dr. Christina Enzmann

Dr. Christina Enzmann is a gynecologist and a certified member of the North American Menopause Society.

I am a board-certified obstetrician-gynecologist and menopause specialist. I am also a certified member of the North American Menopause Society. I completed my medical training at the renowned University Medical Centre Hamburg-Eppendorf in Germany, where I worked until I moved to Baltimore, USA, for family reasons.

In my women’s health practice practice, I became very early interested in managing womens health concerns in their midlife. So I pursued additional training to become a menopausal specialist long before menopause caught up with me –  and like for many of my patients, it caught also me by surprise!  It was on the early side and it was a really inconvenient time in my life for having to deal with some puzzling symptoms and some major crankiness! From that moment on, I decided to make it my mission to help women with menopausal symptoms to understand their symptoms and find their balance again by customizing their treatment and preparing women early for this phase of life.

My Story

Since my teenage years l always struggled with belly fat, even though I was otherwise rather lanky and tall. I remember that I had a hard time concentrating, and I think I was kind of spacy and often fatigued. My diet was not that bad. I grew up in Germany and my mom was clearly way ahead of her time, and there was no sugar or sweet drinks in our house, except natural apple cider. There were no sugary cereals, except the plain cornflakes and German Muesli- Granola. But yes, there was a lot of German bread and pasta dishes and meat and lentils. My mom was a teacher and busy. Luckily this was Germany and I liked biking, and I biked everywhere, even rather long distances. 

When I went to college in Hamburg to study medicine, I noticed for the first time my sudden and extreme fatigue that came over me after lunch. I would literally have to put my head down on my study desk in the library and take a nap. It felt like someone had pulled my power plug. It was so bad that at some point I wondered if I had some type of narcolepsy [I did not] . During my first jobs as a young physician in Germany I often felt restless interspersed with fatigue and sleep attacks. 

I maintained my weight [with the usual belly fat] throughout the time when I had my children and then trained and worked in the US, by carefully watching what I was eating. Traditionally there was only home cooked meals, and no sugar or processed foods, and I started to be careful around pasta dishes, because I realized how they would put me to sleep immediately. But my then husband loved to make homemade pasta and breads, and neither he nor my kids liked greens, so I focused my daily nutrition around meat, cheeses, and yogurt. These were touted by conventional wisdom to be good protein sources and low in carbohydrates. And I tried to squeeze in nightly home workouts into my busy schedule as a gynecologist with two small children and trying to maintain some family life. My hands and feet were often so cold at night in bed, that I was unable to fall asleep. 

In my gynecological practice I became interested in the management of midlife women and became a menopause specialist long before perimenopause caught up with me, and I was rather surprised when it did and as early as it did. When I had the first signs in my early 40’s, in the form of notable menstrual cycle irregularities and feeling unusually warm all the time, I did not think much about it and started the birth control pill ‘to fix the problem’. At age 45 I was divorcing and ergo stopped the birth control pill. After 2 or 3 normal cycles, my cycle stopped for 6 months. It all seemed to make sense to me, considering that I was going through a lot of stress at that time. It is not that it did not occur to me that perimenopause might have gotten to me, I just did not believe how close true menopause would be once a woman over age 45 did not have her cycle for 6 month. But my body followed the science, and not even 3 years later I had my last menstrual cycle, at age 48. 

And I realize that my body had followed exactly what menopausal scientist had described in the STRAW criteria [ Stages of reproductive aging workshop, if you want to learn more, click here: ….], and I had literally been teaching that and presenting that data for so many years, I just did not expect myself to end up being the perfect example for the correctness of that data. 

I did not weigh myself during the time that I retrospectively know was the last stage of my perimenopausal transition [age 45 for me]. But one day I looked at some recent vacation photos, and I realized that I had put on quite some weight, around the belly and back and upper  arms. After I stepped on the scale, and got confirmed what my eyes had been telling me, I was wondering what was going on: I was eating as I always did, worked out to the point of back pains and sciatica, and I started to have joint pains and shoulder pains, felt that I was getting weaker and losing muscle despite all of it. Not to mention the memory lapses and word finding difficulties that had been plaguing me since a while, and yes, I knew the brain fog and memory issues were described in medical literature as part of menopausal transition, but how uncool was that? And did anyone ever write about when and if the memory issues would stop? Having had a grandfather with dementia and a mom that has been complaining since I can remember about her memory issues, did not help to make me feel reassured. 

And there were these palpitations, that made me really worry that something was wrong with my heart, and I only know retrospectively now, that these were part of perimenopause.

My beloved North American Menopause society conferences and workshops did not give me any satisfactory answers, except confirming the obvious and putting numbers on the average amount of weight gain in a midlife woman, another number on the change of fat to muscle ratio, a number on the percentage of women suffering from brain fog and depression, the amount of bone and collagen loss to be expected in the first 6 years and so on. Well, as much as I used to like to present these hard data points, it really did not solve my personal problem, as it had not solved the problems for many of my patients either. 

During the long nights that I was doing in house calls at the academic institution I was working for back then, I was starting to try to gather insight from the integrative and functional medicine realm. I signed up for a program with the Institute for Nutritional Endocrinology, founded by Dr. Ritamarie Loscalzo. I liked the underlying concept of searching for the root cause of bodily dysfunctions and correcting these with nutritional and lifestyle approaches, before resorting to prescription-medicine or even supplements. I signed up for an 8-week program about insulin resistance and nutritional approaches and how to correct it, I was more curious than expecting too much. 

But I wanted as much new insights as possible, and I dove in.  Pre-insulin resistance turned out to have been one of my lifelong problems and I had issues with my bowel function, that I had basically ignored all my life and thought it was normal. I felt like the first time in my life I understood what my body is doing, and I finally had the tools to optimize it. I lost my belly fat and kept it off, my joint pains disappeared, and I can gain muscle, and I have so much energy and the brain fog cleared. I feel my brain is sharper than in my 20’s and 30’s.  My early afternoon slumps are gone! Ultimately, I realized that my prestigious but stressful academic job came with drawbacks to my health, particularly sleep deprivation, and it felt not worth it after some contemplation. I resigned. That was a hard decision, but I never looked back. Instead, I did some flexible temporary work that left me time to dedicate myself to functional medicine studies and have also have some more time for my lightening-fast growing up kids.

I signed up for a full functional medicine program with emphasis in nutritional endocrinology and with every topic I learned about, it seemed I remembered a patient of mine. A patient for whom I did not have a solution in my conventional medicine toolkit back then. I finally understand why my menopausal patients often deal with GI issues and I know now how to heal these. I now have an understanding why women have thyroid symptoms, even when the lab values are normal. And how to heal burnout and fatigue, or to help with brain fog, fatigue, and insomnia. Or what to do about that pesky weight gain in menopause. But I also learned about functional medicine approaches for the treatment of PCOS and heavy and painful menstrual cycles or menstrual migraines. All this has become my unique Functional Gynecology armamentarium, it’s like a treasure of knowledge that has widened my horizon as a women health specialist forever. I still like the clinical-trial-proven hard data points that evidence-based medicine, a concept that is used in conventional medicine, is providing us with. They feel in a way reassuring. But this is nothing compared to the feeling when my patients follow my nutrition/ lifestyle supplement tweaks and lose that belly fat, can sleep again, have lighter menstrual cycles or their cycles are regular again, or whatever it is that motivated them to dive deeper and not just accept a prescribed medication as a band-aid solution, or being told that all their blood work looks fine, even they don’t feel well.

I personally decided to go on a low dose hormone replacement therapy. I made that move because of my strong family history of osteoporosis and my rather early onset of menopause, which increases that risk even further. I tried it initially with and without, and while hot flushes were not my problem, I was very moody and angry without it [through that experience I learned a lot about the term ‘menopausal rage’] and my sleep was poor. There might have been other ways to treat that, including functional medicine approaches, but if anger takes over your brain, it is hard to think clearly, and I needed to be able to think clearly-fast. 

I gained some additional important insights from genetic testing and a functional medicine hormone status. One example that I learned from my genome analysis is that I had the propensity to not metabolize estrogen well, and the hormone status did confirm that. The hormone status evaluates how a person metabolizes estrogen and lists the quantity of the metabolites. 

 

A regular Hormone status from a regular lab does not do that. This is important, because there are protective  and risk-increasing  estrogen metabolic pathways. That means that some  of them can increase your risk for estrogen dependent  cancers, like breast cancer and uterine cancer,  and some are helpful in prevention of osteoporosis. 

All of them turned out to be unfavorable for me. But that information gave me the power for nutritional and supplement intervention, to help my metabolic hormone pathways to perform at their best] . And I do check my hormone levels regularly to make sure I stay on track and only take the minimal dose of hormones needed.  

Thanks to all these events, including my collaboration with NOBODYTOLDME, I am now ready to share this new experience and passion with you!