Menopause and Perimenopause
Some women seem to sail through the menopause but for many it can be a challenging time. Contrary to popular belief the menopause is not simply an on or off switch. It can last up to a decade and the term peri-menopause is a better description.
Menopause is when your periods stop and the one-year anniversary represents the official retirement of your ovaries. As Dr Sara Gottfried says, just like modern work retirement does not mean zero activity – the same is true for your ovaries. At menopause, your ovaries are still making certain hormones like Testosterone but they no longer produce the high levels of oestrogen and progesterone associated with ovulation.
For many women (not all), the perimenopause (the years leading up to the menopause) is not a lot of fun. It’s much like going through puberty again (except without the pimples) with the hormonal fluctuations. Not only is this period of time challenging for women on a societal level (teenage kids, work stress, pressure to look a certain way, caring for ageing parents etc), our hormones conspire against us.
As Dr Gottfried details in her book Hormone Cure:
- Firstly, you are not ovulating every month. Without ovulation, the body does not get the optimal amounts of our calming hormone progesterone (think fluid retention, bloating, irritability, poor sleep). Your oestrogen levels are fluctuating and some women start to complain of symptoms like hot flushes, night sweats, loss of libido, vaginal dryness, poor sleep, brain fog, muscle ache and the list really does go on!
- Next, your thyroid becomes sluggish and your metabolism starts to slow down. You are eating and exercising as you always have but you start to get that spare tyre round your middle. Many women complain of fatigue and put that down to getting older.
- As if that was not enough, your adrenal glands decide to get in on the act and your stress response becomes heightened. You cannot roll with the punches the way you used to. You struggle to focus and concentrate.
Put it altogether, you have the perfect neuroendocrine storm of all 3 hormonal systems – ovaries, thyroid and adrenals. Our hormonal system is complex and dynamic – each hormone having an effect on another through feedback loops.
Does this sound familiar? It’s time to go back to basics:
Getting through the Menopause and Perimenopause
Lifestyle measures are essential to optimising hormone balance (at any age). It continues to come back to your 4 pillars of health – Food, Movement, Sleep and Stress management.
Dr Louise Newson is British GP and menopause specialist. She has a great website that we recommend looking up - https://www.menopausedoctor.co.uk/
This information from her website is very comprehensive and is a good starting place for many women - Living well through the menopause
We are very passionate about the importance of sleep which is essential for all ages but sleep is vital for hormone balance - Sleep and hormones
Dr Sara Gottfried rightly says it is not one size fits all – this is true for diet and this is true for managing the perimenopause and menopause. Please check out this article – Balancing your hormones at any age - https://www.saragottfriedmd.com/understanding-female-hormone-cycles/
Eat the rainbow, maximising on a variety of vegetables and fruit of all different colours. Cut out sugar and beige processed carbohydrates – these will bloat you and sap your energy, especially in the afternoon.
Bone health is an important area especially for women. We reach our peak bone mass in our 20s and then there is gradual decline in bone density from our mid 20s. At around the time of the menopause, bone loss accelerates. The good news is that there are many things we can do to keep our bones strong - Lifestyle for healthy bones
Some women find they feel better cutting out dairy products, some don’t. It may be worth experimenting to see what works for you. However if you do cut out dairy it is important to ensure you are still getting enough calcium from non animal based sources. https://www.osteoporosis.foundation/educational-hub/topic/calcium-calculator
Start to prioritise you and your sleep. Recruit help to ensure jobs around the house get done by not just you. Ensure you have time in the evening for yourself, go for a walk, read a book, take a bath. Try and be in bed earlier in the evening, experiment what time works for you, but most woman find 9-10pm a good fit.
Avoid screen time after dinner and experiment with setting an alarm, not on your phone but with an old fashioned basic alarm clock. Leave your phone downstairs.
Find something that you enjoy but that keeps you moving and builds muscle mass and strength. Try finding a class or doing online yoga, pilates, thai chi. Try an after dinner walk or a pre work swim. If you take public transport to work, could you get off earlier and walk some of the way? Or think about parking further from the entrance and skipping the lift. Take your trainers and during your lunch break take a walk instead of sitting scrolling social media. Even better, recruit a ‘radiator’ friend to walk with you and catch up with them.
All of the above will help to reduce stress by giving you head space and some downtime. However, it may also mean being assertive and having some difficult conversations at home and possibly even work. Are you failing to achieve because what others expect you to do is overwhelming and ridiculous?
As individuals we can’t keep an immaculate home, work long hours and manage all the emotional admin of birthdays, ensuring house insurance and bills are paid on time, booking holidays, MOTS, planning dinners and doing a supermarket food shop. You need help! This may mean some honest conversations with your family, recruiting help with home tasks, delegating home life admin and switching to an online shop. Doing these things doesn’t mean you are failing and not enough as a person. It means you know what you need to optimise health and wellbeing and you deserve that!
Should I take HRT? Following the Women’s Health Initiative study in 2002, many women were very put off taking HRT. This discussion is worth listening to – Dr Sarah Ball, Dr Rebecca Lewis and expert Diane Danzebrink have a frank discussion about HRT – Busting myths around menopause - https://www.menopausedoctor.co.uk/menopause/busting-myths-around-hrt
This information leaflet also summarises a lot of the information from the above talk - Menopause and HRT
For women who choose not to take HRT, this information leaflet is useful starting place - Managing menopause without HRT
Alzheimer’s disease is very worryingly on the rise and a huge burden for society. Women are more affected than men. Prevention strategies should start as early as possible. Please check out this enlightening discussion between Dr Louise Newson and Dr Lisa Mosconi (Director of Women’s Brain Initiative, New York) – Brain health and dementia - https://www.menopausedoctor.co.uk/menopause/menopause-and-the-brain
Read Dr Gottfried’s article on a call to action against Alzheimer’s disease – Women, perimenopause and Alzheimer’s Disease: A call to action - https://www.saragottfriedmd.com/women-perimenopause-and-alzheimers-disease-a-call-to-action/
Balance App by Dr Newson - free to download
The Balance App has been designed by menopause specialists to help you become more informed and more prepared for the perimenopause and the menopause by allowing you to take control of your health and body.
In the app you’re able to:
- Understand more about your menopause with the help of expert content that’s tailored around you.
- Keep an eye on your symptoms and health with the help of the balance journal. You can record your symptoms, mood, periods, nutrition, exercise and meditation.
- Understand your treatment options in the review section, where others have shared their honest experiences of both HRT and alternatives for you to learn from.
- Prepare for any healthcare appointments you may have by downloading a report of everything you’ve been recording in your journal so you can ensure you cover everything once you’re there.
- Track any changes to, or patterns in, your symptoms and health over time with the help of graphs to show you how things are going.
- Join experiments that have each been specifically designed to help relieve certain symptoms of the menopause.
- Share your stories and read others’, balance is a safe place to talk about this time in your life with people who understand. Talking helps to break taboos around the menopause and helps others too.
balance — Menopause Support on the App Store (apple.com)