A brief introduction to what menopause is, which hormones are at play and the best ways to manage the symptoms

What is perimenopause?

As the function of the ovaries declines less oestrogen is produced and a number of symptoms can begin to appear.  This can start as early as 10 years before the menopause, so generally any time in your 40’s you can begin to experience some of the typical menopausal symptoms. (See symptom checker). Some women can experience an early menopause, even as early as in their 20’s.

Symptoms fluctuate throughout the month and as a result of this it is often difficult to use oestradiol (oestrogen) blood tests as a clear indication of your levels.  It is usually recommended that you go by your symptoms.

Menopause

You are only actually menopausal for one day and that day is classed as a year since your last menstrual period.  After this you are post-menopausal, but it is often just referred to as being menopausal.

Which hormones influence these changes during perimenopause and menopause? 

Oestrogen

Oestradiol, known as more commonly as oestrogen, is one of the three main sex hormones. It is created, primarily, by the ovaries. It plays an important role in puberty, ovarian function, the menstrual cycle as well as brain, heart, bone and muscle strength.

Oestrogen levels fluctuate throughout the month when you are of reproductive age but drop off as you get older and your ovaries become less functional.

Progesterone

Progesterone prepares the endometrium (the lining of the womb) to receive a fertilized egg.  If pregnancy does not occur the endometrium sheds and this is the onset of the monthly period. If you do get pregnant progesterone levels increase to support the pregnancy. As well as progesterone you may be offered a synthetic progestogen as part of hormone replacement.

Testosterone

Interestingly, women have higher levels of testosterone during their reproductive years than oestrogen.  Again, as we reach perimenopause and menopause, testosterone levels gradually reduce.  Testosterone can affect libido, muscle strength and energy levels as well as brain function.

Whilst HRT is an important part of many women’s menopause management, there are other ways in which you can help support yourself. I have given a brief overview of a few ways in which you can strengthen your body and mind to improve those pesky peri and menopausal symptoms.

Exercise

There has been, over many years, a lot of research done into how movement and exercise can be advantageous to everyone. It is always a good idea to start of slowly and gradually build up the frequency, duration and intensity.

It has been shown that just a 40 minute walk three times a day can have long term health benefits. You can start at any age.

The benefits of exercise are:

  • It strengthens bones
  • Maintains and builds muscles (and muscles burn more calories)
  • Serotonins (happy hormones) are released
  • Supports good brain function and memory and even helps protect against dementia
  • Assists in getting good quality sleep
  • It reduces the risk of cardiovascular disease
  • Improves circulation and protects veins and arteries
  • Beneficial to help with immune function
  • Helps to balance sugar levels and can be particularly beneficial for Type 2 diabetes sufferers.

Exercise can be fun! Include family or friends. Set an intention to make it a regular feature of your life. I set my alarm half an hour earlier and go for a good stretch out walk to start my day. It can also be helpful to walk after a meal as it can improve the digestion. Just getting up and walking for a few minutes every hour, particularly if you have a sedentary job, can be beneficial.

Nutrition

As we reach our 40’s and beyond our bodies nutritional needs change. We metabolise our food less well so we need to ensure that what we eat nourishes us better. Wherever possible cooking fresh whole foods, from scratch is the healthiest way to eat. Different coloured foods provide us with different nutrients, so by ‘eating the rainbow’ we encourage a wider variety of beneficial vitamins and minerals.

It recommended that we eat approximately 55% carbohydrates (unrefined and wholemeal), 30% protein (eggs, meat, soy, nuts) topped up with healthy fats (avocado, olive oil).

Highly processed foods are not our friends when we reach our perimenopause and menopause.

Ideally we should avoid the following:

  • Fast food
  • Sweets/cakes/white bread
  • Limit alcohol
  • Limit caffeine (drink less and don’t drink after midday)
  • Avoid ultra-processed foods.

As a rule of thumb, most foods that come out of a packet are classed as highly or ultra processed foods and are best avoided as they often contain high levels of sugar, salt, preservatives and additives.

There is a lot of research being done in the field of gut health and the microbiome and how certain foods affect us. Everyone responds differently to different food sources, so how we eat is very individual.

It is often a good idea to get your bloods tested for thyroid function as well as calcium, magnesium, iron, Vitamin B’s and Vitamin D levels. If you are deficient in any of these vitamins and minerals it can often be remedied by diet, but sometimes you may need to take supplements to help.

Water is extremely important for hydration and if possible we should aim to drink between 2-3 litres of water a day.

Intermittent Fasting/Time Restricted Eating

Many people find that intermittent fasting, or time restricted eating, can help with weight loss, improve heart health and control blood sugar levels.

Unlike traditional diets fasting does not restrict what you eat, rather, when you eat. The principle is that your body has a regular fasting period where only water, black coffee or black tea are consumed.

As with everything it is recommended that you start gently and build it up. Most of us naturally fast for around 8-10 hours overnight. A 16:8 fasting schedule would be where you fast for 16 hours and then eat during an 8 hour window. This does not mean that you eat for the whole 8 hours! Often a light, healthy lunch is eaten and then another meal is eaten in the evening. After this the eating window is closed until the 16 hours has elapsed. If you prefer to eat breakfast and forgo dinner in the evening you can move the fasting period to suit you and your schedule.

As with anything, it is recommended that you do your research and consult your GP before you start. There are many informative and comprehensive books available on the topic which will allow you to make an informed decision on whether you feel you would like to try out this routine.

Meditation and Breathwork

For centuries people have been practicing breathwork and meditation, its foundations are in the practice of yoga. Controlled and focussed breathing can have many physiological and emotional benefits. Breathing out removes toxins and breathing in nourishes and refreshes the mind and body.

It is believed that there are several advantages to these practices:

  • It balances blood pressure
  • Assists good quality sleep
  • Can reduce feelings of anxiety
  • Improves the immune system
  • Strengthens the respiratory system
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