What’s menopause?

Our ovaries produce several hormones including oestrogen, progesterone, and testosterone efficiently in healthy women until around the age of 35 years, when one or more of these hormones may start to gradually decline. Menopause is usually reached (when ovaries stop producing these hormones) between 45-55 years and on average women experience cessation of menstruation for 12 months (menopause) by aged 51 in the UK. The British Menopause Society explain that more than 80% of women will be menopausal by the age of 54. (1)

The symptoms of menopause are varied and numerous and as we are all unique, our menopause journey reflects this. Menopause symptoms include but are not limited to flushing and night sweats, insomnia, joint aches, skin changes (dry skin or breakouts, loss of collagen), low libido, vaginal dryness and/or atrophy, urinary changes (more frequent trips to the toilet), palpitations, a loss in motivation and/or confidence, magnified or new anxiety and fatigue, and weight changes, particularly the storage of fat around the middle.

What’s perimenopause?

The prefix ‘Peri’ means near or around but when paired with menopause, we can take an extended view of this definition as you may experience this transition for up to 10 years! Typically, women may experience period changes (shorter or longer, heavier, or lighter) with cycle length change too. But this is not always the case, and many women keep a regular cycle for years throughout perimenopause. Vasomotor symptoms (flushing or night sweats) are another area or symptom group that some will experience, whilst others may feel permanently warm/hot and/or even experience cold chills.

Perimenopause is often identified however by mind and mood changes. Women who historically suffered very little with PMS can suddenly have cyclical symptoms that can last for 7-10 days in the run up to their period. These symptoms can be personality changing and greatly impact quality of life for a significant part of each month. As this stage can last many years, its from perimenopause that most women would benefit from specialist advice and support.

Should I get a blood test?

Some women have symptoms for many years before taking action to support their body through menopause. Women often feel they need a ‘diagnosis’ before they can officially accept or declare peri/menopause. One of the questions often asked is ‘should I get a blood test?’ Follicle stimulating hormone (FSH) levels are used to determine whether menopause has been reached in some cases. However, testing needs to be repeated after 6 weeks to account for variability in these fluctuating hormone levels throughout our cycle. After age 45, most women will not need this testing and the severity, duration and treatment of symptoms will often not correlate with these FSH level findings.

During Perimenopause, FSH levels may be normal or high but if you are under 45, hormone levels are worth checking as raised FSH levels may indicate an early menopause has been reached. Its important to note that if you take contraceptive hormones or HRT,

your hormone blood tests will not reflect what your body is naturally producing at this time. For women over 50, FSH blood levels are also useful as they can indicate whether contraception can be stopped with no risk of pregnancy. (2)

Whether you have clarity on blood serum levels of your hormones or not, women who present with symptoms can be supported in a variety of ways.

Blood testing for other body system functions such as thyroid gland and insulin output can be helpful at this time too as symptoms of other hormone imbalances such as these are often similar to those of menopause.

Post menopause.

Once the transition of menopause has been reached (the 12-month anniversary of no periods), optimizing health for the years ahead should really be the focus. The influence that the lack of oestrogen production has on our increased risk of heart disease and poor bone health has been established and recent science is looking at how lower oestrogen may be linked to the onset of dementia too. (3)

When it comes to cardiovascular health, we know that lowered oestrogen can impair glucose tolerance, increase blood pressure and vascular inflammation. (4) Falling oestrogen levels can cause a build up of fat in our arteries, creating a narrower vessel for blood to be transported through. Risks of narrowed arteries include stroke, coronary heart disease and heart attack. (5)

The combination of weight gain and poor glucose management with blood pressure rising provides a bleak outlook for many chronic health conditions, notably metabolic syndrome. And whilst menopause does not cause diabetes, Diabetes UK state that ‘hormonal changes during menopause can lead to increased body fat around the middle and higher blood pressure. These are both risk factors for type 2 diabetes.’ (6)

What helps?

In the first instance, tracking and monitoring your periods and any symptoms throughout the whole month will provide you with awareness of your body changes. You can do this the old-fashioned way if you are a keeper of journals or diaries or by using one of the many specialist menopause apps on the market. Tracking may also help you join some dots in terms of triggers of any symptoms you may have.

Read expert written blogs and articles that reference evidence-based tools and supplements that support or prevent symptoms, as well as set you up for optimal health longer term.

Eat as cleanly as possible, avoiding processed meals, take-aways and sugar. Fresh produce should be the main staple of each meal, packed with antioxidants and blood sugar balancing fibre. Add quality protein to your meals too, either from animal sources like meat, poultry and fish & eggs or plant-based sources such as pulses and legumes. Satiety or the feeling of fullness and satisfaction comes from regular protein consumption and weight management is far easier when we consume adequate amounts of protein. (7.8,9)

On days where you have fallen a little short on healthy eating for menopause, supplements can be the safety net of nutrient delivery as well as providing live bacteria

for gut health. Gut health is becoming more recognised as being crucial for overall health, including the management of menopausal symptoms such as IBS and our ability to process sugar. (10, 11,12)

Managing a family and job may mean you spend less time on yourself these days – try to prioritise down time, meditation, yoga and Pilates are great ways to strengthen your body whilst calming your mind.

HRT is helpful for many with debilitating symptoms. Vasomotor symptoms are particularly well managed with HRT as well as improved sleep quality. (13) Natural or micronized progesterone as part of HRT has been shown to improve sleep via neurotransmitter effects in the brain, having a natural sedative outcome. (14)

It’s not all doom and gloom!

Perimenopause and menopause can present many challenges for some women but overcoming those challenges through improvements in diet and lifestyle as well as specialist supplements and/or HRT can see us through this. For many, changes made at this time will mean that they are leading healthier lives than ever before, optimising their long-term health as well as helping to manage their current symptoms.

The fact is that menopause is a puzzle of many possible hormone changes that are not limited to oestrogen, progesterone and testosterone. Identifying which hormones are being produced at unhelpful levels is the key to putting the puzzle together. More about these in future articles…

References

1 https://thebms.org.uk/publications/overview/

2 https://thebms.org.uk/wp-content/uploads/2022/07/BMS-Menopause-Practice- Standards-JULY2022-01D.pdf 3 https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/trc2.12174 4 Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric. 2007 Feb;10 Suppl 1:19-24. doi: 10.1080/13697130601114917. PMID: 17364594. 5 https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease#:~:text=If%20your%20oestrogen%20levels%20fall,a%20heart%20attack%20or%20stroke.

6 https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/menopause#:~:text=How%20does%20the%20menopause%20affect,make%20managing%20diabetes%20more%20difficult.

7. https://pubmed.ncbi.nlm.nih.gov/12566476/

8. Simpson SJ, Raubenheimer D. Obesity: the protein leverage hypothesis. Obes Rev. 2005 May;6(2):133-42. doi: 10.1111/j.1467-789X.2005.00178.x. PMID: 15836464.

9. https://www.frontiersin.org/articles/10.3389/fnut.2020.00025/full 10. Caricilli AM, Saad MJ. The role of gut microbiota on insulin resistance. Nutrients. 2013;5(3):829-851. Published 2013 Mar 12. doi:10.3390/nu5030829 11. Heitkemper MM, Cain KC, Jarrett ME, Burr RL, Hertig V, Bond EF. Symptoms across the menstrual cycle in women with irritable bowel syndrome. Am. J. Gastroenterol. 2003;98:420–430. 12 Caricilli A.M., Picardi P.K., de Abreu L.L., Ueno M., Prada P.O., Ropelle E.R., Hirabara S.M., Castoldi A., Vieira P., Camara N.O., et al. Gut microbiota is a key modulator of insulin resistance in TLR 2 knockout mice. PLoS Biol. 2011;9:e1001212. doi: 10.1371/journal.pbio.1001212

13 Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O. When does estrogen replacement therapy improve sleep quality? Am J Obstet Gynecol. 1998 May;178(5):1002-9. doi: 10.1016/s0002-9378(98)70539-3. PMID: 9609575.

14 Prior JC. Progesterone for treatment of symptomatic menopausal women. Climacteric. 2018 Aug;21(4):358-365. doi: 10.1080/13697137.2018.1472567. Epub 2018 Jul 2. PMID: 29962247.