Tackling The Menopause

 

What is the menopause?
As humans we have several easily defined stages to our lives.  From our development inside our Mother’s wombs, our bones growing and to the occurrence of hair appearing in all kinds of wondrous and surprising places.  We see these are natural processes and part of our individual journey.
Menopause is as natural a process as any of these but is seems to carry a different weight.  It marks the end of a woman’s fertile life and the start of a new chapter.  For some the transition goes smoothly yet for others it is a gauntlet of hot flushes, irritability and weight gain that may last several years.  In this article I'll outline some of the reasons for these symptoms and some strategies to keep them under control. 


The Peri-menopause
The menopause is diagnosed 12 months after the last menstrual cycle but the lead up to it can last anywhere between 4 – 8 years which on average takes place between the ages of 45 and 55.  This period of time is known as the perimenopause.  It is where there is reduced production of the hormones (oestrogen and progesterone) created by the ovaries and this is where some of the symptoms stem from.


The Symptoms
The symptoms of menopause can be varied and impact seemingly disconnected parts of the body.  For some, any combination of the list below can present themselves without much warning.  For others, they may only be visited by one or two of these changes but with high severity.

  • Changing periods - length of cycle, duration of period

  • Hot flushes

  • Night sweats

  • Insomnia

  • Fatigue – tiredness or a loss of zest

  • Anxiety, mood swings, irritability and depression

  • A loss of confidence

  • Decreased libido or sex drive

  • Vaginal dryness

  • Breast tenderness

  • Bloating

  • Increased PMS

  • Aches and pains in muscles and joints

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The aim is not to reverse the menopause but to help make the transition a smoother one which provides the best quality of life and emotions possible.

The Science
During the perimenopause the ovaries slowly decrease their production of oestrogen and progesterone.  These hormones help to regulate menstruation and ovulation which is why the menstrual cycle can become unpredictable during the perimenopause but it is during the final couple of years of the perimenopause that the levels of oestrogen and progesterone drops quickly resulting in the onset of menopausal symptoms.


The role of oestrogen

  • Thickens uterine wall

  • Regulates temerature

  • Aids in collagen synthesis to maintain skin integrity

The role of progesterone

  • Facilitates thyroid hormone action

  • Maintains uterine lining

  • Regulated blood sugar levels


Areas of Focus

A holistic approach requires attention being paid to several areas.

Blood Sugar Balancing
The initial area of focus needs to be on the foods consumed and how they're impacting blood sugar.  Insulin and oestrogen work hand in hand and it becomes increasingly difficult to balance hormones if blood sugar is tamed.  Consuming excess refined carbohydrates (chocolate, biscuits, cakes, white bread etc) will impact blood sugar regulation and cause and increase in the hormone insulin whose role it is to store the blood sugar in the body.  This increase in insulin will actually decrease the amount of the molecule that carries oestrogen around the body so in a time where what little oestrogen is being produced by the ovaries even less of it will make it to the parts of the body that require it.

The reduction in progesterone and oestrogen leads to increased insensitivity to insulin which results in increasing levels of sugar in the blood which in turn leads to the same issue outlined about...less oestrogen available in the blood!  The body is fairly keen to send fat to the waist band as the fat cells located here will produce some oestrogen.
 

5 Tips for Balancing Blood Sugar

  1. Include good quality protein and healthy fats with each meal

  2. Limit the amount of processed carbohydrates in the diet

  3. Eat all of your food within a 12-hour window (for example eat all of your meals between 7am and 7pm)

  4. Daily exercise

  5. Apple cider vinegar (1 tablespoon in warm water first thing in the morning)

 

Stress Management
Small amounts of stress can be helpful but long-term stress become damaging.  Chronic release of the stress hormone cortisol can direct the weight to the waist band and promote the ‘apple’ body shape, a known independent risk factor for cardiovascular conditions.
As production of the sex hormones from the ovaries reduces the adrenal glands begin pick up some of the workload of progesterone and oestrogen.  However, if the adrenals are overworked making from constantly producing stress hormones they simply don’t have the capacity to make taken up the slack from the ovaries and produce oestrogen and progesterone.
Managing stress is often simpler said than done and takes some focus and dedication.  Setting aside 10 minutes a day for a guided meditation can be a good place to start with apps such as Headspace being a great choice.

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Sleep
Poor sleep has been shown to impact not only mood but the food choices we make the following day.  Ensuring that your bedroom is cool and dark and free from electrical devices such as laptops and mobile phones can help to promote a good night’s sleep.

Gut health
The dietary fibre helps to promote regular bowel movements.  This is particularly important during the perimenopause as hormones which have been detoxified in the liver are then directed into the intestines to be eliminated through the stool.  However, if the elimination process is sluggish and the stool spends a prolonged time in the large intestine these hormones may then be reabsorbed into the general circulation and cause a further hormone imbalance.
Our gut is home to millions of beneficial bacteria that we need to nurture.  These probiotic bacteria feed off the same sources of dietary fibre that keep us regular.  In order to ensure the health of the bacterial environment in our digestive system it is important that we keep these bacteria well fed with these fibres.

sources of dietary fibres are:

  • Onions

  • Jerusalem artichokes

  • Garlic

  • Leeks

  • Beans

  • Lentils

Exercise
Exercise helps to balance blood sugar in a number of ways.  Resistance training increases the size of muscles and they grow they have a higher metabolic requirement for sugar, thus clearing the sugar form the blood more efficiently and reducing insulin secretion.  It also acts as a great tool for stress reduction with practices like yoga and pilates being specifically beneficial.

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Supplements

Supplements can also be useful when dealing with the symptoms of the perimenopause.  Some are more reliable than others but the follow 4 are the ones I’ve seen most consistent benefit with in clinic.

Magnesium (with B6)
Studies suggest a synergistic effect of these supplements when used for anxiety management.  Magnesium also plays an important role in blood sugar regulation (1).

Maca Root Powder
I find this to be one of the most reliable supplements with regards to dealing with symptoms of the menopause.  Studies have shown benefit in reducing anxiety and depression as well as an increase in libido (2).

Red Clover Extract
This herb contains compounds known as isoflavoes which have a similar structure to compounds used in menopause therapies.  Research has been less conclusive however there have been noticeable reductions in reducing hot flashes (3).

Black Cohosh
This shows a similar effect to red clover extract in reducing frequency of hot flashes however if appears to act through a different mechanism (4).

 

The Take Home
If you are currently experiencing any of the issues I’ve outlined in this article I hope some of the information has given you some ideas of things to try.  Managing the journey through menopause is multifaceted and different for everyone but the starting point should always be the same for everyone... 

  1. Balance blood sugar

  2. Reduce stress

  3. Look after your gut


References

  1. Walker AF et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention.

  2. Brooks et al. Beneficial effects of Lepidium meyenii (Maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content.

  3. Van de Weijer et al. PH1 Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo.

  4. Shams T et al. Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis.