What is the menopause?

What is the Menopause?

Considering half the population will naturally go through the menopause at some stage in their life, it is only in recent times that we are talking about it and debunking many common myths.

The average age of the menopause is 51 years old. We spend a third of our lives in the post-menopausal phase of our lives. Many women can naturally get symptoms in their early 40s due to the perimenopause. The menopause and its symptoms can have a huge effect on our lives so it is important to understand what is going on in our bodies and what we can do to help make this transition easier.

The stages of menopause

A female baby is born with a set number of follicles in her ovaries. Follicles are fluid filled sacs that contain an egg and these produce oestrogens. When puberty hits, these eggs are released (ovulation) and the monthly cycles (periods) start. Over time, as these follicle numbers decrease, oestrogen levels will fall until the periods eventually stop. This is a gradual change over many years.

As the levels of oestrogen start to fluctuate, symptoms can start to appear. This is the perimenopause, the average age for this is around 47 years old but can start anytime from late 30’s. This stage lasts around 4 years on average. The menopause is when periods stop. We have reached menopause once we have not had a period for 1 year. So, the menopause is 1 date in time only known 1 year after the date of our last period. As previously mentioned, the average age of the menopause is 51 years old and following this date we are said to be post-menopausal.

Physical changes in the body during perimenopause and menopause

We have oestrogen receptors in all the tissues in our body and so oestrogen has an effect on every organ in the body.

In the brain, oestrogen along with other hormones has an influence on temperature control memory and libido. It helps to regulate serotonin (the hormone that makes us “happy”) and so low or fluctuating oestrogen can cause a variety of symptoms from mood swings, irritability, “brain fog” and memory lapses. A decline in oestrogen causes aging of our neurons and aids in the formation of amyloid plaques which can be associated with Alzheimer’s disease.

In the heart, oestrogen influences heart rate by a variety of mechanisms and when it comes to blood vessels, it influences the lining of our blood vessels. In the liver, oestrogen helps with cholesterol regulation and in the nervous system, oestrogen aids and influences the transmission of signals. Taking all this into account explains why we have symptoms of hot flushes, heat intolerance, night sweats and palpitations. The loss of the protective effects of oestrogen on the lining of our blood vessels and the poorer cholesterol regulation that comes with lower oestrogen means there is a staggering 5 times increased risk of heart disease at menopause (if we do not make changes to lifestyle).

In the joints and muscles, oestrogen has an anti-inflammatory effect and aids muscle strength, flexibility and joint lubrication, so stiff or aching joints or muscles is a common symptom in perimenopause and menopause.

In the bowel, oestrogen helps to maintain function and works with our own bacteria in the gut (the gut microbiome) and so bloating, constipation and symptoms of irritable bowel syndrome are also common during perimenopause and menopause.

In the bladder, oestrogen helps to control bladder function and decreases the risk of infection by various mechanisms, at the vagina, it aids lubrication and reduces bacterial overgrowth and so low oestrogen can lead to symptoms such as incontinence (loss of bladder control), recurrent urinary tract infections, vaginal dryness and soreness.

Our skin, hair, nails and even our eyes are influenced by oestrogen, dryness is common.

In our bones, oestrogen supports the cells that build up bone strength. Our bone mass peaks at the age of 30 years, it stays static for 10 years and then starts to decline. In women, this decline accelerates as we lose the protective effects of oestrogen and so 1 in 2 women develop osteoporosis in the menopause.

How to cope with menopausal changes

As detailed above, perimenopausal symptoms range from hot flushes, mood swings, memory loss, palpitations, vaginal dryness and even dry eyes. There are long term effects on our health particularly our heart, bones and brain health.

The way we breakdown fat is different and we may be more prone to weight gain, especially if we become less active as we get older. Lean body mass goes down and our metabolism is slowing down.

Hormone Replacement Therapy (HRT):

In the UK we have been talking about HRT and thanks to documentaries from Davina McCall and various podcasts and women’s health apps, more women are now taking HRT than ever before. In the past, there was some concern about the safety of HRT due to flawed studies and wrong information being released in the press. Today we know more about HRT and new HRT that is given through the skin is the safest it has ever been being “body identical” – it replicates our own hormones exactly and is made from yams. It comes as a patch, a gel or a spray in oestrogen form. When replacing oestrogen, we also need to take progesterone if we have a womb to stop overgrowth of the cells of the lining of the womb and prevent cancer. The body identical form of this in the UK is utrogestan also made from yams. This is a tablet but can also be used vaginally. The combination of utrogestan and oestrogen through the skin is by far the safest way to take HRT and has huge benefits for those suffering with debilitating symptoms as well as helping with long term complications.

Lifestyle changes:

Many women may prefer not to have HRT or find they have manageable symptoms. We all have the power to help ourselves with our lifestyle and while hormone replacement therapy (HRT) can be lifechanging for some women, it is important that every woman looks at their lifestyle whether using HRT or not.

Diet can have a big impact on short term symptoms of menopause as well as the long-term complications. Avoiding processed foods and increasing your intake of natural oestrogens known as phytoestrogens can help. These can be found in soy products, chickpeas, lentils, grains, flaxseeds, fruits and vegetables. Changing your diet will help with weight control but also have an impact on bone, heart and brain health. For more information on diet read my blog on diet and the menopause.

Sleep and prioritising sleep is another essential way of helping your health particularly around the time of the menopause. This can be difficult, especially if you are experiencing night sweats and hot flashes. Having a regular bedtime routine with a winddown before bed such as a bath or yoga can be helpful. Exercising earlier in the day and getting natural light first thing can help. For more information on sleep and the menopause see my blog.

Exercising and activity as above will help with sleep but also help keep weight under control. Exercise can also help with mood if you are feeling low with fluctuating hormones. This doesn’t need to be exhausting and 150 minutes of activity a week is the recommended amount. This should be strenuous enough that you are able to still talk but not sing. It is important not to overdo it and for women, it may be a time to shift the type of exercise you do. Resistance exercises are particularly important for bone health.

Stress management can also make a difference to your symptoms. We have a “fight or flight” mechanism in our bodies. When we are under stress, we activate our sympathetic nervous system and produce hormones such as cortisol and adrenaline (epinephrine). This raises our heart rate and blood pressure as well as increasing sugar levels in the blood. All very useful if under threat of a predator, but not so great if you are under chronic stress. It is obvious that this response certainly won’t help women having symptoms of palpitations and hot flashes. The opposite pathway when we are not stressed is our parasympathetic nervous system. The phrases “rest and digest” or “feed and breed” can be used here. This drives our sex hormones, particularly important if they are already low.

Deep breathing exercises, meditation, mindfulness yoga, thai chi or even just settling aside time to close eyes and listen to relaxing music can help. Exercise consisting of a brisk walk, particularly in nature can also make a huge difference. Social support and setting time aside for ourselves to rest and find time for meaningful social relationships can play a role in helping to deal with menopausal symptoms. (See here for more).

Summary

There is good news. As we learn and understand what is going on in our body, we can take measures to overcome symptoms or help to cope with them. Perimenopause and menopause is a stage in life when there can be lots going on…. children leaving home, relationship difficulties/divorce, caring for elderly parents or bereavement. It is crucial as women that we learn to look after ourselves.

As detailed above, there are a wide range of symptoms that can be experienced during menopause and our bodies are changing. We are not powerless against these changes. We have “body identical” HRT derived from yams that are much safer with fewer side effects and life changing for women with severe symptoms. Aside from HRT, there are a lot of lifestyle changes we can make. Looking after our diet, ensuring we keep active, prioritising sleep and stress management are key to a longer happier and healthier life.

If you would like help on managing symptoms of the menopause with lifestyle and coaching advice, then CLICK HERE to book an initial appointment.

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