Menopause in Focus: Targeted, Functional Tools for Hormonal Disruption
Menopause can be a very challenging time for many women. The challenge is that many women do not recognise their symptoms as signs of perimenopause.
What I tell my patients is that you do not need to suffer. There are numerous tools to help with the symptoms and systematically looking at dietary but moreover lifestyle changes can make a significant positive impact. So where to begin?
Identify your specific challenges, as these differ for each woman.
Menopause, marked by the time when periods have ceased for 12 months, is precluded by the Perimenopause, which can last up to 10 years or more. Many women are not aware of this as their periods may still be regular, although the flow may change at times, but symptoms are frequently inconsistent making it particularly difficult to understand what is happening. It is a time when hormonal fluctuations lead to a wide range of symptoms. Hot flashes, for example, are more easily recognised as menopausal symptoms. However, the list is rather challenging to say the least.
Night Sweats, Irregular Menstrual Cycles, Vaginal Dryness, Sleep Disturbances, Mood Swings, Irritability, Anxiety, Depression, Reduced Libido, Fatigue, Weight Gain, Memory Problems, Concentration Difficulties, Joint and Muscle Pain, Thinning Hair, Skin Dryness and Itching, Urinary Tract Infections, Bladder Problems, Headaches or Migraines, Heart Palpitations, Breast Tenderness or Size Changes, Dizziness or Lightheadedness, Burning Mouth or Tingling Extremities, Changes in Cholesterol Levels, Osteoporosis Risk, Digestive Changes, Increased Sweating, Mood Disorders, Decreased Bone Density.
Many women I see complain of weight gain, especially around their middles, this is a known phenomenon and the drop in oestrogen is a major contributor. Stress is going to make this worse, so it is important to identify your major stressors and work on strategies to mitigate them. Now this can be particularly challenging, but not impossible. This is where lifestyle changes can have such a positive impact. Introducing mindfulness and/or meditation is helpful for some. Others may find yoga and breathwork more helpful, or maybe you find going for a walk or gentle swim is more your thing to destress. Or just sitting with a nice cup of herbal tea and a good book for 20 minutes on your own without being disturbed is what you need to destress.
Besides lifestyle practices to target stress reduction, there are also various adaptogenic herbs and medicinal mushrooms that can mitigate the stress response. The calming herbs tend to be best for the tired and wired type of stress, such as Ashwagandha whilst the stimulatory herbs such as Schisandra Chinensis enhances cognition. Rhodiola Rosea improves cognitive function and has anti-fatigue properties. Maca has been shown to be as effective in early peri-menopause as HRT moderating oestrogen metabolism hand regulating adrenal and thyroid function. Siberian Ginseng, different from Panax Ginseng, also has anti-stress properties whilst enhancing physical and cognitive performance.
The medicinal mushrooms are often an overlooked tool; however they can exert significant benefits for many women. Cordyceps has been shown to increase oestrogen, progesterone and testosterone production which in turn improves mood and focus (anti-anxiety, anti-depressant). Furthermore, cordyceps can also improve athletic performance via vasodilatation. Lion’s Mane helps to reduce anxiety and depression and improves focus and memory. Reishi has immunostimulatory and antifatigue effects as well as increasing the sensitivity or oestrogen receptors which reducing vasomotor symptoms (hot flushes).
It is important to speak with a trained practitioner regarding these herbs and mushrooms. Although they are non-prescription compounds, they may not be suitable for certain individuals, and some are contra-indicated with specific prescription medications. Furthermore, there are specific doses to suit different symptoms and some of these compounds need dose cycling, (e.g. 8-10 weeks on then 4 weeks off).
Another consideration with weight gain is the management of glucose levels, as insulin sensitivity is impacted negatively with decreasing oestrogen levels. At this stage in life it becomes more important to focus on protein intake (2-2.2g per kilo body weight) whilst optimising carbohydrate intake by making choices that do not spike blood glucose which in turn drive an insulin response. Insulin is a necessary hormone to regulate blood glucose so that it doesn’t get too high and cause cellular damage. There are various nutrition and lifestyle hacks that can help including taking a walk or moving after a higher carb meal or eating a big salad before eating your carbs. Identifying your specific pitfalls around managing blood glucose is key to managing your weight. There are tools that can help such as continuous glucose monitors (CGM) e.g. Ultrahuman that can be a great way to learn how your body responds to different meals. I usually suggest wearing such a device for up to three months.
Bone health is also a big consideration at this stage of life. Bone is a dynamic tissue in the body, continually breaking down and rebuilding. However, when oestrogen levels decline bone rebuilding starts to decline too. This can lead to brittle bones and the conditions known as osteopenia and osteoporosis. Besides dietary calcium intake, exercise is an essential part of the bone health equation. Resistance workouts with heavy weights, and jumping, skipping etc create dynamic forces that trigger bone remodelling and help offset the decline in bone density.
Insomnia is a very common symptom and has huge knock-on effects driving further stress. Developing a rigorous sleep hygiene routine. Most parents have a bedtime routine for their kids, and you probably did as a kid yourself, so prioritise your time to reintroduce “wind-down” strategies known to help improve sleep architecture. There are certain compounds that can aid with sleep such as magnesium, which can be taken to bowel tolerance ie. the point where your stools are too loose. Magnesium bisglycinate is a good choice for sleep and does not have the same laxative effects compared with magnesium citrate. Other herbs and precursors to sleep derived compounds include L Theanine, Montmorency Cherry Powder (a natural source of melatonin), Passionflower, Hops, Vervain, Valerian, Lemon Balm, Ashwagandha, 5 HTP and Gaba. It is important to note that amount of melatonin produced naturally to induce sleep is very small and many supplements have doses that are far too high, even in the region of 1,000,000 times too high.
What about HRT (Hormone Replacement Therapy)?
This is a discussion to be had with a doctor that truly understands menopause. Besides HRT, there are other prescription drugs that can be useful for debilitating symptoms when herbs and medicinal mushrooms are not enough. For example, Gabapentin has been shown to mitigate hot flashes in early perimenopause.
Speak to your general practitioner or your gynaecologist to discuss HRT options for your symptoms, even before your periods have stopped. In fact, I would advise to have the discussion well before you think you may need HRT so that you understand the signs to look out for.
There isn’t only one specific thing that will help you navigate perimenopause. There are numerous strategies and lifestyle hacks that can be beneficial including time saving tips which can be almost lifesaving when one is feeling overwhelmed.
I understand that setting priorities for your own health and wellbeing can be a struggle for many women. Maybe you are juggling full time work with a growing family or maybe you have recently relocated and are missing a social support network. Maybe you have recently become an empty nester and feel totally overwhelmed missing the structure that having children at home provides.
I feel every woman deserves to have access to the best options available to her to navigate this challenge of declining hormones, perimenopause to menopause, with ease and grace. It is possible to be a healthy strong woman during and beyond the menopause. Do not suffer in silence, seek help.
