By Dr. Hannah Watson
Menopause: a word that's often whispered rather than spoken, shrouded in a veil of misinformation and perceived as an inevitable "downhill" slide that comes with a stigma for many women of being less desirable and seen by society.
What if menopause was not a dreaded milestone, but viewed as a doorway to a powerful new chapter? It's time to shed outdated expectations and step into a life brimming with vitality and self-discovery. For far too long, stigma has clouded this natural and inevitable transition, leaving women feeling unprepared and apprehensive. Dive into the science behind menopause, understand your unique experience, and discover evidence-based strategies to thrive during perimenopause and beyond. With increasing life expectancy, being post-menopausal can encompass up to a third of your life, why spend it feeling invisible, resigned or in discomfort? Let's redefine what it means to age vibrantly and celebrate this exciting new chapter with confidence.
Understanding Your Changing Body:
As women, we experience various hormonal phases throughout our lives: puberty, menstruation, our individual menstrual cycle, and ultimately, the transition to perimenopause and menopause.
- Perimenopause: The phase leading up to menopause, typically starting in the mid-40s, though it can start as early as 38. During this transition, hormones fluctuate, leading to changes in periods and potentially triggering other menopausal symptoms.
- Menopause: Officially occurs when a woman has not menstruated for a full year, typically around age 51. This marks the winding down of ovarian function and a significant drop in hormones like oestrogen, progesterone, and testosterone.
The Hormonal Shift:
The symptoms experienced during perimenopause and menopause are caused by both imbalanced and declining hormones. Let's revisit the roles of our main female hormones:
- Oestrogen: Plays a vital role in regulating the menstrual cycle, bone health, and mood.
- Progesterone: Supports the lining of the uterus and balances the effects of oestrogen.
- Testosterone: Influences sex drive, energy levels, and muscle mass.
A Spectrum of Experiences: Symptoms of Menopause
Menopause is a natural experience for all women, but symptoms can vary widely in nature and severity:
Common Symptoms:
- Vasomotor: Hot flashes and night sweats.
- Psychological: Low mood, anxiety, irritability, mood swings.
- Sleep: Fatigue, difficulty sleeping.
- Cognitive: Brain fog, poor concentration, memory lapses.
- Sexual: Decreased libido, vaginal dryness and soreness.
- Urinary: Increased frequency and urgency.
- Other: Joint pains and headaches.
Body and Skin Changes
Menopause brings various changes due to hormonal fluctuations and the decline in oestrogen and progesterone. You might notice weight gain, especially around the abdomen, and the development of varicose veins due to reduced elasticity and poor circulation. Additionally, bone density loss becomes more pronounced, increasing the risk of osteoporosis.
Skin changes can include increased dryness and thinning, making the skin more fragile. The loss of collagen and elastin causes sagging and wrinkles, while hormonal imbalances can lead to hyperpigmentation and acne, even if you never had it before. Hair often thins on the scalp, while facial hair may increase due to higher androgen levels. This fat redistribution results in a loss of facial fullness, and skin tags may appear. Moreover, nails can become brittle, and hormonal changes may cause dry mouth and tongue inflammation.
These are not just things to accept about ageing but signs that your hormones need some support!
Long-Term Health Considerations:
As life expectancy increases, the post-menopausal phase becomes a significant span of a woman’s life, making proactive health management more crucial than ever. Maintaining healthy habits such as regular exercise, a balanced diet, and adequate calcium intake is essential for protecting bone health, while engaging the mind helps preserve cognitive functions.
Charting Your Course: Management Options
There are different approaches to manage symptoms and improve your quality of life during menopause and beyond. It's important to be proactive and explore the available options:
Healthy Lifestyle is Key:
- Diet: The decline in oestrogen impacts the gut microbiome, reducing beneficial bacteria and increasing harmful ones. This shift can cause digestive symptoms such as bloating, gas, constipation, diarrhoea, and indigestion. Hormonal changes also increase gut permeability, leading to systemic inflammation, joint pain, and fatigue. Maintaining a balanced diet rich in fruits, vegetables, whole grains, and healthy fats is essential for providing the necessary nutrients to support gut health during this time.
- Stress management: Stress significantly exacerbates menopause symptoms, including hot flashes, sleep disturbances, mood swings and fatigue. Women experiencing high stress levels often report more frequent and severe symptoms compared to these with lower stress levels. Techniques like mindfulness, meditation or yoga can help manage stress and anxiety
- Exercise: Regular physical activity helps manage weight, improve energy levels, and boost mood. Activities that also support stress reduction and management pay dividends when it comes to the impact of stress on the body during menopause.
- Sleep Hygiene: Establishing a regular sleep schedule and creating a relaxing bedtime routine can improve sleep quality. A consistent sleep schedule and quality rest stabilises circadian rhythms, promoting balanced hormone production and lowering cortisol levels.
Hormone Replacement Therapy (HRT):
HRT remains the most effective treatment for alleviating menopausal symptoms. For many women under 60, the benefits outweigh the risks.
Considerations:
The choice of HRT depends on your dominant symptoms and circumstances.
On the NHS, the preferred option is now body-identical HRT, where the hormones used are chemically identical to the ones produced by the human body, particularly oestrogen and progesterone. Older types of HRT contain synthetic oestrogen combined with a molecule called progestin. Progestin is a synthetic version of progesterone. There is some debate about the relative risks and benefits of synthetic HRT compared to body-identical HRT. Discuss this with your doctor to determine the best option for you.
It's important to discuss the HRT regimen with your doctor to ensure it meets your individual needs. During perimenopause, when you still have periods naturally, the HRT regimen will be introduced cyclically, mimicking your bleed pattern. In menopause, a continuous regime is used to prevent bleeding.
Delivery Methods
The preferred route for oestrogen is through the skin, either as a gel/cream or patch. This is because oral oestrogen has a slightly increased risk of clotting due to how it's absorbed and digested in the digestive system. Skin absorption avoids this risk. Progesterone and progestin are usually given as tablets, although the Mirena coil, which releases progestin locally, can also be used.
- Testing and Doses
- On the NHS, there is generally no requirement for hormone testing before prescribing HRT. Standardised doses are used. If you have symptoms at an age consistent with hormonal changes, then HRT at these prescribed doses is an option
- Privately, you can opt for hormone testing with a specialist, who may then prescribe customised, tailored bioidentical HRT.
Risks
Many women are worried about HRT because of associated risks. A decade ago there was huge media attention following the release of some large studies which raised concerns over safety, particularly around breast cancer and heart disease. However, some of these studies have now been shown to have flaws and inaccuracies. In more recent years, other published studies have demonstrated clear benefits of taking HRT.
Breast cancer is the risk that most women worry about with HRT. There may be a small increased risk of breast cancer if using some types of HRT. The British Menopause Society supports there being a lower risk when using HRT containing progesterone compared with those using synthetic progestogens. An individual's background risks, including age, family history and general health, must be considered with your doctor when deciding whether or not to take HRT.
Alternative and Complementary Therapies:
Integrating practices like acupuncture, yoga, and meditation can significantly aid in managing menopausal symptoms by promoting relaxation and reducing stress, additionally, including phytoestrogenic foods such as soy, flax, and legumes in your diet offers natural hormone support. Explore non-hormonal pharmacological options that target specific symptoms like hot flashes or mood fluctuations. Psychological interventions, such as cognitive behavioural therapy (CBT), offer robust tools for managing mood and anxiety. Consider natural remedies like black cohosh, evening primrose oil, or Red Clover, found in SABI's Gentle Period blend along with herbs that support the taxed menopausal nervous system like Oat Straw for mood balance. Herbal remedies can be powerful and some people are more sensitive to them, so best to consult your doctor before starting any new supplements.
Building Your Support System:
Building a strong support system is crucial for navigating menopause with confidence.Here are some resources
- Connect with other women: Join online forums or support groups specifically for women experiencing menopause, such as Menopause Support UK, Peanut Menopause and Menopause Matters. Sharing experiences and advice with others going through the same changes can be incredibly empowering.
- Talk to your doctor: Open and honest communication with your healthcare provider is essential. Discuss your symptoms, concerns, and treatment options to find a personalised approach that works best for you. Don't hesitate to ask questions and be an active participant in your healthcare decisions.
- Seek professional help: Don't hesitate to seek professional help from a therapist or counsellor if you're struggling with emotional challenges like anxiety or mood swings. Therapists can equip you with strategies for managing stress, improving communication, and fostering emotional well-being.
- Embrace your village: Lean on your partner, close friends, and family members for emotional support and understanding. Open communication about your experiences can help them understand what you're going through and provide valuable support.
Your menopause journey is a call to personal revolution—a chance to rewrite the narrative and redefine what it means to be a vibrant, empowered woman. Embrace this exciting new chapter with confidence, armed with knowledge and a supportive community. Menopause is not the end; it's a powerful transformation, opening doors to self-discovery, growth, and a life brimming with possibilities.
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ABOUT THE AUTHOR
Dr. Hannah Watson is a UK-based general practitioner who runs the Hormone Balance Clinic, a clinic specialising in women's hormone health. Dr Hannah has a particular interest in assessing, investigating and treating hormone imbalances, using a holistic approach that includes lifestyle modifications and supplements, alongside bioidentical and body identical hormone replacement therapy.
She has been a qualified doctor since 2002 and has practised as a GP (General Practitioner) in North Leeds since 2006. She is a member of the Royal College of General Practitioners and the British Menopause Society, among other professional bodies.
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