Most mums tell their young daughters about the menstrual cycle and how to deal with it, so although it will still be quite a shock when it arrives, at least they’re more or less prepared. But were you told about the menopause? What do you know about it, other than the odd horror story from other women?
TLL spoke to nutritional therapist Monique Parker about why ‘the Big M’ still has a bad rep, how we can embrace it and the importance of understanding what is actually happening during this natural, important part of the female life cycle.
For a long time the menopause, which is a natural phenomenon (unless surgically induced), has been described as a disease, causing negative assumptions. According to medical historian Louise Foxcroft, as recently as 50 years ago an American doctor called David Reuben wrote in his book Everything You Always Wanted to Know About Sex, ‘as estrogen is shut off, a woman becomes as close as she can to being a man … they have outlived their usefulness as human beings’. Pretty shocking, don’t you think? Especially given the fact that there are plenty of women over 50 who look great, have a healthy sex life, are very content, still contributing to society and are definitely not ‘written off’.
To start with, there is a lot of confusion about the difference between being pre-menopausal, peri-menopausal, menopausal or post-menopausal.
Pre-menopause is the time when you still have periods and, although you might have some hormonal changes, they may not be noticeable yet.
Peri-menopause is the time when you still have periods but start to experience menopausal symptoms such as hot flushes, mood swings or changes in your menstrual cycle. This period of transition can last as long as 10 years. It usually starts in your 40s, but sometimes earlier.
Menopause starts officially once you haven’t had a period for 12 months. The day after your last period marks the menopause. The average age for a UK woman to start the menopause is 51.
Post-menopause refers to the years following the menopause, starting 12 months after your last period, when symptoms start to cease. It is a bit confusing, but consider the menopause as a moment in time and post-menopause as the time following that.
What happens during the menopause (including peri- and post-menopause)?
During the years leading up to the menopause, the ovaries become more and more inefficient. Once they stop working completely, there won’t be any more eggs released and there won’t be any more shedding of the uterine lining, so no more periods. While this is all happening, the balance of the sex hormones changes dramatically and becomes increasingly erratic.
Unfortunately, sometimes the ovaries stop working earlier (this could be as young as 20s or 30s), leading to early menopause. This is called premature ovarian failure or primary ovarian insufficiency. Chemotherapy, and surgery, i.e. hysterectomy with removal of the ovaries, are two possible causes.
Before the menopause, oestrogen is mainly produced by the ovaries, so when the ovaries become less efficient, oestrogen levels start to fluctuate and eventually the ovaries stop making the hormone. As oestrogen is also produced by fat cells, overweight women will have more circulating oestrogen.
Luckily, after the menopause, the body can still make small amounts of oestrogen by changing hormones called androgens into oestrogen. Androgens are produced in the ovaries, by the adrenal glands, which are located on top of the kidneys, and in fat cells.
Another hormone affected by the menopause is progesterone, the one that prepares the uterus lining for the fertilised egg and helps maintain early pregnancy, but it also protects nerve cells. Less progesterone production can cause irregular, heavier and longer periods.
What are the symptoms of the menopause and what can cause them?
• Irregular periods
• Hot flushes and night sweats
• Poor sleep
• Poor concentration
• Poor memory
• Joint and muscle aches
• Skin and/or hair changes
• Low self-esteem
• Urinary issues, i.e. urinary urgency
• Dry vagina
• Painful intercourse
• Low libido.
According to the Indian Journal of Psychiatry, most symptoms relate to fluctuating oestrogen levels, but why do some women sail through the transition and others clearly suffer?
The above symptoms cannot always be blamed on the menopause; studies show that some are simply signs of ageing that happen to coincide with the menopause. We also shouldn’t forget that this phase in life can be stressful for many women – children leaving home, caring for elderly parents, or simply having to accept you are getting older can all have quite an impact on health and vitality.
And then there is the thyroid. Many symptoms that are experienced during menopause overlap symptoms of a thyroid that is not working properly, which can cause confusion.
Interestingly, menopausal symptoms and age differ in different parts of the world; in the West, hot flushes are the most common, while in Japan it is shoulder pain. Western women are usually older at the onset of menopause than those in developing countries.
Hormones are chemical messengers that travel throughout the body coordinating complex processes such as fertility, growth and even brain chemistry. In good health, the body is a fine-tuned machine that is working well, but with such a lot going on, things can go wrong. As soon as something goes wrong with this tuning, i.e. hormone levels drop, the problems start. When hormones become imbalanced, the symptoms start appearing, and we all experience this differently.
According to Hays’ Perimenopause, Menopause, and Women’s Health, factors that contribute to menopausal symptoms include:
1) Hormone imbalances:
• Decreasing levels of oestrogen
• Decreasing levels of progesterone
• Decreasing levels of testosterone
• Stress hormones, e.g. cortisol
• Thyroid hormones.
2) Problems with how oestrogen is processed in the body, i.e. detoxification and elimination
4) Problems with blood sugar regulation.
Is there anything women can do to help the transition go as smoothly as possible?
Absolutely! Here are some factors that could disrupt hormone balance:
• Diet, nutritional deficiencies, food allergies and intolerances, etc.
• Chronic stress
• Being overweight or obese
From a nutritional and lifestyle perspective there are several steps a woman can take to support hormone imbalances:
A nutrient-dense diet
The body needs building blocks to produce hormones, provided in the form of nutrients from your diet. For example, good fats are needed to make sex hormones.
If your diet doesn’t provide enough building blocks, it will use the available material to produce stress hormones, which are vital for survival and are number one on the body’s priority list. A colourful, nutrient-dense diet with good protein, fats, fibre, some complex carbohydrates, and plenty of vitamins, minerals and antioxidants will provide the right information for our bodies to function properly.
Research published in the BMJ shows that what you eat could affect the age you will start your natural menopause, i.e. intake of oily fish was associated with a later onset of menopause by about three years for each additional portion per day. Vitamin B6, zinc and fresh legumes such as green beans, were also linked with a later onset of natural menopause. However, refined pasta and rice were associated with an earlier age of natural menopause.
Stress has a huge impact on hormone levels, and large amounts of the stress hormone cortisol will affect the production of oestrogen and progesterone, as the body steals the prehormone pregnenolone to make the extra cortisol instead of using it to produce sex hormones – all the more reason to manage stress, especially during menopause when oestrogen and progesterone levels are dipping anyway.
Stress management is very personal; some women benefit enormously from regular yoga sessions, others find stress relief in the gym, being outdoors or doing favourite hobbies at home.
Physical stress such as obesity, blood sugar imbalance, gut dysbiosis and inflammation can all be supported with nutrition and supplements.
Oestrogen and progesterone have an important, but complex effect on the body’s inflammatory response. Oestrogens can either increase or reduce inflammation, depending on a variety of factors:
• The amount and composition of oestrogens
• Immune responses
• Which cells are inflamed
• The presence of other hormones
• The presence of hormone receptors.
Studies in pre-menopausal women suggest a beneficial role for oestrogen in preventing inflammation in the blood vessels and resulting atherosclerosis.
Obesity is associated with inflammation, while chronic blood sugar imbalances have inflammatory effects, and as both can cause hormone imbalances, it is all connected.
Reduce toxins, alcohol and caffeine
Oestrogen travels through the bloodstream in order to do its job. It is then converted in the liver through a complicated detoxification process and is excreted through the gut and the kidneys.
If the oestrogen is not detoxified properly, it will reappear and recirculate in the bloodstream in a more toxic form. If this happens repeatedly there will be high levels of circulating oestrogen, which can cause serious problems including hormone-related cancers.
Having to deal with toxins, alcohol and caffeine, etc. during the detoxification process puts extra burden on the liver, and oestrogen-clearance might suffer as a result.
There are also toxins that can disrupt hormone balance by mimicking hormones like oestrogen, which bind to the oestrogen receptors and block the ‘real’ oestrogen. These toxins are called endocrine-disrupting chemicals and can be found in pharmaceuticals, plastic, pesticides, etc.
So, good detoxification requires a healthy liver, gut and kidneys, as well as a reduction in toxin exposure, alcohol and caffeine intake.