Menopause: Your Questions Answered

What is the menopause
​Menopause is the time that marks the end of your menstrual cycle. This generally occurs from the ages of 45 to 55 years old. Menopause is normally diagnosed after you have stopped having a menstrual bleed for 12 months, when you’ve stopped producing the hormones that cause your menstrual period. Many women experience significant symptoms during the menopause but also during perimenopause. 


What is the difference between the menopause and perimenopause
Perimenopause is the time leading up to menopause. In fact, this can occur in women from 35 to 45 years old. Perimenopause describes the time in which your hormones will begin to fluctuate, and your menstrual cycle can even become erratic and often irregular. But this is also a transitional time as it’s the lead up to menopause.

Menopause means your periods have ended. When you have had no menstrual cycle for a full 12 months, then you have officially reached menopause.

Symptoms of menopause
The symptoms of menopause can range between individuals.  The most common symptoms are:

• Vaginal dryness.
• Hot flashes.
• Chills.
• Night sweats.
• Sleep problems.
• Mood changes.
• Weight gain and slowed metabolism.
• Thinning hair and dry skin
• Loss of breast fullness
  
  

Women often experience many other symptoms including brain fog, fatigue, low energy and motivation, low sex drive, problems with memory and concentration, recurrent UTIs, as well as symptoms of anxiety and depression. 


Can you test for menopause?
Although there is not one specific test, we do offer some fundamental testing in the clinic to help us to identify imbalances of hormones relating to perimenopause and menopause. 
We offer a metabolic blood screen that tests Thyroid hormones and antibodies, cholesterol, liver enzymes, HbA1C, Vitamin D and B12 status, ferritin and urea. In menopause it is essential to do a thorough metabolic screen as our risk of cardiovascular disease can increase and changes in the thyroid also need to be fully assessed. 

We also offer the DUTCH test which tests the levels all the sex hormones and their metabolites, adrenal function, methylation, and oxidative stress status. This allows a view of your current hormone status, your body’s ability to detoxify hormones through the liver as well as risk factors of oestrogen driven cancers and osteoporosis. 

If you really want to dig deep and individualise the care even further you can also do genetic testing. Testing offers information on an individual's genetic predispositions related to various aspects of their health and well being. It provides insights into how each individual's genetic make up may influence their risk for certain conditions such a type 2 diabetes, gluten sensitivity, detoxification processes (very relevant to menopause and also cancer), bone health and osteoporosis risk as well as their response to certain lifestyle choices including diet, exercise, sleep and stress management to name a few . 


Is menopause just about oestrogen and progesterone?

Not at all, in fact there are many factors involved in menopause. Oestrogen itself has many more roles within the body than just its involvement with our menstrual cycle. Oestrogen is important for the reproductive tract, the urinary tract, heart health and blood vessels, bone health, breast health, skin, hair, mucous membranes, pelvic muscles, and the brain. Symptoms associated with lowering oestrogen levels can include trouble concentrating, irritability, vaginal dryness or atrophy, hot flashes, and night sweats.

Progesterone is known for its role in preparing the body for pregnancy and regulating the menstrual cycle, but it also helps to regulate gene expression, modulate neurotransmitter systems, and activate signalling cascades. Progesterone is often called the “feel good hormone” because of its mood-enhancing and anti-depressant effects. Lowering levels during menopause can cause symptoms of mood changes, sleep disturbances, anxiety, and depression.
Testosterone is often thought to be the male hormone, but we do produce testosterone albeit in smaller amounts. Testosterone helps with the growth, maintenance, and repair of the reproductive tissues, is important in bone mass, and human behaviours such as boosting self-esteem and libido. An imbalance of testosterone in the female body can have damaging effects on a woman's health and sex drive. Testosterone can also be affected during menopause and lowering levels can result in symptoms of low libido, low self-esteem, and significantly reduced motivation.


What factors influence menopause symptoms
Although menopause is a natural transition, there are many factors that can influence symptoms and even their severity. Each woman will experience menopause very differently, so it’s never a one size fits all. Our diet, stress levels and lifestyle play a big role in the transition of our hormones, as well as risk factors for heart disease, type 2 diabetes, and some cancers (1).

Studies have shown that diets high in refined carbohydrates such as pasta and bread are associated with earlier menopause transition as well as more severe symptoms, whereas a diet with higher intake of vitamin B6 and zinc is associated with later age of menopause (2).

We also know that when we experience stress our adrenal glands produce hormones such as cortisol and adrenaline in response. Unfortunately this is at the expense of the production of oestrogen and progesterone. This is bad news for menopausal women, as we need these hormones for our health and emotional well-being (3).

Exercise is also a vital component not only for our overall health but to manage symptoms associated with menopause. One study showed that women who lived sedentary lives had more severe menopause symptoms than active women and another study showed that including daily exercise and movement improved symptoms of hot flushes and night sweats (4).


What is HRT

Hormone replacement therapy (HRT) is medication that contains pharmaceutically produced female hormones. The medication is prescribed to replace the oestrogen that your body no longer makes during and after menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.
There are two main types of oestrogen therapy. Systemic hormone therapy which often comes in pill, skin patch, ring, gel, cream or spray form and is higher dose of oestrogen that is absorbed through the body. There is also low dose oestrogen which comes in cream, ring and tablet form. This is only often used to treat the vaginal and urinary symptoms of menopause.
If you haven't had your uterus removed, your doctor will often prescribe oestrogen along with progesterone or progestin (progesterone-like medication). This is because oestrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer.


What are bioidentical hormones
Bioidentical hormones are typically known as duplicates of our own hormones such as estradiol E2, estriol E3, estrone E1, progesterone, dehydroepiandrosterone, testosterone which are normally synthesised by the ovaries and adrenal glands. Bioidentical hormones are plant based derived from yams, which are of similar structure to our own hormones  are thought to have a better side effect profile. 


Why might you not opt for HRT
Although the HRT industry is worth over £31 billion, there is less research into the effects of these hormones but also the side effects.
It can often take a while to find the right combination that will work for you. We also know that if you have been diagnosed with breast cancer in the past, that it is recommended that women with a history of breast cancer should not take types of HRT that affect the entire body (called systemic HRT).
We also know that overall exposure to HRT is associated with an increased risk of breast cancer, The risks associated with HRT are related to the duration of use. There appears to be less risk with oestrogen cream or vaginal preparations (5).

There is also recommendations that women with the following conditions should not take HRT:

• History of prior heart attack or stroke and/or increased risk for cardiovascular disease
• Unexplained vaginal bleeding
• Fibrocystic breast disease
• Active liver disease
• Endometrial cancer
• Gall bladder disease
• High risk for blood clots or a history of blood clots
• Porphyria cutanea tarda 
• Dubin-Johnson and Rotor syndromes
  
  
  
  

Is HRT or bioidentical hormones right for you?
Due to the nature of both HRT options, they must be tailored to your individual needs, taking into account your health history and symptoms. We always support our clients with dietary and lifestyle changes to help reduce menopausal symptoms as well as improve overall health which can work alongside any form of treatment that you decide to go with. One thing is for sure, HRT alone is not enough to address the full complexity of needs during menopause. The current lack of care and comprehensive training by practitioners supporting women in menopause means that so many risk factors are being ignored and left unaddressed.  In addition, just because a women is of a certain age we shouldn't  assume that any new symptoms are due to menopause. Neither should we assume that symptoms are due solely to menopause when there can be multiple underlying reasons for any symptoms we may experience. 


Why we differ?
Nourishing Insights provide a personalised approach to each of our clients, looking at each person’s overall health, medical history including family health history, diet, lifestyle, and providing support and guidance to manage your symptoms and the transition. We offer testing to determine your current hormones levels and metabolic health factors to help you to make an informed decision about your health and choose what is right for you, but also providing you with diet and lifestyle guidance that can help to reduce menopause symptoms as well as help to balance your hormones naturally through the menopause. Remember that each woman’s experience with menopause is very different, so we make sure to provide each one of our clients with the tools they need to support the transition and improve their overall wellbeing.


Do we offer bioidentical hormones?
If relevant we refer to a private GP who specialises in bioidentical hormone replacement therapy who we work with to provide our clients with personalised support and guidance.

To book a free 15 min discovery call to learn more about our services  click here 

References

1. Silva, T., Oppermann, K., Reis, F. and Spritzer, P., 2021. Nutrition in Menopausal Women: A Narrative Review. Nutrients, 13(7), p.2149.
2. Dunneram, Y., Greenwood, D., Burley, V. and Cade, J., 2018. Dietary intake and age at natural menopause: results from the UK Women’s Cohort Study. Journal of Epidemiology and Community Health, 72(8), pp.733-740.
3. Taylor-Swanson, L., Wong, A., Pincus, D., Butner, J., Hahn-Holbrook, J., Koithan, M., Wann, K. and Woods, N., 2018. The dynamics of stress and fatigue across menopause: attractors, coupling, and resilience. Menopause, 25(4), pp.380-390.
4. Thomas, A. and Daley, A., 2020. Women’s views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study. BMC Women's Health, 20(1).
5. Vinogradova, Y., Coupland, C. and Hippisley-Cox, J., 2020. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ, p.m3873.