Managing menopause

Menopause officially occurs when a woman stops having menstrual cycles altogether. However, the process of getting to that point can take a long time. Dr Marissa Kelaher shares some tips to help manage symptoms.

Perimenopause and menopause are times of massive changes in a woman’s life, but often are not talked about much, meaning many women may suffer in silence for years before seeking help.

They refer to the transition that occurs when a woman’s ovaries gradually slow down, and levels of oestrogen, progesterone (and to a lesser extent testosterone) can fluctuate for months to years, before eventually dropping to low levels - then periods and fertility stop. It’s a natural process, yet with women often juggling family life, careers, and other responsibilities during this time, it can be challenging.

Yet on the flip side, educating and empowering women about menopause can have huge benefits.

✔️Perimenopause is when hormone levels fluctuate, yet ovulation and menstruation still occur.

✔️Menopause is once these have stopped (usually defined no period for 12 months).

Traditionally it was thought women only got symptoms during menopause, and these were limited to hot flushes and night sweats. Yet we now know both perimenopause and menopause can cause a huge variety of symptoms, including mood changes, migraines, palpitations, joint pains, brain fog, poor sleep, weight gain, hair loss, dry skin, inflammation, urinary symptoms, low libido, and vaginal dryness.Which makes perfect sense when you think that hormone receptors are present in almost every cell of a woman’s body.

Menopause also increases the risk of other health issues, such as heart disease, dementia, type 2 diabetes, high blood pressure, osteoporosis, and depression, so focusing on health then is vital.

Fortunately, with the right tools, women can thrive through menopause and beyond.

Diet is key, as it helps symptoms and reduces the risk of future health issues.

An anti-inflammatory whole food plant focused diet is recommended, it improves health, and helps hormonal symptoms.

This also protects the heart, brain and bones; reduces inflammation; optimises immune health and metabolism; and boosts our gut microbiome.

Try:

✔️Swapping refined carbohydrates ('white' carbs) for whole grains.

✔️Avoiding ultra-processed foods and limiting added sugar as much as possible.

✔️Swapping saturated (animal) fat for unprocessed/minimally processed unsaturated (plant) fat, such as seeds, nuts, avocado, and olive oil.

✔️Limiting fat to 30% of calories.

✔️Eating legumes, seeds and nuts daily.

✔️'Eating a rainbow', of 5+ servings of colourful veges per day, and 2+ servings of fruit.

✔️Having daily omega 3 rich foods (essential for brain, heart, and immune health), this can be found in oily fish, flaxseed, walnuts, chia seeds and hemp hearts.

✔️Getting enough B12, iron, folate and iodine (important for energy, mental health, thyroid and hormonal health).

✔️Including lean protein at every meal, ideally mostly from plants (legumes, nuts, seeds etc) to balance blood sugars and energy and build muscle. Women need more protein after menopause (around 1.2g/kg/day).

Gut health also plays an important role in hormonal health, so feeding your microbiome (gut bacteria) with lots of fibre (aim for 30 different plant foods per week, and at least 30g fibre per day) as well as probiotic (fermented) foods will keep your gut bugs happy!

Phytoestrogens are worth mentioning, these are plant compounds which mimic oestrogen.

They're found in high levels in soy, flaxseed, sesame seeds, legumes, whole grains, peanuts, and tea. Try to include them in your diet regularly, as they can help with menopause symptoms (especially hot flushes, brain fog, and poor sleep), improve bone health, and reduce the risk of breast cancer and heart disease.

Soy in particular is effective in reducing the risk of breast cancer, as well as reducing recurrence in breast cancer patients, it may also help hot flushes. Soy contains isoflavones, the compounds found in red clover extract (a popular menopause herbal supplement).

Calcium is important for bone health, and women need more (1200mg per day) after menopause.

Dairy alone isn't particularly protective for bones, so its best to get calcium from a variety of sources, including tofu, green leafy veges, seeds, and legumes.

Vitamin K is also needed for bone health, dark green leafy veges are rich in this (they also help brain and heart health and inflammation.)

And lastly, vitamin D is crucial for bone health, this is made from sun exposure, so take a supplement if you are mostly indoors, during winter, you cover up your skin, or if you are darker skinned.

Alcohol increases the risk of many cancers, and can negatively affect heart and brain health, as well as sleep and mood. It's also a common hidden cause of weight gain.Try limit to 10 units per week at most, the less the better.

Caffeine may worsen hot flushes and poor sleep, so try cutting down or switching to decaffeinated coffee if you suffer from these.

Time restricted eating may help with weight loss, blood pressure, cholesterol and blood sugars. This means aiming to eat your meals within a 10-12 hour window. It's not recommended if you are malnourished or have a history of eating disorders.

In summary, aim to eat a variety of colours, fibres, whole grains, lean protein, unsaturated fats, whole plant-based foods, foods rich in calcium and which optimise your gut health. Your body will thank you for it.

From an exercise perspective, strength training is particularly important for menopause, as women progressively lose muscle from age 40. Muscle is vital for immune health, metabolic health, and bone health. The drop in oestrogen during menopause also means women can become more insulin resistant (increasing diabetes risk), and muscle helps regulate blood sugar too. Muscle is also helpful to increase metabolism and counteract the weight gain that's common from perimenopause onwards.

Aim for strength training 3-4 days a week, alongside cardio, flexibility, and balance exercises. You don't need to bulk up or join a gym - just aim to work all the muscles in your body regularly!

Sleep and stress are important, as hot flushes worsen with stress, and sleep deprivation affects blood sugar levels, mood swings, brain fog and weight gain, and increases the risk of other health issues.

Ironically these can be a challenge in menopause, as estrogen and progesterone improve mood and sleep - so when levels drop it can become a vicious cycle.

Sleep disturbance can occur even without night sweats too.

Some tips to keep in mind:

✔️Keep your bedroom cool and dark, consider a fan.

✔️Wear light natural clothing to bed.

✔️Switch off electronic devices at least one hour before bed.

✔️Aim to get up the same time each day and get outside in the morning daylight for at least 20 minutes to help set your body clock, or sit close to a window with natural light. This helps regulate sleep cycles.

For stress, practices such as slow breathing, meditation, yoga, and exercise help to 'turn down' the stress response and improve sleep and menopause symptoms. Even 5-10 minutes a day helps. Try be kind to yourself and allow at least 30 minutes a day to do something you enjoy, that's just for you.

And if you're still struggling despite lifestyle changes, or symptoms are severe, Hormone Replacement Therapy (HRT) can help. The new body identical forms of HRT (oestrogen patches and utrogestran) are extremely safe and effective and can make a huge difference to symptoms and quality of life.

The key to healthy menopause is truly understanding why changes are occurring and feeling empowered to be able to do something about them.

Dr Marissa Kelaher is a GP and lifestyle medicine doctor. She runs health courses and offers one-on-one consults at yourlifestylemedics.com