Dr Libby’s advice: dealing with menopause
In the first of a new series, Dr Libby tackles a problem head on.
Dear Dr Libby
I am pre-menopausal. I’m not sleeping well due to hot and cold sweats. I have mood swings, my memory is getting worse, my hair is getting thin and frizzy and my nails are becoming brittle. I already drink green smoothies, meditate and do yoga. Please help me avoid putting on weight and get through the next 10 years without drugs.
The symptoms of menopause are as varied and individual as the menstrual cycle itself. Some women transition from regular menstrual flow to the cessation of their periods and beyond with little or no challenging symptoms, while for others it’s a time of insomnia, hot flushes, constant heat, low mood, no libido and/or weight gain. Any or all of these experiences may lead to strained relationships in both family and career, yet this doesn’t have to be the case. Challenging symptoms are just another way the body is asking you to make some changes to your choices and, instead, the transition into the post-menopausal years can be ones of renewed vigour and personal growth.
Fundamentally, menopause means the ovaries cease their production of sex hormones – predominantly oestrogen and progesterone. Small amounts are still made in other areas of the body – by the adrenal glands, liver and body fat cells, for example. Physically and emotionally, however, this transition can be life changing in more ways than simply not menstruating anymore. Symptoms primarily arise from hormonal decline as well as physiology (particularly muscle mass), organ function (particularly the liver and adrenals) and lifestyle (diet and health history). Emotions, too, can play a role.
The relentless output of stress hormones in the lead-up to menopause can provoke some of the most debilitating symptoms. If your adrenal glands have been receiving the message that they need to churn out stress hormones – due to genuine stress, excess caffeine consumption, or from the perception of pressure and urgency – then they won’t have efficiently made sex hormones across that time. This means that when menopause hits (no more ovarian hormones) you are supposed to predominantly rely on adrenal hormones, yet you may not have made sex hormones from your adrenals for a very long time. So instead of going from having bucket-loads of hormones to a small amount, you virtually go from having plenty to none. Couple this with a liver that has likely been in overdrive trying to deal with the liver-loaders many people ingest or absorb these days, and you have sleeplessness and debilitating body heat.
The transition to post-menopause can take several years and this is referred to as perimenopause, when hormonal output gradually reduces over time. This usually initially causes irregularity in period frequency, flow and associated premenstrual symptoms. For some, blood flow becomes increasingly heavier, while for others, the flow is reduced and they experience fewer symptoms. Once the ovaries cease the production of hormones entirely, small amounts of oestrogen and progesterone are supposed to be made by the adrenal glands, which act to protect against a degenerative disease associated with bone density and cardiovascular decline, yet to reiterate, this often doesn’t happen due to the consistent and relentless output of stress hormones for too many women for many years leading into menopause.
The health and function of the adrenal glands, therefore, plays a major role in determining how the transition of menopause affects us. Another thing to consider is if the adrenals aren’t up to the task of overseeing the production of yet another hormone, what happens then? The body always has a plan B and in menopause body fat acts as a production facility for oestrogen while the ovaries shut up shop and the adrenals try to take over. If the adrenals don’t have the resources to help, body fat may increase in an attempt to help out… here’s yet another example of how calories as the sole determinant of body size is a myth.
The number one priority here is to manage stress. Creating calm despite what external circumstances ask of us is an essential life skill. Whatever this may mean for you, do it. Meditation and yoga are two powerful breath-focussed practices that can support the body to transition from a dominant sympathetic nervous system (fight or flight) to the calm parasympathetic nervous system (rest and repair). Diaphragmatic breathing (moving your tummy in and out as you breathe) reduces stress hormone output significantly and takes the pressure off the adrenal glands.
A balanced and functional approach to movement is critical – combining restorative movement such as yoga, pilates or qi-gong with resistance training and gentle weight strengthening is particularly important for the metabolic rate. Metabolism through menopause may decrease by 10 to 15 per cent; this is more significant if muscle mass going into menopause is low. It is important to take that into consideration and keep metabolism sustained through building muscle, eating regularly and focusing on whole unprocessed foods. Healthy fats are vital as well – to synthesize hormones we need varied essential fats such as oily fish, flaxseeds, chia seeds, walnuts, pecans, evening primrose oil, blackcurrant oil or borage oil. Avocados and macadamia nuts (and their oils) are also a great choice. They are also very satiating and can help to regulate blood glucose levels.
Essential fatty acids from the aforementioned healthy fats are a critical part of keeping our hair, skin and nails healthy, too. They’re of particular importance if you’re experiencing hair thinning and brittle or dry nails. Nutrients such as magnesium, calcium and vitamin D are often used to help manage hot flushes, sleep and mood. But, most importantly, they can help to preserve bone density. Zinc is also hugely important to help synthesize sex hormones and regulate cholesterol metabolism, which can often increase as hormonal production declines and the liver has more to deal with. Given these symptoms, though, it would be wise to see your GP and have some blood tests, particularly for thyroid function and iron.
Holistically, each person tends to require an individualized plan detailing food, movement, stress management, specific nutrients if required and potentially herbal medicine – particularly when there are hot flushes and/or sleep issues. Medicinal herbs have a unique advantage in that they modulate rather than stimulate a physical response. This means they adjust to the body’s forever-changing environment by acting on hormone receptors to trigger a particular response.
Remember hormonal production varies daily, if not hourly, according to what is required to sustain a balanced system. This is particularly relevant in perimenopause when the ovaries are still producing hormones, albeit in much lower quantities than previously, and thus the internal environment is in constant state of flux. After menopause, the hormonal output is not as varied and requires a different approach.
When formulating a herbal tonic be aware that herbs work well synergistically with other herbs and they can affect different body systems simultaneously. Wild yam, for example, reduces inflammation, spasms and cramping and modulates oestrogen by acting on specific oestrogen receptors. Each herb can help stabilize a different symptom. Please note, this is for educational purposes; it is not prescriptive. Herbal medicine must be tailored to individual needs by a qualified health professional. An example of a formula for someone with hot flushes, difficulty sleeping, low mood, low energy and cravings for alcohol may look something like this: schisandra, rhodiola, wild yam and St John’s wort.
Other helpful herbs include rehmannia, black cohosh, withania and/or milk thistle. Always seek advice from a qualified practitioner who can make a specific formula to suit your needs and understand where in the perimenopause journey your may be.
Lastly – but certainly not least – supporting optimal liver function is vital to help manage hot flushes and sleep. Broccoli sprouts and turmeric can be highly beneficial across this time. Be mindful of coffee and alcohol and take care to avoid synthetic chemicals. There is a growing body of evidence to suggest that we are being exposed to many endocrine-disrupting substances in our current environment – whenever and wherever possible make a concerted effort to choose natural and organic options.
When it comes to this transition don’t be afraid to seek help, your journey doesn’t have to be one of suffering. In fact, make it a time in your life that you thrive. Use the feedback from your body to make the changes it requires from you in your lifestyle choices.
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