Menopause is an inevitable, natural, biological process that marks the end of a woman’s reproductive years. However, for some women, it is a tricky life stage to navigate and one that isn’t wholly understood. The more information we have, the better we will be able to support our bodies through mid-life so you’ll find here an overview as for many of us, it’s been a while since we studied biology.
Perimenopause, menopause and beyond
Women are born with a finite number of eggs that are stored in their ovaries. Our ovaries are involved in the production of the sex hormones - oestrogen, progesterone, and testosterone as well as follicle-stimulating hormone (FSH) and luteinising hormone (LH). These hormones all help to control menstruation and ovulation during our fertile years.
From our forties (although earlier for some), women typically enter the perimenopause stage. This is the body’s natural transition into menopause and the time when our sex hormone levels start changing. Perimenopause may last between 4 and 9 years.
During perimenopause, our overall levels of oestrogen and progesterone will change and the balance between the two may also change. It’s an unpredictable time, to be honest, as they don’t decline in a gradual manner but fluctuate up and down through the transition. This means, for example, that one day oestrogen and progesterone levels could be high, another low.
Progesterone is our calming hormone and is usually the first to dip. Early perimenopause symptoms are often associated with this decline in progesterone and include irregular or skipped periods, spotting before our period, feeling anxious, angry, tired, or sad in the run up to our period. We can also have trouble sleeping and might notice more exaggerated PMS symptoms such as breast tenderness, headaches, and water retention.
Oestrogen plays an important role in maintaining many aspects of our health – there are oestrogen receptors on every cell in our bodies which means changing oestrogen levels can have wide-reaching effects.
Changing levels of oestrogen can hit us in two ways.
The first is lower levels of oestrogen. Symptoms include hot flushes, brain fog, dry skin, irregular periods, vaginal dryness and aching joints.
The second is known as oestrogen dominance and it’s when the balance between oestrogen and progesterone is thrown off and there is relatively more oestrogen than progesterone. Symptoms include night sweats, moodiness, sore and / or lumpy breasts, PMS-related headaches, migraines and heavy or irregular periods.
Beyond these symptoms, Mother Nature has also thrown in a few curveball ones such as burning mouth, pins and needles and dizzy spells, which are less common but still impactful.
Finally, testosterone. Considered by some as our third sex hormone, its decline is more consistent and gradual vs that of oestrogen and progesterone. The symptoms associated with low testosterone can still be significant, however, and include loss of muscle mass and strength, lower sex drive, lower confidence and low motivation, loss of pubic and leg hair and low mood.
As we transition through perimenopause and beyond, it’s important to understand that our symptoms can change – some will stop (and then could reappear) whilst new ones might start. This is all part of the adjustment that our bodies experience.
Menopause and beyond:
Menopause is medically recognized as the day when a woman has not had a menstrual period for 12 consecutive months. Yes, technically the menopause is just one day. The average age of menopause in the UK is 51 years. After that, it’s the post menopause phase which can be summed up as the rest of your life.
It should be noted that being post menopausal does not necessarily mean the end of symptoms. Some of us will continue to experience symptoms for years to come as our bodies continue to adjust to lower sex hormones plus other key health considerations.
What causes menopause symptoms?
The menopause is a complex transition with a number of contributing factors. Each of us will have our own menopause experience with its own set of symptoms and degree of severity. In fact, not everyone gets symptoms – approximately 25% women barely notice any, 50% of women have some and it impacts their quality of life to some degree and that final 25% of women suffer significantly.
It’s important to understand that changing sex hormones are a key cause but they are not the only one. It’s not uncommon for our adrenal and thyroid health to become unbalanced at this life stage and this can impact and exacerbate menopausal symptoms, such as weight gain, constipation, fatigue, and brain fog. Our bodies’ ability to manage blood sugar levels can also decline. Too much sugar in the blood and the body’s need to produce more insulin can also lead to symptoms such as weight gain, mood swings, sleep problems, difficulty focusing and increased hunger.
Research shows that the communication between our brain and body can also be compromised, resulting in exacerbated symptoms due to poor signalling between our organs.
Our genetics play a significant role in our menopause transition too as they determine how quickly oestrogen gets cleared from our systems. They also impact metabolism which is our ability to break down and detox certain substances such as coffee and alcohol.
How can I support my health through menopause?
It sounds obvious, but at this time of life our bodies need the right nutrients to function. That means eating the right foods – what we eat literally provides our bodies with the building blocks they need.
As well as focusing on nutrient dense foods and eating enough protein, there are certain things to avoid. Certain foods, such as refined carbohydrates are harder to digest as we get older and can become a stressor on the body. Alcohol becomes trickier to process and interrupts our sleep which can result in worsening of symptoms the next day (regardless of any hangover).
You can consider supporting your sex hormones via HRT or herbal alternatives. HRT should be discussed with your doctor to understand the benefits vs any possible risks based on your health history.
There are also a number of lifestyle measures that can be beneficial. Building your stress resilience via techniques such as meditation or breathwork can be very helping in supporting your adrenal function. Exercise can help build a strong heart, strong bones, strong joints and more. An understanding of how to improve your sleep can be critical as a solid night of rest underpins so much of our physical and mental health.
Beyond helping with perimenopause and menopause symptoms, these changes will also benefit your long term health. Post menopause, women are more at risk of diseases such as diabetes, heart disease, and sarcopenia as well as declining brain health, which puts us at a greater risk for dementia and Alzheimer's. The choices we make today will help our future health.
To recap, the menopause is a natural transition but one that is complex with a number of different contributing factors. It is also highly personal – all our menopauses are or will be different and therefore which treatments will help the most will vary. There are lots of ways to support our bodies and feel our best, what’s key is to understand which will personally benefit us the most.
Diet may counteract menopause metabolism change, ZOE study shows
Clinical manifestations and diagnosis of menopause
Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause
National life tables – life expectancy in the UK: 2018 to 2020