Perimenopause: It is not all bad news!
There are different seasons to our lives and different stages of our growth and development, all of which bring their own challenges and benefits. One stage of life that brings many challenges to many women is menopause. Just mention the word and all sorts of negative stereotypes spring to mind: a thickening waistline, hot flushes, irritability, mood swings, poor sleep, stress, and increased risk of osteoporosis.
But it is not all bad news! I like to remind my clients that these challenges are not inevitable. There are many positive changes to diet, lifestyle and perspective that can make the process of menopause far less traumatising.
But first of all, what is menopause and what is perimenopause?
Perimenopause is the transition to menopause. It is marked by a gradual decline in the function of the ovaries and this takes place in the year or couple of years prior to menopause. Most women experience perimenopause between the ages of 45 and 55, but it can also occur as early as 35, or for some young women, in their late teens.
Menopause is one year after your last period when it is clear that the ovaries no longer produce eggs. It is the end of a woman’s natural fertility cycle. Oestrogen levels, the hormone that regulates the growth and function of reproductive organs, drop dramatically. Oestrogen also impacts on bone formation, so osteoporosis is a concern during menopause (more on this later).
Because women’s bodies are going through big hormonal and physical changes at this time, there are many physiological and psychological symptoms that can make it a very uncomfortable and, at times, distressing.[1] It is true that hormones wreak havoc on mood, sleep, and pain, but there are many things we can do to combat these difficulties.
What can be done?
Unfortunately, the first thing your GP will talk to you about is Hormone Replacement Therapy (HRT), which provides synthetic oestrogen in a tablet form. I say unfortunately because I believe other treatments should be tried first. HRT has been linked to a number of different health problems, including a potential increased risk of breast cancer for some women.[2] Some doctors now recommend HRT to be taken for no longer than five years and some women consider the alleviation of menopausal symptoms and reduction of osteoporosis to be worth the risk of other cancers.
Your GP may also prescribe antidepressants. However, NICE guidelines now state that GPs should not ‘routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.’
I do not recommend HRT or antidepressants as your first port of call, without first trying some of the other treatments and remedies listed below.
Cognitive Behaviour Therapy (CBT)
One fascinating body of research, undertaken by Myra Hunter, Emeritus Professor of Clinical Health Psychology at King’s College London, was based on cognitive behavioural (CBT) interventions for the main menopausal symptoms, hot flushes and night sweats.[3]
Women in the study made video diaries and were taught paced breathing — slow, deep breathing from the stomach — to ease anxiety. The result was a 64% decrease in hot flushes and 95% decrease in night sweats affecting mood and sleep.
This is important because it clearly acknowledges the link between what we think and how we feel physically. According to Professor Hunter:
CBT has had good clinical evidence for stress and anxiety, but at King’s we have developed and trialled it specifically to help women manage menopausal symptoms. CBT is now considered one of the few effective alternatives to hormone therapy for hot flushes and night sweats. And of course, it is free from the side effects of synthetic hormones.
Finding natural ways to manage stress during perimenopause is important. As progesterone drops, the ability to make GABA, the calming neurotransmitter drops which can increase anxiety and insomnia. L-Theanine can help boost GABA production. You may also need additional adrenal support. The adrenal glands (the glands that sit on top of your kidney’s) produce your stress hormones and post menopause take over from the ovaries to produce oestrogen. This puts the adrenals under more strain reducing the ability to cope in stressful situations
Diet
What you are eating can have a massive impact on how your body copes with the hormonal changes resulting in stress, hot flushes and sleeplessness.
Eating regular meals with plenty of protein regulates blood-sugar levels, which helps balance mood. Eating foods with natural oestrogen known as phytoestrogen’s can help alleviate menopausal symptoms. Traditionally fermented soya products such as tempeh and tofu, homegrown sprouts (particularly red clover, broccoli and alfalfa seeds), flaxseed and linseed, and legumes (particularly chickpeas and lentils) all contain natural oestrogen. I have had several clients who have introduced tempeh and tofu regularly into their diet and they no longer have hot flushes.
It is important to identify and eliminate any foods that may exacerbate symptoms. Some women find that caffeine and spicy foods such as hot curries can trigger symptoms.
Other beneficial foods to increase while dealing with symptoms include oily fish, which boosts both Vitamin D and omega-3 fat intake and can help with muscle aches and pains. Foods rich in calcium such as dairy, green leafy vegetables, nuts and seeds support bones and reduce the risk of osteoporosis.
Clients often worry about weight gain on their hips and I tell them this is normal and good as the fat on thighs produce oestrogen and oestrogen is important for building bones.
Exercise
Physical activity is so important and I have written blogs about the benefits of exercise which you can read here. As oestrogen levels drop, bone density also drop increasing the risk of osteoporosis. Regular weight bearing and muscle building exercise is essential for keeping bones strong during and after menopause. Other gentle exercise such as taking long walks or pilates increases your strength and flexibility and releases endorphins at the same time. This is invaluable for improving mood and reducing aches and pains, and it will also keep your heart in good shape!
Exercise is also important because the risk of cardiovascular disease and high cholesterol, weight gain, thyroid dysfunction, and autoimmunity all increase during and after menopause. If these run in your family and you are worried about them, please book an appointment with me.
Just as important as exercise is doing something you enjoy out in the beauty of nature. This might be gardening or looking after your animals…or even painting or writing. The therapeutic benefits of working with the soil, or sitting outside in the sun, is so important!
I hope this blog has shown you that perimenopause is not all bad news! While there is no stand-alone treatment that works perfectly for everyone, there are a number of treatments and lifestyle changes that combine in a way that can make a massive difference for you.
You might like to read some of my previous blogs which can also be helpful. You might also like to check whether you are suffering from any allergies or reactions to the toiletries and cleaning products you are using. As always, I recommend paying more attention to your gut health as this can make a massive difference to your overall health. I also recommend that you find the kind of exercise that works well for you and try to include half an hour or so of physical activity in each day, if possible in the fresh air! Remember to harness the power of thankfulness and you can move forward with courage and grace despite all the negative aspects of going through such big physiological changes.
Here are some additional herbs and nutrients that have helped other women:
- Sage has been shown to reduce night sweats and insomnia
- Soya Isoflavones reduce hot flushes and prevent bone loss
- Fish Oils (particularly EPA) reduces hot flushes
- L-Theanine, Panax Ginseng and Rhodiola supports mental health
- Vitamin D3 and K2 support bone health
- Black Cohosh and Dong Quai generally reduce menopause symptoms
If you have any questions or would like extra support, please contact me or talk to me during your consultation. Please also note that my prices are increasing slightly in January. Please see my website for more details.
Every blessing,
Emma
Emma Maitland-Carew – Registered Nutritional Therapist
Dip.ION, mBANT, CHNC Registered Practitioner,
Metabolic Balance® Coach, HeartMath Coach.
[1] You can read more about the symptoms of perimenopause and the experience of many other women in research from the ‘Women Living Better Survey’. Woods NF, Mitchell ES, Coslov N, Richardson MK. Transitioning to the menopausal transition: a scoping review of research on the late reproductive stage in reproductive aging. Menopause. 2021 Jan 15;28(4):447-466.
[2] Rossouw J.E., Anderson G.L., Prentice R.L., LaCroix A.Z., Kooperberg C., Stefanick M.L., Jackson R.D., Beresford S.A., Howard B.V., Johnson K.C., et al. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–333.
[3] Hunter, M. S. & Chilcot, J., Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms? British Journal of Health Psychology, Sep 2021, 26, 3, p. 697-708. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12543
