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Menopause

Although the word menopause means ‘final period’ and occurs when as women, we reach the end of our natural reproductive lives, in reality this, the menopause does not happen overnight. Rather, it is a gradual process, which in the UK, usually begins in our later 40’s and concludes at the age of around 51. During this time, we experience individual and changing symptoms as our levels of oestrogen, gradually decline and others increase.

Once ‘out of the other side’, unlike Victorian women whose low life expectancy meant they had only two or so years of post-menopausal life, with good fortune, many of us live for decades once our reproductive years have come to a close.

Understanding the life cycle of the menopause can help us to tailor lifestyle choices not only to help us cope with the transitional part of the process, but to protect and enhance our health in our post-menopausal fifties, sixties and beyond.

Preparing ourselves for the menopause

As is so often the case in life, forewarned is forearmed. Knowing what may happen as we approach, enter and move through the menopause can help us find the right personal ways of dealing with symptoms that arise.

Every woman experiences the menopause differently. Some may describe themselves as feeling ‘on the edge of a breakdown’, others as having a loss of confidence, feeling irritable and forgetful, finding it hard to concentrate and focus and falling prey to panic attacks.

While symptoms can vary widely, once menopause is complete, we know that lower levels of oestrogen circulating in our bodies, we become more at risk of developing heart disease, fragile bones that can lead to fracture and type two diabetes.

Being aware of such outcomes can help us to prioritise our health and take steps to ameliorate symptoms and find the right way for ourselves to deal with our own future physical and mental wellbeing.

Initial Effects of Falling Oestrogen Levels

Seventy-five per cent of women in the UK experience what are known as ‘vasomotor’ symptoms, which are usually worst in the two or three years before periods stop completely and can continue for several more years after this point. Symptoms can include hot flushes and night sweats, palpitations and headaches and while from a clinical perspective, they are in themselves usually ‘harmless’ they can affect, our overall health and psychological wellbeing by triggering issues such as stress and anxiety, poor sleep patterns, low moods and depression.

Hot flushes and Night Sweats

Hot flushes are often described as being a sudden feeling of heat coming from nowhere and spreading quickly throughout our body affecting our face as well as our arms, legs and torso. They are thought to be caused by our temperature control system being affected by changes in hormone levels. When they happen at night, we tend to call them night sweats.

What We Can Do
Smoking, eating spicy foods, drinking alcohol and large intakes of caffeine may trigger flushing. It is worth avoiding each in turn and seeing if this helps. Sipping cold drinks may bring relief and there is some evidence that using a standardised 40mg supplement of red clover isoflavone helps to reduce hot flushing, especially in women who flush many times a day. It is not recommended for women who have had hormone-dependent tumours such as breast cancer as its beneficial effect comes from its oestrogen-like activity in our bodies.
Chasteberry is another herbal extract worthy of consideration, with medical herbalists prescribing this herb for helping to alleviate menopausal flushing and sweating. Extracts of dong quai meanwhile, have been shown in controlled studies to significantly improve the frequency and intensity of hot flushes over a three-month study period.  
Wearing natural fibres that can ‘breathe’ and lightweight cotton bedding may help as may having a lukewarm shower rather than a hot one or a hot bath.

Palpitations

The sensation that your heart is beating abnormally is described as a palpitation and is a symptom that occurs frequently in the four years leading up to the menopause, probably due to fluctuating hormone levels impacting on our nervous systems. Some palpitations have an underlying medical cause and so are worth discussing with your GP.

What We Can Do
If your doctor rules out more serious reasons for their cause, then we can think about our magnesium intakes. A low magnesium diet of 100mg a day (the recommended intake in the UK for women is 270mg daily), has been found to have an increased risk of irregular heartbeat. Including magnesium rich foods like pumpkin and chia seeds is a good idea and you could also consider a magnesium supplement of around 200mg a day.

Headache

Altering hormonal levels can also trigger both cluster and tension headaches as the menopause approaches.

What We Can Do
While our doctors may recommend certain medications, it is also possible that a combination of alternative approaches may be helpful. Neurology experts suggest that acupuncture and yoga along with vitamin E and black cohosh may be helpful.

Stress and anxiety

Coping with the physical and psychological symptoms that accompany the process of the menopause can be challenging and a source of stress, which if it continues over time, can develop into longer term anxiety.

What We Can Do
Limiting our caffeine intake in coffees and teas may be a helpful starting point as well as trying herbal tinctures or teas of chamomile and trying to establish good sleep patterns. Regular time out of doors and physical exercise can both help to dial down stress and anxiety as can seeking help from talking therapies, eating balanced meals and snacks finding time to relax and switch off from everyday life. This can be as simple an activity, as taking a relaxing bath or picking up the phone, to speak with a friend.

Disrupted sleep

Once again, changing hormone levels are often the culprit when it comes to disrupted sleep patterns. If we find it hard to go to sleep; that we are waking several times during the night; that we wake up early and be not able to go back to sleep and / or find it hard to concentrate in the day because tired, then we probably are suffering with disrupted sleep patterns.

What We Can Do
Having our last cup of caffeinated drink eight hours before bedtime may help, as can having a light meal in the evening. Valerian is a traditional herb used to help sleep disorders as is chasteberry. A combination of calcium and magnesium supplements may also be helpful. Simple remedies like, again, relaxing in a bath, perhaps with lavender oil and having a warm drink before bed may be an effective sleep ‘tonic’.

Low mood

With the menopause often coinciding with other pressures and life changing events, it is not surprising if we find our confidence floundering, our self-worth waning and our mood dipping.

What We Can Do
Recognising that we are feeling down is the first step to improving how we feel. Self-care is vital and this includes making time for exercise, relaxation and eating well. Research shows that turning our backs on modern, processed diets and replacing them with traditional Mediterranean or Japanese styles of eating with plenty of vegetables and fruits, some wholegrain carbohydrate and lean plant-based protein plus oily fish can lower the risk of low mood and improve it. Trying a supplement of St John’s Wort may also be helpful.

Depression

It is essential to follow our doctors’ advice when it comes to the treatment of depression, which can also accompany the menopause.

What We Can Do
Keep in mind that clinical research shows that as with the alleviation of low mood, following a traditional Mediterranean style of eating has been proven to help relieve symptoms of depression in a significant proportion of people taking part in clinical studies in this area of research.

Medium-Term Effects of Falling Oestrogen Levels  

As we grow closer to our last period, the continuing effects of diminishing oestrogen levels begin to affect other parts of our bodies, leading to changes for example to our vaginas, urinary systems and our skin, hair and nails.

Vaginal dryness

A fall in oestrogen leads to a reduction in blood flow to the vagina and vulva and the lining of both become thinner and drier as a result. Losing its elasticity means the vagina becomes narrower and shorter, with secretions lessening and pH levels changing, which can in turn make us more susceptible to infections.

What We Can Do
Studies looking at intakes of both soy and red clover supplements have revealed significant improvements in the quality of epithelial cells in the vagina in women. Researchers believe these findings are down to the presence of plant oestrogens in these supplements. It is also worth looking to include more foods naturally containing plant oestrogens such as wholegrain bread and pluses.

Urinary problems

Just as the linings of the vagina and vulva are affected by diminishing oestrogen levels, so too are those in our urinary tracts, making us more prone to urinary tract infections. It can also lead to experiencing the need to pass urine more frequently, sometimes with great urgency and during the day and the night.

What We Can Do
Urinary tract infections can become serious if left unattended and so medical help should be sought if we suspect one. If prescribed antibiotics, it is important to take a probiotic at the same time, to help replace the good bacteria, which are also killed by antibiotics.
To help prevent infections taking hold in the first place, medical herbalists advise good intakes of vitamin C, found in berries, citrus fruits and peppers to help acidify the urine, making it less hospitable for harmful bacteria. Vitamin C is also vital for a healthy immune system. Herbalist advise cranberry juice as well, which contains plant compounds that help to make the lining of the urinary tract ‘non-stick’, making it more difficult for bacteria to cling on and set up infections.
When it comes to reducing ‘nocturia’ when we get up at night to pass urine, try to avoid drinking close to the time you go to sleep. Scientists have linked higher body mass index to more problems with night-time urination and so finding ways to bring our body mass down to within the normal range may also be helpful.  

Skin

Oestrogen plays a well-undestool role in the wellbeing of our skin and as levels decline it is common for elastin and collagen, which give skin its stretch and bounce, to dimmish, leaving it as a result, drier, less elastic and thinner. Hair and nails meanwhile may become more brittle.

What Can We Do?
Reducing external stresses on our skin by covering up and using sun protection in sunlight is wise, as is avoiding smoking, alcohol and diets rich in sugar and fat, which increase inflammation and skin damage from within. A Mediterranean style of eating that is rich in antioxidants and good fats from vegetables and fruits, olive oil and oily fish along with a range of minerals from wholegrains is also a great bedrock for healthy skin.
Specifically including foods that give us plant oestrogens such as soya milk, tempeh and tofu; lentils and again wholegrains, may also help our skin’s ability to maintain more collagen and elastin as we move through the menopause and in turn help to ameleriorate loss of elasticity.    

Long-Term Effects of Falling Oestrogen

Bones

Our bones are made of a highly active and constantly changing living tissue, which is being remodelled all the time. As old bone is broken down, new bone is rebuilt. During childhood, building of new bone outstrips the breaking down of old and during our 20’s and until about 35 years of age, remains in a stable situation where breakdown matches growth. From then on however, bone loss increases as a natural part of ageing.
As our oestrogen levels begin to decline as we approach and move through the menopause, breakdown outstrips formation at a faster rate, and bones become weaker, a process which continues and becomes more intense after the menopause. The resulting loss of strength in our bones can lead to osteoporosis which, leaves one in three women over the age of 50 at risk of fragility fractures, most commonly in the hips, forearm, and spine.

What We Can Do
Taking 10 micrograms of vitamin D daily is vital, as this nutrient is crucial for enabling calcium to be absorbed from foods and drinks we consume like milk, yoghurt, fortified diary alternatives, tofu, almonds and sesame seeds for example. Calcium, along with other minerals like phosphorus, magnesium and silica are essential for bone health along with vitamin K, in dark green leafy vegetables.
It is also important to keep salt intakes down and to control our blood pressure, as too much salt and raised blood pressure also negatively affect bone growth. Regular walking also helps bone growth.

Cardiovascular disease

Also known as ‘CV’, cardiovascular disease is the term given to a collection of problems, which include stroke and angina, heart attacks and issues with the circulation. It is less common in women prior to the menopause but the risk of each increases as we pass through this period of our lives and in the years that follow.
It is important therefore to have blood fats, blood pressure, blood sugar and body mass index checked regularly.

What We Can Do
Eating traditional Mediterranean style meals and snacks and weeding out processed foods is a brilliant place to start. We can do this by basing our food around vegetables and fruits, pulses and wholegrain carbohydrates. Then we can add in some oily fish, olive oil and diary and if we chose, small amounts of meat. This can help to keep you feeling satisfied while having a positive influence on blood fats and sugar levels. When you get your portions right, this style of eating can be delicious, enjoyable and satisfying, leading naturally to steady weight loss.  

Written by:  
Amanda Ursell
BSc Nutrition
Registered Nutritionist AFN
PG Dip Dietetics,  
Associateship King's College (AKC)

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