Menopause: Your Questions Answered

We are frequently asked about menopause; what to expect? How long does it last? Why do I get hot flushes? Menopause is complex and every woman experiences it differently so we are here to shed some light on this topic.

While it can be a seamless transition for some, many women find it a more challenging experience, but why? Let’s get stuck in and discuss some of the frequently asked questions!

When should I expect menopause?

According to the NHS, the current average age for menopause in the UK is 51.[i] This can commonly start between the ages 45-55. Starting menopause before the age of 40 is considered to be early menopause.

So, how do I know if I’m in menopause?

Typically, the first thing you may notice is changes to your menstrual cycle. Your periods may become less or more regular, and the flow might change too, being either lighter or heavier. Any of these are normal and vary from person to person until your periods stop completely. You can also visit your doctor who can take a blood test to measure your follicle-stimulating hormone (FSH) and oestrogen to confirm this.

What are the most common symptoms of menopause?

• Hot flushes/night sweats
• Weight gain
• Digestive changes, such as bloating
• Anxiety and low mood
• Fatigue
• Loss of skin elasticity, wrinkles, hair loss
• Vaginal dryness
• Sleep disruption
• Loss of libido

There are various factors that can make menopausal symptoms worse, such as oral contraceptive use,^[ii] excessive alcohol consumption, weight, smoking, lack of exercise,^[iii] history of Pre-Menstrual Syndrome (PMS),^[iv] and stress.^[v]

There are 3 distinct phases within menopause but we often refer to menopause as the whole process of these phases:

• Perimenopause: This is the time before your period stops completely. This can last from a few months up to 10 years, as the process of oestrogen and progesterone production reduces slowly, and the ovaries slowly stop the release of eggs. It’s within this phase that you may start experiencing symptoms, such as irregular cycles, mood changes, or you might even find your appetite changes. This phase ends when your period completely stops.
• Menopause: This is defined after 12 consecutive months of complete cessation of your menstrual cycle. The ovaries no longer produce eggs, and your oestrogen and progesterone production has significantly reduced. Symptoms may still continue in this phase, but will slowly reduce in frequency and severity.
• Post-menopause: This is the phase after menopause, where symptoms have subsided.

What causes hot flushes?

Hot flushes are a classic symptom for many women during menopause, and often oestrogen gets the blame. The temperature regulation of skin alters dramatically during menopause due to the hormonal changes.^[vi] However, this is not entirely due to changes in oestrogen levels. Elevated stress response plays a vital role in temperature regulation and can increase body temperature dramatically. In fact, it is often a key contributor to hot flushes.^[vii] Therefore, it is important to reduce your stress levels as much as possible. From a dietary perspective, plant oestrogens, also called isoflavones, (found in flax seeds, soya, or red clover) can help to reduce hot flushes.^[viii],[ix]

How can I lose weight during menopause?

Oestrogen regulates numerous aspects of fat and glucose metabolism,^[x] which in a post-menopausal oestrogen depleted state, can lead to changes in our metabolism, and ultimately in weight gain. This can be compounded by sleep disruptions, digestive symptoms, and stress, which are often experienced. Stress can greatly impact the ability to lose weight by stimulating blood glucose and driving fat storage. However, it is possible to lose weight during menopause by improving dietary and lifestyle choices:

• Increase your intake of prebiotic fibre from fresh fruit and vegetables, or through prebiotic supplementation. Prebiotic fibre, such as inulin and resistant starch promote satiety and fullness, reduce cravings, and promote weight loss.[xi] Link to probiotics & weight loss blog
• Reduce stress - incorporate daily relaxation techniques such as breathing exercises, gentle stretching and meditation. Use calming nutrients: chamomile,^[xii] lemon balm, magnesium, and vitamin B6. They help to reduce stress by promoting our calming neurotransmitter - GABA, and even promote better sleep.^[xiii]
• Get a good night’s sleep - create a night time routine; remove technology from the bedroom and opt for cooling, breathable nightwear and bedding. Also try to get some daytime light by going out on a walk. You can monitor how well you’re sleeping using an app such as ‘Sleep Cycle’.
• Check your blood glucose levels. If your blood glucose levels are too high, this will be inhibiting weight loss, which as mentioned above, can often be linked with stress and a lack of sleep.
• Check your thyroid function. The thyroid is the master of our metabolism, so if you have been struggling with weight loss for a long time, and you’re experiencing certain symptoms such as constipation, hair loss, fatigue and anxiety, then getting your thyroid tested could be useful.

How do I reduce bloating during menopause?

Oestrogen is known to have an influence on our gut bacteria,[xiv] and the regulation of fluids in the body.[xv] This means that the fluctuations in oestrogen could be contributing to digestive symptoms such as bloating, reflux or constipation, as well as water retention (which can cause the feeling of bloating) during menopause. Maintaining gut microbial balance by increasing intake of dietary prebiotic fibre, fermented foods, supplementing with probiotics, and reducing your intake of processed, highly refined sugar is important to prevent digestive symptoms. Being hydrated and ensuring you’re consuming enough magnesium and potassium rich foods will support healthy and regular bowel movements, and proper kidney function.

I am taking HRT, what else can I do?

Some women may opt for HRT if their symptoms are severe, or there are other medical reasons. In some cases, not all symptoms are 100% resolved, so there are still other nutritional strategies you can employ to help. On the other hand, it is important that the extra hormones are properly metabolised by your body to reduce the risk of any potential negative effects. Whether you are on HRT or not, the following tips will be helpful to support heathy oestrogen metabolism, but this is even more paramount if you are on HRT.

• Ensure you have adequate intake of B vitamins, in particular folate, vitamins B12, B3, and B6 as they are the key nutrients that support detoxification of oestrogen. A good, methylated B complex, or a multivitamin, may be good additions to your supplement protocol.
• Increase your intake of cruciferous vegetables such as broccoli (particularly broccoli sprouts), cabbage, and cauliflower for their sulforaphane content.^{[xvi],[xvii],[xviii]} Sulforaphane is a sulphur-containing compound which induces a potent antioxidant - glutathione S-transferase,^[xix] thus deactivating damaging metabolites of oestrogens and carcinogens.^{[xx],[xxi],[xxii]} Indole-3-carbinol, another molecule found in broccoli and broccoli sprouts actively promotes the breakdown of oestrogen,^[xxiii] and has been shown to be protective against oestrogen driven cancers (e.g. breast, endometrial and cervical).^[xxiv],[xxv] Ellagic acid, found in large amounts in pomegranates, is another amazing antioxidant which can protect our cells and DNA from damage.^[xxvi]

Why am I suffering with low mood and anxiety?

Low mood and anxiety are very common symptoms for many women throughout menopause.

However, this might not just be down to menopause. It’s always worthwhile getting vitamin D, B12 and folate levels checked with your GP, as these can all contribute towards low mood. Don’t assume it’s all hormonal. Entering this new stage in life can be daunting, and sometimes it’s not all about nutrition, rather about embracing the change and finding new ways to energise yourself. Perhaps finding a hobby that motivates you, even if that’s simply taking a stroll outside, or listening to music.

How do I support bone density during and after menopause?

Oestrogen plays a huge role in bone metabolism, hence there is an increased risk of bone conditions such as osteoporosis post-menopause. A sedentary lifestyle can worsen the incidence of bone fractures and further increase the risk of osteoporosis.^[xxvii] Therefore the need to support bone density increases post menopause. What can you do? Well, increasing certain nutrients such as vitamin D, K,^[xxviii] calcium and boron,^[xxix] as well as incorporating daily physical activity, more specifically weight resistance exercises can help to maintain bone strength.^[xxx]

Are there any other nutrients I should consider?

Yes. If you’re suffering with vaginal dryness or wrinkles, then supplementing with collagen and essential fatty acids could be a great option. Collagen is a key component for our connective tissue including skin, blood vessels, joints and bones. Oestrogen plays a big role in collagen production, so when it’s low, it can be one of the reasons for the loss in skin elasticity. Therefore, supplementing with collagen, vitamin C (which can further promote collagen production), phytoestrogens[xxxi], and essential fatty acids (omega-3) can improve overall skin appearance.^[xxxii]

What are the best supplements for menopause?

Although every woman will have different needs and symptoms, and it is best to discuss your individual requirements with a Nutritional Therapist or another professional, there are certain products everyone could consider as a baseline support:

1. Multinutrient - all in one hormone, energy, and nervous support! Choose a potent multi that contains nutrients in their most bioavailable forms. Look out for methylfolate (the active form of folic acid) and methylcobalamin (vitamin B12) for oestrogen metabolism.
2. Isoflavones (plant oestrogens) - red clover is a good and potent source and suitable for those who avoid soya-based products. They help to reduce most symptoms of menopause,^[xxxiii] from hot flushes and vaginal atrophy, to sleep issues, poor memory^{[xxxiv],[xxxv]} and osteoporosis.^[xxxvi]
3. Omega-3s (from fish or algal oil) - a daily essential to aid healthy heart and brain function, reduce excessive inflammation, and promote healthy skin and joints.

If you have any questions we haven’t answered, or you would like to talk about your menopausal experience, please don’t hesitate to contact our Clinical Nutrition team or arrange to see a registered Nutritional therapist for personalised advice.

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References

[i] NHS. 2018. Menopause. [online] Available at: https://www.nhs.uk/conditions/menopause/

[ii] Pokoradi et al. Factors associated with age of onset and type of menopause in a cohort of UK women. Am J Obstet Gynecol 2011, 205;1-13.

[iii] Morris et al. Body Mass Index and other lifestyle factors in relation to age at natural menopause. Am J Epdiemiol 2012 175:998-1105.

[iv] Freeman et al. Premenstrual Syndrome as a predictor of menopausal symptoms. Obstet Gynecol 2004,103;90-6.

[v]Pimenta et al. Menopausal Symptoms: do life events predict severity of symptoms in peri-and post-menopause? Maturitas 2012, 72:324-31

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[xxxiv] Bedell. The pros and cons of plant oestrogens for menopause. J Steroid Biochem Mol Biol 2012,epub Dec 25

[xxxv] Guttuso. Effect and clinically meaningful non-hormonal hot flash therapies. Maturitas 2012, 72;6-12

[xxxvi] Chiechi. Utility of dietary phyto-ooestrogens in preventing post-menopausalosteoporosis. Current Topics in Nutraceutical Research 2005 (3)1; 15-28.