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SURVIVING PERI-MENOPAUSE

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Meet Sally!

In this video Sally will give you an introduction to the blog about surviving Peri-Menopause.

What is perimenopause

Can perimenopause be diagnosed

Did you know … 

  • The World Health Organisation (WHO) and the International Menopause Society have designated October as World Menopause Month.
  • World Menopause Day being the 18th October
  • But what is Perimenopause
  • Also referred to as menopause transition or The Change
  • And it most definitely is a time of Change
  • Where a woman goes from full fertility to full infertility
  • Is all to do with decline in Estrogen production in the Ovaries
  • Perimenopause can last for years
  • The symptoms of perimenopause, the age it starts and how long it lasts will vary between women
  • Generally starts around late 30’s beginning of the 40’s
  • For some the symptoms of perimenopause will last for years, others only a few months and others don’t feel them at all.
  • There is no one way to transition, there are as many ways as there are women
  • With that said most women develop symptoms about 4 years before their last period which then continue for about 4 years after.
  • Some women experience symptoms for a decade before menopause
  • Some women experience symptoms for 12 years following menopause.
  • When you go a full 12 months without a period, perimenopause ends and menopause is reached
  • The median age of which is 51
  • Common symptoms are irregular periods, vaginal dryness, mood swings, hot flushes, etc.
  • The first symptom, which sneaks up on women is the mental & emotional changes
  • Women go from being mummy for everyone and everything (which by the way they excel at and love) to just me, and me and then more me
  • Regarding treatment – what works for your girlfriends will not necessarily work for you
  • So STOP taking advice from your girlfriend, your mother, your sister, etc and go to a professional
  • 2 things you need to know

1. Stress and increased Cortisol will increase peri-menopausal symptoms

2. ALL women should / need to replace Estrogen if they want to survive the next chapter with strength, physically, mentally and emotionally

  • Remember women who work in medicine are also impacted by menopause

Statistics

  • It’s estimated that around 13 million women are currently peri or menopausal in the UK,
  • That’s 30% of the entire UK female population.
  • 4 million working UK women are in some stage of menopause
  • 1 out of 10 women quit their jobs because of menopause
  • Suicide in women is highest between the ages 45 – 49
  • Over 60% of divorces are initiated by women in their 40s and 50s even in their 60s.

What is Peri-menopause

  • A name for the transition period before the final bleed aka menopause
  • Not officially accepted by the medical world as a condition that needs treatment, unless symptoms are ‘unbearable’
  • The time when hormone production begin to decline
  • Can for some be a very turbulent time
  • Estrogen begins its gradual decline around late 30’s early 40’s
  • Progesterone is more unstable – some cycles you produce it other cycles you don’t
  • Testosterone is usually unaffected until mid-40’s
  • Menstrual cycles become irregular, sometime shorter, sometimes longer
  • Bleeds may become heavier or may be lighter
  • The bleed may be late or even skipped then regular again
  • These menstruation symptoms can last anywhere from a few months to several years
  • Some women have no peri-menopause symptoms and enter menopause suddenly
  • Other symptoms that appear are unique and individual, there can be many or there can be few – see the article called peri-menopause symptoms.

The Change 101

  • In English the menopause is referred to as ‘the change’
  • I promise you, you will change physically, mentally and emotionally
  • BUT it doesn’t have to be for the worse
  • Let me be clear – you will NEVER be that woman you were
  • So STOP trying
  • It will stress you, make you sick and unhappy and steal the Estrogen you have left
  • The Chinese say at age 49 women move into their 2nd spring, where energy leaves your uterus and goes to your heart
  • See this as an opportunity to grow into a new version of yourself
  • Embrace the new amazing woman you can and will become
  • Most of us will have 30 years or more after menopause – what will you accomplish in these years?
  • The old you was a pleaser, a mummy a service person and you loved it
  • The new you wants to please YOU first
  • Claim her, own her, love her
  • Finding your new passion is the first step to creating the new you
  • What makes you feel good?
  • What gives you pleasure?
  • Let these guide you and drive you forward.

Can Peri-menopause be diagnosed?

  • Yes through the symptoms
  • But not through blood, urine or saliva testing – at least not with any certainty
  • In fact testing is notoriously unhelpful when used to make a diagnosis of perimenopause
  • And many doctors will say ‘we don’t test for peri-menopause’
  • True there isn’t an official peri-menopause test
  • And to be fair this is a turbulent time of fluctuating hormone levels where one cycle does not resemble the next making a ‘certain’ diagnosis impossible
  • Another possible reason for not testing could be ?how do we treat this?
  • Unfortunately many in the medical world are still reluctant to acknowledge peri-menopause as a condition requiring treatment
  • Probably the best sign of peri-menopause is the turbulence.

Possible blood tests

FSH (follicle stimulating hormone)

  • A hormone produced by the pituitary gland
  • FSH stimulates the ovaries to mature a follicle containing an egg.
  • If FSH level are high the ovaries are not doing their job, which is eventually how menopause is diagnosed
  • However, FSH tests for peri-menopause can be misleading as cycles can vary from month to month.

AMH – Anti Mullerian Hormone

  • Measures ovarian reserve aka the number of eggs
  • Typically measured if there are fertility problems, so most doctors won’t measure this related to peri-menopause

Estrogen

  • Measuring Estradiol is equally challenging even though it is accepted in the medical world that the decline in Estradiol is the hallmark of peri-menopause
  • There are no statistics or reference ranges related to the age decline in Estrogen, which could indicate the presence of peri-menopause

Progesterone

  • There is no tradition to measuring Progesterone, even though this would indicate anovulation
  • But then again in the next cycle an ovulation could happen.

Symptoms of Perimenopause

Symptoms vary, but most people experience at least one of the following:

  • Irregular periods or skipping periods.
  • Periods that are heavier or lighter than usual.
  • Hot flashes (a sudden feeling of warmth that often spreads up from the toes across the body)
  • Vaginal dryness
  • Discomfort during sex
  • Urinary urgency (needing to urinate more frequently).
  • Sleep problems (insomnia)
  • Mental and emotional changes
  • Brain fog
  • Mood swings
  • More PMS’y
  • Bone thinning – osteopenia / osteoporosis
  • Changing cholesterol levels – HDL decreases and LDL increases.

Number 1 Treatment for Peri-Menopause

Peri-menopause

  • Relatively short term, even though it might feel like a lifetime
  • Turbulent years, ie. the run up to menstruations stop
  • Symptoms created by the imbalances in Estrogen and Progesterone production, for some Testosterone
  • Symptoms aggravated by an increased need for Cortisol aka stress and chronic inflammation

The Number 1 Treatment

  • HRT / Hormone Replacement Therapy – both Estrogen and Progesterone Replacement Therapy

HRT relieves even removes symptoms such as:

  • hot flashes
  • night sweats
  • flushing
  • vaginal dryness
  • brain fog
  • mood swings
  • heavy bleeds
  • tender breasts
  • etc

NB! All symptoms are very much affected by the hormone Cortisol, aka stress hormone, where an increased need for Cortisol can make all symptoms worse

For more information check my blog about stress – READ HERE

NB! I have been asked do I recommend ERT or HRT for all peri-menopausal women?

The short answer is – Yes, but an individual assessment is essential to establish which type of Estrogen and how much.

Non-Hormonal Supplements for Specific Peri- and Post-Menopausal Problems

Medical Treatments for Specific Peri- and Post-Menopausal Symptoms

Hair thinning / loss

  • topical minoxidil 5%, used once daily

Hair loss

  • antidandruff shampoos, commonly ketoconazole 2% and zinc pyrithione 1%

Unwanted hair growth (witch hairs)

  • eflornithine hydrochloride topical cream

Hot Flushes, Anxiety & Depression

  • SSRI’s – selective serotonin reuptake inhibitor

Vaginal dryness

  • low-dose estrogen-based vaginal lubricants in the form of a cream, ring, or tablet, such Vagifem or Ovestin
  • Ospemifene a SERM – selective estrogen receptor modulator

Recurrent UTI’s / bladder infections

  • prophylactic antibiotics

Insomnia

  • sleep medications
  • see my blog on sleep – READ HERE

Osteoporosis

  • Denosumab a bisphosphonate
  • Teriparatide a PTH hormone
  • Calcitonin a Thyroid hormone
  • Raloxifene a SERM
  • Estrogen.

Perimenopause Help for Her

  • Be mindful your needs are changing you are not the woman you were.
  • Be mindful that he is also changing his testosterone levels are declining slowly and he is not the man you married.

10 Tips to Peace & Harmony

  1. Track menopause symptoms and discuss treatment options with your healthcare provider.
  2. Make a commitment to a healthy lifestyle
  3. Update your beauty regimen.
  4. Build a support group.
  5. Communicate with your partner. Don’t shut him out – let him know what you need. Understand he may be confused by your changes and is changing him self
  6. If you are not happy in your current relationship, discuss counselling to communicate and support each other’s needs.
  7. Be receptive to creative adjustments in lovemaking activities.
  8. If your libido is low and or you are suffering from vaginal dryness, discuss your treatment options with your healthcare practitioner. There are hormone and non-hormone options available.
  9. Pamper yourself.
  10. Try to stay positive.

Perimenopause Help for Him

  • Be mindful her needs are changing she is not the woman you married.
  • Be mindful that you are also changing, your testosterone levels are declining slowly and you are not the man she married.

10 Tips to Peace & Harmony

  1. Listen – don’t criticize or try to fix her
  2. Go with the flow – be prepared for mood swings.
  3. Be compassionate, and validate her experience (that means agree with her, don’t try to fix her).
  4. Be romantic. Bring her flowers for no reason. Make her dinner. Give her a massage. Make it about HER.
  5. Cuddle more. Tell her you love her and that she is beautiful. You may just get lucky. If not, do not take it personally.
  6. Support healthy eating and exercise choices. Join her for a walk or go on a hunting expedition at the grocery store to find new healthy foods.
  7. Keep her company shopping, she will love the company
  8. Don’t ignore her menopause symptoms – talk about it – ask her what she needs to feel better
  9. Offer support if she needs to visit her healthcare provider to discuss menopause symptoms, a low libido or depression.
  10. If numbers 1 through 9 fail – disappear for a while. She may be seriously cranky and need space to focus on herself.

Perimenopause & Hair Loss

  • Hair loss tends to be subtler in women than it is in men.
  • Most women experience overall hair thinning rather than noticeable bald spots.
  • The thinning can occur on the front, sides, or top of the head.
  • Hair may also fall out in large clumps during brushing and showering
  • For women going through perimenopause, the cause of hair loss is almost always related to hormonal changes / fluctuations
  • Estrogen and progesterone keep the hair in the growing phase, making it grow faster and stay on the head longer.
  • When estrogen and progesterone levels decline, hair growth slows and hair loss becomes more pronounced
  • Also, the body can produce more androgens during perimenopause (and menopause) in response to the loss of estrogen and progesterone.
  • Androgens shrink hair follicles, which causes hair loss on the head.
  • Interestingly, androgens can also increase hair growth on other parts of the body such as the face – those infamous witch hairs
  • Female hair loss is a common condition an estimated 50% + women experience hair loss.
  • However, there are many other factors that can contribute to hair loss during perimenopause, such as:

– High stress levels

– Illness

– Diet – lack of certain nutrients

– Ethnicity

– Genetic factors

– Rule out other disease states, such as thyroid tests, and or a complete blood count.

  • The good news is the condition isn’t usually permanent.

Symptoms to Look For

  • see more hair than usual fall out on a daily basis
  • check the hairbrush, the pillow, the sink, the floor, in the shower for excess hair loss.
  • wear your hair in a ponytail, maybe the ponytail is reducing in size.
  • where your hair parts at the top of your head may get wider or become more visible as the hair thins.
  • may see more breakage than usual

Fixes

  • Shorter hairstyles
    – a bob or a pixie, or layers that add volume and texture.
  • Wear a hat
  • Hormone Replacement Therapy
    – replace Estrogen especially
  • Minoxidil
    – Rogaine for both men and women with hair loss – Is a vasodilator that widens the blood vessels to increase blood flow to the scalp and hair follicles – available over the counter or in prescription strength and comes in a spray, liquid solution, and foam form. Downside – Minoxidil must be used continuously to maintain hair growth.
  • Antiandrogens
    – like spironolactone are sometimes prescribed for both hair loss or excess hair on the face and body. These drugs are usually given in conjunction with a topical treatment like minoxidil.
  • Red Light Treatment
    – LED light therapies stimulate hair regrowth by targeting biochemical processes in the scalp.
  • De-stress 
    – or rather decrease Cortisol
  • Scalp massage and movements
    – good to increase blood flow, such as GuaSha
  • Eat well 
    – important nutrients Vitamin B. Complex,, Biotin, Vitamin C, Iron, Keratin, Vitamin D, Zinc, Vitamin A, Wheatgrass is excellent for hair health
  • Scalp creaming
    rosemary, coconut oil.

Let’s Talk about Sex

  • Peri-Menopause changes the need and the way women feel about sex
  • Some women experience an increased need, possibly those with higher Testosterone levels
  • Others experience a decrease – which is most common

Hormone roles in Sexual Desire and Arousal

Estrogen, Progesterone, Testosterone and Cortisol all affect sexual desire and arousal.

Estrogen

  • Promotes vaginal lubrication, which makes sex mechanically possible
  • Increases sexual desire.
  • Makes you feel sexy and passionate
  • Increases the need and desire for lovey-dovey, caressing and foreplay
  • NB!
  • As Estrogen levels decline the need for lovey-dovey, foreplay, caressing declines even disappears.
  • As Estrogen declines you desire to ‘please’ sexually declines/disappears (no more ‘close your eyes and think of England)
  • The important question is ‘how do you want your sex now’?

Testosterone

  • Increases sexual drive, it makes you horny
  • There is a clear difference in feeling sexy or horny
  • Increases the need for quick (and dirty) sex without the lovey-dovey.
  • There is some debate around how Testosterone levels affect female sex drive, possibly because Testosterone promotes a different emotion and women are looking the ‘old’ feeling
  • NB! – as Testosterone levels decline sex drive declines/disappears

Progesterone

  • Higher levels of progesterone can reduce sexual desire.

Cortisol

  • High levels of cortisol decrease both sexual drive and desire

Other Causes of Low Libido

  • Vaginal dryness and tightness
  • Pain during sex
  • Too tired due to poor sleep
  • Too fat, don’t feel sexy
  • Less interested in sex due to
  • Depression
  • Mood swing
  • Irritability
  • Hot flashes

What to do?

Hormone replacement therapy (HRT)

  • Vaginal Estrogen for lubrication
  • Brain Estrogen for desire
  • Testosterone for drive
  • Talk with your doctor or a hormone specialist about the best choices

Lubes

  • K-Y Jelly or Astroglide can help make sex more comfortable.
  • Check the blog about vaginal health for more lube info – READ MORE

Exercise

  • Helps with weight loss
  • Can also improve your mood
  • Can reduce stress and trigger positive emotions.

Communication

  • Most women are not good at this
  • Your needs have changed let your partner know.

Focus on intimacy

  • Go on a date
  • Get the kissing going

Kegel exercises

  • Tighten up your pelvic floor and vaginal wall muscles
  • May enhance sensations during sex due to improved blood flow
  • See how here – READ MORE

Therapy

  • Works for some.

Estrogen, The Brain and Menopause

  • Estrogen’s has a neuroprotective role in the brain

– It acts as an antioxidant

– It promotes DNA repair

– It promotes the expression of growth factors (healing)

– It modulates blood flow to the brain.

– It regulates the balance between the growth and differentiation of neural stem cells.

  • The brain loves and depends on glucose for fuel to make energy, it can’t burn fat
  • In emergency situations aka starvation it

– can use ketones derived from the breakdown of fatty acids in the liver or locally in the brain

– can also use amino acids from the breakdown of brain proteins, such as the brain chemicals neurotransmitter eg. serotonin

  • During perimenopause and after menopause control of glucose metabolism is disrupted and insulin resistance prevails due to the reduction of estrogen, which results in a ‘necessary’ shift in brain fuel
  • This shift puts the largest reservoir of local fatty acids, the white matter of your brain at risk for breakdown to make ketones.
  • For those with genotype APOE4 the tipping point for when this happens is accelerated.
  • Want to know if you have the APOE4 genotype, then this test is for you – BUY MORE
  • The menopausal transition impacts many brain circuits associated with: (which explains all the symptoms of menopause)

– reproduction

– hypothalamic functions (so every function in the body)

– sensory integration

– learning

– memory

– emotion

– motivation

– serotonin production

  • Menopause-associated neurological symptoms have been identified as risk factors for Alzheimer’s and the development of and/or exacerbation of autoimmune disease such as RA/rheumatoid arthritis and MS/multiple sclerosis
  • Neuroscientist Lisa Mosconi used a brain imaging technique called Positron Emission Tomography (PET scan), to demonstrate how  the drop in Estrogen causes the loss of a key neuroprotective element in the female brain, with an aggressively higher vulnerability to brain aging and Alzheimer’s disease.

Possible solution

  • If ketones are important for the aging brain due to glucose dysregulation and insulin resistance then eating foods that readily create ketones makes sense
  • Science demonstrates that ketones are predominantly made form long chain fatty acids ALA and EPA and MCT fatty acids
  • Long chain fatty acids DHA and AA are used for brain structure and function and don’t readily converted to ketones
  • Supplementation of MCT, ALA and EPA can possibly be a way to slow, even prevent the breakdown of the brains white matter and Alzheimer’s

ALA – BUY HERE 

MCT – BUY HERE 

  • Preventing insulin resistance with low glucose diets and intermittent fasting is also important
  • For more information READ MORE HERE and HERE and HERE.

Menopause and the Workplace

  • Hot flashes, heart palpitations, foggy memory, irritability and poor sleep don’t just happen at home – they also happen at work.
  • These symptoms can be extremely uncomfortable and also embarrassing.
  • Lack of workplace support for menopause symptoms is ruining women’s careers.
  • Studies have shown that 60% of women feel their work is negatively affected by their menopause symptoms.
  • A survey by Bupa found that 3 in 5 menopausal women were negatively impacted at work.
  • 25% of the entire workforce, 50% of all working women, are either in perimenopause or menopause.
  • Many feel forced to reject promotions or even leave the workforce entirely.
  • 20% reduced their hours
  • 12% resign due to menopause symptoms.
  • This is not only bad for women – it’s also bad for businesses.
  • The fact that menopause is a taboo topic in the workplace makes things worse
  • Employers don’t ask – women don’t tell – so nothing gets done to help the situation.
  • Some women fear that as nothing is said about menopause symptoms, it must be bad if you have them and they must grin and bear it to keep their jobs.
  • In the UK approx. 10% of businesses have some type of menopause policy, this should be encouraged in all businesses.
  • Menopause is a natural event and not considered a disability, maybe we need to re-evaluate as many women certainly need support just like any other physical condition.
  • Women are living longer and indeed working longer and addressing menopause symptoms may prove to be a cost-effective thing for businesses to do.

Peri-menopause and Weight Gain

  • Many women in perimenopause and early post menopause years gain fat mass as their oestrogen levels drop.
  • Women of childbearing age tend to store fat in the lower body making them ‘pear-shaped’
  • Men and postmenopausal women store fat around the abdomen making them more ‘apple-shaped’
  • During perimenopause, many women experience weight gain, particularly around the abdomen.
  • Contributors to weight gain

– declining oestrogen levels – affects insulin ability to regulate blood sugar leading to more insulin and therefore increased fat storage

– age-related loss of muscle tissue – increases blood sugar and therefore insulin

– diet – women become more carbohydrate / glucose sensitive ie. don’t tolerate as before

– lower motivation / energy to exercise – never a good thing but critical during perimenopause especially H.I.R.T to maintain / increase muscle mass

– declining stress tolerance – impaired balance between estrogen and cortisol, cortisol dictates that fat stores on the tummy

– use of anti-depressant medications (often instead of Estrogen)

Solutions

  • Replace some Estrogen
  • Low carb meals
  • TRE – 8 -10 hours eating windows
  • I.R.T – 30 mins in am every other day
  • De-stress – embrace the new woman you are becoming – the next years are yours.

WANT MORE?

CHECK OUT THE OTHER BLOGS ABOUT FEMALE HEALTH & HORMONES

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Vaginal health

All about menopause

Female health after menopause

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