Menopause – A Time of Change

Most women, certainly those of a certain age know that menopause (or “the change of life”) is when your periods stop. But actually our hormones have been gradually changing for a number of years and the levels also fluctuate over that time, so we may notice a few hot flushes or mood changes that are not persistent but can be unpredictable and affect our quality of life.

Peri-menopause refers to the time before and for 12 months after the final period. This transition can last from 4 to 8 years. Many women complain that they just “don’t feel right”.
Symptoms may include: irregular menstrual bleeds, feeling fatigued, tender breasts, low libido, disturbed sleep, weight changes, mood swings, anxiety, aches and joint pains.

Menopause is officially when a woman has had no menstrual bleed for 12 months. It is a point in time and you then become post-menopausal. This is a sign that ovarian function has ceased and you are no longer fertile. The average duration of menstrual symptoms is 7 years.
Symptoms include: hot flushes and night sweats, feeling fatigued, difficulty sleeping, urinary problems, vaginal dryness, painful intercourse, loss of libido, dry skin, low mood, poor concentration and memory, aches and joint pains.

It is considered normal to have your menopause any time between age 45 -55 years. Premature menopause is defined as occurring under age 40 years.

Menopause is not just a time of hormonal and physical changes, it also often occurs during a period in our lives when roles and responsibilities are different. We may have elderly parents to care for, our children are older, hopefully more independent and may have even left home. Many women also find that around this time they recognise their wisdom, have more confidence and become more in tune with what they need.

The menopause also brings increased freedom from no longer having to worry about contraception (this is still needed for 12 months after your last period), periods and whether they may occur at an inopportune moment and relief from cyclical mood changes.

Through our focus on the menopause we hope to give you insights and actionable tips to breeze through your transition to the menopause!

The menopause is a natural process so should we treat it with HRT?

A Functional Medicine approach to managing the menopause is different to that in conventional medicine. As always we are considering each woman as an individual interconnected being. This is because we cannot look at just sex hormones in isolation without considering the other areas of how the body functions both physically and our mental/emotional/spiritual health. We look to build strong foundations for your health by addressing your modifiable lifestyle factors – sleep, movement, nutrition, stress. This is where assessment and advice from a nutritional therapist and health coach is invaluable.

Our gut and liver health are crucial in how we process and detoxify hormones, so if there are imbalances here it has a knock on effect on other areas of function including our sex hormones.
All our hormones should work in harmony, again if one area such as stress hormones, thyroid or blood sugar is out of balance this will have an effect on our sex hormones.
We may consider how our genetic expressions are affecting hormone levels and how this influences our risk of hormone related diseases.

Hormone Replacement Therapy (HRT) is an option for those women who feel their peri-menopausal or menopausal symptoms are significantly affecting their quality of life but we would always recommend this is considered as part of the wider picture of you as a whole person.

What is the difference between HRT, “body identical” HRT and bio-identical HRT?

Prescription HRT used to be synthetic hormones which were similar but not identical to our natural hormones. These compounds would be a close match to our natural receptors but not an exact match which could result in adverse effects.

In more recent years there has been a move towards using “body identical “ HRT in general practice and specialist HRT clinics as these hormones are identical to our natural hormones, so are an exact fit for our hormone receptors. These are prescription products and there are limited dosage adjustment options.

“Bio-identical” HRT again uses hormones which are an exact match for our naturally occurring hormones but the preparations are compounded by a specialist pharmacy so the dose and delivery system can be individualised. For example the hormones can be delivered by oral capsule, sublingual lozenge, transdermal cream, transvaginal cream. The doses can easily be adjusted depending on response, any side effects experienced and blood levels of hormones.

It’s not just about oestrogen!

Yes your oestrogen levels fluctuate during the peri-menopause and may drop by around 75% from their peak.
It is important to remember that we have oestrogen receptors everywhere in our bodies not just in the sex organs resulting in over 400 crucial functions. These include helping to regulate body temperature, preventing Alzheimers, maintaining our muscles, regulating blood pressure, influencing mood and libido.

Progesterone is another hormone that helps to balance oestrogen. It is a lovely calming hormone that helps with sleep and calms anxiety/irritability.
In conventional medicine progesterone is used purely to protect the lining of the womb from the effects of unopposed oestrogen (increases the risk of cancer of the lining of the womb). So women who have had a hysterectomy and don’t need this protection are not offered progesterone when they may well benefit from it.

Oestrogen and progesterone work together to balance the body’s release of insulin and influence blood sugar balance.

Testosterone is not only for men! It is also important in women as it helps to keep our bones strong, reduces excessive body fat, improves mood and memory, increases muscle mass and strength, improves emotional well-being, confidence and libido.

DHEA is a precursor hormone to oestrogen and testosterone. Its production declines with age starting in your late 20s. Its benefits include lowering cholesterol, help in managing stress, increasing bone growth, improving cognitive function, improving general well-being, balancing blood sugars and supporting immune function.

It may seem overwhelming to learn about all these different hormones so always take things back to the basics with the lifestyle factors, good nutrition to help manage blood sugars, support healthy digestion and gut function, check out your thyroid and adrenals, manage stress and know that just small changes in one of these areas will have a positive effect elsewhere due to our interconnectedness.