OWNING YOUR MENOPAUSE: A GUIDE TO SYMPTOMS AND RELIEF
We need to talk …
Premature and early menopause explained
How To Talk To Your Doctor
Breast Cancer and the menopause
Osteoporosis and the menopause
PCOS and the menopause
Hot Flushes and the menopause
5 surprising symptoms you may not associate with the menopause
Managing your menopause
We need to talk about… the menopause
- An estimated 13 million women – one third of the UK female population - are currently going into or through the menopause in the UK.
- According to a 2014 Nuffield Health Survey, 10% of women have seriously considered giving up work because of their symptoms.
Menopause is not an illness or disease, it’s a completely natural part of a woman’s life, but that doesn’t’t necessarily make it easy to live with. Managing it can also be complicated by the fact that two women rarely experience it in the same way. Much like pregnancy or PMS some women breeze through it with no problems, a small percentage suffer debilitating symptoms and the majority of us are somewhere in between. This means there is no ‘one size fits all’ solution.
It is also still seen as something of a last taboo, and whilst things might be slowly changing, menopause has been one of those topics that has historically been largely hushed up or laughed about and brushed aside as ‘women’s troubles’ – to such an extent that many of us still don’t feel entirely comfortable talking about it, even with people we know and love. All too often we are still seeing it negatively – as an ‘end’ of a life we have known when it is possibly more helpful to see it as the beginning of something new and better. Creating a more menopause-friendly culture is the challenge and the more of a handle we can get on the subject the better able we should be able to sail through this transitional time more seamlessly.
Whether you are experiencing perimenopausal or menopausal symptoms now, know someone who is and want to understand more, or just want to arm yourself with the facts so you can recognise the signs when the time comes, We’ve pulled together all the information you need to navigate your way through this confusing and often frustrating life stage.
So, discover the most common (and surprising) symptoms, the most up to date ways for how to deal with them and find the latest evidence and news to help support you through it. If you have any questions left, don’t hesitate to get in touch on firstname.lastname@example.org and we will do our absolute best to help you. Similarly, if you have any tips about what has worked for you let us know about that too and we can share that information here or on our closed Facebook group - The Chilled Menopause where you can talk openly and share ideas and thoughts with other women just like you..
THE MENOPAUSE EXPLAINED
- The menopause is defined as when your periods have stopped for a full 12 months and you are no longer able to get pregnant.
Why does it happen? The menopause happens when your ovaries stop producing eggs and the levels of your hormones oestrogen, progesterone and testosterone fluctuate and fall. As these hormones become more erratic this is generally what leads to the typical perimenopausal and menopausal symptoms.
When? The average age of this happening is 51 but it generally occurs anywhere between the ages of 45-55. You can have symptoms leading up to this point for anything up to 12 years (known as the perimenopause phase). The menopause generally follows three key phases: the perimenopause followed by the menopause and then post menopause (having gone a full two years without a period you are said to be in the postmenopausal).
How do you know it is happening to you? The menopause is, of course, different for every woman. We are all unique and the way the perimenopause or menopause affects you may be nothing like the way it has affected your friends or relatives (if you even know how it has affected them). Sometimes the perimenopausal phase can hit women as young as 30-something. Perimenopause can last anywhere between a few months to over a decade . The most common symptoms include hot flushes, night sweats, interrupted sleep, memory problems, mood swings and anxiety (and possibly many more as yet not fully attributed).
PREMATURE, SURGICAL AND EARLY MENOPAUSE EXPLAINED
- Premature menopause affects one in 100 women under the age of 40
What is premature menopause? If you start the menopause before the age of 40 this is known as premature menopause (premature, because clearly you are going through it earlier than the average woman at around 51). It is also known as Premature Ovarian Insufficiency (POI).
How is it different from early menopause? If yours starts between the ages of 40-45 it is called early menopause.
Why does it happen? Your menopause can be naturally premature or early because your ovaries stop working. In many women no cause can be found – although it is known to run in families. Alternatively, it can happen when one or both ovaries is removed if you have had a hysterectomy (a procedure to remove the womb). Some cancer treatments can lead to early menopause and medical or surgical treatment for endometriosis can also be a cause. Due to the abrupt hormonal changes, women can often experience more severe menopausal symptoms after these types of procedure – what they’re going through is called a surgical menopause.
How do you know it is happening to you? If you are under 45 and seem to be experiencing menopausal symptoms, your GP might suggest a blood test to measure the level of follicle stimulating hormone (FSH) in the blood. This hormone generally increases as you approach menopause and by measuring your blood levels of it, your doctor can ascertain whether your symptoms are most likely to be menopause-related or not. This blood test is often repeated four to six weeks later. If you are over 45 and are having irregular periods it is unlikely a blood test will be necessary.
The effects of early and premature menopause. Both can affect your fertility and psychologically, it can be a difficult time (both dealing with the physical and psychological effects of your menopausal symptoms whilst also coming to terms with the emotional fallout of not being able to get pregnant or getting older). Early and premature menopause increase your risk of osteoporosis (bone thinning) and heart disease so help support both your bone health and heart is vital at this time. Your Doctor should be able to talk you through your options and you can find more detail here and here.
THE PERIMENOPAUSE EXPLAINED
- Perimenopause is literally translated as ‘around the time of the menopause’
When to expect it. Typically, perimenopausal symptoms begin in the 40s but can start as early as the 30s. This phase can last anything up to 12 years – not an insignificant amount of time - before the actual menopause occurs and so it is an important time to take stock of what is happening with a view to keeping yourself as healthy as you can to help minimise your symptoms. What is interesting is that many women who are now postmenopausal look back and realise that the way they were feeling and reacting in the run up to their menopause were actually classic symptoms of the perimenopause – Clearly we all need a better understanding of this phase so that we can help ourselves and each other make sense of what’s going on in our bodies (and heads!).
What to look out for. Symptoms include:
- night sweats
- hot flushes
- disrupted sleep and tiredness
- brain fog
- feeling increasingly emotionally fragile and overwhelmed
- having problems concentrating
- joint pain
- vaginal dryness and itching
- an increased risk of urinary tract infections like cystitis
- increasingly erratic monthly cycles.
Also note that if you are experiencing typically menopausal symptoms whilst still having periods you may be perimenopausal. Your periods might become heavier and more frequent; lighter and spaced further apart and/or a combination of both of these. You can also still become pregnant during the perimenopause phase so you need to continue using contraception.
How to manage it. Almost all menopause experts point out that the women who suffer less with perimenopausal and menopausal symptoms are the ones who generally look after themselves – eating a healthy balanced diet, taking regular exercise , getting enough sleep and finding ways to relax and deal with stress. It might also be the time to discuss HRT with your GP to see if that is an option for you.
TALKING TO YOUR DOCTOR
If you can manage your symptoms yourself with lifestyle changes you don’t need to see a doctor. If, however, they are seriously getting in the way of you going about your day to day life and impacting negatively on your relationships do make an appointment with your GP to discuss treatment options. And make that appointment time count. Rightly or wrongly, most time-strapped GPS have around 10-minute appointment slots and admit it is frustrating that they have so little time to devote to talking over the myriad of options available. To get the most from your allotted appointment time, try to go armed with as much information as possible and with specific questions. It can help to:
Ask if there is a menopause expert in the surgery: Some surgeries have a GP with a special interest in women’s health and the menopause, so ask at reception who in the practice is the most suitable when it comes to discussing all things menopausal.
Make a list of your symptoms: Make a brief checklist of your symptoms with details about how they make you feel or if the symptom appears to be triggered by anything in particular. Mention any treatments you have tried, conventional or complementary, and if they have helped.
Try not to be embarrassed: Your doctor will have seen many women presenting the exact or similar concerns as you. No matter how sensitive the topic feels – from hot flushes to vaginal dryness – your doctor is unlikely to be phased by any of it. If it makes you feel better take someone with you for support. This can be especially helpful if you feel confused or overwhelmed by your symptoms and could benefit from a second pair of ears to absorb and remember the information you are given and/or for asking any helpful questions on your behalf.
Research treatment options: There is a huge amount of helpful advice and a range of discussion forums online where you can chat about symptoms and treatment options with experts and other women. There is a lot of contradictory and incorrect information out there too so look for reputable sites and resources. It will help you to feel more in control if you can go into your appointment with some understanding of what treatment options are on the table and which feel like the most appropriate for you. Some women, for example, go in complaining of feeling teary and down and are often prescribed anti-depressants when Hormone Replacement Therapy (HRT) or another course of treatment like Cognitive Behavioural Therapy (CBT) – or a combination of the two - might be more appropriate. Similarly, HRT might be the most effective treatment option for many women but not everyone can, or wants, to take it. There are a range of complementary therapies available that might work for you – or it might be that a combination of conventional and complementary treatments is the answer. Look at the pros and cons of what is out there, do your own research, talk it over (online or in person) with others and then decide, with the help of your GP, what is right for you.
Check private health insurance. If you have private health insurance and hope to get treatment privately for your menopausal symptoms you might be out of luck. Unfair as it might be, most private health insurers will not pay out for treatment for menopausal symptoms as these are deemed to arise from a natural cause and not the result of disease, injury or illness.
BREAST CANCER AND THE MENOPAUSE EXPLAINED
- Breast cancer is the most commonly occurring cancer in women. Over 55, 000 women are diagnosed with breast cancer each year in the UK according to statistics from BreastCancerNow.org. Around four out of five are diagnosed in women over the age of 50.
However, here’s the good news: going through the menopause does not, in itself, put you at greater risk of breast cancer. In fact, a 2011 study from the US suggested that women experiencing menopausal symptoms were significantly less at risk of developing it. Your risk does, however, increase with age and most women with breast cancer tend to be 40+ or most commonly in their 50s and 60s and so are typically around menopausal age. Any risk is increased because you are older, not because you are menopausal.
Your age is significant. Starting your menopause after the age of 55 has also been found to increase a woman’s risk of breast cancer and endometrial cancer. Experts believe this is because she has been exposed to more oestrogen, due to the more periods she has had.
HRT. Some studies have shown that HRT may potentially raise the risk of breast cancer in some cases (although hormone therapy does appear to reduce the risk of colon cancer). As the link between HRT and breast cancer remains doctors might not recommend you take it if you have had a history of breast cancer or have a high risk of developing it. If you are taking HRT when diagnosed with breast cancer you might be advised to stop. A recent review of studies concludes that current scientific evidence neither confirms or disputes that HRT causes breast cancer.
Breast cancer treatments and menopausal symptoms. Breast cancer treatments such as chemotherapy, hormone therapy or ovarian suppression can cause low levels of hormones that can lead to any early menopause or menopausal symptoms.
Reducing your risk of breast cancer. The same ways you reduce your risk of cancers before menopause is pretty much the same during it: eating well ; getting quality sleep; not smoking; exercising and keeping your weight down. Research shows gaining weight after menopause increases your risk of breast cancer but losing it post menopause reduces it. No one particularly wants to hear this, but for every unit of alcohol you drink you increase your risk of breast cancer so be mindful of keeping your drinking in check (reducing your intake will also reduce your calorie intake and help to keep your weight down too). Check your breasts regularly for any changes and if you are over 50 do go for your breast screening appointment when invited.
OSTEOPOROSIS AND MENOPAUSE EXPLAINED
Osteoporosis (weak and brittle bones) is not caused by the menopause. The risk does however increase after it, as oestrogen is necessary to help build strong bone …
According to the NHS women can lose up to 20% of their bone density in the five to seven years after the menopause as a result of declining oestrogen levels. You are also more at risk if there is a family history of osteoporosis, you have suffered from anorexia and if you went through early menopause before the age of 45. Osteoporosis is known as a silent disease in that it hits without warning and there are no real signs that your bone health is struggling but around menopausal time take stock and make lifestyle changes that can keep your bones healthy so you are ultimately less likely to be at risk of falls and fractures. The advice is:
Keep moving. The more exercise you can do the better. It doesn’t need to be strenuous or difficult – brisk walking, swimming or cycling are all good – but it does need to be regular. If you find it difficult to fit into your day to day life try doing it in 10-minute slots. And aim to incorporate some resistance exercise like weight training to increase muscle and bone strength.
Eat a bone-building diet. Eating a varied and balanced diet should help to minimise menopausal symptoms generally but the nutrients calcium and vitamin D are key for bone health. Good sources of calcium include dairy products like butter, yogurt and cheese (choose low fat varieties if you are trying to keep your weight down); green leafy vegetables (although not spinach which can interfere with the body’s absorption of calcium), nuts, seeds and tinned fish with the bones in (pilchards and sardines). Vitamin D is created naturally in the body on exposure to sunlight but clearly the British climate doesn’t always make that easy and Public Health England (PHE) advise taking a supplement from October to March to compensate. Food sources of vitamin D include eggs, oily fish, dairy produce and foods fortified with this nutrient including breakfast cereals and some fruit juices.
Beware of cigarettes and booze. Smoking is linked to an increased risk of osteoporosis as is drinking excessively. Try to cut down and ideally quit smoking and keep your drinking to within the recommended 14 units a week and ideally less.
POLYCYSTIC OVARY SYNDROME AND MENOPAUSE EXPLAINED
Polycystic ovary syndrome (PCOS) is a condition caused by hormonal imbalance, some symptoms of which are similar to those of perimenopause and menopause, so it helps to know how to untangle these symptoms from those of PCOS…
What exactly is PCOS? Polycystic ovary syndrome occurs when hormones oestrogen and progesterone get thrown out of balance causing irregular periods and higher levels of ‘male’ hormones (like testosterone) in your body which can lead to fluid-filled sacs growing on the ovaries. It is not entirely understood what causes it but it often runs in families. What we do know is that women with PCOS tend to go through the menopause around two years later than the average age of 51.
How are symptoms similar to perimenopausal symptoms? Common symptoms of PCOS include irregular or missed periods; difficulty conceiving; mood swings; broken sleep, unwanted hair sprouting up on the face and/or chest and back or thinning hair on the head. Unhelpfully, however, not all women with PCOS have any symptoms.
How are they different? Symptoms unique to PCOS that are not associated with the menopause include acne and other skin problems and pain in the pelvic area. Perimenopausal symptoms that don’t occur in PCOS include changes to your libido, vaginal dryness, painful sex, urinary incontinence, urinary tract infections like cystitis and hot flushes and night sweats.
Do PCOS symptoms improve with age? There is no cure for PCOS but it can be managed. Research has shown hormone levels of women with PCOS change as they get older as testosterone levels decrease gradually over time but it can take until 20 years after menopause for them to return to normal levels. This decline in testosterone levels does appear to have some beneficial effects on PCOS symptoms, however, making them less severe.
How to manage it? There are a number of ways you can help manage the shared symptoms of PCOS and perimenopause. These include:
Keeping your weight down. Both conditions can lead to weight gain (which can also increase your risk of type 2 diabetes and high cholesterol). Help to keep your weight within healthy levels by exercising regularly, watching your portion sizes (to put this in some sort of context an average portion/meal size in the UK is now three times larger than it was in the 1940s), reducing how much alcohol you drink, avoiding too much processed sugary and/or fatty foods and filling up on vegetables and fruit. Losing weight can help to reduce symptoms.
Trying to get better quality sleep. Both perimenopause and PCOS can stand in the way of a good night’s sleep. To help improve your chances of getting one, sleep experts suggest trying to stick to regular bedtimes and getting up times; taking a relaxing bath before bed (some suggest adding muscle-relaxing Epsom salts or magnesium flakes to the water along with relaxing essential oils like lavender) and or sipping a soporific bedtime drink like chamomile tea or cherry juice (which triggers the sleep-inducing hormone melatonin).
If you have been diagnosed with PCOS there are treatments available to help deal with unwanted hair, erratic periods and fertility issues so do talk about these with your doctor.
- Around 75%-80% of menopausal women experience hot flushes and 25% are severely affected
What exactly are they? Experts suggest they are the result of low oestrogen levels somehow affecting your body’s internal ‘thermostat’ and they are generally one of the most common signifiers of the menopause (although they can also be a side effect of some medication and medical treatments). Sadly, the stock in trade image of a sweaty woman in front of a fan or an open fridge has led to them being treated as a bit of a joke. And whereas humour can help you through the experience, it is not necessarily a barrel of laughs when heat is coursing through your body causing you to sweat profusely, your heart is pounding and your face is turning red whilst trying to appear professional at work and/or keeping it together in your day to day life. Hot flushes are not life threatening but they can make you self-conscious and can clearly interfere with the quality of your life.
What do they feel like? Again, the severity with which you experience a hot flush varies from woman to woman but they are commonly described as a feeling of intense heat that can creep throughout your whole body but is often concentrated through your head, neck and chest. Many women say they feel like an internal fire has started inside them. Others liken it to the kind of intense heat you feel when lying on a sunbed or going into a sauna. This can, unsurprisingly, lead to profuse sweating and may be accompanied by heart palpitations and/or feelings of anxiety.
How long do they last? The whole flush episode can last a matter of minutes (the average is four) but it often feels like longer. They can occur every few hours to a couple of times a week. They may also potentially last for years after your periods have stopped.
To help reduce your risk of a hot flush and relieve the experience if it does happen:
Anticipate them: carry a battery-operated mini fan with you for when you are out and about; keep cooling wet wipes in your bag and/or a cooling spray to spritz over your face and chest to help keep your temperature down. Keep a fan on your desk at work and/or in your bedroom at home.
Avoid triggers: these include spicy foods which can dilate blood vessels and stimulate nerve endings or those containing monosodium glutamate (MSG) – often found in foods like ready meals, salty snacks, stock cubes and packet soups - which can act as a trigger. Alcohol and caffeine (coffee, tea and cola or energy drinks) can also exacerbate hot flushes as can stress so try to find an effective stress reliever. Also make sure you are drinking enough hydrating fluids (water, herbal teas, water-rich foods) as dehydration is known to exacerbate symptoms
Dress for them: wear thin layers so you can take off some items of clothing if you start to overheat. Invest in fabrics that should keep you cooler like our specially created anti-flush clothing like Become clothingdesigned to help absorb heat from the surface of your skin and keep your cool.
90% of women who have tried this ‘Anti-Flush’ vest top say they have seen a reduction in the severity of hot flushes and night sweats they experience.
Look after yourself. Regular exercise and keeping your weight down have also been found to help reduce the risk of hot flushes. A 2017 Brazilian study suggested women who were overweight or obese suffered more severely. Women who smoke also appear to have more severe hot flushes so it makes sense to cut down and ideally give up.
Eat more phytoestrogens. These are plant-based foods which are structurally related to oestrogen and include soy, soy beans, wholegrain cereals, tofu
and alfalfa sprouts. One large report from 2015 has linked eating them to a reduction in the frequency of hot flushes.
Sage supplements. There is evidence to show that sage supplements can help reduce the incidence and severity of hot flushes. Some women also find other botanical supplements like Black Cohosh and Red Clover helpful.
HRT. If you are taking HRT your hot flushes will probably completely disappear and this is what the National Institute for Health and Care Excellence (NICE) – an organisation that provides national guidance on health and well-being issues - recommends for relieving flushes and night sweats. Statistically-speaking it is the most effective treatment for hot flushes. but does carry some risks.
Medication. If you are unable, or don’t want to take HRT and your hot flushes are severely impacting on the quality of your life your doctor could potentially prescribe drugs including anti-depressants like fluoxetine, citalopram or venlafaxine. Clonidine, a drug normally used to treat high blood pressure, may also be recommended.
RECOGNISING THE SYMPTOMS
All common menopausal symptoms, both physical and psychological, are associated with the body’s decreasing levels of the female hormone oestrogen. Oestrogen levels can affect the brain and emotional well-being and lead to a whole range of physical and psychological effects including hot flushes, night sweats, anxiety, depression, difficulty concentrating, feeling muddle-headed, general emotional fragility, heart palpitations to reduced skin elasticity and dry eyes and mouth – which can also affect your teeth and gums.
What can make things harder to pinpoint is that some of these symptoms we might also attribute to simply getting older (tiredness, aching joints, decreased libido, brain fog and forgetfulness etc) and the feelings we might be going through (anxiety, depression and loss of confidence etc) might be perfectly natural responses to other things going on in our lives at this time (kids leaving home, parents becoming ill, caring for a sick relative, possible job insecurity and just ageing in general. Sadly, we live in a culture that prizes youthfulness over experience and this can create a lot of conflicting emotions as we age).
Familiarising yourself with the most common perimenopausal and menopausal symptoms can help you to try and unpick whether what you are going through is hormonally-related or not – and ultimately understand what to do about them.
5 SYMPTOMS YOU MIGHT NOT ASSOCIATE WITH MENOPAUSE
You might be aware of the hot flushes, night sweats and general hormonal bedlam but there are a range of things that could happen to you that you might not have linked to the menopause. Like these…
Your teeth can start moving. Menopausal women have to work harder to stave off gum disease as falling oestrogen levels lead to reduced saliva and collagen production putting their dental health at risk. Teeth are held in place in a bed of connective tissue which is mostly collagen and if collagen levels drop, the gums can lose their grip and your teeth can potentially start moving. Effective night-time cleaning is crucial as this is when saliva production drops naturally (saliva helps protect teeth from plaque bacteria and acidic food and drink) and try a gum-strengthening toothpaste. Drink plenty of water and eat vitamin C-rich foods (vitamin C helps with collagen production). A retainer or braces can help prevent teeth moving or correct any changes.
Your skin might get really itchy. Many women report that their skin becomes unusually itchy around the time of menopause. This ranges from mild irritation to full on “ants crawling all over my skin” sensations. This is known as formication where the skin becomes increasingly sensitive due to lack of moisture. Drinking plenty of water and reducing your caffeine and alcohol intake will help. Also get plenty of vitamin C-rich foods in your diet (like citrus fruits, green vegetables, peppers and berries) to help create more skin-cushioning collagen. Plus, as oestrogen helps the body to handle histamine, decreased levels of this hormone means an increase in histamine – which can make you itch.
You might crave more time on your own. Many menopausal women report feeling a bit more introspective and craving more alone time. Maybe this is necessary to help work through this new time of your life. Many also describe themselves as feeling “less maternal”. This tends to be attributed to a fall in the hormone known as oxytocin (sometimes dubbed the ‘cuddle hormone’). The upside of this is that many post-menopausal women find they no longer need to be doing everything for everyone and can spend more time attending to their own needs.
Your feet might get flatter. Although the link between menopause and flattening of feet is not entirely clear research connects it to an increase in body mass index (BMI). A 2010 study of post-menopausal women concluded that as BMI increases feet “flatten” over time and can result in structural changes including the collapse of the medial longitudinal arch (MLA). There is also an increased risk of plantar fasciitis – inflammation of the band of tissue that stretches from the heel to the middle foot bones. Ideally try to exercise more to keep your BMI down. If your feet do feel “flatter” and less cushioned choose supportive footwear with a slight heel that gives enough arch support and cushioning over the heel and ball of foot - or wear supports (called orthotics) in your shoes.
You could experience indigestion and acid reflux. Many perimenopausal and menopausal women say they either start to experience symptoms of acid reflux with uncomfortable burning, upper abdominal pain and bloating, or if they had mild symptoms before, these get significantly worse. This was born out by a 2008 study of nearly 500 women in which 42% who were perimenopausal and 47% who were menopausal complained of increased gastroesophageal reflux disease (known as GERD) suggesting a significant hormonal link between acid reflux. Over the counter antacids are helpful in some cases but if they are not you might need prescription medicine so do talk to your doctor about this. Other advice includes exercising regularly, eating little and often, limiting known triggers including caffeine, fatty foods, chocolate, raw onions, fizzy drinks, alcohol, tobacco and eating too close to bedtime.
LOW LIBIDO & SEX
Unfairly, at the very time you can stop worrying about contraception and your periods getting in the way of your sex life, many women find their fluctuating menopausal hormones cause their sex drive to nosedive. The reasons can be psychological or physical (or both) but the good news is that it is not inevitable or fixed and for many a few simple lifestyle changes and remedies can help.
Why the lower libido? Our libido or sex drive is complicated at the best of times and is at the mercy of a whole range of factors – stress, tiredness, illness, feeling taken for granted, worrying that you are less sexy and desirable as you get older, over-familiarity to your partner - but during the menopause these feelings can be magnified by fluctuating hormone levels and associated menopausal symptoms like feeling emotionally fragile and overwhelmed, hot sweats, aching joints and changes to your body shape. Menopause is not necessarily glamorous or sexy and it can take a little bit of time to adapt to this transitional time and turn your sex life around.
Can you increase your sexual desire? Sexual desire is complex, multi-faceted and most of us will experience a lack of it at some point in our life. Just some of the things that can make a dent in it include illness, the effects of some medication, regularly drinking too much alcohol, not feeling emotionally satisfied or valued in your relationship, becoming a carer for your partner. Loss of sexual desire is also a well-documented side effect of the menopause as the hormones progesterone and testosterone – which play a key role in firing up your libido – fluctuate and decline. This is significant because testosterone helps increase desire and progesterone helps stimulate the production of this hormone. Many women say taking HRT has helped ‘reboot’ their sex drive – and it could be helpful if low levels are causing your loss of libido - but this might not be appropriate for everyone and there are other lifestyle factors that can help including:
- Adapting to your changing body. According to the International Menopause Society (IMS) women in their mid-40s typically gain an average of around 1lb a year. This means between the ages of 45-60 we could have gained around a stone. Even women who have managed to stay effortlessly slim all their lives can find they start to struggle in their late 40s – if not necessarily with huge weight gain then with the way their fat is distributed – finding they are carrying extra ‘padding’ around their middle and back. Plus, as we get older, we lose muscle tone and are generally not as naturally pert and firm as we once were. In a world that prizes slimness and youthful beauty all of this can conspire to make us feel less sexual and desirable. While there are many examples of sexy and desirable 40+, 50+, 60+ women in the public eye, and this can be positive in overturning the assumption that we all become ‘invisible’ in middle age, the flip side is it can also heap more pressure on us if we don’t look like someone whose job, let’s be honest, is being paid to look good. Avoid comparing yourself to other women and just aim to get healthy and fitter for you. Eat a balanced diet with plenty of phytoestrogen-rich foods, keep your portion sizes down (an average meal in 2019 is now three times the size it was in the 1940s) and take regular exercise – this should not only help to keep your weight down and improve muscle tone and stamina it should also help to reduce the severity of ‘unsexy’ menopausal symptoms like hot flushes, joint pain and poor sleep.
- Managing stress. This is a tricky one as we all have stresses but around menopause age we can have even more heaped upon us – potentially dealing with kids leaving home and ‘empty nest syndrome’; parents becoming ill and/or more dependent on you; job insecurity (when businesses are ‘streamlining’ their workforce the over 50s tend to be the first ones to take the hit and it can become harder to get re-employed) and this at a time when menopausal symptoms like brain fog, anxiety and tiredness can make the impact of those stresses so much harder to deal with. That sex comes lower down on your agenda at this point should not be any massive surprise. There are, however, many ways to help reduce stress – exercise is key but there is increasing evidence to show mastering relaxation techniques like mindfulness that train your brain to be still can significantly help.
- Talking about it. Not always easy we know but there are a range of ways you can access help and advice about low libido from your GP to relationship therapists or online sites like the Sexual Advice Association. Ideally, talk to your friends and partner. If you can swap notes with your friends about how, or if, their sex life was changed by the menopause and what they did about it then great. Not everyone feels comfortable doing this face to face, however, so chatting anonymously online in a chatroom or forum is another option. Some women might find they are happy to exist in a sex free relationship but if your partner doesn’t this is going to take some negotiating. The key is to keep talking about it so those closest to you can understand what is going on.
- Easing vaginal dryness.The drop in oestrogen during the perimenopause and menopause tends to make vaginal tissue drier and sex potentially uncomfortable. This dryness can generally be remedied very simply using a vaginal moisturiser – there are a range of these available from the chemist or online. There are also a number of non-surgical treatment options such as laser treatments that works to stimulate vaginal tissue by boosting collagen levels. Alternatively, there are different pelvic floor toners available – some of which use infrared light and heat to increase vaginal lubrication and tone pelvic floor muscles (plus improve bladder control). There is also growing evidence that taking sea buckthorn supplements (the antioxidant rich oil from the sea buckthorn plant contains omegas 3, 6, 7 and 9) can help.
New sex. Okay, so you are not 20 and sex will mean something different to you now than when you were younger but that really doesn’t mean your days of being sexual or enjoying sex are over. It means it might be different - your sexual responses might be slightly slower, you could find it harder to become aroused but taking more time to explore what you do enjoy can come with new rewards. Spend extra time on foreplay – stroking and caressing each other. If it helps, read or watch erotica. If intercourse is uncomfortable try mutual masturbation and/or oral sex. If you don’t want to have sex don’t feel obliged to but do explain to your partner sensitively why you don’t so he/she doesn’t feel rejected. Ultimately, try to enjoy this time in your life free from the worry of contraception. It might be a different phase in your love life but that doesn’t mean it can’t be good or better than before.
AT A GLANCE GUIDE TO COMMON SYMPTOMS
Fluctuating hormones can create unexplained feelings of worry, dread, edginess and doom; sudden bursts of anger or weepiness and then possibly periods of introspection and wanting to be left alone. Data shows some women are just more sensitive to hormone levels, including reduced oestrogen, than others. What we also know is that anxiety often co-exists with depression and that mid-life events like empty nest syndrome may also have an impact.
What to do about it.
A healthy diet , exercise , trying to reduce stress, a good night’s sleep will all help. Avoid self-medicating with alcohol - sadly, it is likely to exacerbate both the physical and psychological symptoms triggered by perimenopause and menopause. The technique of mindfulness meditation has been shown to help with mild anxiety as has inhaling geranium essential oil. Cognitive Behavioural Therapy (CBT) – a way of substituting harmful thought patterns with more positive ones - is also an established and effective way to help reduce the impact of reducing anxious thought patterns. Talk to your doctor about all options.
Up to 60% of menopausal women complain of ‘brain fog’. This is not simply about forgetting the name of someone you have worked with for years or misplacing your keys it is more the feeling that their brain is completely cluttered which leads to difficulty retrieving information that they once knew and/or finding it harder to remember or recall new information. For some women these symptoms can be so debilitating that they can actually think they are suffering with dementia. Why does it happen? Research suggests that when oestrogen levels dip the brain must learn to function with less of it and it takes time for your grey matter to get its head around this change. Combine this with other potential symptoms like night sweats, sleeplessness and a general feeling of lethargy and these feelings of muddle-headedness can be compounded.
What to do about it.
To help you think more clearly keep yourself well hydrated – drinking water and herbal teas will help – evidence shows even very mild dehydration can lead to difficulties concentrating. Avoid alcohol and eat a diet with plenty of water-rich vegetables and fruit. Stress-relieving activities like exercise or meditative techniques can also help you to unwind and declutter your brain. Inhaling peppermint or rosemary essential oils can have a short-term effect in helping with concentration and there is some evidence that the herb ginkgo biloba can help stimulate memory. DHA, one of the compounds found in oily fish, has also been shown to help speed up reaction times in short term memory. If lifestyle changes don’t help do talk to your doctor who may suggest HRT. Be reassured this brain fogginess is temporary and when your hormones regain balance your brain will too.
No-one knows for sure why some women find their breasts can feel sore and tender around the time of menopause but it is thought to be triggered by fluctuating and falling oestrogen and progesterone levels. Just as you would expect during puberty and your normal period patterns. The bigger your breasts the more likely they are to feel heavy, swollen and uncomfortable.
What to do about it.
Ideally, try to keep your weight down – the heavier you are the bigger your boobs are likelier to be. Wear a comfortable and supportive bra. Dress in comfortable soft layers like a Become™ vest. Eat a diet high in phytoestrogens. Breast pain should subside once your hormone levels rebalance but if yours is getting in the way of you going about your daily life do get advice and help from your doctor particularly of you notice any changes in shape, size and/or find lumps.
Fluctuating hormones during perimenopause and menopause can lead to a greater risk of depression. Those who have had a history of depression are at greater risk.
What to do about it.
Talk to your doctor and or/mental health professional. Anti-depressants are one option but it could be that HRT and possibly CBT (or other forms of counselling support) could be more appropriate. Discuss this with her or him. There are lifestyle factors that can help like exercising, eating well and avoiding alcohol (which is a depressant). Try to make time for yourself alone to avoid becoming overwhelmed. Take a relaxing bath with added neroli essential oil – there is evidence to show this could go some way to helping alleviate depressive symptoms.
Hormonal changes can trigger a change in hair growth patterns which can result in unwanted hair appearing on your upper lip and/or coarse dark hair sprouting on your chin. You might find your eyebrows and/or eyelashes become thinner and sparser too. At a time when your confidence levels can feel at an all-time low this doesn’t exactly do much to help matters (although if you want to find the silver linings: men tend to start sprouting hair from their nose, ears and shoulders in mid-life…).
What to do about it.
Invest in a magnifying mirror and/or tweezers with magnifying mirror attached to pull out the offending hairs (if they bother you). Slanted tweezers tend to be more efficient at grabbing onto stubborn bristly hair. Alternatively, have them waxed or professionally threaded at a salon. For a more long-term solution try electrolysis or laser hair removal which can get rid of the hair semi-permanently. If facial hair starts to affect your self-confidence talk to your doctor about potential treatment options. There are serums available from the chemist that claim to increase the thickness of brows and/or lashes although how effective they are is inconclusive. You can also have your brows dyed to help define them more or use brow make-up to give the illusion they are thicker. A volumizing and lengthening mascara will temporarily help your lashes look longer and thicker.
It is common to notice your hair thinning, weakening and growing more slowly during menopause as oestrogen and progesterone levels fluctuate and fall (these hormones help hair grow faster and stop shedding so quickly) and the testosterone in your body can assume a more dominant position leading to a male pattern hair growth and loss.
What to do about it.
Eat a varied, balanced diet with plenty of hair-healthy foods including essential fatty acids like oily fish and nuts and seeds. Taking vitamin B6 and folic acid supplements have been shown to help restore hair growth. Try to reduce your use of hot styling tools (like blow drying, straighteners and curling tongs) which can dry the hair and make it increasingly brittle. When you wash your hair use volumising shampoos and conditioners. Be wary of some types of hair extensions which may make your hair look thicker in the short term but long term are likely to make it even thinner (due to traction caused by sustained tension on the hair follicles). If your thinning hair is severely affecting your confidence levels see your doctor and/or a trichologist who can suggest suitable treatment.
Menopausal night sweats coupled with associated feelings of edginess and anxiety are not exactly a recipe for good night’s sleep. After a night of tossing and turning you then tend to drag yourself through the day feeling not just tired but having increased difficulty concentrating and remembering things.
What to do about it.
Exercise regularly – study after study shows it leads to better quality sleep (just don’t do too vigorous a routine too close to bedtime which can be overstimulating). Activities which involve deep breathing and mediation like yoga can be particularly beneficial. Aim to stick to a routine of going to bed and getting up at roughly the same time each day. Take a bath before bed containing Epsom salts or magnesium flakes which have been shown to help relax muscles and lead to better quality sleep (check with your doctor first if you have High Blood Pressure). Avoid alcohol and sip soothing and soporific bedtime drinks like chamomile tea or tart cherry juice in hot water. Log off from your iPad, laptop or smartphone at least an hour before bed. The blue light from these devices can stimulate the brain precisely at the point when you want to calm it. Wear fabrics in bed like Become™ vests and pants which can cool your raised body temperature. If after incorporating these lifestyle changes you are still struggling to sleep do discuss this with your doctor.
It might be the butt of jokes but ‘brain fog’ where fluctuating hormones can lead to you having difficulty concentrating, processing information and remembering can be really distressing. Doctors point out they have seen many women of menopausal age in their surgery so alarmed by their dwindling memory they actually think they are developing dementia. Few of us make the link between menopause and memory loss but oestrogen plays a major role in brain function and it can take time for your brain to adapt to the dwindling levels of this hormone – and developing a memory like a goldfish is a side effect of this. This problem should be short lived and when your hormones rebalance themselves your ‘woolly’ brain should revert back to normal.
What to do about it.
To stop the menopause messing with your mind, keep yourself well-hydrated: research shows being only mildly dehydrated means our brains have to work a lot harder. Avoid alcohol, it is dehydrating, a depressant and being hungover makes most of us muddle-headed at the best of times. Eat small regular meals to keep your blood sugar levels balanced and try supplementing with the herb ginkgo biloba – recent trials show it can be effective at boosting memory. Regular exercise can also be a huge help : the benefits are due to its ability to stimulate the release of chemicals that help improve the health of brain cells and improve the survival rates of new brain cells.
Muscle aches and joint pains
If you increasingly wake up feeling achy and stiff, find it harder to recover after exercise or find your muscles and joints generally feel more sore and inflamed (neck, shoulders, back, knees, ankles and hands tend to bear the brunt) it can be tempting to write this off as simply the signs of old age. Yet this is a classic menopausal symptom that has been dubbed ‘menopausal arthritis’.
What to do about it.
Keep your weight down. As a nation we are getting fatter, with levels of obesity more than doubling in the last decade. Carrying extra weight puts you at increased risk of developing joint and muscle pain in the first place and also exacerbates any existing joint problems. Many people credit yoga and Tai Chi with helping not just to get them fitter and slimmer but also with helping manage joint pain and increasing their flexibility. Including anti-inflammatory foods in your diet like omega-3 rich oily fish (compounds like the EPA and DHA found in oily fish have been shown to reduce joint pain and tenderness), nuts, seeds, olive oil and vegetables and fruit can help reduce inflammation. Evidence also shows how some herbs and spices also appear to stimulate anti-inflammatory effects in the body - ginger and turmeric (the root that gives much Indian cooking its distinctive yellow-orange colour) in particular. If you don’t get these in your diet you might benefit from a supplement.
Feeling your heart suddenly start racing, pounding or fluttering inside your chest for no obvious reason (although it also tends to coincide with a hot flush) can be understandably frightening. Couple this with other symptoms like anxiety and you can start to feel extra panicky and stressed which can cause your heart to race all the more. It is however a generally harmless and temporary symptom of the menopause which is attributed to diminishing levels of heart-protective oestrogen.
What to do about it.
Eat little and often to prevent your blood sugar levels dropping which can make you feel tired, irritable and anxious. Cut down on stimulants like caffeine (coffee, tea, cola, energy drinks, chocolate) and nicotine which can exacerbate feelings of jitteriness and can cause your heart to race even more. Reduce your stress levels where you can and try to make time for a daily relaxation technique such as mindfulness or yoga. Whatever exercise you normally do, you might prefer to switch to a more laid-back type like walking, Pilates and swimming rather than high intensity activities that are likely to make your heart pound nineteen to the dozen.
Vaginal dryness and discomfort.
It’s not something that you necessarily want to talk about but fluctuating and falling hormones do lead to a reduction in vaginal lubrication and cause the vaginal walls to become thinner and less elastic. This can cause irritation, a burning sensation and itchiness that make it difficult for you to go about your daily life. It can also get in the way of you enjoying sex as the lack of lubrication can lead to difficulty becoming aroused and/or reaching orgasm. It can also put you at increased risk of urinary tract infections (UTIs) like cystitis. Understandably all this can put a dampener on your sex drive and doesn’t exactly add to your quality of life.
What to do about it.
Keep hydrated. Not drinking enough fluid can leave your body drier generally – skin, eyes, mouth and your vagina. There are a range of vaginal moisturisers available from the chemist which can offer immediate relief. Other options include HRT or vaginal oestrogen (the hormone that naturally keeps the tissues of your vagina lubricated and healthy) so discuss all options with your GP.
MANAGING YOUR MENOPAUSE
The case for and against HRT has flip-flopped over the past 50 years or so. Thousands of women stopped taking it in the 90s and early 2000s after a series of negative studies linked it to an increased risk of some cancers, blood clots and stroke. The pendulum has, however, swung back as we have more evidence about potential benefits and risks so arm yourself with all the facts…
What exactly is it? A hormonal treatment containing oestrogen (and potentially progesterone) to replace the oestrogen that is no longer made naturally by the ovaries after the menopause.
The benefits. If you are having troublesome symptoms the benefits of HRT, on balance, appear to outweigh the risks for most women under 60. Starting it when you are over 60 is generally not recommended. HRT is not only statistically the most effective treatment for reducing hot flushes but it also appears to help improve mood, sleep, muscle and joint pain, vaginal dryness and libido. It is also known to help reduce the risk of osteoporosis (thinning of the bones) by helping to increase bone density. As well as been shown to reduce the risk of coronary heart disease if started within 10 years of the menopause although the evidence regarding HRT and cardiovascular disease is still largely controversial.
The risks. It would be fair to say HRT has had something of a chequered history falling out of favour in the early 2000s when a series of large studies linked it to an increased risk of stroke, breast and endometrial cancer and gallbladder problems. Women who take combined HRT in tablet form are also known to have an increased risk of blood clots. Current thinking is that whilst HRT may increase your risk of some health problems, the risk is very small in most cases and generally, the benefits outweigh the risks. Those risks are also dependent on a range of factors including family history and lifestyle factors. You significantly reduce your risk of developing problems, however, if you have a healthy lifestyle – eating well, keeping your weight down, drinking moderately, taking regular exercise and not smoking.
Could it help you? If your menopausal symptoms are interfering with the quality of your life, then yes, HRT could help. Many women wax lyrical about how it has given them their ‘life back’ and made them feel ‘normal’ or ‘like themselves’ again.
How do you take it? HRT is available in tablet form, as hormonal patches, creams, gels, nasal sprays or in the form of a vaginal ring. How you prefer to take it is largely up to you and the symptoms you present with. You can chat to your doctor about which seems the best delivery method for you.
Side effects. Depending on the type of HRT you are prescribed side effects can include breast tenderness, headaches, nausea, bloating, leg cramps, backache, depression and bleeding (generally every 28 days but this can be irregular in the first three to six months). If you use HRT patches this can sometimes cause skin irritation.
What happens when you stop taking it? When you come off HRT your body will be going from a high hormone level (courtesy of the HRT) to your natural levels which will be low. This can trigger withdrawal symptoms that can mimic menopausal ones. The advice is to come off it slowly – generally over a six-month period – with the help and advice of your doctor.
Who shouldn’t take it? The NHS say HRT may not be suitable if you have a family and/or personal history of breast cancer, womb or ovarian cancer; have a history of blood clots; have high blood pressure or liver disease. If this is you, discuss alternatives to HRT with your doctor.
Ongoing care. If you are taking HRT you should have regular – generally annual check-ups. You should also do regular breast checks and be vigilant about any changes. See your doctor if you do notice anything that seems out of the ordinary and if you are over 50 attend your breast cancer screening appointment when you are called.
MENU FOR A GOOD MENOPAUSE
Nobody is saying you can’t have a slice of cake, pizza or a glass of wine because you are menopausal. But what you do eat can make a whole heap of difference to how well you cope with your symptoms – both physically and psychologically.
A healthy diet is, of course, recommended for everyone regardless of life stage but as the British Nutrition Foundation point out ‘a healthy varied diet and a healthy lifestyle including not smoking, limiting alcohol consumption, doing physical activity and maintaining a healthy bodyweight, can help to reduce the severity of menopausal symptoms and protect against long-term health problems associated with loss of oestrogen, such as cardiovascular disease and osteoporosis’. The point is, you can significantly reduce your risk of menopausal symptoms by eating better plus you help to reduce the risk of heart disease and thinning bones with what is at the end of your fork. To give you an idea of what can help:
Eating Mediterranean-style. Recent research by the American Journal of Clinical Nutrition involving around 6,000 women between the ages of 50 to 55 found those who followed a typical Mediterranean diet and lifestyle were around 20% less likely to experience menopausal symptoms. Think a typically Greek and Italian-style way of eating including plenty of vegetables, fruit, wholegrains, pulses, fish, lean meat, plenty of garlic and herbs, olive oil and moderate amounts of alcohol. Researchers suggest the high fibre in this kind of diet can help stabilise oestrogen levels.
Taking bits of Japanese food. Taking some tips from the Eastern diet, researchers from the Department of Integrated Medicine at Westminster University polled 1,000 British women aged 45 to 55 and compared their answers to women from the US, Canada, China and Japan. They found Japanese and Chinese women suffered the least with menopausal symptoms and British ones the most. This is largely attributed to the Japanese and Chinese diets that are rich in soy foods like tofu, edamame beans and miso. In Japanese culture, soy products are eaten almost daily and what makes this so significant in terms of the menopause it that soy is an isoflavone, an oestrogen like compound. There is evidence that eating isoflavones in foods or taking them as supplements can help to reduce menopausal symptoms like hot flushes and vaginal dryness.
Food to help increase your heart health. Before the menopause, oestrogen helps to protect women from the risk of heart disease so it’s important to eat a range of heart-healthy foods. Omega 3 fatty acids play a key role in protecting the heart so include plenty of omega 3-rich oily fish, nuts, seeds (like chia and flax) and dark green vegetables. These fatty acids have also been shown to help reduce hot flushes.
Nutrients to help keep your bones healthy. To help with bone strength and density and reduce your risk of osteoporosis you need calcium and vitamin D. You’ll find calcium in dairy products like milk, butter and cheese; many green leafy vegetables (although avoid spinach which can interfere with the body’s ability to absorb calcium); fish containing bones (like pilchards or sardines); sesame seeds and dried figs. Getting enough vitamin D can be slightly trickier in that there are few food sources of it. It is found in small amounts in oily fish, eggs, red meat and foods fortified with it including some cereals and dairy products. Vitamin D is made naturally in the body on exposure to sunlight but this can difficult to achieve for us Brits when sunshine is in short supply for half of the year. Plus, our ability to synthesise vitamin D via sunlight from 50 onwards and this is one area where most of us can benefit from a supplement. The advice from Public Health England (PHE) is that we should all take a supplement of this nutrient between October to March.
What to eat more of:
* Vegetables and fruit (aim for 5-10 portions daily)
* Fish (particularly oily fish like salmon and mackerel. Aim for two portions of oily fish weekly)
- Dairy products (choose low fat varieties and keep portion sizes in check)
* Nuts and seeds (sunflower, chia, linseeds, pumpkin etc)
* Pulses (lentils, chickpeas and beans)
* Wholegrains (brown rice, quinoa, whole wheat pasta, wholemeal bread)
* Vegetable oils like olive, sunflower or rapeseed
* Soy products like tofu, soy milk and yogurt, edamame beans and miso.
What to avoid or cut down on:
* Refined sugar
* High fat, sugar and/or salt laden ready meals or fast food
* High fat and sugary or salty snacks including biscuits, cakes, pastries, pies and crisps
* White carbohydrates like white pasta, bread or rice
* Saturated fat like butter or coconut oil
* Caffeine (coffee, tea and cola)
* Alcohol and fizzy sugary drinks
Many menopausal women don’t like the idea of a medical or hormonal treatment and prefer to find a more natural solution. Some like to use them alongside conventional medical treatments. For others, treatment like HRT is just not advisable so what are some of the alternatives (along with a balanced diet, supplements and exercise) for easing symptoms?
Homeopathy. This is based on the idea that taking certain highly diluted substances (derived from plants and minerals) can kickstart the body into healing itself. Homeopathy is an holistic treatment (where the homeopath looks at the whole of your lifestyle – including your emotional states, how you respond to stress, any physical problems – to help pinpoint the right homeopathic remedies for you) and while some people are evangelical about its effects, others are of the opinion there is no way it can work. A 2010 House of Commons Science and Technology report concluded homeopathy performed no better than placebos. The choice, however, is entirely yours, if you find homeopathic remedies helpful continue taking them and seeing your homeopath. Common remedies used during the menopause include:
Calcarea carbonica – for night sweats, abnormal cell growths like cysts, weight gain, disrupted sleep, painful sex, tiredness and anxiety (particularly about your health).
Pulsatilla – for oversensitivity, low moods and pessimism. Women who are said to benefit from this remedy are said to be very sensitive to the quality of their food, environment and relationships and tend to get particularly tired during mid-afternoon.
Sepia - For those who find it difficult to switch off and/or say no, are always working or going out of their way to please others which causes them to disconnect from their own feelings. Women who benefit from sepia are also said to thrive in the sun and warmth.
For more information check out the Society of Homeopaths.
Reflexology. This is based on the idea that specific sites on the feet (and hands and ears) have connections to other parts of the body and by stimulating them you encourage the body’s natural healing processes. This natural, soothing, drug-free treatment has been found particularly helpful in alleviating stress and it has also been shown to reduce levels of pain. In terms of helping to manage menopausal symptoms a 2002 study concluded foot reflexology was no more effective than a standard foot massage in helping to manage the psychological symptoms associated with the menopause. While we wait for more clinical evidence to show exactly how reflexology helps, as things stand it is thought to be a safe treatment to help with general well-being, relaxation and stress relief.
To find a reputable reflexologist near you go to The Association of Reflexologists.
Acupuncture. This is the practice of inserting needles into specific points of the body which are said to help relieve pain and promote healing. There is some evidence that acupuncture can alleviate hot flushes and feeling of anxiety during the menopause. One 2016 study suggested it could reduce the incidence of hot flushes by half after three acupuncture treatments. It appears perfectly safe but overall, however, evidence is mixed and there are calls for more rigorous trials to assess its effectiveness in helping to ease menopausal symptoms.
For more information go to the British Acupuncture Council.
Aromatherapy. Plant essential oils have been used for centuries to help alleviate menopausal symptoms and there is increasing scientific evidence to confirm how aromatherapy can help. A 2016 study showed that inhaling lavender essential oil twice a day over 12 weeks reduced menopausal hot flushing. There is evidence that inhaling peppermint and/or rosemary essential oils can help increase concentration and may help with menopausal brain fog. Research from 2015 suggests geranium oil may help alleviate depression and anxiety in menopausal women. In 2014 researchers found postmenopausal women who inhaled neroli essential oil reported an increase in sexual desire and were also found to have lower blood pressure.
Find more information at The Aromatherapy Council.
There are a range of herbs that have been used for thousands of years to relieve menopausal symptoms. You can now find many of these in supplement form and a sizeable amount of women find them really helpful – so which ones are most likely to help you?
Sage leaf extract. Sage, part of the mint family, has been used for centuries for the relief of hot flushes and there is encouraging scientific evidence to testify to its effectiveness. In one Swiss study 71 menopausal women who were given a sage preparation daily for eight weeks were found to have a lower incidence of flushes which were also less severe if they did happen. In another clinical study involving 30 menopausal women given a combination of sage and alfalfa (which contains plant oestrogens), 20 of those women reported their hot flushes and night sweats had completely disappeared.
Black Cohosh: This traditional north American herb has been used for centuries to help reduce hot flushes. Scientific evidence for its effectiveness remains mixed, however, with some studies showing no benefits when compared to a placebo whilst others show a reduction in symptoms that are similar to those achieved by menopausal medications. Many women report that it has significantly helped them so it could be a matter of finding what herbal supplement works for you. Black cohosh is known to interact with some other medicines however so do tell your doctor you are taking it if you are prescribed any medication.
Soya isoflavones. These are a type of plant oestrogen or phytoestrogen known to have a mild oestrogen-like effect. Soybeans and soy products like tofu and miso tend to be the richest sources of isoflavones in our diet. The effects of taking them in supplement form is said to be around 40% less effective at relieving menopausal symptoms than taking HRT but when taken for long enough (in trials around 48 weeks for maximum effects) they have been found to significantly reduce hot flushes and night sweats. Some clinical trials have also shown how soy isoflavones could help to keep your weight down. They have also been studied for their role in helping improve heart and bone health in postmenopausal women.
Red Clover. Red clover is a flowering plant containing phytoestrogens, plant compounds which act in a similar way to oestrogen. A number of clinical trials involving red clover showed no benefit over a placebo although other small studies have shown it may increase bone density and increase collagen levels (which can help with skin ageing and possibly vaginal elasticity). A 2017 study gave a combination of Red Clover and probiotics to 62 perimenopausal women over the course of 12 weeks and it was concluded that the women’s hot flushes and night sweats improved when compared to a placebo. The plant appears well-tolerated and there are calls for more research into this popular remedy.
Sea buckthorn oil. There is evidence that sea buckthorn supplements (the antioxidant rich oil from the sea buckthorn plant contains omegas 3, 6, 7 and 9) can help to lubricate the whole body including the eyes, mouth and skin. A study on postmenopausal women also shows taking sea buckthorn in supplement form can improve the condition of vaginal tissue.
St John’s Wort. This herbal remedy has traditionally been used to treat low mood and this is often a symptom of menopause. A 2013 trial studied taking St John’s Wort on its own, Black Cohosh alone and a combination of the two for the relief of menopausal symptoms. It was the St John’s Work and Black Cohosh combo that was found to improve hot flushes when compared to a placebo. Women taking the breast cancer drug tamoxifen should not take St John’s Wort, however, as it can make the drug ineffective.
Valerian. Valerian root is another phyto-estrogenic herb that has been used for centuries primarily to improve sleep but which has also been found to help reduce the incidence and severity of hot flushes. One 2013 study involving menopausal women complaining of hot flushes showed taking valerian root led to a significant reduction in them. Reducing the severity or incidence of flushes or night sweats should also help improve your sleep and valerian has traditionally been used as a sleep aid. One 2006 study published in The American Journal of Medicine found this traditional herbal remedy improved sleep quality by 80 per cent compared to a placebo. Another of its benefits is that it doesn’t leave you with any sort of groggy or ‘hungover’ feeling as some other sleep remedies do. A 2011 study from Tehran University randomly assigned 100 menopausal women with either two valerian capsules daily for a month or two placebos. Overall, 30% of women said the valerian improved their sleep quality compared to 4% in the placebo group.
Herbs v drugs. Many of us prefer the idea of taking something natural rather than a drug or medicine. However, natural is not always straightforwardly better or necessarily harmless. The guidelines from NICE (the National Institute for Health and Care Excellence) are that herbal remedies which are not regulated by a medicine authority should not be considered safe. Look for the THR (Traditional Herbal Remedy) logo on supplement packs to ensure the product you are buying has been approved. And do tell your doctor if you are taking any herbal supplements as they can interact with medicines.
It is difficult to find something exercise doesn’t improve and menopause is no exception. Research shows it is one of THE most effective ways of helping you cope…
If you feel tired and weighed down by your menopausal symptoms the last thing you probably feel like doing is exercising. And yet…falling oestrogen levels can reduce your muscle tone and bone density as well as impact on the health of your heart – all factors which can be improved by exercise. This is to say nothing of the fact physical activity can help to keep your weight down at a time when you might be finding it harder to lose it. Exercising also has the effect of relieving anxiety and stress and it known to help you sleep better.
Nobody is saying you suddenly have to start circuit training or running marathons (although if you do then great) but whatever you choose, the key is try to do it regularly aiming for the NHS guidelines of 150 hours a week (that’s five lots of half an hour) of moderate activity.
Why walking works. A 2008 study from the US involving 380 menopausal women found that simply taking a brisk walk can reduce stress, depression and anxiety. It was found that 40 minutes of walking five times a week is all it takes to make a significant improvement to mood during menopause. Walk to the shops, up the stairs and escalators, join a walking group, take a lunchtime and/or evening stroll. This should not only help reduce anxiety by helping you collect your thoughts it will also help keep your weight within healthy levels.
Weight training is important. Weight training using dumb belles and/or resistance bands, weight machines at the gym and/or your own bodyweight will help build muscle strength and bone, burn body fat and should go some way to revving up your slowing metabolism. Use weights that are heavy enough to tax your muscles and aim for 10-12 repetitions of each exercise. If you hate the gym invest in a couple of weights and a resistance band to use at home for 10 or so minutes a day. There are a whole range of exercise routines online to help.
How HIIT training could help. High intensive interval training (HIIT) – involving short bursts of high intensity exercise interspersed with rest periods - has become increasingly popular in the last decade and evidence suggests it can also have a hugely beneficial on menopausal symptoms. Recent research from Liverpool John Moores University has shown women who regularly work up a sweat through exercise suffered fewer hot sweats that those who didn’t exercise.
The benefits of Yoga, Pilates and Tai Chi. Yoga, Pilates and Tai Chi can all help keep you supple plus improve balance and muscle strength and tone. The deep breathing and meditative aspects can help to relieve stress and anxiety.
Do something you enjoy. Sounds blindingly obvious but if you don’t enjoy a type of exercise you are not going to stick with it. Some women love tennis, others enjoy dance or high-energy classes like Zumba or spinning. You might prefer something more low-key like swimming or cycling or exercising in the privacy of your own home. Just as the menopause experience is different for all women so is the exercise we choose and whether we prefer to do it in a group, keep it as a solitary pursuit or enlist the help of one exercise buddy. You know yourself and what is more likely to keep you motivated.
RELAXING INTO IT
Mastering an effective relaxation technique can make you better able to cope with everything from hot sweats to mood swings.
The hormonal changes you are going through can take it out of you and leave you feeling not just tired but also possibly anxious, irritable and maybe prone to bursts of anger. General lifestyle changes like exercise, eating well and getting enough sleep can all help but the need to take some time to rest and relax to allow your body and brain to adapt is crucial. Easier said than done we know, especially when the demands on your time can be as taxing as ever but research shows making time for yourself to fully recharge can help you cope. Unfortunately watching tv with a glass of prosecco or flicking through a magazine or social media doesn’t necessarily do this – you need to make a concerted effort to make time for yourself alone and train your brain to fully relax and change your thought patterns.
So, what could help you?
Mindfulness. This has become a hugely popular trend in the last decade. Basically, it involves being generally still and fully immersed in the moment whilst accepting without judgement what you are thinking and has been shown to lower levels of stress, anxiety and even pain. It might sound a bit airy-fairy but there is growing research to show how just being - sitting quietly and being mindful (not thinking about the past or the future but being in the now) can help you relax. Science shows not only does being mindfully in the moment help to reduce cortisol levels, (the hormone released when we are under stress which is also linked to an increase in abdominal fat) in this state you are also less likely to experience negative emotions like envy, anger, fear and stress and so feel more chilled out. Recent research from the Mayo Clinic in Minnesota has also shown menopausal women who practised mindfulness suffered less with anxiety, irritability and depression. You can find many online sites devoted to mindfulness and how to do it and there are a range of downloadable apps to help you. You can also start by leaving your phone at home and walking for 10 minutes or so uninterrupted. If you live near water go and sit near and watch the water just ripple. Alternatively, pull up a comfy chair by the window and sit and stare out of it for 10 minutes. Try to feel comfortable with doing nothing.
Meditation. Mindfulness and meditation tend to be linked and there are cross-overs in terms of how it is achieved and what the effects are. Meditation tends to focus more on the flow of breath in the body and encourages you to concentrate on your thoughts and emotions. Evidence shows menopausal women who do this regularly cope better with symptoms like hot sweats and report a generally improved quality of life. You can find plenty of online help with techniques but if you find it difficult to do by yourself it might be worth signing up for a class
Deep breathing. When we’re feeling anxious or emotional we tend to breathe shallowly through the chest. Help yourself combat this by practising breathing more deeply: Place one hand on your belly and the other on your chest. Now breath in through your nose so that your belly lifts – when you exhale your stomach should dip back down. If you notice your chest rising and falling concentrate more on drawing the air into your abdomen. Deep breathing triggers the parasympathetic nervous system which highjacks the response associated with anxious feelings leaving you feel calmer and more centred. This is also a technique you can use anywhere and anytime.
WORKING WITH THE MENOPAUSE
- The number of women aged between 50-64 in employment has risen by over 50 per cent in the last 30 years. The average age of women going through the menopause is 51 so it stands to reason more of us are likely to be experiencing symptoms whilst at work. One in four women report these to be so debilitating their work life is severely affected and around 10 % say they have seriously considered giving up their job because of them.
Creating a more menopause-friendly work environment is one of the big challenges of our time – not least because most of us do not have the option of packing in our job and need to know how best to navigate our way through work while going through menopausal symptoms. Some menopause experts have likened the situation now to how pregnancy and mental health problems were treated 10-15 years ago but which have now, thankfully been brought out into the open and support and understanding have changed dramatically for the better.
Another reason tackling menopause in the workplace is such a big issue is that symptoms (like hot flushes, night sweats, interrupted sleep, vaginal dryness, memory problems, brain fog, mood swings, anxiety and anger) can last between four and 12 years – a not insignificant amount of time. This is also a largely unprecedented problem in that it is only relatively recently that such a high proportion of older women are still in the workplace. Plus those experiencing menopausal symptoms can be loath to talk about it for fear of being seen as weak or incompetent in a highly competitive job market. But think about it (if you haven’t already experienced this): If you don’t get a good night’s sleep you wake up feeling exhausted and drag yourself through the following day’s work. You might also be experiencing serious brain fog and struggle to absorb information. If you are also on edge and teary and can’t concentrate it is highly unlikely you are going to be on top of your game. Sadly, many employers tend to be oblivious to the impact this can have on their employees and there are some frankly shocking statistics revealing just how alone women feel at this time: nine out of 10 say they don’t feel able to talk to their managers about their symptoms.
You can’t necessarily see menopause at work
The whole work situation is not made any easier by the fact many women often put symptoms like low mood, feeling unmotivated, irritability and lack of energy down to natural signs of ageing and/or stress. And whereas more of us might be more familiar with the classic image of the menopausal woman pouring with sweat and standing in front of an open fridge or fan – a more visible sign – it is the psychological and emotional symptoms – the ones that aren’t visible – that can be the hardest to cope with. Feeling overwhelmingly anxious, irritated or weepy and/or angry are emotions that are hard enough to handle in the comfort of your own home, let alone somewhere where your livelihood is at stake.
What works at work?
Look after yourself first and foremost. Eat a healthy, balanced Mediterranean style diet, cut down on alcohol and try to get some gentle exercise. Taking a walk in your lunch hour will not only help keep your weight down, research shows it can significantly reduce feelings of anxiety, stress and depression during menopause. Do whatever you can to improve the quality of your life at home and work – take muscle-relaxing Epsom salt baths to help you sleep; invest in clothing like the Become™ clothing range that can help keep you cool; carry a portable fan for your commute; use a vaginal moisturiser if you are affected by vaginal dryness and itching; download relaxation or mindfulness apps on to your phone and listen to them when you are feeling overwhelmed. Take your time when responding to someone or an e-mail or text that has made you angry – if you are feeling anxious, irritable and tired you could say or write something you later regret.
Many women benefit from HRT - hormones need to be balanced for women to function well physically and they play an important role in cognition and memory. Those taking it generally report their performance at work improves dramatically.
Creating the climate for change
There are other practical considerations that can help. Keep a fan on your desk if you are allowed, request that the air conditioning be turned up or open a window (negotiating this with colleagues who feel the cold can be a challenge but explain politely why it is important for you). What we need to push for, though, is a climate where we as employees feel able to talk about it. There have been strides forward in the last few years and initiatives are being set up in many companies.
In 2016 the Faculty of Occupational Medicine also introduced new guidelines for women, their colleagues and managers to help them navigate their way through menopause more seamlessly. There is also ongoing research at King’s College London in collaboration with the University of Nottingham looking at how flexible working hours could help. They are suggesting, for example, the possibility of having a later start to your day if you have had a bad night’s sleep or coming in a bit later to avoid a hot, sweaty commute. Or possibly doing a shorter working week. There are also helpful in-work menopause workshops available, for example from Let’s Talk Menopause, which have not just helped women going through it but significantly many younger women, and men, who say they have been helped to understand what may be happening to their mum/partner/colleague/boss. By raising awareness of the issues, listening to suggestions from menopausal women and implementing practical changes we should start to make a better job of working through the menopause.
If you need further advice and support or are concerned about any aspect of your health and wellbeing, please do talk to your doctor.