Mere mention of the word ‘menopause’ can provoke strong emotional responses amongst women and their partners, most of which are negative. There is so much misinformation ‘out there’, particularly in the health, fitness and well-being industries.
To move past the myths and misconceptions we need to talk and share information about the menopause. This will help women and their friends and family going through this phase of life. Almost everyone is affected by menopause!
All experiences of menopause are individual and will differ significantly. Whilst some women may discover newfound freedom, others may not find the menopause a positive or enriching life experience and need to mourn the loss of their fertility. In Chinese medicine, menopause is called the ‘second spring’ reflecting a time for change and a bursting forth for life!
Menopause is not a disease but it does mark the end of a woman’s fertile years. At this time periods usually become less frequent before they stop altogether. It may take place over a few months or years but can sometimes occur suddenly, either naturally or following surgery or illness.
As individuals transition from reproductive years to menopause there is a period known as perimenopause. This phase is a journey of hormonal shifts that eventually lead to menopause. It begins much earlier than most people realise, often in the late 30s. The shifting hormonal landscape can be subtle or like a reverse rollercoaster of puberty. This transition phase can be variable in length (lasting from a few months to 10 years) and it continues until the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, the drop in oestrogen speeds up and at this stage many women experience concerning or bothersome symptoms.
This article intends to debunk some of the common myths about the menopause and give you some natural ways of managing symptoms.
1. Blood tests are the only way to diagnose the menopause
The National Institute for Health and Care Excellence (NICE) advises that for those older than 45 years, an account of symptoms is sufficient on its own to diagnose perimenopause or menopause. Although some people want blood tests and they may be helpful in some cases, especially in younger women suspected of undergoing premature menopause, they are not required.
2. Early 40s is too young to start the menopause
Unfortunately, this is not true. Women may experience symptoms of perimenopause in their early 40s. In addition, around 1 in 100 women will experience menopause before the age of 40, known as premature menopause. Premature or early menopause (before 45) can occur spontaneously because the ovaries stop working or after chemotherapy/surgery.
3. Hot flushes are the first sign
Whilst hot flushes and night sweats are the most discussed symptoms and incredibly common, many women don’t have either – lucky them! There do appear to be ethnic and cultural differences in how women experience their change.
4. Night sweats only last six months
80% of women going through menopause experience night sweats, also known as vasomotor symptoms. It used to be thought that menopause related night sweats would fade 6 to 24 months after the last period or removal of ovaries but, in reality, many women suffer a lot longer, in some cases 10+ years.
5. Menopause causes weight gain
Although menopause changes where weight is laid down, shifting from the breasts to the belly (abdomen), many females may find more weight around their waist and stomach. Most middle-aged weight gain, however, is down to the ageing process and age-related decreased muscle mass, less physical activity and poor sleep. Adding resistance and weight training exercises and looking at diet will usually combat midlife weight gain.
6. Menopause ruins sex
Changes in hormones can affect libido, but not all women experience a drop. Some women experience an increase in libido as the freedom from worries about pregnancy and a monthly menstrual bleed are liberating. Vaginal lubricants, creams, gels, and pessaries, both hormonal and non-hormonal, can help so talk to your doctor or menopause specialist.
7. I got my period young, so I’ll start menopause early
There’s no set number of periods to get through before menopause. The average age remains 45-55, depending on ethnicity. We are, however, born with all our eggs and they run out when they run out!
8. Hormone Replacement Therapy (HRT) is dangerous
Hormone replacement is safe for most women and recommended for those who start menopause under 45; it will help with hot flushes, decreased libido, vaginal dryness, and energy loss. It will also reduce the risk for heart disease and osteoporosis. To decide whether HRT is suitable for you, talk to your doctor or a menopause specialist so you can weigh the potential risks and benefits for you as an individual. Ask about Body-Identical HRT which is plant based and, as the name suggests, contains the same hormones your body produces not a synthetic version.
9.Menopause only lasts a few years
Whilst this may be the case for some women, symptoms may last for up to 10 years in others. One person’s experience may be entirely different from another’s. Most women spend one-third of their life postmenopausal.
10. You cannot have HRT while still having periods
This is not the case; talk to a menopause specialist for individual advice.
11. You can only use HRT for five years
The NICE guidance states that under the age of 60, the benefits of HRT far outweigh the risks but here is no age or time limit. Again, you should discuss this with your GP or a menopause specialist.
12. Overweight people can’t have HRT
Weight, migraine, smoking and diabetes are reasons women are given to explain why they are being declined HRT. You should speak to your GP or menopause specialist for advice on the type of HRT that may be suitable for you.
13. HRT is the last resort
It is the most effective treatment available to relieve the symptoms caused by the menopause, according to current British Menopause Society guidelines. There are, however, many natural remedies which you can try (see below for a non-exhaustive list of the most common including diet, supplements and lifestyle).
14. Perimenopause/Menopause means no more babies
Until there has been a minimum of a year (2 years if under 50) of no periods, contraception or abstinence is necessary to prevent pregnancy. HRT is not a contraceptive and women can, and do, get pregnant whilst taking it!
15. The symptoms are all physical
There are 30+ reported peri and menopausal symptoms – physical, emotional, psychological, and sexual because our hormones affect so many areas of our lives. Insomnia is a common symptom which, whether related to hot flushes or not, can cause everything to be magnified and amplified. The ability to think clearly, find words and concentrate is often lost; this may be described as brain fog. Bones, heart, and brain are also left unprotected by oestrogen after menopause.
16. Only men need testosterone
Did you know that loss of libido and fatigue may result from low testosterone. Women only have a small amount of testosterone before menopause, so its loss can have significant impact. Unfortunately in the UK, there are no female testosterone products available on prescription. Doctors generally prescribe a tiny dose of male testosterone ‘off label’. You may need to talk to a menopause specialist to get a female specific testosterone which is available privately.
17. Bladder issues are inevitable with ageing
The loss of oestrogen can cause bladder issues, including incontinence and cystitis type symptoms, making life miserable for some women. Many have had a barrage of tests and been put on courses of unnecessary antibiotics when some topical oestrogen could help to solve the problem.
18. Postmenopausal bleeding
You must speak to your GP if you have any vaginal bleeding after the 12 month anniversary of periods stopping. Do this regardless of any other symptoms and even if: it only happened once, it was a tiny amount of spotting, it was pink or brown discharge, or if you are not sure it was blood. Postmenopausal bleeding is not always a worry, but it can be a sign of cancer.
20. Life won’t be the same again
It may be hard to believe, but it is entirely possible to thrive during menopause and the rest of your life.
Menopause management
The following gives an idea of some of the dietary, supplements and lifestyle choices you can make to help with menopausal symptoms.
Protein
This is the building block of the diet, which means we need to eat a minimum amount to function correctly. Guidelines recommend that females over 50 need around 90gm of protein per day. Assuming you eat a regular UK diet of three meals a day, that equates to 30gm with each meal (about a palm-size piece of chicken, tuna or salmon, 3-5 eggs, 300gm of Greek yoghurt or cottage cheese or 300gm lentils or black beans, or tofu). Did you know that it is the protein that signals brain fullness or satiety? Make high-quality protein a part of every meal rather than just consuming it once or twice a day.
Omega-3 Fatty Acids
Omega-3s are a type of polyunsaturated fat with many powerful health benefits for both the body and the brain. Whilst they are essential for health, they cannot be made by the body, so must be consumed by food or supplementation. The recommendation is a minimum of 250–500 mg of omega-3s per day for adults.
Phytoestrogens
These are compounds in foods that act as weak oestrogens in the body. Although there has been some controversy about including them in the diet, the most recent research suggests they may benefit those going through menopause. Studies show that postmenopausal women who took a soy isoflavone supplement (a phytoestrogen) had higher oestrogen levels than those who took a fake or placebo supplement. Foods sources of phytoestrogen include soybeans, chickpeas, peanuts, flax seeds, barley, grapes, berries, plums and green and black tea.
Magnesium
This is a mineral that supports hundreds of chemical reactions in the body. About 60% of the body’s magnesium is in our bones with the rest in our muscles, other soft tissues, and fluids, such as blood. Low levels of magnesium can interfere with sleep and contribute to fatigue and aches and pains. There are many supplements but magnesium is possibly best taken before bed to aid sleep and through the skin via an Epsom Salts bath or oils/sprays.
Ginseng
A few studies have found evidence that ginseng might boost mood and improve sleep.
Black cohosh
One of the most well-studied supplements for menopause, black cohosh is made from the root of the North American black cohosh plant, a member of the buttercup family. It is available as liquid drops or tablets. Several studies have found it helpful with hot flushes compared to a placebo. Is is on the NICE recommendation for menopause care.
Red Clover
A review of 15 studies showed that taking a red clover supplement reduced the incidence of hot flushes with no severe side effects.
Other supplements which may be beneficial:
- Vitamin D with K2
- Calcium
- Zinc
- Milk thistle
- Sage
- Evening primrose oil
- Valerian root and hops
Whilst supplements are natural this does not mean they are without risk. All substances from nature have potential side effects, including the potential to interact with prescription medication. Please talk to your doctor, a pharmacist, or a qualified health care professional before starting supplements.
Lifestyle factors
Alcohol and caffeine
Studies have shown that alcohol, caffeine and cola can contribute to the feeling of rising heat in the body and trigger hot flushes; they are also sleep disruptors. As such, it may be worth testing whether eliminating these substances can help to alleviate hot flushes.
Alcohol consumption is a conversation that many perimenopausal and menopausal women may need to have with themselves. There is some evidence that small amounts of alcohol can be beneficial when consumed with a Mediterranean diet. If, however, you are a perimenopausal female, this is probably not okay. Too many mid-age women report new unpleasant side effects and more easily obtained hangovers from small amounts of alcohol. Alcohol can also cause sleep difficulties and make you feel awful on the following day.
Did you know there’s a much higher link between alcohol and breast cancer and alcohol and dementia than between hormone therapy and breast cancer?
Spicy Foods
Reactions to spicy foods are individual and cultural but for some people spicy foods can contribute to heat rising in the body during the lead up to menopause. It may be worth avoiding or limiting these foods for few weeks to assess whether it helps.
Sleep
Sleep is the best supplement to protect from severe long-term illnesses such as heart disease, dementia, and Alzheimer’s. Approximately 60% of perimenopausal and menopausal women report sleep problems and daytime drowsiness. The human brain is a hungry organ; it uses 20% of our energy, whether awake or asleep. The brain needs regular rest periods to restore and maintain optimal function; this includes restorative sleep. Did you know poor sleep increases appetite and is in fact the main factor in obesity, more significant even than what you eat!
