Women in the UK are currently experiencing menopause with 70% saying their symptoms have a moderate to severe impact of their life, career and wellbeing
Every woman will be subject to the menopause at some point!
If symptoms arrive earlier than expected, during your 30s or 40s, having a change in your wellbeing can be really disconcerting, but having them later into your 50s can be devastating as you may think you have sailed through your menopause.
Even worse, the increase in irritability and the emotional rollercoaster that comes with these changes can adversely impact on life at home and work. The menopause can also have long term effects on both mental and physical health, causing a deterioration to an individual’s overall wellbeing and self-esteem.
In order to understand menopause and what happens through it we first need to understand our own menstrual cycle and what happens through our reproductive life.
All females are born with their eggs (oocytes) already in their ovaries and an amount of these will lie dormant until puberty. After this females loose their eggs until they completely run out. From puberty and through the reproductive years their eggs grow in little “bubbles” on the surface of the ovary called follicles. Under normal circumstances these follicles start growing with the onset of each cycle and form an “ovulation” cyst (or follicular cyst) that eventually releases the mature egg. The follicle is also responsible for the production of oestrogen and progesterone. Female hormone production and egg development are inseparable. When ovarian egg production stops oestrogen and progesterone levels fall dramatically. This is usually at around the age of 51-54 in Western society and 45-49 in Asian society.
The Follicular stimulating Hormone (FSH) which is produced in the pituitary gland stimulates the follicles to grow. This occurs from Day 1 of cycle until Day 12, when the Luteinising Hormone (LH) encourages the follicles to produce Oestrogen as well as getting the follicle to rupture and cause an egg to be released. Of course this will vary depending on cycle length. The LH also increase progesterone production in the later stage of the cycle.
THE LINE BELOW SHOWS THE CHANGES IN HORMONE LEVELS FOR FEMALES 20 - 70 IN AGE
However, this is not the whole story as females get into their 40’s the quality and amount of eggs produced start dropping and this is the start of the menopause transition. Although many will continue to have periods these may become irregular or heavier than normal this is due to changes in Oestrogen and progesterone levels caused through falling egg production and poorer quality of these eggs. This is known as the peri-menopause.
Currently in the United Kingdom 13 million are going through the menopause.
What exactly is Perimenopause?
Peri-menopause is the time before your menopause when your oestrogen levels start fluctuating up and down in preparation for your periods stopping. This can be a time of considerable upheaval and changes both physically and emotionally. Although the average age of the peri-menopause starting is usually 40-45 for some women it may start in their 30’s.
To begin with you may think you are more stressed than usual or that your premenstrual tension is worsening and so causing you to become more irritable. Sadly this is all to do with the fluctuating oestrogen levels.
Your periods may remain normal so you don’t automatically realise that it is peri-menopause and these may well be the last thing to change or stop.
These symptoms can change from month to month. So some months you feel well and others are a different story altogether. It is like being a teenager again on that rollercoaster craving high carbohydrates and high sugary foods.
So what symptoms can you expect through this time:
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For many women they see their body shape changing through the peri-menopause and menopause and this can be upsetting. A change in hormone levels, mainly oestrogen, influences body fat distribution. Fluctuating and falling hormone levels around menopause can affect the way we store fat. This is because our bodies want to store fat for later - a bit like "puppy fat" at puberty. We develop "insulin resistance" making our bodies store, rather than burn, calories.
How the body handles food also changes. Before menopause if for example eating 1000 calories women will use 700 of the those calories leaving 300 spare for later. Through menopause this changes so women use 300 calories and store 700 calories. Hence the weight gain. Through the menopause as we lose oestrogen this causes a change in how we lay down our fat - leading to a pear shape. Whereas after menopause with the loss of oestrogen women tend to lay down the spare fat onto their abdomen similar to men. So in this situation with weight going on around the middle a small weight gain can lead to a change in clothing size. Women’s bodies need less energy at this time and studies suggest we may need around 200 calories a day less than we did in the past.
As oestrogen is lost causing aching muscles, joint pain and stiffness women may well find that they move less and therefore do not use as many calories. This leads to the body becoming less metabolically active and less energy is burnt. In addition, due to the loss of oestrogen in the liver, women are more likely to be insulin resistant and this can also cause weight gain
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It is considered that 7 hours is the optimum amount of sleep that an adult needs. Lack of sleep has been shown to have a negative effect on our cognitive function, mental health, heart, weight and can lead to an increased risk of osteoporosis. By the same token too much sleep can be a sign of underlying illness and can lead to cardiovascular disease. Non-REM (rapid eye movement) sleep is considered the best type of sleep and there are 3 stages of this - 1, 2 and 3 and they follow each other in a cycle.
A cycle lasts on average 90 minutes and each cycle occurs four or five times a night, depending on how long you sleep. Stage 3 is considered to be the most valuable. This is deep sleep and usually occurs during the first half of the night, it's where our brain activity, breathing, heart rate and blood pressure are all at their lowest. It’s the time when we are most likely to dream too. This is restorative sleep and is essential for the body and mind to heal and repair.
Up to 63% of women will suffer with sleep problems through the menopause and this often correlates to night sweats, but not always. Other causes include restless leg syndrome, sleep apnoea and the decline in oestrogen which causes the issue of all the above problems as well as leading to low mood, depression and worrying unnecessarily.
Hot Flushes & Night Sweats
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Hot flushes vary from woman to woman - for some women they are fleeting for others a hot flush can last up to 30 minutes. So what causes them?
Low oestrogen levels lower another hormone called Norepinephrine, which is a neurotransmitter. This helps the body to regulate its temperature and low levels of norepinephrine can lead to a rise in your level of body temperature at its core and this can cause a hot flush.
So what can you do to help during this time:
Get more exercise - This can help maintain a healthy weight as well as helping you feel better. Exercise in the fresh air is wonderful
Healthy diet - 3 meals daily with protein at each meal - try to avoid snacking as this can trigger weight gain and if you must snack make it apples, pears or berries. Reduce sugar as it encourages hot flushes and night sweats as well as lowering mood.
Sleep, sleep, sleep - Get into a good night time routine. Try to go to bed at the same time each night. Turn off and don’t sleep in the same room as your electronic devices. Read a proper book - keep the kindle/iPad for daytime reading.
Mindfulness and deep breathing - These will not necessarily help with your symptoms but they can help with you coping through this time and help to keep that anxiety under control.
Journalling - write it all down. This can help you stop worrying - keep a list as it stops you worrying about the next day.
A really good breathing technique is:
Take a breath in for 4 seconds, hold your breath for 7 seconds and breath out for 8 seconds - this is brilliant for those nights when you just can’t sleep. You are so focused on your breathing that you forget what you have been worrying about