In our middle age we are squeezed between caring for teens/young adults and elderly parents/in-laws. It’s often a demanding time in our working life, with our skills and experience bringing great responsibility. Is it any wonder that we feel tired? Stressed? Irritable? Can’t keep all the plates spinning? Is that just life or are they symptoms of the menopause? Is there a way of coping with menopause symptoms?
The Change, the Shift, is well named, with significant changes affecting our body, our mind, our emotions and our energy levels. Symptoms are often dismissed as the inevitable consequence of a busy life, or go unrecognized altogether. But because the symptoms are the result of hormonal shifts, they can be altered by changes that we make to diet, exercise and lifestyle.
Often the osteopathic conversation starts with a woman complaining of joint aches and pains or muscle weakness, for no apparent reason. On further questioning, it becomes clear that all sorts of menopausal symptoms are present – brain fog, fatigue, dry skin and hair, weight gain, the list goes on. Let’s look at what lies behind these troublesome changes to our health.
The Hormone Hierarchy
There is a common misconception that menopausal symptoms are all about declining levels of the sex hormones. In fact, it’s a much bigger picture that involves our entire hormonal system. The sex hormones are at the bottom of a hierarchy, whereas stress hormones are at the top.
Let’s go through the hierarchy from top to bottom. The most important thing to help cope with your menopause symptoms is to listen to your body – eat when you’re hungry, sleep when you’re tired, keep active and enjoy yourself. All are fundamental to good health!
Manage Stress
Cortisol and adrenaline are released from the adrenal glands in times of stress. This is fantastic if you need to run from danger but nowadays it has become an almost permanent state for many of us.
Cortisol levels rise during the menopause which makes it even more important to try and manage stress. Cortisol, adrenaline and the sex hormones are all made from cholesterol. If cholesterol supply is short, cortisol wins over the sex hormones because survival is more important than reproduction. This means that when you are stressed it may reduce the level of your sex hormones even further.
The stress response is also mediated through the autonomic nervous system. This is the subconscious part of the nervous system that orchestrates our response to the external environment. The fight-flight response (sympathetic nervous system) helps us deal with dangerous situations but it also makes us irritable, hypervigilant, wakeful, anxious and fearful. The rest-digest-repair end of the system (parasympathetic nervous system) is our social engagement and sense of safety response. It is characterised by curiosity, compassion and openness.
We can engage the rest-digest-repair response by stimulating the Vagus nerve, part of the parasympathetic nervous system. Deep, slow breathing, mindfulness meditation, massaging the muscles at the base of the skull, massaging the ears, splashing cold water on your face, laughing and humming can all help. A small amount of attention to this can reduce cortisol and adrenaline and help you into a healthier rest-digest-repair state.
Oxytocin is sometimes called the ‘love hormone’ and it counteracts the action of cortisol, so we can also try to boost our oxytocin level. Pleasurable activities, whether it’s walking the dog, singing in a choir or sex and cuddles, all give us an oxytocin rush.
Diet and Eating Pattern
Rising cortisol triggers the release of sugar into the blood, which in turn triggers insulin release. Eventually our cells stop responding normally to insulin, sugars are stored as fat and we are left feeling tired and hungry, while our weight easily increases. Ultimately this can lead to conditions such as diabetes and Alzheimer’s disease. The situation is exacerbated by the lower level of oestrogen which also contributes to insulin resistance.
Intermittent Fasting can be an effective way of managing insulin and provides a wide range of long-term health benefits. For menopausal women, try a daily pattern of 14:10, where you eat within a ten hour window and then fast for fourteen hours (overnight) till the next meal. It’s worth checking your fasting blood sugar level – in the morning before you eat – as a proxy for your cortisol level. If your fasting blood sugar level is high it may mean that your cortisol has gone up due to the fasting regime – your body thinks you are at risk of starving and pumps you full of sugar. If that’s the case, shift to, say, a 12:12 pattern and retest. Experiment and find a pattern that suits you.
Regular exercise can also make a huge contribution to your long term health. Strength training helps you push back against the loss of bone density and muscle mass and also stimulates the conversion of testosterone to oestrogen, boosting levels in all your tissues post-menopause.
Thyroid
Another hormonal change that occurs at menopause is a decline in thyroid function. In fact, menopausal symptoms and hypothyroid symptoms can be very similar and it may be worth getting a blood test, especially if there is low thyroid in your family. 18-25% of women in their 40s and 50s are thought to have hypothyroidism, which can be treated. Thyroid function and the menopause are connected to each other. The decline in sex hormones disrupts thyroid T3 production leaving you feeling tired, anxious and irritable, with dry skin and unpredictable bowels.
Sex-hormone based HRT can make hypothyroid symptoms worse. Equally, thyroxine treatment can interfere with HRT’s bone density benefits, so it’s important to have the correct diagnosis before starting pharmaceutical treatment. Regular exercise and a good multi-vitamin/multi-mineral supplement can support thyroid function, with zinc and selenium particularly important.
Sex Hormones
When it comes to the sex hormones themselves, I hope the above explanation has clarified that they are somewhat at the mercy of other hormones in your system! Oestrogen declines slowly and in waves, while progesterone just falls rapidly between 35 and 50 years of age. The decline in progesterone disturbs our sleep, affects mood, leads to anxiety, causes hot flushes and makes periods irregular. Low oestrogen leads to dry skin, vaginal dryness, low libido, painful sex, urinary tract infections (UTIs), irritability, depression, loss of bone density and muscle mass, aches and pains, headaches and weight gain. Post-menopause low oestrogen can affect cardiovascular and brain health.
The shifting balance between these two key hormones affects menopause symptoms, as well as their actual levels. In fact, the entire hormonal system is a matter of delicate balance, with small changes often having large impacts across the system.
Ask For Help
Armed with this information I hope you will be able to negotiate a better path through your menopause and beyond. Don’t be a heroine though! Get some help to guide you on your way, there are many resources available, which we can discuss. Start by having a look at Menopause Matters, which is full of great information and support. If you are concerned about your symptoms ask your GP to refer you to a specialist in menopausal health. If you are under 40 years old and think you may be perimenopausal, please seek medical advice as soon as possible.