Over the course of their lives women have many changes in their hormone levels. Nothing much happens until we hit puberty, when hormone levels increase, causing us to develop female characteristics and we start menstruating. For many women hormones can start to fluctuate in their late 30’s and through into their 40’s, a period known as perimenopause, or the bit before menopause. Changes around this time can be quite confusing, so I thought I would try and explain what is happening and what to expect.
Hormones start to become unbalanced as ovarian function starts to decline. It may mean that one and eventually both ovaries stop ovulating as egg supplies dwindle. Generally our progesterone levels drop first, which means it becomes out of balance with oestrogen, making our oestrogen levels too high. Here’s what can happen when these hormones go out of balance.
• Progesterone is the hormone that maintains the lining of the uterus in the second half of our cycle, levels increase days 14 to 28; with day 1 being your first day of menstruation. If the egg released at ovulation has not been fertilised the progesterone levels drop, the lining is no longer maintained and we start our period. If progesterone levels are lower when ovulation starts to fail the result is that menstrual cycles may start to occur earlier than normal; often around day 21. Sometime women may end up getting cycles every couple of weeks or spotting.
• As time progresses you may have short cycles and longer cycles. The closer you get to menopause the larger the gap between periods.
PMT gets worse
• Since progesterone is the hormone that makes up calm and happy lower levels can leave us feeling angry, moody and anxious. Women in peri-menopause who may have previously had not issues may suddenly start to get these mood swings as hormone levels change
• As we have said previously when progesterone goes down by contrast we get oestrogen excess. This can lead of sore breasts, fluid retention, headaches and skin breakout.
Oestrogen Excess conditions
• Excess oestrogen around peri-menopause can often lead to heavy periods. Again women who may have always had light periods may suddenly find periods getting heavier. For some bleeding can become excessive and they may end of with clots and flooding. This is often associated with oestrogen driven growths such as fibroids and polyps, which are generally benign. Of course if you do suffer excess heavy painful bleeding you should get it checked by your GP. You may also end up low in iron which will leave you feeling constantly fatigued.
Hot flushes and insomnia
• In general this tends to occur only as periods start to become infrequent. Have a read on the notes about menopause to understand this. You may find yourself waking in the night too.
Weight gain round the middle and sugar cravings
• As you get closer to ceasing periods you will find that the metabolic rate naturally starts to slow down and you don’t seem to need to eat so much without gaining weight. You may also find you have weight round the middle and start to have sugar cravings.
What can be done about it?
If you have heavy bleeding your GP will probably offer you a special IUD (intrauterine device) called a Mirana that is low dose progesterone that helps balance the hormones. You can also have an ultrasound to look for fibroids and these and polyps can be removed by surgery if they are really bad.
There are a number of herbs and nutrients that can be used to help balance hormones and make the transitions to menopause a little easier. Unlike the oral contraceptive where the hormone levels in the body are controlled these herbs work with our own hormones to bring them back into balance. This can help reduce bleeding and mood swings. We can support the liver, which is trying to manage clearing excess hormones that can lead to weight gain, sluggishness and headaches. Dietary changes and supporting blood sugar imbalances can also help.
What to expect from Menopause
Ladies have you recently started having a few random hot moments, been feeling anxious or are wide awake in the middle of the night? If you are in your 40’s or 50’s it could be the start of menopause. Menopause is officially classified as when you have had no period for a year. However you could have been missing your period for a couple of months and find yourself experiencing menopause symptoms. At this point we are no longer ovulating, so the ovaries stop producing oestrogen and progesterone.
We do have maintain lower levels of hormones in the body, but they are produced in the adrenal glands. Having reduced hormone levels can lead to many physical and mental changes, so I thought I would outline some of the things you could expect.
Hot flushes and insomnia
Hot flushes are a well-known feature of menopause. You will experience a sudden over-heating and your face will become flushed. It often happen after caffeinated drinks, when you are stressed or in the night. Wearing layers is a great tip as you are always needing to take clothes off and on at the drop of a hat. It often happens at the start of menopause as hormone levels are setting down.
However a major contributor to hot flushes and insomnia (often waking round 3am) are adrenal imbalances, caused by the adrenal glands taking over hormone production. This is because for many women in their 40’s and 50’s life is very busy. You might be juggling family, work, friends, looking after elderly parents and trying to stay fit. Quite often this leads to stress, which is managed by our adrenal glands by releasing stress hormones. So many women are hitting menopause with their adrenal glands working at full capacity and the new job of producing hormones is the last straw.
The additional stress to this hard working gland can lead to the production of excess stress hormones - namely cortisol. High cortisol can lead to waking in the night, hot flushes and feeling of being wired and tired.
This can be the result of our testosterone levels going down. However if you are tired and not sleeping well this is not going to help.
Vaginal and bladder issues
This is a less talked about issues with menopause, but an area that cause a lot of discomfort. As our oestrogen levels go down the tissues in the vaginal and bladder thin. This can lead to an increased propensity towards urinary tract and vaginal infections. It can also lead to a drying out of the tissues and general vaginal dryness, which can cause issues for some women during sex.
As with perimenopause low progesterone levels can leave women feeling anxious and less able to cope with things that would normally be no issue. Some women can feel quite flat and generally exhausted, often due to lack of sleep.
Weight gain round the middle
Like perimenopause our metabolic rate can slow down and weight gain becomes easier. Again this weight gain centres round the middle, which is often due to poor liver function and blood sugar imbalances.
When the adrenal glands are producing too much cortisol this can lead to blood sugar dis-regulation, so restoring the balance here is import when looking to improve blood sugar balance. It is also important that we manage our central adipose fat as once we enter menopause we have the same risk of heart disease as men.
Bone density issues
When oestrogen levels declines there can be an increased possibility of bone density less. Some women may have family history of bone density issues, so they may need to take extra care to prevent any loss.
In relation to serious hormone imbalances your general practitioner may offer you HRT (hormone replacement therapy) or an integrative doctor might suggest bio identical hormones, which are a more nature identical version of HRT. Looking at sleep issues you may be prescribed sleeping pills for a short period or you can ask for a script to get melatonin, which works well but is expensive as it is not funded. For low mood anti-depressant medication may be offered.
With regards to low oestrogen level affecting the vagina there are low dose vaginal hormone creams and tablets that can support local oestrogen levels to relieve discomfort.
My first priority as a practitioner working with menopausal women is to support the adrenal glands. This can help with sleep and hot flushes and generally feeling slightly more able to cope. There are many herbs and nutrients that can help to balance the adrenal glands, helping them to function better.
One group of herbs that I would use are known as adaptogens and as the name implies they help our body and adrenal glands adapt to stress. There also great herbs for nourishing the adrenal glands at this time when they can become a little over worked. They are great calming and restorative herbs and really help with getting sleep patterns back into balance. There are a number of calming herbs and nutrients that can support anxiety levels and help to build positive mood.
When looking at weight gain then we would look at regulating blood sugar levels and some dietary changes that can help to stop that middle area weight gain. Diet and nutrition can also help with heart health and bone density issues as we age.
Finally there are natural products that can help those prone to vaginal dryness, frequent urinary tract infection and vaginal infections like thrush.
If you can identify with any of these area then come and book an appointment - I can help you with a smoother transition through your time of change.