What Menopause Lifestyle Planning Looks Like
As Menopause Awareness is upon us, GP, Functional Medicine, and Hormone Doctor Sohère Roked shares her insight around lifestyle planning during menopause.
Thankfully, the menopause is shedding its taboo status as a talking topic, and there’s a palpable shift in open discussion around how the condition presents in our lives. The menopause is having its wellness moment, although a historical lack of dialogue has deemed it difficult for some of us to feel clear about exactly what the menopause is (and perimenopause), navigating the impact on our lifestyle, and what solutions are available to support with coping.
What is Menopause?
This is when women stop having periods, it usually happens between 45 and 55 years old.
What is the Perimenopause?
Perimenopause is the stage before menopause and before periods stop. It can last up to 10 years and is often more difficult to manage because periods can be more frequent or irregular and affect mood and energy a lot.
What are the symptoms of menopause?
People often think of symptoms as being hot flushes, but menopause can affect mood, cause anxiety, you can be more worried, have poor sleep, increased aches and pains, poor concentration or focus, lower sex drive, vaginal dryness and urinary symptoms like increased frequency or cystitis. There may also be issues with dry skin, more wrinkles, hair loss, bloating, tingling and dizziness. The symptoms are broad, and they vary.
Exercise in Menopause
Exercise at every stage of your life is very important, in terms of exercising in the perimenopause and beginning of menopause, the key is to review what form of physical activity you should be doing. Quite often I see patients who feel extremely weak, fatigued and un-motivated (if their testosterone is low). In these situations, I don’t believe it is good to push yourself too far because you can end up driving the stress hormone cortisol up higher, which is not conducive to hormone balance! If an individual is feeling particularly weak and fatigued, I suggest that walking for 20 minutes every day is a good idea. Perhaps a bit of yoga, which is good for both the mind and the body.
However, if someone is used to exercising and thrives from it, there is nothing wrong with some running, a bit of HIIT, going to the gym or doing weights – what’s important is that they feel better after the exercise – not more exhausted! If they feel weaker and more fatigued after this is not a good sign, it shows that their cortisol is very high, and the exercise is making it higher. When I see an individual who really enjoys running, I ask if it’s causing them fatigue, if it is I suggest reducing the intensity of their efforts perhaps to 50 or 60 % of what they normally do. In terms of the best type of exercise at this time of life, weights are great for building strength, muscle mass and bone density – and amazing for helping testosterone production! When the body is under stress and there’s lots of inflammation (like in perimenopause and menopause) exerting too hard can make the situation worse. If you do enjoy high intensity just look at the way you are doing it, perhaps for less time, or reduce the intensity.
Nutrition in Menopause
I am often asked what foods best when in the menopause. A lot of it comes down to good, common-sense nutrition! For example, avoiding a lot of sugar and processed foods. Sugar interferes with our hormones; it hinders our stress hormones and causes more inflammation making hot flushes and sleep worse. It is very important to have a good quantity of healthy fats, found in nuts, seeds, avocado, olive oil… Fat is essential for female hormone production. Especially during the perimenopause, where hormone levels are fluctuating, an amount of healthy fats will be very important – I’d say with every meal. A good level of protein is also key, particularly if you are perhaps vegetarian and not eating meat and fish, make sure you are getting an adequate protein source. When it comes to fruit and vegetables, I advise to go for a minimum of 5 servings of fruit or veg each day. Vegetable choices should be more cruciferous - broccoli, cauliflower, brussel sprouts, kale etc because these are great for hormone balancing.
I suggest that fruit choices are more on the berry side - also important for balancing hormones. In a nutshell:
Get rid of the bad stuff like processed and sugary foods. A little bit now and again is fine, but it’s good to be mindful that a little bit doesn’t turn into a lot!
Add in the good stuff – good fats, enough fruit and vegetables, and enough protein.
Carbohydrates are not a bad thing, especially when your body is under stress, like it is when you are in the menopause. Go for healthy carbs that are non-refined like rice, brown pasta and sweet potato, which are all balancing.
Ideally your plate should be made up of 1/3 protein, 1/3 carbs, 1/3 veg, fruit or salad and added fat like an olive oil dressing.
Work in Menopause
This is such a key topic, people often wonder should they tell their boss they are in menopause, do they need a meeting with HR, is it anyone else’s business...? Ultimately, the main priority is what support an individual feels that they need. As with any kind of medical concern someone is going through, if you find it’s impacting your work it probably is something that should be discussed. As a whole, these days we are looking at taking away the taboos around menopause and I think having a conversation with someone in management or in HR, if you are struggling, is important and certainly shouldn’t be held against you in any way. It’s worth explaining some of the symptoms you’re having and how it could be impacting your work, for example if you’re not sleeping very well that could have an impact on your work and perhaps you could change your hours, or sometimes work from home to accommodate this. If you’ve got doctors’ appointments to attend, these are obviously important if you’re reviewing HRT etc, so that should be made a priority. If you’re experiencing brain fog and want to change the way you work a little bit, or maybe you don’t actually want to change anything and you want to emphasise that to your boss and explain that you simply want to make them aware that you’re not quite yourself.
I think the first step is to get clarity around the support you feel will benefit you before you have a conversation, if you want to have a conversation at all, and once you’re clear on that you can approach any discussion with your needs at the forefront. I think it’s great that it’s becoming less taboo to talk about menopause and that’s a vital move towards keeping women in the workplace. A huge number of women actually stop their job because of their menopausal symptoms, I’ve seen many patients where this has happened. But the good news is, once they are stable on treatment the patients I’ve seen are usually able to go back to their work and find it fulfilling.
HRT (Hormone Replacement Therapy) in the Peri-Menopause
It’s pleasing to see that there is more recommendation for women to take HRT in the perimenopause instead of waiting to reach menopause. The difference is, in perimenopause you are quite often still having periods, but they may be irregular, or they might be heavier, you could notice more PMS or other symptoms such as sleep disturbance or flushes periodically throughout the month. Quite often patients come to see me because their GP won’t treat them util they’ve had an amount of time with no periods, which signifies the menopause. Sometimes patients come to me and say they weren’t treated because they were told that they were too young! If you’re having symptoms and if you’re having irregular periods, menopause can happen at any age as can perimenopause. Perimenopause is more common in your 40’s and menopause in your 50’s but it can happen at different stages, and age shouldn’t be a barrier to receiving hormone replacement therapy. I often talk to patients about their symptoms, we sometimes do tests to establish what is going on with their hormones and to look for the balance between the hormones. When we start HRT sometimes it can be progesterone alone which is really good for mood and sleep. Other times it can be oestrogen and progesterone, oestrogen helps with flushes, focus and concentration. And sometimes we also add in testosterone which targets energy, mood, concentration, muscle strength and sex drive.
I work with women in the perimenopause, when their hormones are fluctuating, to try and get them feeling more balanced and then the experience can be much easier for them as they transition through menopause. Like I said, I don’t feel age should be a barrier and if an individual is concerned, they should see an expert who does provide hormones on a regular basis and understands how to treat perimenopause. I’ve been treating perimenopause for almost 10 years now so it’s an area that I’m very comfortable with. It’s always important to speak with an expert who knows what they are doing and has seen many cases so they can spot the patterns that patients can present. New studies show that starting oestrogen early, in the beginnings of perimenopause or in the early stages of menopause, can help prevent neurological changes that can lead to conditions like dementia, Parkinson’s or other brain pathology. These do affect women more than men and this is thought to be due to the lack of hormones in menopause, so it’s not just important for symptom relief but in relation to long term health improvement.
