Menopause

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Menopause is the term used to describe the end of a woman's periods, signalling the end of the reproductive years. The process is not sudden and will usually occur gradually with periods becoming less frequent before eventually coming to an end.

The menopause sets in when the ovaries stop responding to controlling hormones released by the pituitary gland and the brain. Without the eggs there is no way for the body to produce the female sex hormones oestrogen and progesterone, meaning the levels of oestrogen in the blood will fall and disrupt the menstrual cycle.

These hormonal changes can trigger a series of significant emotional and physical transitions which can be difficult and at times overwhelming.

When will the menopause happen?

According to the NHS, the average age for menopause onset in the UK is 52. The menopausal stage is said to begin when periods have been absent for one year, after which she is considered to be post menopausal.

Menopause onset before the age of 45 is known as early menopause/premature menopause, though this is fairly rare and only affects approximately 1 per cent of women under 40 and 0.1 per cent of women under 30.

Menopausal symptoms

The period of time preceding the menopause is usually referred to as perimenopause and this is when many women will begin to experience a series of hormonal and emotional changes which can result in unpleasant side effects.

The majority of women will experience symptoms and side effects during all stages of the menopause and unfortunately many women will find these difficult to keep under control and a struggle to live with.

Some women will be lucky enough to experience no adverse side effects of the menopause, though this is quite rare and most will be effected by at least one of the following common symptoms:

• Hot flushes

  Hot flushes bring about a sudden and intense feeling of heat in the upper body that may result in red and patchy skin and perspiration. Typically hot flushes only last for a few minutes but they can cause faintness, weakness and nausea. Some women may only experience the occasional hot flush but others can be plagued by in excess of each day.

  When hot flushes occur during the night they are referred to as sweats or night sweats. Generally symptoms are similar to a normal hot flush though some women experience such excessive perspiration that it disturbs their sleep and requires new bedding.

• Sleep disturbance

  In addition to the worry, medication, pain and certain medical conditions that keep us lying awake as we get older, menopausal women also have the results of various physical and emotional changes to contend with.

  These hormonal changes can bring about a plethora of sleep disturbances. From trouble sleeping due to night sweats through to difficulty falling asleep, broken sleep, insomnia, early waking times and sleepiness during the day.

  Lack of sleep can become debilitating if it continues for prolonged periods of time, causing irritability and memory and concentration problems.

• Urinary symptoms

  Bladder issues unfortunately become far more common we age, with the menopause resulting in increased susceptibility to cystitis, urinary tract infections and a weak bladder.

• Vaginal symptoms

  Symptoms include discomfort and itchiness due to vaginal dryness which can mean sex becomes uncomfortable and painful. It is thought that around one third of women experience this at some point with symptom onset happening shortly after the menopause for some but the majority experiencing symptoms later on.

Treatment options

Very few women actually seek advice from a medical professional with regards to their symptoms, going through the menopause without receiving any medication from their health care provider. Those who are able to do this will find that in time their symptoms will naturally subside after between two and five years from onset, though for some they will persist for longer.

If symptoms ever reach the stage where they are beginning to have a detrimental effect on your everyday life then there are various treatments which can help. The type of treatment you can take will depend on your symptoms and medical history and may involve one of the following options:

• Alternative remedies

  Many women wanting to control mild symptoms or those who are concerned about the possible side effects of hormone replacement therapy have turned to complementary and alternative treatments. Remedies such as black cohosh, red clover, soya, raspberry leaf, starflower oil and various homeopathic remedies can be purchased from most health food shops and though there is no hard evidence that they work, are relied upon by millions of women who have found them to be beneficial.

  If you are considering introducing one or more alternative remedies into your lifestyle then be aware that long term safety has not been assessed and some do contain oestrogenic properties which mean they are not suitable for women who should not take oestrogen.

  Where possible individuals should consult their GP about the changes they intend to make and should consult a qualified alternative therapist.

• Antidepressants

  Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help to reduce hot flushes in menopausal women. Though drugs such as SSRIs have a high success rate, they can cause adverse side effects such as nausea and reduced libido.

• Clonidine

  Originally designed as a treatment for high blood pressure, clonidine can also help to reduce night sweats and hot flushes in some women.

  It is usually prescribed for an initial trial period of between two and four weeks as it can bring about side effects such as depression, dry mouth, constipation and drowsiness. If side effects do occur, or if no difference is seen in symptoms then usage should be discontinued.

• Diet and lifestyle

  Many women find that making simple changes to their diet and lifestyle can help to ease certain menopausal symptoms. Throughout all stages of the menopause women should ensure they are regularly exercising and eating healthily.

  Frequent exercise, light clothing and cutting down the amount of caffeine and spicy foods consumed may help to reduce night sweats, and exercise in combination with relaxation techniques such as yoga and plenty of rest will also help to improve mood disorders.

• Hormone replacement therapy (HRT)

  There are various types of HRT all of which are based around the premise of replacing the missing oestrogen that the ovaries are no longer producing. There are three main types of HRT:

  - Cyclical, containing oestrogen and progestogen for women who are experiencing symptoms of menopause but are still have periods.

  - Oestrogen only, for women who have had their womb and ovaries removed.

  - Continuous, for post-menopausal women.

  HRT can effectively prevent hot flushes, night sweats and vaginal symptoms, and prolonged use has also been found to contribute to the prevention of osteoporosis and bowel cancer.

  Despite the benefits there are of course some risks, with some studies finding that HRT increases the incidence of stroke and breast cancer. Though these risks are small, if you are worried then visit your GP and discuss your concerns with them.

• Tibolone

  Tibolone is similar to HRT and is often used as a substitute for combined HRT for post-menopausal women who wish to end their periods. Can help to reduce hot flushes, night sweats and sexual issues such as reduced libido.

• Vaginal lubricants

  Moisturising creams and lubricants to help ease dryness can be purchased from most pharmacies.

Menopause and good nutrition

There are certain stages in our lives when we must adjust our lifestyle and nutritional habits in order to keep up with any changes to the body. When a woman reaches the menopause she may find that making some simple changes to her diet and way of life could actually help to decrease certain symptoms associated with menopause and could also help to protect against any related diseases.

Women who are going through the menopause may find that their need for certain nutrients will have reduced slightly whilst levels of others may need to be increased. Ideally, women should be aiming to include a healthy level of the following food groups in their diet:

• Calcium

  As discussed in the above, when a women enters menopause the body produces far less of the hormone oestrogen which subsequently increases the risk of osteoporosis. Osteoporosis is essentially thinning and weakening of the bones which can make them more prone to breaking. Keeping your calcium levels up can help to protect against osteoporosis because of it's key role in bone health.

  Keeping your calcium levels up is really important during the menopause because it plays a key role in not only bone health, but also in keeping your blood, muscle and nerves in working order. Good sources include dairy, canned fish, green leafy vegetables and tofu.

• Carbohydrates

  Carbohydrates provide us with energy and fuel, both of which are especially important for women whose hormonal changes mean they can often feel tired and lethargic throughout the day.

  A healthy and balanced diet should include wholegrain cereals, wholemeal pasta and bread and starchy vegetables which are high in fibre and vitamins. Try to restrict your intake of refined carbohydrates such as white bread and pasta and heavily surged cereals.

• Fats

  Reducing your intake of saturated fats can really help to protect against heart disease. Try swapping full-fat milk for semi skimmed or skimmed, stop using butter and replace it with a low fat spread and try to choose leaner cuts of meat.

  In addition to this you should also try to introduce healthy fats. For instance, the fat found in certain oily fish such as sardines and mackerel can contribute to a reduced risk of both heart disease and diabetes.

• Protein

  As we age protein plays an increasingly important role in helping the body to recover from illness, infection and surgery. It can be found in meat, nuts, pulses and dairy.

How could nutritional therapy help me?

As well as ensuring that the above food groups play an integral role in their diet, menopausal women can take further steps by introducing certain foods which may help in the management of common symptoms such as hot flushes, headaches, night sweats and irritability.

Some women may find that researching nutrition and the menopause and implementing certain dietary changes independently will be enough to keep their symptoms under control, though others who are experiencing more severe symptoms may require the help of a professional.

Consulting a qualified nutritionist could potentially benefit any woman who is struggling to cope with menopausal changes. They will work with individuals to create a personalised strategy of symptom management that will be tailored to each individuals unique circumstances.

The strategy may include targets, food suggestions, meal plans, supplement suggestions and motivational tips. It is also highly likely that the programme will involve a physical activity schedule, as exercise is key to maintaining a healthy weight. Though this is not strictly nutrition, weight management and fitness does indirectly help to manage certain symptoms of the menopause.

Any dietary or lifestyle changes made will be realistic and achievable, and regular meetings with your nutritionist will ensure you remain on track and motivated.

Below are a few examples of suggestions a nutritionist may include as part of a nutrition programme. Remember that a nutrition programme would be personally tailored to suit your needs so some of the following may be effective whilst others may have little to no effect:

• Eat more of the Right Fats

  Foods which are high in fat are quite often high in calories but low in vitamins and nutrients. Saturated fats are needed in the body, but as it stands most of us are eating too much of them and would benefit from reducing our intake. Cut down on the bad saturated fats and trans fatty acids which are found in processed foods, ready meals, fatty meats, butter, biscuits and pies etc and try increasing your intake of good fats such as omega-3 fatty acids which can be found in fish and olive oil.

• Increase your fruit and vegetable intake

  Phytoestrogen are chemicals which occur in plants which have a similar structure to that of oestrogen. Because of their similarity to oestrogen, many experts believe that the phytoestrogen fools the body into thinking that the body contains more oestrogen that it really does, potentially reducing some of the discomfort caused by low oestrogen levels throughout the menopause.

• Stay well hydrated

  The majority of healthy adults require between one and a half to three litres of water per day to replenish fluid levels and keep the body functioning. It is necessary for general growth and maintenance as well as helping to flush out waste and regulate temperature.

  Dehydration can lead to headaches, tiredness and concentration difficulties, symptoms which are common among some menopause sufferers. In order to stay hydrated we don't have to drink just water alone and juices and hot beverages with a high water content will also work in the same way.

  If possible steer away from drinking too many caffeinated drinks such as tea and coffee as caffeine is a diuretic which forces the kidneys to flush out more water than they should. The same goes for carbonated drinks such as cola, and alcohol, both of which may lower the amount of calcium your body is able to absorb from food. All of these drinks are find in moderation but should be included as part of a balanced diet.

• Eat smaller portions more regularly

  Working lives now mean that with the exception of Sunday lunch, most of us eat our main meal in the evening. Though this makes sense in terms of time and convenience, it also means that we are consuming the most calories at a time when the body is burning the fewest. In contrast, most will start the day eating a small breakfast when this is the time the body is in need of fuel and is more likely to burn off calories in the day ahead.

  It is impractical to expect people to eat their dinner at 7am, or indeed during their lunch break, but what we can do instead is eat smaller and more regular meals throughout the day. Those who do eat small but frequent meals tend to consume less calories and fat towards the end of the day and also give themselves more of an opportunity to burn off calories.

  Menopausal women will often feel tired and lethargic throughout the day and grazing means that the risk of tiredness due to low blood glucose is reduced.

  Understandably it will be difficult to change life long habits of eating dinner in the evenings so try to eat light low fat dinners as often as possible, serve smaller portions and discourage late night snacking which is usually down to boredom.

• Exercise frequently

  Exercise is important for body maintenance and weight management and should be considered and included as part of a healthy lifestyle.

  During the menopause exercise plays a particularly important role in improving circulation and heart function, decreasing cholesterol and bone loss and helping to improve our ability to cope with stress.

  In addition to this is it also a great way of making sure we stay within a healthy weight range, which can become particularly difficult as we age because of a drop in our metabolic rate and because we are less likely to engage in a range of physical activities.

• Take supplements (where necessary)

  During the menopause the body may need a little help in maintaining adequate levels of all the required nutrients. In order to give the body a helping hand you may benefit from taking one or more supplements which could be of benefit on both an emotional and physical level. Supplements which are commonly taken by women experiencing the menopause include vitamin B6 for anxiety, vitamin E for breast tenderness, St. Johns wort for depression and Magnesium for insomnia.

  Always consult your healthcare provider before introducing any vitamin or mineral supplements to your diet.

Further Help

• Menopause Matters

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All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional. Whilst some people have benefited from nutritional therapy, no claims can be made to treat, cure or heal specific conditions, and we strongly advise individuals with any health problem to seek independent medical advice from their GP before considering nutritional therapy.