Historically, treatment options have been limited to hormone replacement therapy and symptoms have often been dismissed as being normal and part of the process. In addition, there has been little recognition of the changes that can occur in the years leading up to menopause, with very few women ever having heard of perimenopause.
For clarification, menopause is a retrospective diagnosis with women reaching menopause 12 months after their final period. The average age of menopause in Australia is 51. However, many hormonal changes occur in the lead-up to this final period and often cause more disruptive symptoms than menopause itself. This transition period is called perimenopause and can start anywhere from 2 to 12 years before the final period.
The hormonal changes with perimenopause include a gradual decline of progesterone and a fluctuation in oestradiol, with levels being up to three times higher than in early perimenopause. These changes can cause symptoms such as increased anxiety, sleeplessness, night sweats, hot flushes, body pains, heavy periods, and migraines, just to name a few. As blood hormone testing often looks normal at this time, women are often diagnosed with other conditions, such as anxiety, depression or fibromyalgia and given treatments to target these. However, there are many lifestyle changes women can make that can support their bodies, reduce symptoms, and even improve their long-term health after menopause.
Symptoms of menopause and perimenopause are largely neurological, with the changing levels of hormones affecting function in the brain. Therefore, anything that is affecting the brain can lead to an increase in symptoms. So here I have listed my top 5 lifestyle changes women from 40 years of age can make to improve their symptoms and set themselves up for a smooth transition through menopause.
One of the best ways we can support our bodies is by fuelling them with the right foods to assist with hormone detoxification as well as lowering insulin levels. High insulin levels cause a lot of inflammation around the body and can result in the worsening of perimenopausal and menopausal symptoms. Levels increase in response to increased blood glucose levels, so the goal is to maintain steady blood glucose during the day.
I recommend filling your plate in this way:
One of the worst meals in our modern-day society is breakfast, with common breakfast foods spiking blood sugars and setting up a labile blood sugar for the day. In the evening, adding in a good source of carbohydrate to your meal to support hormones and aid with sleep is crucial. Instead of reaching for pasta or bread, look to incorporate a wholefood carbohydrate, like sweet potato or pumpkin.
Women that suffer from hot flushes or night sweats will attest to the fact that they are worse after a few drinks. Alcohol wreaks havoc on the body in multiple ways, it is a neurotoxin and acts directly on the brain. It also requires detoxification by the liver, which during perimenopause is under the pump with the added requirements of hormone detoxification. Both result in reduced alcohol tolerance and worse hangovers. Alcohol affects the quality of sleep and increases cortisol, which further increases the effects on our brain. Add in the fact that alcohol increases a woman’s risk of breast cancer, and you are looking at a lot of reasons to cut down or ideally eliminate alcohol!
Muscle mass is directly affected by growth hormone and testosterone levels, both of which decline in women after the age of 40. Therefore maintaining muscle mass can be so difficult and why weight gain around the abdomen is so common. In recent years, high-intensity exercise has been the focus of a lot of fitness talk. While small amounts of cardio certainly have a lot of benefits, too much high-intensity exercise raises cortisol and increases the stress on the body. Increasing strength and weight-bearing exercises, women can improve their muscle mass, assisting with weight management, bone density and lower insulin levels.
The circadian rhythm is a process that occurs inside just about every living thing that is predominantly affected by light patterns. The body takes a lot of cues from the world around it to assess the environment. Nowadays with electricity and technology, the body can become very confused and interpret threats unnecessarily. Trying to support the circadian rhythm can assist the body’s function and reduce overall stress levels. When the sun goes down, turn off overhead lights and use floor or table lamps around the house. Minimise screen time and aim for a regular bedtime every night. In the morning, try a morning routine of doing some breath work outside in the sunlight (even if it is overcast!). In addition to light, the body also takes cues from things like food intake. Eating three meals per day during daylight hours assists the body in its day/night recognition and assists with digestion.
From an evolutionary point of view, perimenopause was a time when life was slowing down and becoming most restful. However, in our modern society, with women often having younger children, being at the peak of their careers or caring for elderly parents, women in their 40s are often more stressed than ever. Some stresses can’t be eliminated but permitting yourself to say no to things is extremely powerful. Prioritising sleep, getting out into nature, and focusing on breathing and meditation practices will become more essential. I often recommend changing social catchups to a nice walk outside instead of catching up over a glass of wine. This is an important time to also mention the importance of past trauma. Progesterone is our body’s “chill pill” and helps us cope by acting on the GABA receptors in the brain. As the levels decrease from around 40, women can experience more anxiety than ever before. This is particularly predominant in women with past trauma or adverse childhood events. Sometimes things that a woman has packaged up neatly inside their brain become unravelled during this time. Seeking support and looking at vagus nerve regulation in these circumstances becomes particularly crucial.
In addition to the tips above, it is also beneficial to seek advice from a health practitioner experienced in this area to help assess any increased risk of health conditions associated with menopause, including cardiovascular disease, diabetes mellitus, and osteoporosis, as well as discuss the possibility of Menopausal Hormone Treatment. I also suggest women take certain supplements such as magnesium bisglycinate and taurine to improve symptoms and highly recommend seeing someone trained in this area to prescribe supplements depending on the individual needs to improve overall health dramatically. With the right education and treatment approach, women should be able to thrive during this transition period and enter menopause with good health and vitality.
Dr Lucy Caratti is a highly qualified Integrative Doctor with 15 years of clinical experience and an expert in women's health, particularly issues like menopause, gut health, metabolic diseases, and hormonal imbalances.