Many women experiencing menopausal symptoms tell me they want to ‘push through’ naturally using lifestyle habits to manage their symptoms.
There is absolutely no doubt in my mind that eating a healthy, wholefood rich, well balanced diet, that includes a wide range of plant based foods, limited processed foods and is rich in essential fatty acids and protein will help immensely.
Similarly, regular exercise that challenges all areas of fitness including cardiovascular, strength, endurance, coordination, flexibility and motor skills will ensure that the decline in bone and muscle density is slowed, maintaining heart and lung function, helping with weight management as well as mental wellbeing.
There’s certainly benefit to be gained in terms of symptom management from ensuring we get enough good quality sleep and managing our stress levels through stress management techniques such as focused breathing, meditation, mindfulness and restorative exercise such as yoga or Tai Chi.
But there is, in my opinion, a limit to how effective lifestyle habits alone can be in fighting the inevitable depletion in hormones encountered as we reach menopause.
HORMONE FLUCTUATION VS HORMONE DEPLETION
Many women experience hormone fluctuations throughout the whole of their reproductive life. Rising and falling levels of oestrogen and progesterone throughout the menstrual cycle can lead to symptoms such as irritability, tearfulness, drops in energy levels and cloudy thinking.
These fluctuations may benefit from the lifestyle habits I mentioned earlier, although many women choose to use hormone based contraception to help regulate hormonal fluctuation too.
‘Balancing’ erratic hormones through diet and exercise is one thing, but it is my belief that as we approach menopause we may need more than lifestyle measures alone to combat not only menopause symptoms but also longer term health risks.
Unlike during the menstrual cycle, as we head towards menopause (the point at which women no longer produce eggs) we are gradually losing oestrogen and progesterone – key hormones that play a much wider role in the body than simply reproduction.
Women are now living much longer lives than our predecessors with many potentially spending a third or more of their lives deficient in oestrogen and progesterone.
This has major implications on longer term health, since oestrogen is a key hormone in supporting bone, heart and brain health.
Once oestrogen production in the ovaries stops, oestrogen levels in the body drop significantly. Although oestrogen is also produced in the fat cells and the adrenal glands, the amount produced post menopause is not sufficient on its own to offer the same level of protection to the heart and bones as ovarian produced oestrogen.
There is some evidence to suggest that a diet rich in phytoestrogens, plant based oestrogens found in certain foods such as soy, oats and flax seed among others, may help to support oestrogen production. All of these foods are healthy, whole foods and useful to add to the diet, but in my opinion will never be sufficient to replace the depletion in ovarian produced oestrogen encountered through perimenopause and beyond.
HORMONE REPLACEMENT THERAPY
Since the early 2000s HRT has taken a beating in the media following the premature publication of the Women’s Health Initiative Study which highlighted an increased risk of breast cancer in women taking HRT.
This study has since been reviewed, with many of the findings being either rejected or amended, but its legacy lives on with continued sensationalist headlines giving a biased and sometime wholly inaccurate account of the risks related to HRT.
This has led to many women being afraid of HRT despite the fact that it has been proven without doubt to be the most effective treatment for managing many of the symptoms related to menopause including vasomotor symptoms (hot flushes and night sweats), psychological symptoms (anxiety and depression) also sleep issues, dry skin and erratic moods.
There is no right or wrong when it comes to what we believe to be the right approach as we navigate our way through menopause.
We all have beliefs about what is right for us as an individual and the decision about how we manage our symptoms and our health is ours and ours alone. No one should ever dictate which route we choose to go down. And I believe that also includes our GP!
However I also think it’s important to remember that our beliefs are simply thoughts which we have chosen to accept as the truth. Consequently it is always useful to challenge those beliefs from time to time, especially if we become aware of facts or information which we previously didn’t know.
I personally was of the belief, like many women, that HRT was a no-no since my mum died of breast cancer at the age of 54. I believed that my close relationship to her put me at too high a risk of breast cancer and I believed all of the information I read in the newspapers reinforcing the risk.
However when I started to do more research and educate myself beyond the newspaper headlines I began to challenge my original beliefs. I looked for balance in the information I was reading. I looked at the research and the science and realised that in many cases even the ‘experts’ disagree about the level of risk.
But in doing this research I was able to question my thoughts and beliefs around menopause and around HRT in particular. I started to look at the wider picture and assess the risks in a broader context. I explored not only the risks but also the benefits of hormone replacement, not often written about in the media and often overlooked or discounted by GPs who lack currency in their menopause knowledge.
My aim, in writing this article, is not to ‘convert ye non-believers’, far from it. It is very much my philosophy that everyone has the right to their beliefs and choices around how they manage their menopause. My aim is simply to remind us all that our beliefs may not always be based on facts and that it is a good idea to challenge our beliefs occasionally to make sure that they are serving us in the best way possible.
The British Menopause Society has recently issued a joint statement on menopausal hormone therapy, commonly referred to as hormone replacement therapy, in response to an article published in the Lancet on 30 August 2019. It offers a well balanced response and is worth a read.