October was menopause awareness month – which provided a welcome opportunity to challenge views, as well as raise awareness.
Despite 50% of the population going through menopause…there is relatively little general education around it…and for many previous generations it was mentioned in hushed voices……the same as the onset of menstruation! It is great to see that this is changing.
What is menopause and perimenopause?
Menopause, is defined as the end of menstruation (periods). A woman is considered to be post menopausal (completed menopause) when she has been free from menstruating for a year.
The transitional time leading up to menopause is known as the perimenopause. This can be very different from woman to woman, in terms of age of onset, duration and severity of menopausal symptoms.
There is no easy way to predict when perimenopause will start and how long it will last, though family history (experience of mother, older sisters) gives some indication. The average age of onset in the UK is 51 years and if onset is below 45 years, this is considered to be premature menopause.
There is also medical menopause, which due to its nature, has a sudden onset. This occurs as a consequence of medical interventions which affect the ovaries, such as chemotherapy, radiotherapy or removal of the ovaries, often during hysterectomy.
Hormone changes
Menopause is not a disease or a disorder, it is a natural event that occurs as a consequence of changes in hormone levels. During perimenopause levels of oestrogen and progesterone fluctuate. The main symptoms of menopause are due to the decline in levels of oestrogen.
Menopausal Symptoms
No woman’s experience of perimenopause is exactly the same. While most women will have menopausal symptoms, they can range from being few and mild to extremely debilitating, such that they impact on everyday life. These symptoms, for some, can be relatively short lasting just months, and for others, can persist for over a decade!
Hot flushes and night sweats
While hot flushes are common the intensity, length and frequency vary considerably. They are a consequence of changes in blood vessel activity and are often a cause of misery. This can range from the embarrassment of being red and sweaty to being unable to function due to lack of sleep (night sweats) and ‘brain fog’.
Sleep problems
Affect about 50% of women. Sleep patterns become more disturbed and unpredictable. This is thought to be linked to more light sleeping and the mind being more active. Drenching night sweats, which are common, can have a serious impact on sleep.
Mood changes
Fluctuating hormone levels can result in a roller-coaster of emotions from ‘menorage’ and irritability to floods of tears, low mood and depression. Mood changes may also be caused or exacerbated by factors not related to hormonal changes, such as lack of sleep.
‘Brain fog’
Many women report difficulty in concentrating and other issues with cognition, such as poor memory. It is thought that hormone changes, in particular the wild fluctuations at the onset of perimenopause cause ‘foggy thinking’ and that this settles down as the brain adjusts to the new levels. ‘Brain fog’ may also be connected with sleep disturbance and vascular symptoms associated with menopause, such as hot flushes.
Impact on physical and mental health
Post menopause the changes in hormone levels can impact detrimentally on physical and mental health.
Increased risk of cardiovascular disease (CVD).
This was the focus of this year’s menopause awareness month. While menopause doesn’t actually cause heart disease, as oestrogen levels decline, women lose their protective effect against heart disease.
Oestrogen is generally protective in that it keeps blood vessels ‘healthy’. Flexible and open, ensuring good blood flow and prevents cholesterol from building up. It also helps regulate blood pressure.
Essentially, changes at menopause mean that the risk factors for CVD are increased in women. This includes unfavourable changes in cholesterol levels leading to atherosclerosis, changes in fat distribution causing increased abdominal fat, increased blood pressure and reduced glucose tolerance.
Post menopause women’s risk of heart attack increases to the same level of men. It is the major cause of death in women in the UK. Despite this known increased risk women are frequently misdiagnosed and are less likely to receive resuscitation (CPR) in the street.
Changes in Fat distribution.
Menopause is associated with changes in energy expenditure and fat distribution. This can lead to weight gain and redistribution of fat toward a male pattern of visceral fat. This is fat stored deep in the abdominal cavity and surrounds the internal organs. This is a risk factor for insulin resistance and Type 2 Diabetes.
Osteoporosis
The risk of osteoporosis, characterised by low bone mineral density, is increased post menopause. This is due to oestrogen deficiency affecting the normal bone turnover cycle, resulting in net bone loss. The more porous and fragile bones are, the higher the risk of bone fractures.
Vaginal and bladder problems
When oestrogen levels diminish, vaginal tissues may lose lubrication and elasticity, making intercourse painful. In addition, low oestrogen may increase susceptibility to urinary or vaginal infections and loss of tissue tone may contribute to urinary incontinence.
Anxiety, stress and depression
Changing hormone levels we know can cause mood swings and for some women there is a marked increase in anxiety, stress and low mood. Why might this be? The same hormones that control the menstrual cycle also influence serotonin levels, a brain chemical that promotes feelings of wellbeing and happiness. Consequently, when hormone levels drop, serotonin levels also fall, which in turn contributes to increased anxiety and sadness.
Not surprisingly, there is an increased risk of having a depressive episode during perimenopause, especially for those who’ve experienced major depression in the past.
It should also be noted, that there may be other life changes happening at this stage of life that may be contributing to stress, such as children leaving home or parents requiring more care. There is also a vicious cycle set up, in terms of feeling stressed dealing with menopausal symptoms and stress exacerbating those symptoms. This can lead to a ‘spiralling down’ feeling unable to cope with things that previously were manageable.
Managing menopause and perimenopause
Menopause is a physiological phenomenon, characterised by the cessation of periods. Ovarian function naturally declines with age and when the ovaries stop making normal levels of certain hormones, particularly oestrogen then perimenopausal symptoms will be experienced.
For some fortunate women this transition is easily managed, for others this can significantly impact on their quality of life and requires hormone replacement therapy. What else can we do to help with this transition?
Research has shown that yoga and mindfulness can be beneficial in managing menopausal symptoms and help to reframe this transition more positively.
If you are interested in trying yoga and/or mindfulness, do get in touch.
I trained with Petra Coveney (Founder and creator of Menopause Yoga) to teach Menopause Yoga – using yoga poses, breath work and meditation to help alleviate hot flushes, manage fluctuating moods and help maintain heart health as well as bone and muscle strength.
I hold a Masters degree in Mindfulness based cognitive therapy (MBCT), which blends meditation and mindfulness alongside cognitive behavioural therapy techniques. This is really beneficial in tackling unhelpful thought patterns and reframing thoughts and behaviours. It is thought that helping women to change the way they perceive their symptoms can help manage them.
Interestingly, the National Institute for Clinical Excellence (NICE) has just published (17th November) a draft updated guideline on menopause. It calls for more treatment options for managing menopause symptoms and outlines the benefits of cognitive behavioural therapy (CBT). It reports that there is new evidence to show that cognitive behavioural therapy (CBT) can help reduce menopause symptoms including hot flushes and night sweats, depressive symptoms and problems sleeping
It is well known that stress exacerbates menopause symptoms so learning to manage and reduce stress is hugely beneficial. Yoga and in particular ‘slow’ paced breathing techniques are useful for switching on the relaxation response and reducing stress. Mindfulness practices are also effective in helping to regulate the nervous system and better manage stress. Clinical hypnotherapy, which induces a deep state of relaxation is excellent at reducing stress and anxiety. It is also effective in changing mindsets which can help in reframing menopause to a more positive experience.
I love the analogy of menopause being referred to as the ‘second spring’ in Traditional Chinese Medicine….a time for new beginnings….
Maybe we should take the opportunity to reflect and reframe menopause, looking towards the next stage of our lives.
Here is my preferred reframing – Menopause is
If you would like any help with managing this time of transition do get in touch to see how we can help support you.
Yoga has been shown to be really beneficial at ameliorating menopause symptoms and mindfulness is a wonderful tool for managing emotional fluctuations and improving brain function (neuroplasticity). While, Solution Focused Hypnotherapy can help support you with reducing stress, building confidence and seeing through those changes you want to make.
