Do I need HRT? And is 40 too young for symptoms? And how long will this last? Claire Turnbull has answers and tips for navigating this transitional time of life.
Not that long ago, the word ‘menopause’ was something that was associated with older women who sweated uncontrollably at night, or who had to deal with hot flashes at their desk making life uncomfortable and for some, embarrassing.
This phase of life wasn't talked about in the workplace and wasn't something many women felt comfortable to talk about anywhere else either. When it came to managing symptoms, it was pretty much, suck it up and get on with it.
More recently though, this conversation has been thrust into the spotlight, and we are on a major catch-up trying to help women manage the transition from one phase of life to another – which can go on for over a decade.
With increasing research, awareness and conversation about this topic, women are finally starting to access support to manage many of the over 50 symptoms they can experience – from being vaginal dryness, brain fog, and rage, to unbearable joint pain, loss of libido and weight gain round the middle.
There is, however, still a lot of misunderstanding about this phase of life and a lack of awareness of the impact on lifestyle from symptoms. Here are seven things you need to know to get yourself up to speed.
1. What is the difference between perimenopause and menopause?
Menopause refers to the final menstrual period, confirmed once you haven’t had a period for 12 consecutive months. The average age of menopause in New Zealand is 51-52.
On reaching this one-year milestone, you are then officially considered to be post-menopausal. Although importantly, this does not mean that symptoms like hot flushes, night sweats, sleep issues and mood changes, for example, just suddenly stop. For some, they can stick around for a while.
Perimenopause is the phase of life leading up to menopause and on average can last around 7-10 years, less for some, more for others. It’s in this phase that there can be wild fluctuations in a women’s reproductive hormones, especially oestrogen and progesterone which can result in the wide range of symptoms that can occur.
2. Am I too young to experience perimenopausal symptoms?
I have met hundreds of people in my work in their early 40’s particularly who have been told they are too young to be experiencing perimenopause, and this simply isn’t true. When you consider the averages of menopause and perimenopause symptoms starting, it is absolutely possible that some people in their early 40’s are struggling with symptoms and even younger for some.
I hit this phase myself at age 41 after experiencing extreme anxiety, rage, unbearable pins and needles in my hands and feet, as well as forgetting what I was doing almost every time I walked into a different room or opened a cupboard. This was without anything else changing in my life which could explain it, everything else I was doing was status quo.
The first GP I saw dismissed my situation because of my age, but having worked in the medical world for over 20 years, I know that sometimes you need to get a second or third opinion from a specialist in the area. Eventually, when all other causes of my symptoms were eliminated, I got the answer which I knew to be correct and, now with more knowledge and on treatment, I feel immensely better.
3. How can I get through?
The first step is to look at your lifestyle as there are many things you can do that can really help manage symptoms. What you eat being one of them. Research shows that eating a wide variety of plant-based foods can help. That means getting across the basics of good nutrition with your five-plus handfuls of veggies a day and two servings of fruit, even at the weekend.
A good way to achieve this is by following the way they traditionally eat in the Mediterranean which as well as plenty of fruit and veg, also includes pulses and unsaturated fats that are found in olive oil, nuts, seeds, and avocados, plus several serves of fish each week. This way of eating also helps provide plenty of fibre which is good for your gut and fuels your gut microbes which in turn can make many beneficial compounds to support your body.
You may also find that including foods rich in phytoestrogens such as soy products, flaxseeds, chickpeas, and lentils can be helpful, as they provide plant compounds that have a very mild oestrogen-like effect and may help support the body as its own oestrogen levels decline.
Managing caffeine and alcohol, as much as no one really wants to hear it, can truly help. You may find that as you hit this phase of life you become less tolerant to caffeine – it can make you feel more anxious and increase the risk of heart palpitations, another symptom that women may struggle with.
Alcohol can also really screw up your sleep, mood and worsen hot flashes, so trying a week or two without it to see how much of a difference it makes is worth a go. You can then assess your level of tolerance and see what can work for you in the longer term. Personally, I have gone from being able to have a couple of units a couple of days a week, to not being able to manage more than one unit in an evening, without it resulting in night sweats and being awake from 3am.
Prioritising 7-9 hours of sleep, keeping active (including both aerobic and strength-based training) and ensuring you spend enough time outside in nature are all also essential steps.
Beyond lifestyle changes, there are other things which can help with symptoms including Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT). This supplies oestrogen, progesterone, and for some women, testosterone, to help manage the symptoms that come with the decline in these hormones during perimenopause.
This option is something to discuss which a GP who knows your health history and can help you decide if this would be right for you. Look to see a GP who understands women’s health and is across the latest research in this area as day in day out I still come across people who tell me that they have been told that they are too young for HRT or don't need it because they aren’t having hot flushes, neither of which are in line with current guidelines.
4. Why are my clothes getting tighter even though I eat the same amount?
It sucks and I hear you. I feel like my clothes have been put in the dryer on hot over the last few years and everything has become too snug!
There are many things at play here.
One, your muscle mass declines as you age, and this is a very metabolically active tissue meaning it burns lots of calories even at rest. So, to combat that, we need to take action to maintain and build muscle mass, and yes that means including some form of weight or resistance training.
Secondly, you become more resistant to insulin as you go through this phase which means you don't manage the amount of sugar in your blood as efficiently. The remedy for this, as mentioned above, is getting adequate sleep, keeping active with a goal of keeping hold of your muscle mass, plus being mindful of the quality and quantity of carbohydrates you eat. That doesn't mean ‘going keto’, it means going for things like oats, wholegrain bread, grainy crackers and brown rice over more-processed white varieties and trialing having a little less than you used too.
Three, a decline in oestrogen changes the way that fat is stored on your body meaning you are more likely to gain weight round your middle.
5. Do I need to obsess about protein?
Focus yes, obsess, no. I am all for getting adequate protein but in recent times I feel like this message has got out of hand and out of balance with the importance of remembering the totality of what you eat also matters.
Yes, you may benefit from eating more in this phase of life than you did previously, so go ahead and look to make sure you are getting protein at each of your meals and your snacks (my goal is 20-30g/meal with additional protein in snacks if I have them).But thinking you have to add endless protein powder to everything you eat, eat tubs on tubs of cottage cheese every week and feel stressed when you have a meal without protein is sometimes taking things too far.
6. How can I deal with this night-time waking?
As we get older this is something that can become more and more common and seems to be a particular problem during this phase of life for women. I myself now wake up at least twice a night, partly because I need to pee, another joyous symptom of this phase of life!
My key tips here are firstly a great eye mask that blocks out all the light, and if it works for you, some ear plugs. Both have changed the game for me. Secondly, don't check the time or your phone when you wake up. It just gets your mind buzzing and makes it harder to get back to sleep. Thirdly, if you do get up to pee, keep things as dark as possible. Try not to drink too much too close to bedtime. Also, remember alcohol and caffeine can hugely impact night-time waking!
7. Are there supplements I need to start taking?
The rise of awareness in any topic to do with health comes the opportunity to market something to you, the consumer! From lotions, potions and powders to treatments and of course supplements... the marketing messages are out in full force ready to try and get you to spend some of your hard-earnt money.
There are only really a couple worth solidly considering. Here are a couple of examples. First up, Omega 3 in the forms of DHA and EPA. The amounts recommended are the same for all adults currently, however there are links between omega 3 and perimenopause symptoms like depression and hot sweats as well as their ability to reduce inflammation in the body, so this is something to think about. Food is best, but if you aren't getting what you need through your diet, a supplement may be required.
Secondly, Vitamin D may be something to consider, this is essential for many things including bone health which comes under the spotlight in this phase of life because as oestrogen helps protect our bones and as it declines, this increases our risk of osteoporosis. Post menopause, your calcium requirements go up from 1000mg to 1300mg. For most people, this increase can absolutely be managed through diet changes rather than supplements.
Magnesium may be helpful to support sleep, and creatine may also be something that some women find helpful to support their training and, with emerging research about bone and brain health, may have additional benefits too.
Many of the menopause-specific supplements have limited evidence to support them; so far nothing has been found to be as effective as MHT for the main symptoms of menopause.
For personalised advice on supplementations (as there are more you could consider) and doses which are right for you, talk to a registered dietitian or nutritionist.
Claire Turnbull is a registered nutritionist.
SHARE ME