From menopause symptoms, to diagnosis, diet, weight gain and bloating, get the lowdown on how to handle your health so you can thrive through the perimenopause
It’s World Menopause Month all through October and, while I’m not planning a street parade, now is the perfect time to focus on your health and get the help you need if you even slightly suspect you might be headed towards menopause.
While in the thick of menopause-related symptoms, it might feel like nothing you try would make any difference but there really are things that are game-changers, and I want to share some of these with you today.
As a nutritionist and health coach specialising in helping women rebalance their wonky lady hormones, I speak to women over 40 every day and many of them are having the worst time of their lives when their experience could and should be so much better.
The thing that bothers me most from the people I speak to is the misinformation, confusion and shame about this time in a woman’s life. It’s like it’s some big secret of which we must not speak, which is weird given it’s something that half the human population will experience at some stage in their lives.
Even having spent years ploughing through textbooks and lectures on anatomy, physiology and hormones as part of my training to become a Registered Nutritional Therapist, I was truly shocked myself when I started experiencing some of the lesser-mentioned joys of this mid-life challenge.
So now seems as good a time as any to answer 15 of your biggest perimenopause questions, bust open some of the menopause myths and secrets, and share some of the truths I have discovered on my own menopause journey, including the thing that I found the most terrifying.
Let’s get the ball rolling…
#1 - What’s the difference between menopause and perimenopause?
Menopause is the name given to the point in time your periods when you haven’t had a period at all for a year. The average age is about 51 but it can be a lot earlier.
Perimenopause is the 5-10 years in the run-up to menopause, aka menopause transition. So, you really could be on a downhill slide in your 30s.
Many people collapse the terms menopause and perimenopause together or use them interchangeably and that does make things a bit confusing. Although many people get “menopause symptoms” after they’ve reached menopause, the roughest ride usually comes during perimenopause when hormonal output is a bit more unpredictable. I’ll be using the term perimenopause throughout most of this article to make things a little less complicated.
#2 - What are the symptoms of perimenopause?
There are a LOT of symptoms of perimenopause and many different parts of the body are affected. Small wonder since there are oestrogen receptors all over the body.
Allergies/ intolerances, anxiety, bloating & other digestive problems, body odour, brain fog, chills, depression, fatigue, forgetfulness, gum problems, headaches, heart palpitations, hot flushes/flashes, irregular periods, irritability, itchy skin, joint aches & pains, low sex drive, osteoporosis, pain or bleeding during sex, panic attacks, pins & needles, night sweats, sleep disturbances/ insomnia, sore boobs, thinning/ dry hair, urinary incontinence, more UTIs (like cystitis), vaginal dryness, and weight gain.
If you have a handful of these symptoms, you could be in perimenopause.
#3 - How is perimenopause diagnosed?
It’s very common for women to get packed off with antidepressants instead of getting a proper evaluation of their symptoms. Ideally, you want a sympathetic GP to listen to your symptoms, and they may or may not send you off for a blood test for confirmation of perimenopause/menopause before making a comprehensive plan, which may or may not include hormones (topical or systemic).
NICE guidelines state you don’t need confirmation from laboratory tests if you’re over 45 but if you’re under 40 and have symptoms, your FSH (follicle-stimulating hormone) levels will almost certainly be looked at. If you’re over 45, FSH is not a reliable enough marker since levels can be erratic by this point in your life.
#4 - Am I in early perimenopause?
If your periods stop before the age of 45, this is considered early. Premature menopause or premature ovarian insufficiency occurs before age 40. Anything that damages your ovaries can cause early menopause, including surgery and some medical treatments like chemotherapy.
Where there is no obvious cause, it might be in your genes. If your mother entered menopause, there is a greater chance that you will, too. There are lifestyle factors that play a part, too, including smoking and very low body weight can cause early onset menopause.
#5 - Why are my periods so heavy?
Is this you? One minute your periods are normal, then they’re light, then heavy like you’ve been killed in your bed. Maybe they’re on time or, at other times, delayed.
In perimenopause, your hormones fluctuate instead of a reasonably steady and predictable output you might have experienced in previous years.
What does it mean if my periods are shorter?
Your changing hormones can lead to a shorter follicular phase as ovulation happens sooner in your cycle.
What is happening if my periods are heavier and last longer?
If your oestrogen levels are higher (relatively) than your progesterone levels, bleeding can be heavier or last longer. This is because the uterine lining is greater, which leads to more bleeding.
NOTE: while heavy bleeding is very common in perimenopause, it’s always worth getting this checked by your doctor. Although it’s probably nothing to worry about, very heavy periods can occasionally be a sign of something more ominous.
#6 - Can I get tested privately?
Organising your own tests can be very empowering, and this is a service we offer in the Food Fabulous clinic.
One of the most helpful tests is the DUTCH test, and it has nothing to do with the Netherlands. The DU part stands for ‘dried urine’. Don’t let that put you off. It’s a fantastic test for measuring what is happening with all kinds of hormones from oestrogen and progesterone to testosterone and cortisol. We’re not only looking at levels of these hormones in your body, we’re looking at how the hormones are being metabolised.
What makes this test better than blood or saliva tests is that the sheer volume of information we collect in a single test.
Typical tests you can get from your GP are nowhere near as helpful, and they typically won’t look at cortisol rhythms or oestrogen metabolism. Your results are then interpreted for you and a personalised plan is created. If you are interested in ordering the test for yourself, email the office at info@foodfabulous.co.uk.
#7 -Why am I struggling to lose weight in perimenopause?
Once women hit their 40s, they typically gain an average of 1lb a year so you could easily be a stone heavier by the time you reach 55. Terrible news.
This happens thanks to the complex relationship between oestrogen and progesterone. While oestrogen levels drop in perimenopause, progesterone usually drops more dramatically, resulting in oestrogen levels being proportionately too high. This leads to increased conversion of carbohydrates into fat, as well as sugar cravings.
As you edge closer to menopause, low oestrogen levels cause fat to be stored around the middle as visceral fat.
You might also find you’re hungrier – studies show that the hunger hormone ghrelin is often higher in perimenopausal women compared with those who are pre-menopausal or post-menopausal. Long and short: you might feel driven to eat more calories than you actually need.
At this stage of life, you’re also more likely than before to be insulin resistant. Insulin is the hormone the body makes to deal with carbs, so you don’t end up with too much of what ultimately gets turned into sugar in your blood.
When you lose your sensitivity to insulin (you become more insulin resistant), the body makes more insulin than it needs to because it reads the hormonal signals less well. More insulin = more storage of fat when you eat carbs.
As a side note, lack of sensitivity to insulin is often lurking behind some of the more obvious symptoms linked to menopause like hot flushes, exhaustion, difficulty concentrating and weight gain. I’ll be telling you how you can change your diet to help fix this later.
#8 - Why does perimenopause cause bloating?
Bloating might well have started knocking at your door like an unwelcome guest. It’s a bit more complicated than this but let me give you a rough outline of why this happens. As you age, levels of stomach acid decrease, and you also make also fewer digestive enzymes. Both are needed to help you break down the food you eat.
When food isn’t broken down in a timely fashion, it starts to putrefy (gross, right?) and this causes gasses that can make you farty and uncomfortable.
Then there’s that oestrogen dominance piece from earlier, where oestrogen levels are too great as a ratio compared to progesterone. You might have more water retention which can, in turn, cause bloating. Progesterone usually acts as a natural diuretic that helps to get rid of water retention. Remember that, although oestrogen drops in perimenopause, progesterone levels fall off a cliff.
#9 - Why is gut health important in menopause?
Gut health is really important for every woman (OK, it’s important for men, too). You may have heard of the microbiome. No? It’s the term used for your digestive ecology and there’s a tremendous amount of work right now into how this affects health in general.
The microbiome is also critical for the health of your hormones. The ‘estrobolome’ is the community of bacteria responsible for metabolising and modulating oestrogen levels in your body. Your gut bacteria affect your oestrogen levels, which in turn has an impact on your weight, your sex drive and how you feel along with how you experience other symptoms of perimenopause like hot flushes and night sweats, memory problems, and problems with your vagina.
This is all linked to an enzyme called beta glucuronidase, which impacts the level of oestrogen circulating in the body.
I do like a stool test in my clinical practice since it’s always ideal to know exactly what you’re dealing with when making a personalised plan. Good stool tests will look at all kinds of things, from the types of beneficial or pathogenic bacteria, the presence of yeasts, inflammatory markers, digestive enzymes and also beta glucuronidase. Fascinating stuff. Do get in touch if you are interested in functional testing like this.
In short, an unbalanced gut is terrible news for those perimenopausal symptoms.
#10 - Do I need to change my diet in perimenopause?
Look, I’m not the police and what I’m about to tell you isn’t the law, but if you’re struggling with perimenopause, I really do recommend it. The ideal situation is you make some sweeping changes to your overall eating strategy. This is what I support my clients to do so know that you don’t have to do this on your own. – unless you want to.
Remember, your body can’t handle carbs in the same quantities as it used to so basing your diet around protein like organic meat, wild fish, eggs, nuts, seeds, tofu, chickpeas, beans and lentils is a good start. Then, add in lots of veggies, especially green leafy veg. Focus on those things that grow above the ground.
Then you’ll want to take a look at how many carbs you eat and what kind. The former speaks for itself, but also think about whether you can swap to brown or wholemeal versions, which have less of an impact on your blood sugar levels, requiring your body to make less insulin and, consequently, make you store less fat.
This is not the same as no carbs. It’s the right carbs.
It’s not just a question of weight, remember. A diet higher in carbs will make perimenopausal symptoms much worse in general.
I appreciate that might sound a bit scientific and possibly a bit scary but eating this kind of diet really is enjoyable and filled with foods you’d probably heard you couldn’t eat, like good fats, avocados and eggs!
#11 - What are the best foods for perimenopause?
It’s easy to forget that food is much more than the sum of its parts; the vitamins and minerals, and whether it’s a protein, fat or carb. And don’t even get me started on calories. What I’m talking about here are functional foods that actually “do stuff” in the body.
You’ve seen how, on one level, the food you eat can help balance your blood sugar and energy levels. The cherry on top is to use the very subtle yet magical powers of food to help support your body in times of need.
At this time of your life, that means phytoestrogens. Phytoestrogens are plant-based chemicals (the good kind), which are structurally similar to oestrogen and exert a weak oestrogenic effect. They include soybeans (and anything made from them like tofu, miso, tempeh and so on), flaxseeds, lentils, beans, chickpeas, oats, alfalfa, apples, pears, carrots, fennel, onion, garlic, and sunflower seeds.
Bringing more of these into your diet is an excellent tactic.
#12 - Does stress affect menopause?
Self-care in your 40s and 50s is no longer a ‘nice thing to do’, it is essential for managing symptoms of the transition to menopause and also – she says dramatically – staying alive. If you’re more stressed, you will experience far worse symptoms. Fact.
Let’s start with stress and the #1 perimenopause bugbear: weight gain. The stress hormone cortisol keeps glucose in the blood high this is the exact opposite of what you want if are hoping to lose the perimenopause belly.
It also has you craving carbs.
As oestrogen decreases, the body is less well able to regulate cortisol so you experience stress more readily.
More stress equals chemical signals to eat more carbs and also comfort eat.
Now is the BEST time to really focus on your stress action plan and your self-care.
By the time you get to your mid to late 40s, you are likely working, and juggling family and relationship commitments. Your own happiness falls right to the bottom of the to-do list – often to the extent that you might not even remember what makes you truly happy. And with this apparent lack of other things to bring joy, the biscuits always end up winning.
The impact is that this makes any hormone imbalance worse, and you find you’re in a constant conversation with yourself about what it means that you have just polished off a whole packet of Hobnobs.
During coaching sessions with me, if ever my clients start eating in a way that isn’t aligned with their health goals, I know that self-care has disappeared. When they bring it back in, the biscuits take a back seat in their lives again.Now is the BEST time to really focus on your stress action plan and your self-care.
#13 - What’s the best exercise to lose weight in perimenopause?
My clients have often turned to really punishing exercise regimes in a bid to lose their menopause weight – think long runs and spinning. Eating less and exercising more really is a flawed concept for women at this stage of life. It’s all to do with those stress hormones.
Exercise is generally considered a positive stressor on the body, which means it places stress on the body but in a good way. The caveat in midlife is you need to choose the type of exercise that doesn’t add stress.
Your body would really prefer you to lift some weights to take care of your bones and build muscle, which does start to otherwise decline at our age. And it would like you to move in a way that feels good – like dancing, regular cycling, yoga or pilates, or Zumba.
#14 - How does perimenopause affect the brain?
Hormones play a big part in mental health because these chemical messengers are the background to everything that happens in your body. In fact, there are a huge number of symptoms that are common to both depression and hormonal imbalance. These include low energy, dizziness, low mood, apathy, anxiety, irritability, anger, lack of enthusiasm, despair, headaches, poor concentration, feelings of hopelessness, lack of confidence, low libido, fuzzy brain, memory loss, and insomnia (although there are others).
One of the first things to know is that the production of dopamine and serotonin (the two main brain chemicals linked to feelings of wellbeing) is heavily linked to levels of oestrogen.
Around your age, testosterone will also be declining. Though you might be thinking that’s OK because you’re not a man, women need testosterone too. Testosterone can increase sexual desire and libido, make bones and muscles strong, and have you feeling assertive and confident.
#15 - Is the only way to improve menopause symptoms to take HRT?
HRT is one of the ways that you can support your hormones in perimenopause but it’s not magic and it’s not suitable for everyone.
Hormone Replacement Therapy is either systemic – acts on the body as a whole – or topical (vaginal). It might be a tablet, patch or gel (systemic) or cream or pessary (vaginal).
It might contain just oestrogen or be a mix of oestrogen and progesterone. Some women also take testosterone. That’s a conversation for you and your doctor.
Before perimenopause, I was always of the opinion, do it all naturally. Very much in the same way I knew I was NEVER going to ask for an epidural during childbirth. In both scenarios, there came a point when I thought ‘just give me the drugs already!’
There was no ONE moment. It was a kind of layering of symptom upon symptom. And when it got to the stage my joint aches and pains prevented me from being able to open a bottle of water and I felt a hundred years old… That.
You will draw your own conclusions, but I really invite you to do your research. There are some great books around. And talk to your doctor. I’d also say, don’t take no for an answer. If your questions are not being answered in a supportive, helpful manner, see a different doctor. You don’t have to take this thing lying down. You have the right to have a decent perimenopause. If you’re looking for some support when it comes to fixing your diet and lifestyle, I’m your gal. You can book a free call to let me and my team know what you need.
PS Want to know the most surprising thing I learned about menopause?
Frankly, there are so many things that might surprise you about the transition to menopause if you thought hot flushes were the main symptom. I think the thing that shocked me most was that vaginas shrink with age. It’s called shortening, which feels astonishingly inaccurate since it’s not the relative lack of length that causes the discomfort.
It’s all part of something called ‘vaginal atrophy', which is effectively your vagina slowly dying.
You can expect your ladybits to shrink and shrivel and to get more UTIs and thrush due to the change in bacterial balance ‘down there’ and a general lack of lubrication. It really is quite brutal and hardly anyone is talking about it.
Please don’t worry, there is a lot you can do about it! You must go to your doctor and brace yourself for a discussion about the health of your vagina, which for some might be excruciatingly embarrassing.
The truth is the situation can really be greatly improved by topical oestrogen. In this particular instance, even dietary change cannot make enough of an impact.
If you’re really struggling, I heartily recommend the book Me & My Menopausal Vagina by Jane Lewis.
Right now, what I have for you is this fantastic guide – yours free and gratis – 7 Secrets to a Healthy Happy Menopause. Get yours here - https://www.foodfabulous.co.uk/healthy-menopause
The first step to getting back into balance is this
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