The Essential Guide to Thriving in Menopause

Menopause is a natural stage in a woman's life, yet it can often feel overwhelming due to the multitude of changes occurring within the body. This guide aims to provide an in-depth understanding of menopause, its stages, symptoms, and the various treatment options available. Drawing insights from respected experts in functional medicine, Dr. Lara Briden and Dr. Jolene Brighten, we will explore both conventional and natural approaches to managing menopause.

Menopause marks the end of a woman's reproductive years, characterised by the cessation of menstruation. It typically occurs between the ages of 45 and 55, with the average age being around 51 in the UK (1). However, some women may experience menopause earlier due to genetic factors, medical conditions, or surgical procedures (e.g., hysterectomy).

Determining if someone has entered perimenopause is complex, as there is no single test for it. The transition to menopause is gradual and hormone levels can vary unpredictably. Therefore, doctors consider a range of factors such as age, menstrual history, and symptoms to diagnose perimenopause. Common symptoms include irregular periods, hot flashes, and sleep disturbances.

A healthcare professional can determine if a woman is experiencing menopause by conducting blood or urine tests to measure hormone levels. These tests can assess the levels of:

Estradiol

This hormone's levels decline around the time of menopause and become undetectable after menopause.

Follicle-stimulating hormone (FSH)

FSH levels rise as menopause approaches. The brain produces FSH to prompt the ovaries to produce estrogen. However, FSH levels can vary throughout the menstrual cycle.

Menopause is not a singular event but a series of stages that can span several years:

This transitional phase can begin as early as the mid-30s, lasting until menopause occurs. During perimenopause, hormone levels fluctuate significantly, leading to irregular menstrual cycles and various symptoms (2).

Menopause is officially diagnosed when a woman has not had a menstrual period for 12 consecutive months. This stage signifies a significant decrease in oestrogen production (3).

This stage begins after menopause and lasts for the rest of a woman's life. Symptoms may ease for some, while others may continue to experience menopausal symptoms related to lower hormone levels (4).

Women may experience a variety of symptoms during menopause, including (5):

• Hot flashes
• Night sweats
• Mood swings
• Vaginal dryness
• Sleep disturbances
• Weight gain
• Changes in libido

Hormone Replacement Therapy (HRT) is commonly prescribed to manage menopausal symptoms, but it’s essential to differentiate between conventional HRT and bioidentical HRT (BHRT).

This approach typically uses synthetic hormones derived from pregnant mares' urine or manufactured in laboratories. While it can be effective for some, many women experience side effects, including bloating, headaches, unexpected vaginal bleeding, mood changes including low mood and depression, diarrhoea, hair loss, and an increased risk of certain health conditions (6).

In contrast, BHRT utilises hormones that are chemically identical to those produced by the human body, making them more compatible and often better tolerated. Dr. Jolene Brighten advocates for the use of BHRT, citing its safety and efficacy in managing menopausal symptoms with fewer side effects (7).

In addition to BHRT options, many women seek natural remedies to alleviate menopausal symptoms. Consider implementing the following:

• Herbal Supplements: Herbs such as black cohosh and red clover have been traditionally used for their potential to alleviate hot flashes and other menopause-related symptoms. Black cohosh, in particular, may help regulate hormonal fluctuations (8), while red clover is rich in phytoestrogens that can mimic estrogen in the body (9), providing relief for many women experiencing these changes.
• Acupuncture: This ancient practice of traditional Chinese medicine involves the insertion of fine needles into specific points on the body. It has shown promising results in reducing the frequency and intensity of hot flashes, as well as improving overall mood and well-being (10). Many women report a greater sense of balance and calm after undergoing acupuncture treatments, making it a valuable option for managing menopausal symptoms.
• Mind-Body Practices: Techniques such as yoga and meditation focus on the connection between the mind and body, promoting relaxation and stress reduction. Regular practice of yoga can enhance flexibility and strength (11), while also fostering mindfulness, which has been linked to improved hormonal balance. Meditation, on the other hand, helps to quiet the mind, reduce anxiety (12), and cultivate a sense of inner peace, all of which can be beneficial during the transition of menopause.

Functional medicine takes a holistic view of health, focusing on identifying and addressing the root causes of symptoms rather than merely treating them. Both Dr. Briden and Dr. Brighten advocate for this approach:

• Individualised Treatment Plans: Each woman’s experience with menopause is unique, with diverse symptoms and challenges that can vary widely from one individual to another. Functional medicine practitioners take a comprehensive approach by thoroughly assessing each woman's health history, lifestyle choices, and environmental factors. This in-depth evaluation enables them to create highly tailored treatment plans that address specific needs and promote overall well-being during this transitional phase of life.
• Gut Health: Dr. Brighten emphasizes the crucial connection between gut health and hormonal balance, highlighting that a well-functioning digestive system plays a significant role in the body’s hormonal regulation (13). She suggests that maintaining a healthy gut, through a balanced diet rich in probiotics and fiber, can lead to improvements in menopausal symptoms. By supporting gut health, women may experience reduced hormonal fluctuations, enhanced mood stability, and overall better management of menopausal challenges.

Both Dr. Briden and Dr. Brighten have shared valuable insights regarding effective natural management of menopausal symptoms.

• Nutrition: Dr. Briden emphasizes the crucial role of nutrition in achieving hormone balance during menopause. Incorporating a variety of foods rich in healthy fats, fiber, and antioxidants not only supports overall health but also alleviates some menopausal symptoms. Foods like avocados, nuts, seeds, and leafy greens can be particularly beneficial, helping to stabilize energy levels and improve mood (14).
• Gut Health: According to Dr. Brighton, maintaining gut health and addressing inflammation is vital for effectively managing menopause symptoms. Probiotics and prebiotics can play a significant role in sustaining a healthy gut flora, which is essential for hormone regulation and overall well-being (15). Foods such as yogurt, fermented vegetables, and whole grains can help nourish beneficial gut bacteria, leading to improved digestion and reduced inflammation (16).
• Physical Activity and Sleep: Both experts highlight the importance of engaging in regular physical activity and prioritizing quality sleep to enhance overall quality of life during menopause. Exercise can help reduce stress, improve mood, and maintain a healthy weight (17), while adequate sleep is necessary for hormone regulation and recovery (18). Incorporating activities like walking, yoga, or strength training, along with establishing a calming bedtime routine, can significantly contribute to better health during this transition.

Navigating the stages of perimenopause and menopause can be a challenging experience. These life transitions bring about significant hormonal changes that can impact your overall health and well-being. One area that often requires attention is nutrition. Understanding common nutrient deficiencies and extra nutritional needs during these phases can help you maintain optimal health and manage symptoms more effectively.

Hormonal changes during menopause can lead to a decrease in bone density, increasing the risk of osteoporosis. This is mostly due to the lowered levels of oestrogen (19). Calcium and magnesium are both crucial for maintaining strong bones (20). Women in perimenopause and menopause should aim to get enough calcium and magnesium through their diet and supplements if necessary. Magnesium also aids in sleep, and helps regulate muscle and nerve function (21). A deficiency can exacerbate symptoms like cramps, insomnia, and mood swings.

Sources of Calcium (22):

• Dairy products like milk, cheese, and yoghurt
• Leafy green vegetables such as kale and spinach
• Fortified foods like orange juice and cereals

Sources of Magnesium (23):

• Plant foods: Legumes, dark green leafy vegetables, nuts, seeds, whole grains, and fortified cereals. Some specific examples include:
  • Leafy greens: Spinach and kale
  • Nuts and seeds: Almonds, cashews, and pumpkin seeds
  • Whole grains: Quinoa and brown rice
  • Fruits: Avocados, bananas, apples, and papayas

Vitamin D enhances calcium absorption and plays a critical role in bone health (24). Due to reduced sun exposure and aging, many women may experience a deficiency in vitamin D during menopause.

Sources of Vitamin D (25):

• Sunlight exposure
• Fatty fish like salmon and mackerel
• Fortified foods and supplements

Vitamin B12 is essential for energy production and cognitive function (26). Absorption of B12 can decrease with age, making it important to monitor intake during menopause.

Sources of Vitamin B12 (26):

• Meat, fish, and poultry
• Eggs and dairy products
• Fortified cereals

While the risk of iron deficiency decreases post-menopause due to the cessation of menstruation, some women still struggle with low iron levels. Iron is vital for oxygen transport in the blood and energy levels.

Sources of Iron (27):

• Red meat and poultry
• Beans and lentils
• Spinach and fortified cereals

Phytoestrogens are plant-based compounds that can mimic the effects of estrogen in the body. They may help alleviate some menopausal symptoms such as hot flashes and night sweats (28).

Sources of Phytoestrogens (29):

• Soy products like tofu and tempeh
• Flaxseeds
• Legumes

Omega-3 fatty acids have anti-inflammatory properties and support heart health, which is crucial as the risk of cardiovascular diseases increases post-menopause (30).

Sources of Healthy Fats (31):

• Fatty fish such as salmon, mackerel, and sardines
• Chia seeds and flaxseeds
• Walnuts

Fibre is important for digestive health and can help manage weight by promoting a feeling of fullness. It can also aid in controlling blood sugar levels and lowering cholesterol (32).

Sources of Fibre (33):

• Whole grains like oats, barley, and quinoa
• Fruits like apples, berries, and pears
• Vegetables such as broccoli and carrots

Adequate protein intake is essential for maintaining muscle mass, which can diminish with age. It also supports overall metabolic health (34).

Sources of Protein (35):

• Lean meats like chicken and turkey
• Fish and seafood
• Plant-based proteins like beans, lentils, and chickpeas

Perimenopause and menopause are periods of significant change, but with the right nutritional support, you can manage symptoms and maintain your health. Paying attention to common nutrient deficiencies and incorporating foods rich in essential vitamins and minerals can make a substantial difference in your well-being.

Navigating menopause can be challenging, but with the right support and knowledge, it can be a smoother transition. Here are some actionable tips:

1. Stay Informed: Educate yourself about menopause through reputable resources, forums, and workshops.
2. Connect with Others: Join support groups or online communities where you can share experiences and advice with other women going through similar changes.
3. Consult Healthcare Professionals: Work with healthcare providers who understand menopause and can guide you through treatment options.

Women in the UK have access to various resources and support networks:

• Menopause Matters - A dedicated website offering information, forums, and support for women experiencing menopause.
• The British Menopause Society - Provides educational resources and guidance on managing menopause.
• Online Communities - Platforms such as Facebook Groups and Reddit forums where women can connect and share experiences.

Menopause is a natural phase of life that comes with its challenges, but understanding the process and exploring treatment options can empower women to manage their symptoms effectively. Whether through conventional methods like HRT or natural alternatives, the key is finding what works best for you but always being aware of the pros and cons of any treatment so you can make an informed decision first.

By adopting a functional medicine viewpoint and heeding the advice of experts like Dr. Lara Briden and Dr. Jolene Brighten, you can approach menopause with confidence and make informed decisions about your health.

For further support and resources, consider connecting with health professionals who specialise in menopausal health and functional medicine. Your transition doesn’t have to be daunting—embrace the change with knowledge and community backing you.

Written by Amy Morris, BSc (Hons) Nutritional Therapy. Amy has been a nutritional therapist for 12 years, specialising in recent years as a functional medicine nutritional therapist. Women’s health, and pre-diabetes and type 2 diabetes prevention are Amy’s specialist areas. Diagnosed with a chronic condition called endometriosis at age 20, this is what motivated Amy to study nutrition. Amy has been in remission for 6 years now, attributing powerful nutrition, lifestyle and bio-identical hormone strategies she now shares with her clients. 

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