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Menopause and Your Microbes

With more voices than ever speaking up about menopause, we asked Dr Shahzadi Harper to share some tips on how it affects your gut, and how to prioritise your health as you journey through it. This is one you definitely need to share with your friends.

Let’s start at the beginning, what is the menopause?
Menopause is when a woman’s periods have stopped for longer than 12 months. It's what we call a retrospective diagnosis, meaning it's only after you’ve not had a period for 12 months can you say that you’ve gone through menopause. It signifies the end of a woman's reproductive life because her ovaries have stopped ovulating – releasing an egg because her body is no longer producing the sex hormones, oestrogen, progesterone and testosterone. For most women this is usually around the age of 51 but for approximately 10% of women this can naturally occur earlier between the ages of 40 and 45, and for 1% of women it can occur prematurely under the age of 40yrs.

And perimenopause?
The time leading up to a women’s menopause is called perimenopause, this can start 4 to 8 years before your actual periods stop and this is when the symptoms of menopause first present.

Symptoms occur because the ovaries are winding down their production of oestrogen and progesterone, however it’s not a straightforward decline as hormone levels can fluctuate giving rise to peaks and troughs, which can mean some days symptoms can be worse than others and some days feel better than other days.

The first symptoms may well be changes to your menstrual cycle, you notice your cycle has got shorter, the nature of your period has changed i.e., you may notice that your periods have some months got lighter other months heavier, and eventually more spaced out until they eventually stop.

What are the most common symptoms?
The most common symptoms that most people have heard of is hot flushes and irritability. 60-70% of women do experience hot flushes and night sweats however, there are more symptoms than just these.

In the early stage of the menopause transition women often experience insomnia, anxiety, forgetfulness, brain-fog, and low mood. Women often say how they can feel overwhelmed, experience panic attacks and find that their normal multitasking skills just aren’t as sharp. Joint aches and pains also affect 60% of women, bloating and digestive issues are very common as well as maybe lesser talked about symptoms such as bladder leaks, vaginal dryness and loss of libido.

Women often feel they’ve aged overnight as their skin loses plumpness and glow and your skin and hair start to thin and break.

What can you do to help look after yourself?
Women can help themselves during this time by prioritising themselves and their health with the following tips.

Go back to basics and look at your diet and lifestyle
Bloating is a common uncomfortable symptom many women experience with hormonal change. It's important to look after and consider your gut microbiome during this time, as good gut bacteria can support with the digestive symptoms of menopause, as well as mood and immunity.

Look into the Mediterranean diet, which is plant-based with nuts, seeds, and oily fish and reduce the amount of red meat consumed.


Create a sleep routine
Insomnia and broken sleep have a huge impact on women's mental and physical health, so it's important to address any sleep issues in menopause. Many women talk about being able to fall asleep but that their sleep is broken, they’re waking up between 3-5am and in the morning and they wake feeling tired. Sleep management is very important as it affects concentration, focus and mood. It can exacerbate brain fog/haze and affect weight due to women fuelling themselves on caffeine and craving sugar/carbs to energise them the following day.

The reason why our sleep cycle is thrown off balance is because whilst we know our hormones oestrogen and progesterone are declining, this also has a knock-on effect on the hormone melatonin, which is responsible for our sleep-wake regulation cycle and so impacts our quality of sleep.

Creating a sleep routine and hygiene is important:

  • Learn to wind down in the evening by dimming lights, putting away any blue light such as your computer or phone.
  • Try doing some breathing exercises, having a bath and adding some magnesium salts - magnesium helps to calm and relax.
  • Declutter your bedroom and ensure that your bedroom is for sleep i.e. it’s not your office.
  • Ensure your bedroom temperature is not too hot nor cold, optimal is around 18-20c.
  • Having a weighted duvet can also help with sleeping well as it releases the hormone oxytocin.
  • Eating a lighter meal in the evening, reducing your alcohol intake or avoiding it completely in the evenings.
  • Also avoiding coffee in the evening and limiting it before 2pm can also help with your sleep.
Get moving
Getting some fresh air and keeping moving is an important part of looking after your general health. Keep moving, find something that you enjoy, there is no need to run a marathon, just 10-15 minutes 3 times a week, is good for your heart but also good for your brain.

Protect your mental health
Talking about the brain, many women experience symptoms such as anxiety, low mood and sense of loss of joy, so it is important to not only look after your physical health but your mental health too. Look at the way that you breath, is it shallow, are you getting oxygen all the way deep down into your lungs? Practice some diaphragmatic breathing, which is breathing in and ensuring that your lungs are fully inflated.

Have you thought about some rest and relaxation? Making some time for yourself, mindfulness is just as important as keeping active. Menopause can be a fantastic new chapter in a woman's life - this is a time to pause and reflect on life and prepare for a new phase.

If you’re finding it hard to cope with symptoms?
If you’re finding it hard to cope with your symptoms, it’s affecting your work, your home, your relationships, then let’s not forget about HRT, hormone replacement therapy. Talk to a health professional, weigh up the pros and the cons, the risks and the benefits for you. HRT usually consists of adding back the hormone oestrogen, as well as progesterone and sometimes testosterone. There are many different preparations and not only can it help with your symptoms in the here and now but also for future long-term health.

Speak to a health care professional to work out what is right for you, many women can benefit and there can be alternative medical options for those who are unable to take it. Bottom line is women don’t have to unduly suffer, midlife can be an exciting new beginning.

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