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Menopause and Perimenopause (told in Penguin Paperback bookcovers)

A bit of fun with a serious message underneath. Those who know me well will know I'm an avid reader. To celebrate this, I have this picture on a wall in my house made up of lots of front covers of Penguin paperbacks (thank you Gemma), and it occurred to me how many of them could feature in a piece on peri-menopause and menopause the covers below as you would a comic strip before you read the text of this blog!

On a more serious note, entering peri-menopause can be a really challenging time in a woman's life, and it's only really recently that we've started to talk about it. Firstly, definitions - peri menopause can last for years and is the period leading up to the menopause. Menopause is defined as being the point in time one year after you had your last period. On average in the UK that's around 52, but it can vary enormously.

Some of the book covers above reference the symptoms of (peri)menopause which are extensive and can include:

  • weight gain, especially around the middle

  • hot flushes, night sweats and temperature variations

  • insomnia

  • irritability and mood swings

  • changes in digestion, including slower gut motility, increased bloating and flatulence

  • memory issues and brain fog

  • loss of libido

  • dryness - vaginal, skin, even eyes and elsewhere

  • loss of bone density

What fun eh?! And this isn't even an exhaustive list.

As beautifully set out by Dr Lara Briden, the underlying reason for these symptoms is hormonal changes. As if you didn't know that. But you may not know that the first hormone to drop away is in fact progesterone. Then oestrogen goes on a rollercoaster ride. I read somewhere recently (I will come back and credit it as soon as I remember where) that progesterone is like a "pressure cooker lid", that it helps keep those oestrogen roller coaster symptoms under control. So once progesterone drops away, then oestrogen is free to wreak its havoc....

If you look at the oestrogen curves (here, oestradiol, or E2, in pink), it ramps up during puberty, then does a monthly little up-down jig all through our reproductive years (it's around though the whole cycle because it has roles way beyond reproduction). Meanwhile progesterone, the orange curve here, again ramps up in puberty and then has a very definite "up" at ovulation and lasts during the luteal phase of each cycle, to drop away again at menstruation.

But look at oestrogen compared to progesterone in peri-menopause ...woah. Those oestrogen up-downs, varying in pattern, without the progesterone to keep the proverbial lid on. That's one (but not the only) reason (peri)menopause can be such a sh*t show.

The standard approach these days seems to be to put a woman on HRT. Great, you can just plug in missing hormones, eh? All very well but if you are one of the many women who do not metabolise or detoxify oestrogen so well because of your genetic make-up, you are placing a detox burden on your body. (Watch out in the next blog for a cautionary tale of HRT). The image here is of a client's epigenetic test results, looking at the genes involved in oestrogen detox. The black blobs show areas where she needs support. Perhaps we should be testing we can adequately detox oestrogen before putting everyone on HRT.

So what else can you do to support yourself through this life phase? Lots, as it turns out. Balance your blood sugar (all hormones will react to blood sugar rollercoasters). Some sort of weight-bearing exercise to counteract sarcopenia (muscle loss as we age) and loss of bone density. Homeopathy can be wonderful (but see a qualified homeopath, don't self-prescribe). Those epigenetic glitches in the pink box above? There are some amazing dietary interventions that can help you get the oestrogen detoxifying more effectively. There are also some really great natural herbs and botanicals, including adaptogens, which can be really helpful.

The Japanese word for menopause, konenki, means renewal, which is exactly what it should be. So help yourself to a bit of renewal and revitalisation, don't suffer alone.


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