Some women find that menopause causes them little bother – perhaps a bit warm from time to time, a few aches and pains. Other women suffer multiple debilitating symptoms. Why is this and what can you do to create a smoother passage?

What happens during menopause?

‘Menopause’ is when the ovaries stop releasing eggs and menstruation ends for good. However, the transition to menopause is gradual, lasting for several years: a time called ‘peri-menopause’. During this time, the amounts of the sex hormones, oestrogen, progesterone and testosterone produced by the ovaries decrease. Most people know that oestrogen levels fall at menopause, but the story is more complicated (isn’t it always?).

Unfortunately, levels of the sex hormones do not fall at the same rate as each other, nor do they do so steadily: there are times when hormone levels increase again and then decrease. These constant ups and downs in hormone levels, particularly in relation to each other, means that the body is unable to compensate for the constantly changing levels causing of many of the symptoms experienced.

Three stages of menopause

Pre-Menopause: periods are still regular but there may be some evidence of changing hormones. This generally occurs when a woman is between 35 to 45 years old.
Peri-Menopause: as the ovaries start to run out of eggs, symptoms worsen, periods may become irregular, perhaps stopping for months, then restarting; sometimes heavy, sometimes light. Changes in mensturation tends to occur around the age of 44 years.
Post-Menopause: defined as from last period onwards. The average age of the last period is 51 years. Hormone levels continue to fluctuate and decline for several years into post-menopause.

Symptoms and why they happen

There are a huge number of symptoms that are associated with the menopause (1). Some of which you may not have realized were due to your hormonal changes.

Hot flushes
Night sweats
Insomnia
Forgetfulness
Brain fog
Difficulty concentrating
Low mood
Tearfulness
Irritability
Anxiety
Headaches/migraines
Unexplained fatigue
Cravings
Weight gain, especially around the middle
Itchy skin
Dandruff
Sore throat
Bloating
Constipation
Diarrhoea
Irritable bowel syndrome
New food intolerances and allergies
Muscle weakness, joint and back pain
Loss of bone density
Morning stiffness
Sore breasts
Vaginal dryness and vaginal infections
Bladder infections
Painful intercourse
Low sex drive
To name a few!

These symptoms of menopause come about because of the close involvement of the sex hormones in so many body processes, including temperature regulation, blood sugar regulation, body fat deposition, bone health, vaginal health, ability to break down stress hormones (which therefore affects mood by affecting how long stress hormones persist in the body) and, importantly thyroid hormone function (which in turn regulates all other body functions). As these hormone levels change so do these body functions.

Why do some women get so many symptoms and others very few?

Stress

The biggest likely cause of having worse symptoms is stress. This is because high stress levels affect the way in which the body responds to the sex hormones, and also because, as the oestrogen from the ovaries declines, the adrenal glands start to take up the slack. If they are unable to do this, hormone levels will fall faster. Our fat cells can also create some oestrogen and it is theorised that if the adrenals are under stress, we are more likely to gain weight at menopause to create another route for making oestrogen.

Liver and gut health

Secondly, the body makes different types of oestrogen which have greater or lesser effects, so the balance of these types can affect menopause symptoms. The liver plays an important role in this balance. Another key factor is bowel health. In particular, constipation can contribute to hormone imbalance

Blood sugar balance

High levels of insulin (the hormone which controls blood sugar levels) can affect the balance of sex hormones. As the amount of insulin the body produces can be affected by your diet, some dietary patterns may exacerbate the hormone imbalances in menopause.1

Environment

Exposure to environmental sources of oestrogen-mimicking compounds (‘xenooestrogens’)(2,3) can contribute to hormone imbalances.

Genetics

And, of course, there will inevitably be genetic factors that influence how easily we pass through menopause (1)

What you can do to help

If possible, prepare for menopause during your reproductive years by addressing stress and eating healthily…this will help the transition when it comes. Unfortunately, for many women, the time of menopause also coincides with increased stressors from children leaving home, aging parents and perhaps increased responsibilities at work.

As stress has such a major impact on how your body makes and responds to sex hormones, it is vital to take steps to reduce sources of stress. This stress can be due to work or family pressures, but also physical stresses from poor diet, not enough sleep, excessive exercise, injuries or illnesses. Stress can also affect thyroid hormone balance which can contribute to problems with weight gain, and many other menopause symptoms.

A healthy diet, low in sugary, starchy foods, and high in essential nutrients will help cushion the menopause. Good hormone balance requires our bodies not only to make hormones effectively but also to be able to break down (metabolise) those hormones after they have been used.1

We need a range of micronutrients to make hormones effectively. Not only that, but for our livers to process our hormones correctly and keep them in balance, we need B vitamins, antioxidants like vitamin A and vitamin C, sulphur groups from onions and garlic, and enough protein. Zinc and copper work in balance in the body, when zinc is low, copper tends to be high. High copper levels increase oestrogen levels, potentially adding to imbalances, thus the right balance of zinc and copper is needed in our diets (4).

Certain foods may help balance female hormones:

Cruciferous (cabbage family) vegetables especially broccoli5
Beans and pulses, nuts and seeds
Fruits such as apples, oranges, grapefruit, blueberries, pomegranate
Onions, leeks and garlic
Herbs and spices (cinnamon, sage, rosemary)
Sprouted seeds (broccoli, alfalfa, mung)
Green tea, sage and liquorice herbal teas
Oily fish and other seafood
Olive oil, avocado, coconut oils.

Some nutrients that may be especially useful for certain symptoms:

Tea (black or green) contains a compound, L-theanine, which combats stress hormones and may help reduce hot flushes and improve sleep.
Vitamin B12 (from animal sources, such as meat, milk, eggs and cheese and from seaweed-based foods) can help with mood swings, memory problems and brain fog.
Vitamin B6 and B5 (good levels are found in salmon, eggs, mushrooms, legumes and pulses, sweet potatoes and carrots) are important for balancing progesterone and oestrogen levels.
Folic acid (from green leafy vegetables, avocado, nuts and legumes) helps the body manufacture and use oestrogen.
Vitamin D (from sunlight and oily fish) can help reduce the risk of osteoporosis associated with menopause and may also help with sleep.
Vitamin E (from avocados, nuts and seeds, and leafy green vegetables) may help reduce hot flushes and relieve vaginal dryness and painful intercourse.
Magnesium (found in salmon, spinach and other green leafy vegetables, nuts and seeds, avocados, beans, quinoa and dark chocolate) may help improve a variety of hormonal issues.
Zinc (from foods high in zinc but low in copper, such as red meats, oysters and other seafoods, eggs and pumpkin seeds) is beneficial for symptoms of oestrogen dominance.

Foods/drinks to avoid

Sugar and refined carbs. Sugary, starchy foods will cause peaks and troughs in blood glucose, this is stressful for the body, triggering hot flushes.
Spicy foods often seem to worsen hot flushes
Alcohol can worse hot flushes
Caffeine may affect sleep but many women report that it can worsen hot flushes
Vegetable oils – apart from olive oil, coconut oil and avocado oil (and make sure these are minimally processed)
Foods that are especially high in copper but low in zinc, such as sesame seeds, cashew nuts, soy and edamame beans, and shiitake mushrooms.

Hormone disruptors

Avoiding chemicals that mimic oestrogen or interfere with hormone balance may help (1). Obvious sources of female-hormone-like chemicals are those found in the contraceptive pill and other devices or HRT. If the balance of hormones in these medications is not right for you, they can worsen your symptoms. There are other xeno-oestrogens, such as pesticides, industrial compounds, detergents, cosmetics, sunscreens and bathroom products.

To minimise your exposure to hormone disruptors:

Avoid foods treated with pesticides (plants) or hormones (animals) - choose organic where possible
·Use glass, ceramic, paper or other non-plastic packaging instead of plastic for food and water (especially, avoid heating food in plastic containers or wrapping foods containing fats in cling film)
Use cosmetics, anti-perspirants and beauty products that are free from parabens, aluminium, and sunscreens
Avoid copper cooking pots and other sources of copper. If you use a copper IUD for contraception, consider changing to a different method.
Consider using a water filter.

References

1. Newson, J. About Female Hormones. (2018). Available at: https://www.amchara.com/hormones/about-female-hormones.

2. Nicolopoulou-Stamati, P. & Pitsos, M. A. The impact of endocrine disrupters on the female reproductive system. Hum. Reprod. Update (2001). doi:10.1093/humupd/7.3.323

3. Casals-Casas, C. & Desvergne, B. Endocrine Disruptors: From Endocrine to Metabolic Disruption. Annu. Rev. Physiol. (2011). doi:10.1146/annurev-physiol-012110-142200

4. Osredkar, J. Copper and Zinc, Biological Role and Significance of Copper/Zinc Imbalance. J. Clin. Toxicol. 2013 00 S3:001, 1–18 (2011).

5. Fowke, J. H., Longcope, C. & Hebert, J. R. Brassica vegetable consumption shifts estrogen metabolism in healthy postmenopausal women. Cancer Epidemiol. Biomarkers Prev. 9, 773–9 (2000).