Menopause & Perimenopause
During the perimenopause and menopause, all sorts of things change in the body so it’s really important to look holistically at how you reduce your symptoms now and improve your future health.
At Ōtepoti Integrative health we provide comprehensive menopause assessments, discuss individualised risk and benefits of body identical hormone replacement therapy (HRT) to replace the hormone deficiency caused by the perimenopause and menopause.
We also consider ways to optimise movement, nourishing food, sleep, stress management and relational health as these contribute to supporting your transition through menopause. We also offer functional medicine approaches to support gut-brain axis, stress and HPA axis function.
Dr Deb Brunt will support you to not only survive menopause, but to thrive through it and beyond.
The menopause is sometimes called 'the change of life'. The changes occur via a longer transitional period known as the menopause transition, perimenopause or climacteric. This menopausal transition can take more than 10 years. The menopause marks the end of a woman's reproductive life and is an important hormonal transition during which healthy habits can really optimise women's health.
At menopause, eggs are no longer produced by the ovary and production of the 2 main reproductive hormones by the ovary, oestrogen and progesterone ceases. There is also a reduction in testosterone. The word "menopause" refers to the last or final menstrual period a woman experiences.
When a woman has had no periods for 12 consecutive months she is considered to be “postmenopausal”. Most women become menopausal naturally between the ages of 45 and 55 years, with the average age of onset at around 50 years.
"Early Menopause" occurs between 40 and 45 years.
“Premature menopause” may occur before the age of 40 due to either natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments. Women whose periods stop prior to 45 years should see their doctor to exclude other medical causes such as thyroid issues or polycystic ovarian syndrome (PCOS).
What are the symptoms of menopause?
Symptoms of preimenopause and menopause vary between women and also can change during the menopausal transition. SOme women breeze through menopause with minimal symptoms and others have significant symptoms which impair quality of life, enjoyment and negatively affect home and work life.
Common symptoms include:
Light headed feelings
New facial hair
Crawling feelings under the skin
Less sexual feelings
Read more about 34 symptoms of perimenopause.
The Stages of menopause
Menopause Treatment Options
The aims of treatment during menopause is not only relief of symptoms and improvement of quality of life, but also health screening to minimise risks of future chronic disease such as heart disease, diabetes, stroke, Alzheimer's.
Integrative medicine supports women in perimenopause and menopause by supporting healthy habits that will hopefully last a lifetime and will reduce the risks of chronic disease.
At least 150 minutes per week of moderate intensity exercise is ideal, but any exercise is better and beneficial for health than none. Exercise in 30-60 min sessions at the gym, walking to work, cycling, running, dancing or swimming.
You can also do snack size exercises multiple times during the day by setting a timer on your phone to jog on the spot or jumping jacks. Using a Fitbit or other device can help motivate and remind you of your goals. It can take some-time to make exercise a habit, but most people once they get going with an activity that they love, find it a pleasure to move their body.
Exercise during menopause and beyond should include these 3 important aspects:
Aerobic exercise that gets the heart rate increasing for heart, lung and brain health.
Resistance exercise that increases muscle strength by making your muscles work against a weight or force. This is important to maintain muscle mass. Resistance exercises can be carried out with free weights, machines, resistance bands or using your own body weight.
Weight-bearing exercise - this is exercise that force you to work against gravity. This includes activities such as jogging, running, stair climbing and dancing.
2. Real Food
Fuelling the body and brain are important to support the phenomenal hormonal and metabolic changes occurring during menopause. To support hormones and metabolisms consider including in your diet:
Brassicas (cauliflower, broccoli, cabbage, bok choi etc) which are high in indole-3-carbinol and diindolylmethane (DIM) that help regulate estrogen metabolism.
Phytoestrogens such as lignans and isoflavones are beneficial for health. Non-ultraprocessed soy products such as whole soybean milk, miso, tofu, contain isoflavones. Flaxseeds contain lignans.
Diverse plant foods are beneficial as they contain a variety of fibres and acts as including fruit, veg, of many colours, whole grains such as steel cut oats, quinoa, buckwheat, nuts, seeds, legumes, lentils, herbs and spices.
Protein is important for fuelling the moving body, synthesizing protein essential for happy brains and maintaining bone and muscle function. Legumes such as beans, peas, lentils, peanuts, chickpeas and nuts such as walnuts and almonds are great protein sources. Lean meats such as chicken and fish.
Green tea contains antioxidants and epigallocatechin gallate (EGCG). EGCG supports metabolism, helping stabilise body composition and increase bone mineral density.
Vasomotor symptoms of menopause such as hot flushes and night sweats can interrupt sleep. Additionally variations in hormones can lead to early waking, and difficulty sleeping resulting in non-restorative sleep for many women during menopause. Exercise, particularly morning or afternoon exercise can aid with sleep. There are a number of mind-body therapies which can be useful for improving sleep including cognitive behavioural therapy and yoga.
Some women find support for sleep from magnesium, tart cherry, micronised progesterone or melatonin.
Often the best treatment for impaired sleep is management of hormonal fluctuations with hormone replacement therapy (HRT).
4. Stress Management
Often menopause is occurring concurrently with a busy time in a woman's life. She may have children or older teens, or grandchildren to care for, she may be progressing in her career or making a mid-career shift. Some women are caring for aging parents and others are involved in relationship breakdown or discovering new relationships.
It is important to have strategies in place to maintain balance and boundaries and to avoid becoming too overloaded so that you can avoid burnout.
Stress management depends on adequate restorative sleep, and is aided by exercise. Additionally these are some strategies some people find useful in managing stress:
mindfulness, deep abdominal breathing or meditation
daily gratitude practice
5. Healthy Relationships
Perimenopausal and menopausal symptoms affect women in many different ways, for some, the mental and physical symptoms can be detrimental to relationships. Mood changes, brain fog and lack of sleep can compound to create irritability and unhappiness and difficulties in relaationships. Lower hormonal levels can also contribute to vaginal dryness, discomfort during sex, low libido and low sexual desire.
Good communication is essential for maintaining healthy relationships. Utilising lubricants can help with vaginal dryness. If mood changes and menopause symptoms are having a negative impact on your relationship, hormone replacement therapy may be useful. You may also benefit from talk therapy.
It is important to seek help if your relationships are being affected as it's important for your health and wellbeing to be surrounded by loving, supportive relationships.
Read more about Sexual Health Clinics Dunedin.
6. Minimising substances that negatively influence hormone health
Some foods and substances can worsen symptoms during menopause so these are best avoided or minimised.
Caffeine - coffee consumption exacerbates menopausal vasomotor symptoms--hot flashes and night sweats that occur due to the constriction or dilation of blood vessels. A cup a day is unlikely to have a detrimental effect, but several cups and especially coffee or caffeinated drinks later in the day are likely to contribute to symptoms and impair sleep.
Alcohol - unfortunately alcohol is bad news for the menopausal woman. It is one of the largest risk factors for breast cancer, and breast cancer is the most common cancer caused by alcohol among women globally. The good news is that alcohol is a modifiable risk factor for breast cancer, meaning cutting down consumption reduces the risk.
What is HRT Therapy?
Hormone Replacement Therapy
Hormone replacement therapy is the use of hormones to replace the deficiency of reproductive hormones created by menopause. It is the most effective way to control menopausal symptoms while also providing other health benefits such as reducing the development of heart disease, diabetes and osteoporosis. It is safe for most women to use during perimenopause, menopause and post-menopause.
At Ōtepoti Integrative Health we tailor the type of hormone treatment best suited to you depending on your medical history, family history, symptoms, risk factors and your preferences.
There are multiple options available that come in tablets, gels, patches and creams, and they come as separate hormonal preparations or in combination products. Types of HRT regimes include:
Cyclical HRT - this mimics the normal menstrual cycle. Estrogen is taken every day and natural progesterone or progestogen for 12 to 14 days. When the progestogen is stopped, there is some bleeding as the progestogen is “withdrawn” so the uterine lining (endometrium) is shed. Progestogen regulates bleeding and protects the endometrium from harmful pre-cancerous changes
Continuous combined therapy HRT (CCT) - this type of HRT combines an estrogen and progestogen. They are prescribed continuously to achieve period-free HRT.
Estrogen-only HRT - this is normally prescribed to women who have had their uterus removed (hysterectomy).
Body identical hormone replacement therapy is safer than non-body identical hormones.
Estradiol is a body identical estrogen. It has no increased risk of blood clot when used via the skin in a patch, gel or vaginal cream.
Oral micronised progesterone has advantages over synthetic progestins as it is converted to allopregnanolone in the liver which helps support sleep. Funding for this type of HRT therapy was funded by PHARMAC in New Zealand from 1 Dec 2022.
Get in touch if you'd like to book an appointment.
HRT Risks and Benefits
Hormone replacement therapy tablets containing oestrogen does increase the risk of blood clots.
deep vein thrombosis (DVT) - leg vein blood clots
pulmonary embolus (PE) - lung vein blood clots
stroke - brain vessel blood clots
Oral oestrogen tablets are NOT associated with an increased risk of heart attacks or heart disease.
Breast cancer risk with HRT is complex.
Different progestogens have different risk ratios for breast cancer.
Micronized progesterone (body identical progesterone) and dydrogesterone (similar in structure to natural progesterone) are safer than most synthetic progestogens.
In women using HRT short-term, there were 3 extra cases per 10,000 for oestrogen use and 9 extra cases per 10,000 for oestrogen plus synthetic progestogen use.
For women with a family history of breast cancer, their risk of breast cancer is the unchanged by use HRT.
Women with a high body mass index (BMI) have an increased risk of breast cancer. HRT use in these women does not further increase their risk of breast cancer.
Use of oestrogen and progestogen HRT is associated with better health outcomes including reduced risks of:
osteoporotic fractures (44 fewer cases per 10,000),
diabetes (14 fewer cases per 10,000),
colon cancer (6 fewer cases per 10,000).
Learn more about Perimenopause and Menopause
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