Menopause

Question 1

Menopause

Answer 1

Menopause = the life stage where menstruation and reproductive potential ceases. Stages include:
* Early menopause (40‒45 yrs.): Cessation of ovarian function without identifiable underlying secondary cause. Affects 5‒12%.
* Perimenopause (around 45‒50 yrs.): Begins from the onset of irregular menstrual cycles and ends 1 year after the final period.
* Menopause (50‒55 yrs.): After 12 months of amenorrhoea.
* Post-menopause (55 onwards): Periods cease and generally
the worst of the hormonal symptoms have subsided.
* Premature menopause (<40 yrs.): Permanent (bilateral
oophorectomy) or due to ovarian insufficiency (genetics).

Question 2

Perimenopause

Answer 2

Perimenopause = the transition phase of declining reproductive hormones where ovarian follicular activity begins to fail.
* Hormonal changes: FSH / LH levels rise due to reduced negative feedback. FSH levels can vary markedly.
O:P ratio fluctuates a lot during perimenopause.
* Menopause = low oestrogen, persistently high FSH (> 30 iu / L checked 4‒6 weeks apart) and LH levels. Note: FSH is not accurate in perimenopause.
* Post menopause = ~65% produce sufficient testosterone in their adrenal glands to sustain libido. Assessing adrenal health pre-menopause is a valuable tool to assist a smoother transition.

Question 3

Factors affecting menopause transition

Answer 3

• Obesity — can exacerbate menopausal symptoms.
• Smoking — linked to an earlier onset. It can be hypoestrogenic.
• Chronic stress (HPA axis) — associated with menstrual irregularity.
• Long term lead exposure — associated with early menopause.
• Gut microbiome changes (the ‘oestrobolome’).
• Lead — a long-term cumulative exposure to lead is associated with early menopause.
• Family history — women whose mothers entered menopause at an early age are at a high risk of early onset menopause.
• Hypertension — at an earlier age is linked to an early menopause

Question 4

Menopause: Signs and symptoms

Answer 4

Signs and symptoms — vasomotor symptoms (VMS):
* Hot flushes / flashes — characterised by sudden intense sensation
of warmth (affecting the face, neck, chest); often followed by a chill.
* 30–70% of women experience VMS during perimenopause.
* Negatively affected by obesity, smoking, alcohol, spicy foods, caffeine and stress.
* VMS contribute to sleep disturbances.
* Women with a plant-based diet appear to experience less menopausal VMS.
* Proposed mechanism: Oestrogen is a neuromodulator — changes
in levels can impact areas involved in temperature homeostasis
* Weight gain and obesity — due to genetic factors, hormonal
factors and exogenous factors (e.g., poor nutrition, low activity).
* Sleep disturbance — night sweats and mood changes contribute.
* Genitourinary symptoms — dry / sore vagina, dysuria, dyspareunia. Urogenital atrophy.
* Mood disturbances — irritability, aggressiveness, mood swings, anxiety and depression.
* Other — hair loss, joint and muscle pains, headaches, itching skin,
burning tongue, daytime fatigue, low libido. Loss of confidence
and reduced self-esteem. Memory / concentration issues.

Question 5

Natural approach to menopause

Answer 5

CNM Naturopathic Diet with a hormone balancing approach, and:
* Increase antioxidants and fibre from fruits and vegetables.
* Include a phytoestrogen source daily.
* Choose more plant than animal proteins and eat organic
where possible to reduce exposure to endocrine disruptors.
* Regular pre- and probiotic foods.
* Drink at least 1.5 litres of water a day.
* Maintain a low GL, omega-3 rich diet.
* Avoid foods / beverages which can aggravate hot flushes, e.g., coffee, very spicy foods and alcohol.
* Increase phytoestrogen foods and herbs,
e.g., flaxseeds, sage, fermented soy (non-GM). Red clover.
* Sage home remedy — 6 sage leaves soaked in lemon juice overnight in the fridge. Strain and drink lemon juice in water.
* Reduce weight and focus on balancing blood glucose levels — hypoglycaemia increases hot flushes.
* Acupuncture has been shown to reduce VMS.
* EPO (attributed to GLA content).
* Avoid smoking, alcohol and caffeine.
* Herbal medicines (see later)
* ↓ fracture risk (support bone density) — calcium,
vitamin C, D, K2, magnesium, black cohosh. Weight-bearing exercise (promotes osteoblasts).
* Manage stress / anxiety — yoga, acupuncture, breathing exercises, L-theanine, B vitamins, magnesium, ashwagandha. Bach flowers.
* Improve sleep — poor sleep negatively affects eating patterns. Remove stimulants. Use passionflower, valerian, magnesium etc.
* GU health — use organic natural lubricants (close to vaginal secretions pH); oral or local probiotics (lactobacillus based).
* Optimise intestinal microbiome (also for vitamin K2).

Question 6

Herbal medicines for menopause

Answer 6

• Black cohosh — oestrogen-modulating (isoflavone content) and energetically cooling. Reduces hot flushes and supports BMD.
• Shatavari — reproductive tonic (testosterone-like effects) and adaptogen. Relieves vaginal symptoms incl. vaginal dryness.
• Valerian root, passionflower and chamomile — nervines.
• St. John’s wort extract — reduces hot flashes,
  improves sleep, mood and relieves anxiety.
• Liquorice root — mildly oestrogenic (isoflavones).
• Maca — improves libido, sleep, mood and hot flushes. Appears to interfere with androgen receptors