Understanding & Embracing the Menopause

Practical tips & insights for a happier transition

Francesca Liparoti• Registered Nutritional Therapist mBANT,

CNHC - since 2013• Corporate Nutritionist at SuperWellness

(employee wellbeing specialists) delivering regular workshops & programmes in the workplace since 2015

• Including; NBC Universal, Barclays, Harrods, REM, Engine Group, AMC Networks, Linklaters & many more

• 1-2-1 nutritional therapy & coaching practice

Today

• Quick look at some stats & stigma• What happens to your body & hormones leading up to,

during and after menopause• Resulting symptoms & experiences • How diet & lifestyle habits can make profound difference

(whether using HRT or not)• The 6 point nutrition & lifestyle plan for a smoother &

happier transition

Did you know…

A 2009 study on National Association of Female Executives, of 846 women:• 95% experienced physical symptoms

and 79% physical AND emotional• 40% said symptoms problematic in at

least one area of their life• 47% need to take time off work• 33% feel less outgoing socially

And…

• Other studies find that menopause symptoms significantly impact daily life - emotionally, professionally, socially

• The SWAN study - “Vasomotor symptoms, such as hot flashes and night sweats, are the most bothersome symptoms of menopause and affect an estimated 75% of women aged over 50 years”

Menopause Mindset & Stigma

• Still a taboo, almost shameful subject

• Images of women with walking sticks to depict the menopausal woman

• Thought to be emotional, hormonal, erratic, can’t cope or be relied upon

From perimenopause to menopause• A gradual transitional phase of

adjustment between active & inactive ovarian function

• Biological & physical changes• After 12 months with NO periods

you enter menopause (average 51)

• The permanent loss of ovarian oestrogen & progesterone production, marking the end of the fertile phase of a woman’s life

Oestrogen’s Magic

• Our main metabolic hormone• Gives us our female characteristics - round breasts, soft

skin, full hips• Confidence, outgoing, sharp, motivated, good mood• Supports strong bones & lean muscle mass• Supports mood & libido• Boosts ‘happy chemical’ serotonin & ‘motivation’ chemical

dopamine• Supports collagen & blood supply to skin

Losing Oestrogen

• Associated with issues that come with “getting older”..• Weaker bones & increased risk for osteoporosis• Loss of muscle mass & strength• Slower metabolism & more prone to insulin resistance• Increased fat around the middle• Increased inflammation• Loss of skin tone & elasticity (wrinkles)

Progesterone's Magic

• Important for overall sense of wellbeing (esp. sleep)• Anti-anxiety, calming hormone, a natural anti-depressant• Brain-protective (cognition)• Boosts metabolism & lean muscle • Supports thyroid hormone production• Natural diuretic (prevents water-retention/puffiness e.g.

ankles, fingers)

Losing Progesterone

• More sensitive to all stressors• Anxiety & irritability• Sleep issues / insomnia • Low mood• Cognition or memory issues• Water retention (‘puffiness’)• Increased body fat• Thyroid problems

Menopause & Weight Gain

• 3 times more likely to gain weight here! Loss of oestrogen results in slower metabolism

• Body becomes better at storing fat and worse at maintaining muscle mass L

• Mostly abdominal (belly) fat (“apple shape”)• Oestrogen keeps cells ‘sensitive’ to insulin

(prevents insulin resistance)

How you make oestrogen after menopause

• You still make some oestrogen just not as much as before

• Once your ovaries bow out the adrenal glands take over to make oestradiol – about 10% of what you used to make

• Adrenal glands need extra support now• Also make some in the rest of body via enzyme

called aromatase (oestradiol and oestrone)

So we MUST support adrenal glands!• The main source of oestrogen

production post-menopause (and small progesterone production)

• Adrenal glands release cortisol in response to ANY stressor = reduces oestrogen production

• Cortisol shown to increase hot flashes, mood, sleep & cognition problems

• Managing stress & self care is a non-negotiable!

Hot Flashes & Night Sweats• Vasomotor symptoms; most

commonly known symptom of menopause

• Episodes of profuse heat accompanied by sweating and flushing, predominantly around head, neck, chest, and upper back

• Night sweats are heavy perspiration during sleep, causing sleep disruption

• Last 10s to 10 mins, average 4 mins• From every few days to up to several

times an hour

Help for hot flashes & night sweats• They are your own personal stress barometer! • High stress = pressure on adrenal glands = more hot flashes & night

sweats• Strength training, walking in nature, yoga, qi gong, tai chi,

meditation • 2018 study found yoga significantly reduced hot flashes, night

sweats, anxiety & vaginal dryness for some women• Studies show deep breathing exercises reduce frequency & severity• Avoid high cardio, HIIT, CrossFit, spin, boot camp, long runs• Alcohol shown to aggravate hot flushes & night sweats

Black Cohosh • Popular herb for hot flashes• Many clinical trials with mixed results• 2010 meta-analysis - may slightly

improve menopausal symptoms • Other recent studies show reduced

sleep disturbance • Until further research some doctors

recommend short-term use only (<6 months) whilst changing lifestyle habits

• Nothing trumps nutrition & lifestyle changes

Sage

• 2011 study found reduction in hot flushes by 64% within 8 weeks

• Fresh sage extracts (e.g. tincture/drops)

Genito-urinary Symptoms

• A broad term for vagina, bladder, & pelvic floor associated symptoms

• Dryness, pain, atrophy, itching, increased need to urinate, incontinence, prolapse, and increased susceptibility to UTIs

• Associated with lower oestrogen, resulting in thinning of tissues of vagina, vulva, & urethtra

• One of the few permanent, rather than temporary menopause symptoms

Help for genito-urinary symptoms

• Maintain health of epithelial cells that line vagina by supporting friendly bacteria in vaginal ‘microbiome’

• Lactobacillus species shown to be most prominent in healthy vaginal microbiome

Other ways to support epithelial cells include:• Avoiding wipes, douches, antibiotics & smoking• Increase protein, vitamin A, omega 3, zinc

Muscle Fatigue, Aches & Pains

• Common symptoms of menopause

• Some studies suggest they even outrank hot flashes

• Common to receive diagnosis of fibromyalgia

• But most likely due to poor sleep and loss of anti-inflammatory effects of progesterone and oestrogen

Rewiring the Brain: help for hot flashes, sleep, migraines, memory & mood• Research suggests brain undergoes massive rewiring

during perimenopause & first few years of menopause

• The reason for many of these symptoms• Loss of protective actions of progesterone &

oestrogen• As you transition into menopause your nervous

system has to reorganise itself

Things to consider

• Honest conversations with line management & colleagues

• Ask for help• Request flexible working / working from home• Desk fan / better ventilation• Move desk / better location within office

Helping your brain to recalibrate

The key is to prevent or reverse insulin resistance:• Blood sugar balancing diet• Fast between meals and

overnight• Build muscle• Soothe your nervous system

(stress management, self care, sleep)

Why Build Muscle?

• Improves insulin sensitivity and therefore brain energy & promotes ‘neurogenesis’

• Strength training found to improve hot flashes & protect brain

• Strengthens bones & reduces osteoporosis risk

• Improves metabolism

The power of sleep for menopause

• Can be significantly disrupted• Out of sync circadian rhythm

(body’s master clock) = feelings of ‘permanent jetlag’ & fatigue

• Oestrogen maintains this master clock

• Stress has significant impact on clock

The Circadian Rhythm

CORTISOL

Tips for better sleep• Daylight exposure upon waking • Outdoors midday• Use lux light box in darker monthsA robust evening routine:• Dim lights all over the home• Blue light blocking glasses• No screens 1 hour before bed• Restorative practices – yin yoga, Qi

Gong, Tai Chi, meditation• Yoga nidra sleep meditation

What About Coffee?• May be beneficial – polyphenols found to

lower inflammation, improve insulin sensitivity & promote healthy breakdown of estrogen in liver

• BUT stimulates cortisol so may aggravate vasomotor symptoms, sleep, mood, weight, energy

• Caffeine tolerance varies from person to person

• Black, no sugar, high quality bean• 1-2 cups max is best

Green Tea Instead?

• Contains L-Theanine, a calming amino acid shown to increase dopamine and serotonin levels in the brain, which may account for its anxiety-reducing activity

The 6 Point PlanPractical nutrition & lifestyle tips to support your body

naturally - for a smoother and more enjoyable transition into this wonderful phase of life

Protein With Every Meal

• Key food group for stabalising blood sugar, thus supports insulin sensitivity

• Supports muscle mass à bone protective & healthy metabolism

• Amino acids; raw materials for brain chemicals

• Reduces cravings & regulates appetite

1 tablespoon nut butter: 4gA handful of cooked kidney beans or chickpeas (about 50g): 2g10 almonds: 2.5g1 tablespoon of sunflower seeds: 3g1 tablespoon of hummus: 1g1 cup of broccoli (about 90g): 5g1 medium sized fillet of chicken (150g): 37g

1 medium egg: 6g3 oz of lean, cooked beef: 24g3oz tuna: 24g1oz soft cheese: 6g3oz salmon: 22gScoop of protein powder: 20g

1.5g – 2g

How Much?

Per kg of body weight per day, depending on energy needs & activity levels & type of activity

2. Slow-releasing carbohydrates only

• ‘Complex’ & fibre-rich for slow breakdown into glucose

• Keep insulin under control• Avoid refined/white flour

products, & sugar• Portion control• Balance with protein & fat

• Omega 3• Omega 6 • Saturated• Monounsaturated• Medium Chain• Dietary cholesterol

3. Plenty of good fats

Especially Omega 3 Fats• Anti inflammatory• Best source is oily fish:

Salmon, Mackerel, Anchovies, Sardines, Herring, Trout

• Smaller amounts in flaxseed, walnuts, chia seeds

MCT Oil• Medium-chain triglycerides, a

beneficial fatty acids • May help calm brain & reduce

inflammation• Converts into ketones, providing

non-glucose source of energy to brain

• Occurs naturally in small amounts in coconut oil, palm kernel oil, dairy fat

• Pure MCT oil best for substantial dose - 1-2 tablespoons daily e.g. in smoothies or porridge

4. Ditch Trans Fats

• Inflammatory – a menopause & hormone mess-maker!

• Vegetable, rapeseed, sunflower oils

• Cooking sprays • Margarine• Processed foods• Long life baked goods• Deep-fried foods• Takeaways & eating out

5. Eat the RainbowüQuality fibre to feed friendly gut bacteria üPhytonutrients - chemical compounds produced by plant foodsüDifferent colours provide array of compounds with health benefits including

healthy liver detoxification of oestrogen, energy production, heart health

6. Nourish & Soothe Your Nervous SystemCreate your own sleep, self Care & stress management toolbox:• Get outside in nature • Laughter• Hobbies/express creativity• Prioritise sleep & robust

evening routine• Yoga

• Meditation• Deep breathing • Tai Chi or Qi Gong• Epsom salts baths• Embrace breaks, ‘me’ time &

lazy time!• Surround yourself with good

people only

What About ‘Phytoestrogens’?• 2 major classes: 1) isoflavones

from soy 2) lignans from seeds, whole grains, legumes, fruits, & veg

• ‘Act’ like oestrogen as interact with oestrogen receptors

• During menopause may have mild pro-oestrogen effect

• Lots of research into phytoestrogen supplements e.g. soy as HRT alternative

• No clear evidence found

Other Key Foods & Nutrients to Focus On

Cruciferous Vegetables• Broccoli• Brussels Sprouts• Cabbage• Cauliflower• Kale• Bok Choy• Rocket• Watercress

• Sulphoraphane• DIM• Indole 3 Carbinol

Herbs & Spices

• Dill• Sage• Rosemary• Red Clover• Ginger• Paprika

• Turmeric• Cumin• Cayenne Pepper

• Parsley• Cinnamon

• Coriander• Nutmeg• Fennel seed

• Hops• Mint

• Wonder mineral! Soothes nervous system – mood, sleep & stress supportive

• In high demand during & after menopausal transition

• Research in 2011 found magnesium helped over half the patients to diminish hot flashes

• Supports healthy bones (along with vitamin D3 & K2)

Magnesium

• Almonds, cashews, buckwheat, oats, pecans, beans, green leafy vegetables

• 2 handfuls of Epsom salts in a warm bath (or 1 handful in a footbath), for 15 minutes

Magnesium Sources

Zinc

• Deficiency strongly linked with depression

• Found to improve mood in several studies

• Reduces brain inflammation• Improves BDNF and new

brain cell production

Vitamin E

• Research finds vitamin E (400 IU daily for 4 weeks) significantly reduced severity and frequency of hot flashes

• Sunflower seeds, almonds, hazelnuts, spinach, avocado, butternut squash, pine nuts, olive oil, kiwi, Sweet potato, Tomatoes, wheat germ oil

Choline

• Drop in oestrogen at menopause can result in lower choline production in body

• Crucial nutrient for memory, cognition, energy production, and healthy oestrogen detoxification

• Eggs (yolk), liver & salmon

B Vitamins

• Often nicknamed ‘anti-stress’ nutrients for their powerful ability to balance mood and calm the nervous system

• Top sources: meat (esp. liver), fish & poultry, eggs

• Beans & pulses, dark leafy greens, kefir, cottage cheese, natural yoghurt, nuts & seeds

Vitamin B12• By age 50 - 40% chance of being B12 deficient• Critical nutrient for brain (and energy, metabolism, nerve

function & detox)• Animals foods only source, but difficult to absorb if lower

levels of stomach acid & ‘intrinsic factor’ • Alcohol & stomach acid-lowering meds further impair

absorption• Test regularly and supplement accordingly• ‘Methylated’ forms are best and spray or drops under

tongue for best absorption

Vitamins D3 & K2 • Vitamin D3 promotes healthy absorption of calcium into bone• Best when combined with vitamin K2 • Shown to be powerful combination for reduced fracture risk • D3 & K2 work together to absorb calcium and put it where it’s

supposed to be (into bones not blood vessels)• K2 also shown to help reduce heart disease risk (due to ability

to prevent blood vessel calcification)• K2 FOODS: Natto (traditional Japanese dish of fermented

soybeans), sauerkraut, LIVER & other organ meats, egg yolks, chicken, beef

Key takeaways• Change in metabolism & weight

is likely due to insulin resistance• Blood sugar balancing diet is

KEY - 3 square meals (avoid snacking) & minimum 12 hour overnight fast

• More protein, extra mindful of type & quantity of carbs

• Build muscle! Muscle is your best bone & metabolism protector – make the most of it!

• Good sleep, stress management & self care non-negotiables now. Must support adrenals now more than ever

• Create more joy! What makes you happy? Do more of that

• Create your stress management & self care toolbox

• Learn to say ‘no’. Be more selfish!

What changes will you make?

• Share 1 key takeaway or 1-3 changes you will make

Additional Resources

Resources• Hormone Repair Manual by Lara Briden

(Naturopathic Doctor & Women’s Health Specialist

• Lara Briden’s blog – www.larabriden.com/blog/• Dr Louise R Newson, GP & Menopause

Specialist www.menopausedoctor.co.uk• Environmental Working group – www.ewg.org• Guidance for employers -

https://www.acas.org.uk/guidance-for-employers-to-help-manage-the-impact-of-menopause-at-work

References• Study on members of National Association of Female Executives - https://pubmed.ncbi.nlm.nih.gov/18779760/

• Effect of menopause on work - https://www.menopausedoctor.co.uk/menopause/menopause-work-new-guidelines

• Study of Women’s Health Across the Nation (SWAN) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185243/

• Insulin resistance more likely after menopause - https://diabetes.diabetesjournals.org/content/68/2/291

• Cortisol levels higher in menopausal women & linked to increased abdominal fat, CVD & menopause symptoms - https://pubmed.ncbi.nlm.nih.gov/16645535/

• Stress (cortisol) increases intensity of hot flashes -https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-018-0038-x, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749064/

• Studies on support for hot flashes - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230515, https://pubmed.ncbi.nlm.nih.gov/29452777/, https://pubmed.ncbi.nlm.nih.gov/17000582/

• Black cohosh for hot flashes - https://pubmed.ncbi.nlm.nih.gov/20085176/

• Sage for hot flashes - https://pubmed.ncbi.nlm.nih.gov/21630133/

References Continued • Vaginal microbiome & UTIS, dryness, pain and atrophy - https://pubmed.ncbi.nlm.nih.gov/27451320/

• Brain re-wiring during peri-menopause - https://pubmed.ncbi.nlm.nih.gov/26007613/

• Strength training for hot flashes & brain protective - https://pubmed.ncbi.nlm.nih.gov/31333805/

• Potential health effects of phytoestrogens - https://pubmed.ncbi.nlm.nih.gov/27723080/

• Alcohol & hot flashes & night sweats - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230515

• Omega 3:Omega 6 ratio & menopause symptoms - https://pubmed.ncbi.nlm.nih.gov/30628472/

• MCT oil as brain protective - https://pubmed.ncbi.nlm.nih.gov/29914035/

• Brain energy & intermittent fasting - https://www.nejm.org/doi/full/10.1056/nejmra1905136

• Intermittent fasting & blood glucose control - https://journals.stfm.org/familymedicine/2019/march/br-mar19-scherger/

• Magnesium - https://pubmed.ncbi.nlm.nih.gov/21271347/

• Zinc - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492454/

• Vitamin E - https://pubmed.ncbi.nlm.nih.gov/17664882/

• Further references available on request