Recognising and handling the signs of the menopause

WILD SESSIONS PODCAST

Recognising and Handling The Signs of Menopause.

with Lorna Driver-Davies

Henrietta: For this episode, I'm talking to Lorna driver Davies, and I'm really excited to talk to her because Lorna is our head of nutrition at 'Wild Nutrition'. She's also a naturopathic nutritionist and herbal medicine dispenser, and a font of knowledge, particularly on the subject that we're going to unpick today, which is perimenopause and menopause.

Henrietta: It literally is round the kitchen table and the animals are likely to be in and out. So please excuse the background noise.

Henrietta: Lorna it’s just amazing to have you here and today we are going to take a bit of a deep dive into what's called the menopause, but it's actually broken down into different stages and I hope that what we're going to do is to help people to understand what's going on with their body a little bit better.

Lorna: Absolutely yes

Henrietta: And tell everybody, I know a lot about you but tell everybody else, more about you and where, and how you got into nutrition.

Lorna: So I was a child in the eighties, who was having rice cakes and avocado before they were cool. So that's

Henrietta: Oh I feel your pain.

Lorna: Yes. And this is very uncool in the eighties at school when everyone else has got wagon wheels and white bread.

Lorna: But as I got older, I felt very lucky to have such good health. So it was like a natural transition to want to be a nutritionist and I've been practicing for over a decade and I have a passion for women's health; everything from adolescent health, all the way through to perimenopause and menopause.

Henrietta: Can we talk about what defines perimenopause, menopause and then post-menopause

Lorna: Yes. Yeah, sure.

Henrietta: The Latin meaning of perimenopause being before, around, menstruation pause, stopping menstruation. So perimenopause can be, you know, up to 10 years prior to actually cessation of periods.

Lorna: Yes, totally

Henrietta: Women might go then and seek help, but actually all the other symptoms , signs you could have been going through perimenopause for a lot longer….beforehand.

Lorna: Absolutely. Yeah, exactly. So pre-menopause is going to be starting to happen at around, I would say, early 40s, kind of mid 40s. Quite a good, useful thing is to actually try and ask your mum when she went through menopause, because it can give you a bit of a timeline.

Lorna: In fact, if your Granny's still alive, she might also be able to, to give you a comment. And if you're noticing some kind of odd symptoms going on or something's going on with your menstrual cycle and other symptoms, and you're under 40, do you get that checked out, because it could be something else going on. What perimenopause is, is the lead up to the end of your periods, you know, the end of your fertile years. What you might start to notice is a change in your cycle, and it could be that your cycle is becoming shorter or longer. You might notice some changes in your bleeding and menstruation.

Lorna: Um, one of the things that's going on eventually is that you're gonna stop ovulating, but you might still then be having periods still.

Henrietta: So when we're saying changes in menstruation, it can be anything from heavier, clottier, lighter

Lorna: Heavier, lighter. Yeah, yeah, yeah

Henrietta: So that you can still keep that pattern of regularity can’t you

Lorna: Absolutely, yes

Henrietta: Which I think is a bit but can sometimes be quite mysterious. Surely I can't be going through it because my cycle is still very regular.

Lorna: And when there's not ovulation going on, ‘cos obviously you can be menstruating, but there's no ovulation going on, then you're not going to get that dose of progesterone that you'd get in the second half of the cycle. So you can often then start to see heavier periods. And that's an interesting one around nutrient loss as well, and things like iron, for example. So, you might then also start to notice that you're getting more tired. Now that is also a related symptom of perimenopause, changes in energy, you know, changes in your sleep, mood changes, feel a bit more vulnerable. They feel a bit more like they can't tolerate stress as well.

Henrietta: Yeah, absolutely, and I think it's a perfect illustration of how complex and integrated all the systems are in the body. So, you know, what you think is going to be a very physical experience, change of menstruation, hormonal changes actually ends up being something that you experience in your brain, in your emotions so it's all of those signs as well.

Lorna: We're so wedded to our cycle and hormones and so much of our personality and our brain and our ability to process information is really powered by a lot of those amazing hormones. At that stage, you might start to be having lower levels of testosterone and testosterone gives us loads of drive; it helps things sleep and mood and sex drive and gives us muscle tone. So if you've got lower levels of hormones, as you're kind of going through that phase towards menopause, you know, you're not going to feel like you did.

Henrietta: So just to recap on that, there are biochemical changes that are starting to happen under the skin and can be disguised as things that we wouldn't necessarily put down to menopause.

Lorna: No

Henrietta: Changes, emotionally, changes psychologically, feeling just slightly out of kilter.

Lorna: Yeah

Henrietta: But your cycle can remain the same.

Lorna: Yes.

Henrietta: Nuances, nuance changes there, maybe longer, shorter, heavier, but still regular menstruation can still be occurring?

Lorna: Yes.

Henrietta: And that can be for anywhere between 2 and 10 years can’t it?

Lorna: Absolutely, yeah

Henrietta: And then, what do we define as menopause?

Lorna: So menopause is medically defined as no period for more than 12 months. And actually, the five years after you've actually had that 12 months are also special post-menopause years, that also need support and help because, you've got very low, very low levels of hormones then, and your body is expecting those hormones to kind of be around.

Henrietta: ‘Cos actually, estrogen is often thought about in terms of menstruation, in terms of reproduction but actually we have cells in our brain and in our, all over our body that respond to estrogen. So the amount of estrogen that we have in our body, particular types of estrogen that we have in our body, can determine how well our heart functions, how well our brain functions. So actually when we see a decline in estrogen we can sometimes see a decline in those cognitive functions as well, and so that's why it so needs supporting.

Lorna: Interesting point on that one is that alzheimers is more common in women, than getting breast cancer, We're not talking enough about women's brain function and that relationship to hormones; it's really important, and you know, in full menopause, for example, back to the heart, suddenly the stats go up on, high blood pressure, heart attacks, that kind of thing. And women are like, this is so strange I cycle every day, I eat really good food, I take my supplements why have I got high blood pressure. It's like, well, you haven't got the estrogen there cause estrogen is really calming and soothing and kind of just settles everything.

Henrietta: If somebody wanted to know definitively, what stage they're at and they went to a doctor or in the case of us, a functional medicine practitioner, who would look not only at what's happening with your hormonal regulation, but as looking at various other things that we know to be so incredibly important; lifestyle, food intake, supplementation, nutrient deficiencies, so many other functions. What do you think is the most important thing for them to go and ask for?

Lorna: If you’re still having a cycle, so we're talking about premenopause still, then you, I would recommend having a day three cycle test. This is to have hormones such as FSH, LH checked, progesterone, estrogen. Progesterone is harder to check on that day, ‘cos obviously you wouldn't get a natural rise, but sometimes it can be added in on that day if you want to. I would probably even check testosterone, and actually the thyroid. So I always put that in, because actually there's a big relationship between how our cycle functions and our hormones. Sometimes I've seen women who are beginning to get thyroid symptoms because they're going into perimenopause.

Henrietta: So one of the topical conversations at the moment is around HRT. And there's been a huge amount of awareness being built up around menopause and particularly around the benefits of HRT, which can play a really central role in a woman's experience of going through the menopause and an improvement of symptoms. What I would like us to discuss is the limitations of HRT from that perspective, because HRT is hormone replacement therapy and actually perimenopausally, menopausally and then postmenopausally what we want to be doing is we want to be encouraging the body's own production of a different type of hormone, of different type of estrogen but it's so important to produce those manufacturing sites in the body, supporting immunity and various other functions. So I just wanted to talk a little bit around, HRT may be part of that process or not, but what other factors can women look to support to improve their symptoms?

Lorna: So I think consider the role of the adrenal glands. So, when you are in your menstruating years, production is coming from your ovaries and you're producing stronger amounts of a type of estrogen, because estrogen is sub-categorized not just kind of, one estrogen. And so when you're going into menopause, it's this shift into having hormones produced just by the adrenal glands.

Henrietta: and a little bit of a fat tissue as well, which, which is why little bit of holding on to

Lorna: fat, which actually is why you want to be not too skinny, you know, going into that stage. A lot of the narrative around the adrenal glands, a lot of people might know is, we talk about stress this as well, that stress hormone is produced. If you've got like a lot of stress going on and the adrenal glands are being used for you to kind of deal and manage stress, and they won't be then doing a fantastic job of producing these smaller amounts of hormones that are really important. So one of the things to do is to look at whether you are being kind to your adrenal glands and how are you looking after them. And that is going to be

Henrietta: Stress management

Lorna: It can just be that life is quite busy and it's quite a juggle. You could be biologically stressing yourself going to a spin class every day and feeling exhausted at the end of it, even if the rest of your life isn't stressful. Working on stress management is probably going to give you a much better experience of perimenopause, for sure.

Henrietta: The phrase that comes to mind is robbing Peter to pay Paul. If you're using up a lot of your resources then...

Lorna: Absolutely.

Henrietta: That's going to present itself more, explicitly because, the body won’t be able to manufacture hormones in the way that it needs to and the different way it needs to.

Henrietta: So, stress management, a big one, and then things that come with that are sleep and how important sleep is for also helping our, you know, our hormonal cycle is part of our circadian rhythm, so really nurturing that in terms of food, nutrition and

Lorna: What sort of thing would I advise? I go on and on about vitamin D and omega three, because those are two components in nutrition that a lot of people don't get right. So, vitamin D has a hormonal role in the body and plays a big role in women's health all the way through your whole life. In fact, we correlate low levels of vitamin D with gynae conditions, like PCOS, endometriosis, fibroids, that sort of thing. So vitamin D is super important. So if it's not coming from sunshine, then definitely supplementation. And our vitamin D is amazing because it's in a biologically active form, and then, omega three. So from oily fish or supplementation is super important because the omega three is going to be supporting hormone production because it's literally the raw materials of the hormones.

Lorna: So if you don't put the ingredients in the cake, you can't make the cake. Omega three is anti-inflammatory, and actually as you go through those perimenopause, menopause years, you do actually become slightly more able to become inflamed because you've got these hormone changes going on. And actually that happens because the hormones are getting lower, but also sometimes you can get estrogen dominance or high estrogen in perimenopause, which can be quite inflammatory, you know,

Henrietta: Stoke the fire

Lorna: It can stoke the fire, you know, 60% of your brain is fat. You really want to be feeding your brain at this time. The next thing is making sure you're getting lots of really great fibre in the diet for lots of reasons. So fibre from fruit and vegetables, but also what the vegetables for all the amazing phytonutrients, all the antioxidants. Cause again, the immune system changes at this time and essentially what's happening in full menopause is you actually have a slightly weaker immune system, which is why you're more likely to get inflamed or things don't heal as well, or you're a bit more vulnerable. Maybe you catch colds more easily. Again, getting lots of fibre, lots of antioxidants from amazing kind of vegetables and things is important. But also we want to be looking at hormone metabolism, particularly if you've got elevations of hormones kind of going up and down.

Lorna: And why fibre’s important is that's going to be a way of helping you to excrete those hormones when you don't need them anymore. So I love cruciferous vegetables, and they're delicious and tasty, but they are also going to help you manage your hormone levels and keeping things kind of in balance as well.

Henrietta: I think that's really been validated in the emerging science that’s coming through, emerging research about how important gut bacteria, diversity, the microbiome is for hormonal regulation. So at any stage, so that doesn't, that's not unique to the menopause, but how important the role that that has on how well we can regulate and produce our hormones.

Lorna: ...and try and get as much magnesium into your diet as possible. So we're looking at dark green vegetables. We're looking at, you know, nuts and seeds, meat and fish.

Lorna: What magnesium is going to do is, well it’s got 300 plus jobs in the body. So it's going to be great for the adrenal glands. Great if you're stressed, brilliant for sleep, really great for your brain for mood.

Lorna: I mean, it's a bit of a massive, it’s a bit of desert island item, isn't it, and I think, people said, is there a diet you would lean towards? I would say, you know, Mediterranean diet really, I think accessible for lots of people, gives you a lot of really great, lots of healthy fats, like avocado, olives, that sort of thing.

Lorna: And actually, again, as you're going later on towards menopause, you probably will feel that things are getting more dry. So this is why the essential fats are really important. Like dry hair, dry skin, dry vagina, dry eyes, dry nose. So you want to be getting these things in, earlier on and going back to the gut, the Mediterranean diet is really great for the gut. And therefore it'll be really great for helping you to manage this estrogen gut relationship going on.

Henrietta: Amazing. And then would you say..

Lorna: Oh less booze, as well. Sorry to say it but actually,

Henrietta: Less booze, now actually, that's another podcast in itself, because you know, one of the things actually that, when clients level and go, do you know what, I just can't take the amount of wine that I used to, or, oh,

Lorna: Yeah, oh gosh, yeah.

Henrietta: There is

Lorna: Bad hangovers from like one glass of wine.

Henrietta: It's not a sort of, I just can't take my booze but there is a reason why we can't take our booze anymore because the enzymes in our liver that help us to break down booze are changing at that stage in our life as well. And that's not unique to women. That's a natural part of what happens

Lorna: That's just what happens. Some will say, I've started to almost see a pattern that my perimenopause symptoms feel worse if I have a bit too much wine.

Henrietta: Exactly

Lorna: Or if I have just one more G’nT or whatever.

Lorna: We're not saying suddenly go and live in a cave in the outer Hebrides and never drink or something. We're not saying that, but actually it's just being aware that probably your tolerance isn't as good. Save that lovely glass of wine for the weekend and don’t have three glasses.

Henrietta: ...and the impact that it has on blood sugar levels, blood sugar regulation being a key component can amplify symptoms or decrease symptoms. And also perhaps we should just very quickly talk about the impact that those breakdown materials have on estrogen as well and around.

Lorna: Yeah, and if you're wanting your body to be working well for you, but you keep putting something in that is also quite hard work for your body to deal with, because things like alcohol are what we call an anti nutrient. It's a lot of work to detox that out.

Lorna: Interlude

Henrietta: Lorna, can we talk about herbal medicine, particularly at this stage, actually for any hormonal, regulation or dysregulation issue. Can you talk to us a little bit about that?

Lorna: Yeah. I think my two favorite ones are going to be Ashwagandha and Dong Quai. Ashwagandha is an adaptogen, which means that it helps us to adapt to things. If you need help in any kind of area in the body, it will go there and support that. So it could be that maybe you need to feel calmer or maybe your energy needs to be better, or maybe you need to sleep better. Ashwagandha is amazing, it will know what it needs to do. And the Ashwagandha that we use is amazing because obviously we use a clinically trialed Ashwagandha. There's great research around supporting hormone production as well. And not just that, but going back to adrenal glands, supporting those glands that they can also produce hormones as well. It's such an amazing herb, it's such a lifesaver. I mean, we get these amazing reviews, don’t we, people are like, oh my God, it changed my life, you know.

Henrietta: Incredible.

Lorna: It is such a wonderful ayurvedic, beautiful, gorgeous herb, and I love using it.

Henrietta: A rather, rather shameless plug here as well. But it is combined, we’ve combined it with magnesium.

Henrietta: So, uh, for those very reasons that it's actually perfect nerve tonic plus, also the mineral that most people need to help manage stress and to help with sleep

Lorna: Yeah. You know, so actually people talk about the adrenal glands, but the nervous system is so important because, if you’re scared or worried about something, or you're stressed, you're getting a nervous system response before you're getting adrenal response. Some people don't feel stressed and things, but they might feel nervy and kind of a rattled and frazzled, so actually Ashwagandha is just really great at just taking the volume down. So I think that sort of sense of calm and peace and look, it doesn't mean that suddenly, all your symptoms go away. It's about riding those waves, a little bit more easily.

Henrietta: Exactly. We're not meant to be static. We're not static creatures

Lorna: Exactly.

Henrietta: Like it or lump it, but we were not created to remain static. We were always trying to find that equilibrium, but it's just moderating the ebb and flow of that.

Lorna: Yeah, totally.

Henrietta: Um, and then Dong Quai

Lorna: Amazing women's herb, and it's actually a herb that's amazing in adolescence in your fertile years, but again, it's so supportive in, in perimenopause and menopause years. And actually what's nice about Dong Quai is that you don't need to know where you're at too much with it. You can sort of, you can put it in, in those perimenopause years and in those menopause years and it's going to be really supportive. So it's really great for improving blood flow around the body. It'll help to, the big thing here is that you're helping to modulate existing hormones, but also to help you with production of your own estrogen as well. So it's really like a tonic. It's very kind of modulating.

Henrietta: It sort of meets your body where it is, wherever it needs to be met.

Lorna: Exactly. Sometimes if HRT isn't prescribed properly or you're not having regular tests, the dose that you're taking might not be right. The cocktail might not be right. So what's nice about herbs, like Ashwagandha and Dong Quai, it's like having a really good thermostat. Like you need a little bit more of this. No, no, you need a little bit less than that. I need to go here and do this. I need to go that and do that. Whereas, you know, sometimes with drugs, it's less sophisticated actually. So, so what

Henrietta: It works with your body's intelligence

Lorna: And what's great about this is that we've got this ancient usage, but this stuff is is really well researched and fantastic.

Henrietta: So Lorna, such an amazing body of information there. So if I just recap it, for anybody who just wants to kind of bullet, so it's more fibre.

Lorna: Yes.

Henrietta: So fruits and vegetables into your diet,

Lorna: Plant antioxidants

Henrietta: Plant, plant antioxidants. Fish oil, omega three, either through oily fish or taking supplementation, vitamin D

Lorna: Yes

Henrietta: Again, through food, but it's harder to get it in the diet. So again, supplementing with vitamin D, lifestyle management, getting as much sleep as you can, everything that supports that.

Henrietta: So magnesium, getting a good sleep hygiene. So going to bed at a regular time, waking up at a regular time, and other stress management tools like mindfulness of whatever. I mean mindfulness and meditation can be so off-putting for so many people. So let's just call it stillness or timeout, pausing, and then you've also mentioned Ashwagandha. So we talked about actually our Ashwagandha plus it's got the magnesium in it and also Dong Quai which can be found in our botanical menopause complex.

Henrietta: In relation to sort of adrenal function as stress management and how lots of women, actually, a lot of people turn to exercise for that. And there is a sweet spot with exercise isn't there, there's that sweet spot of where it's really working with your body, and then there can be times when it's actually adding more stress onto the body and how important changing things like that can be at a time when our body's going through a lot of change. So

Lorna: We talk about adjusting exercise around your cycle, so like not really pushing yourself when you’re premenstrual or during menstruation, and maybe having days where you've got more energy to do more full on exercise, so like adjusting it. So actually we take that and then we kind of put that same thing into perimenopause in that it's about picking exercise where you love it and enjoy it, but not pushing yourself.

Lorna: And you're not going to get a badge of honor for doing a spin class at nine o'clock at night, because you think you've achieved something, actually there'll be a kickback. You might not immediately see it, but there will be a kickback somewhere else. It's the voice in your head going...

Lorna: Do you know what today, I just don't feel like I can push myself that much, but then maybe in two days time, you just, you get, you know, had really good sleep. You feel better, and then you want to go and play tennis for a few hours. So it could be that those days before that, where you were feeling a little bit tired and things that you just did, some gentle stretching, you went for a lovely long walk, because also I think this should be a time where you try and carve out time for yourself as well, because around perimenopause particularly women have got children, what you tend to find is that they've got teenagers in the house and it's quite, it's got a busy, full on sort of life and mums will say, I just don't get any time on my own or if I have a bath that's time on my own. So, you know, we both like wild swimming don't we? And it's like, yeah, I know you have that time to go and disappear off on your own and just do it. No, no husband, no business, no kids, just you and the water and how lovely that is.

Lorna: So I think it's also, it could be that you're looking for different types of activities to go with your new lifestyle. So not losing exercise, it's having a review.

Henrietta: Okay. Well, I, I definitely find that, certainly in my twenties I might, living a more urban lifestyle, might be going to a gym now is so pulled to, to exercising in nature and the impact that that has.

Lorna: Yeah. Yeah.

Henrietta: So, um, no pun intended, but building in pause into our life is so incredibly important, no matter what life stage you’re at, but I feel, and I can bring personal experience into this as a woman in my mid forties, you know, who's encroaching on this time in my life, actually building pause in every day. It's not about the two week holiday. Once a year in the summer, burning it, burning it, demanding life, busy working children, and then two weeks holiday; for me, the gift is in pauses every day,

Lorna: Consistent, everyday little kind of ...I started doing...So I get up in the morning and actually go outside with no shoes on and just ground for a few minutes on the grass and just be still for few minutes, considering the rest of the day will be really quite full on and busy in a nice way. That starting the day like that. And it only takes like two or three minutes...

Henrietta: I was going to say, a little goes a very long way.

Lorna: And actually I've been doing it for so long. Now you just do, without even thinking, and it just feels so much better. It's good. A moment to pause.

Henrietta: Amazing, absolutely. And my gosh, we need it. Um, particularly I feel like in this last year and a half, I mean, you know, it's just been very little time to pause.

Henrietta: So you mentioned how important sleep is.

Lorna: Yes.

Henrietta: I absolutely fully agree with that as does, as does the evidence, the mounting evidence around sleep, circadian rhythms and hormonal health. So if somebody is struggling, being challenged with their sleep, what would you recommend?

Lorna: Well, what I do often is think, what's happening in the beginning of the day, because a lot of people will focus on sleep as the bit that happens in the evening, which obviously it does, but it's like how you start your day.

Lorna: So I'd be looking at things like is there enough magnesium in the diet, are things like Ashwagandha going to kind of help because if the sleep is hormone-related, do we need some help from that kind of side, are they low in vitamin D? This will affect your sleep waking cycles. So if you feel like you're listening to this and your sleep is getting poorer, because you’re in perimenopause, there are things that you can do, and then if you sleep better, you probably find your perimenopause symptoms are better and easier to manage. So there are solutions for that and that's, and there are the great supplements and herbs that will really, really help with that, for sure.

Henrietta: So Lorna you've given such an amazing amount of information, and there will no doubt be people thinking I'm going to employ some of those tips and hints that you've given, but there will also be people that will be thinking, actually, I need to look deeper, I need to...you know, because actually one of the things that the menopause or perimenopause highlights is just how incredibly, incredible actually the body is, you know, it really is a scientific marvel, so complex. And so if we've also highlighted the fact that it's not a simple take HRT and it's done, if somebody wants deeper advice, if somebody wants deeper support, what would you recommend?

Lorna: So we have a fantastic consultation service, which you can book online on the website and you can book in for a 15 minute consultation or 45 minutes, if you want to go deeper. And what my fantastic team will do is really find out more about you as an individual, because health is very individual, and work out, do you need this herb, do you need this nutrient, are there additions to your diet that you can make?

Lorna: And it's actually your chance for someone to really listen to you and really engage and hear you and hear your symptoms, and then actually help you work out what would be right for you to take. Cause also, health is a journey. So what's right for you, maybe for like a couple of months might need to change after that.

Henrietta: Absolutely

Lorna: ...as well, and that's why you can book in as much as you, as you like as you kind of go through this journey and that's your opportunity also to ask more about the products and nutrients and have that time for you essentially..

Henrietta: Well, Lorna, I mean, it's just been lovely as always to chew the cud with you,

Lorna: Thank you for having me, and the animals..

Henrietta: I know we could do this for a long time….and the animals!

Henrietta: And I just really hope that where women are seeing this stage in their life as something that they're wanting to get as far away from..

Lorna: Dreading it.

Henrietta: Terrified of, dreading it, exactly, that’s exactly the term or when they're going through it just feel like I have to grin and bear it and it's awful, and, and I really, really hope that the conversation might have contributed to the change of rhetoric around that. Um, and that, it doesn't need to be one of those things to dread..

Lorna: No

Henrietta: Or one of those things to think of as a negative experience, because it's an opportunity as well.

Lorna: Especially as if you think back to when we were like, you know, twenties, like how you're less confident, you're more worried about what people say or clothes or whatever; I think in those perimenopause years probably got to a point where you were like, yeah, I'm actually pretty cool. I really like myself. I’m not this like insecure 25 year old. So actually it should be like, yeah, let's do this, let's actually like, enjoy this phase because I've got to this point and I'm a real bad-ass and I'm brilliant. Let's just love it rather than that's why it's all about, just kind of going, it's actually going to be okay. Get some help. It's going to be all right. And it's gonna be fun. Yeah.

Henrietta: Lorna, thank you so very much, you're a gem.

Lorna: Thank you for having me.