Perimenopause is a different experience for each woman, yet there are common questions that need answers! Fortunately, nutrition and lifestyle medicine can be a big help at this time of transition. From hot flushes to anxiety and low mood, making changes to what we eat and how we live can make a powerful difference during perimenopause.
Q. My periods are getting shorter and heavier and I’m starting to get hot sweats during the day. I’ve just turned 41 – could this be perimenopause?
A. Yes! Some of the first signs of perimenopause are changes to period frequency and flow. These can start happening in your mid to late 30s. However, many women don’t notice this if they’re taking the Pill or using hormonal implants. Hot flushes are another sign of hormone fluctuations. Caffeine and stress are major flush triggers too, so be mindful of caffeine intake and stress levels.
Q. My periods are incredibly painful and heavy and I don’t want to take the Pill or have a coil fitted. Do I have to put up with this until after menopause?
A. Symptoms like this can be a sign of fibroids or endometriosis. Both conditions are influenced by oestrogen and hormone fluctuations. During the early stages of perimenopause we can be in a temporary state of oestrogen dominance. Because we stop ovulating every month, there’s very little progesterone produced to counter-balance oestrogen. Unfortunately it can take months, even years, for fibroids or endometriosis to be diagnosed as many doctors fail to recognise how serious the symptoms are. Ask for a referral to a gynaecologist who will be able to offer the right support and testing. It will also be helpful to get your iron levels checked to make sure the heavy periods aren’t depleting your iron stores.
Q. Hot flushes are keeping me awake every night. I’m feeling exhausted all day, and having difficulty concentrating at work. What can I do?
A. Hot flushes are one of the most distressing perimenopausal symptoms. I can’t promise these tips will get rid of them completely but they can certainly reduce the severity and frequency:
– Minimise caffeine as much as possible. Avoid it altogether if you can! This means tea, coffee, energy drinks, and chocolate. And decaff versions too – sensitive people can react to the trace amounts of caffeine left in decaffeinated drinks.
– Keep your blood sugar levels balanced by eating within 2 hours of waking, replacing refined carbohydrates (white bread, white pasta, cakes, sweets, biscuits etc) with smaller portions of wholegrain versions, and only snacking if there’s a gap of more than 5hrs between meals.
– Try drinking sage tea or taking sage tablets or tincture. The A.Vogel ‘Menosan’ tablets and tincture are a licensed herbal remedy for managing hot flushes and sweats and can help with temperature regulation.
– Relax! Stress is a big trigger for hot flushes. We can’t always make stress go away but we can change how we respond to it. We can do this by building daily downtime into our schedules. This might mean going for a mindful walk, listening to music, following a guided meditation, doing crafts or creative writing, or simply soaking in a bath with essential oils. Mindful relaxation (as opposed to flopping in front of Netflix) is a great way to build our resilience to stress.
Anxiety & low mood
Q. Since starting perimenopause my moods have been really low. I feel anxious and depressed a lot of the time. I’m also really tired. Is this normal?
A. Mood swings and anxiety can be symptoms of perimenopause, but they can also be linked to other conditions. Have you had your thyroid checked? Depression and fatigue can be signs of an underactive thyroid. Many women start to experience thyroid issues around the time of menopause so it’s worth getting your thyroid hormome levels checked with your GP. Ask them to check your levels of TSH (thyroid stimulating hormone), T4 and T3 (thyroid hormones) and thyroid antibodies. The thyroid antibodies are important because an underactive thyroid may be due to auto-immunity. If your results come back positive for underactive thyroid see a Registered Nutritional Therapist for a personalised plan to support thyroid function.
If your thyroid is OK, look at ways to manage the anxiety and depression and low energy:
– Follow the blood sugar balancing tips (see previous Q&A) as poor blood sugar balance can worsen mood swings.
– Include at least 3 servings each day of foods rich in magnesium and B-vitamins such as avocado, sweet potato, nuts, seeds, dark green leafy vegetables, poultry, and eggs. These nutrients are vital for mood balance and energy levels.
– Make sure you’re getting enough sleep. Our brains need 7-9hrs each night, with at least 1 hr of that before midnight. Aim to be in bed by 10.30pm-11pm to give yourself the opportunity for a good rest.
– Include mindful relaxation time each day. Yoga, journalling, mediation, spending time outdoors in natural surroundings, and crafts are all known to be beneficial for managing depression and anxiety.
– Swap regular tea and coffee for herbal teas that soothe and support the nervous system. Lemon balm, chamomile, oat straw, valerian, and lavendar are good options.
Q. I’ve been told to eat phytoestrogens. What are they and where can I find them?
A. Phytoestrogens (phyto = plant) are naturally occurring substances found in fruits, vegetables, and grains. They have a similar effect to human oestrogen, but are hundreds and hundreds of times weaker. They’re not a hormone replacement therapy by any means. Instead, they have a modulating effect on our fluctuating oestrogen levels and may help reduce hot flushes and offer protection to our bones.
There are 3 types of phytoestrogens. The top food sources include:
Isoflavones found mainly in soybeans (edamame) and fermented soy products like tofu and miso. You can also find them in chickpeas, aduki beans, kidney beans, and red clover. Red clover seeds can be sprouted – try sprouting them alongside mung beans and alfalfa seeds.
Lignans flax seed is by far the richest source, followed by sesame seeds, broccoli, and cashew nuts.
Coumestans found in mung bean sprouts and alfalfa sprouts.
Q. Is soy safe to eat? I’ve read so many conflicting things about it!
A. Soy foods certainly are a controversial subject! Unfortunately a lot of the research done on soy uses raw soy extract – not the natural wholefoods recommended for perimenopausal women. The soy foods suggested for perimenopause are the fermented soy products like tofu and miso, and whole cooked soy beans. These foods are part of the traditional diet in Far Eastern countries where women have far fewer menopausal issues. Having said that, no food is entirely suitable for everyone, and some people find soy difficult to digest. If you have any concerns about soy, give yourself peace of mind and enjoy other phytoestrogen foods instead.
I hope you’ve found this Q&A helpful! Watch out for more updates on my forthcoming book “Perimenopause – The Natural Nutrition Guide: What to eat to feel good and stay sane” which will cover all these points and so much more.
Got more questions? Come and join the Facebook Group or follow my Facebook page – or join me on Twitter @nutritioninyork
Anxiety has been an unwanted companion of mine since childhood. From anxiety-induced stomach aches before school swimming lessons, to panic attacks while out shopping, anxiety has a big impact on my life experiences.
Over the years I’ve learned to take a two-pronged approach to anxiety. To manage it I use:
Speedy remedies like chewing on lemon balm leaves, drinking valerian tea, dosing up on Bach Rescue Remedy, and using Ashwagandha tincture each day whenever I’m in a particularly stressful phase.
Long term nutrition support. I regularly include foods that supply the vitamins and minerals my nervous system needs to manage anxiety and support mental wellbeing.
This 5-minute video covers 5 of my favourite foods for nervous system support. Each one is easy to find and easy to prep – there’s no weird ingredients or lengthy recipes here. I recommend including these on a regular basis and noticing how you feel. If you scroll on down past the video you’ll find some more ideas for foods and drinks that can help manage anxiety. All of these foods can be safely consumed alongside anxiety medications.
More Good Foods for Managing Anxiety
Fermented foods: let’s not forget the gut microbiome! Our gut flora produce important molecules that influence the nervous system and the production of mood chemicals.
One of these molecules is GABA (gamma amino-butyric acid). GABA is an inhibitory neurotransmitter that calms the nervous system. Fermented foods contain the probiotic bacteria that produce GABA, and fibres to nourish other gut bacteria. In turn, this support a healthy environment in the gut, and continues the production of GABA.
Including a serving of fermented foods each day is a great way to top up and fertilise your microbiome. Choose from:
Sauerkraut: available from healthfood stores and some supermarkets (avoid the pasteurised versions as the bacteria die off during pasteurisation) or make your own
Kefir: milk kefir, water kefir, coconut water kefir – there’s plenty of different varieties. Again, you can make this at home with some starter granules
Plain live natural yoghurt
Keen to try home fermenting? I can heartily recommend this book. It’s packed with tips and has easy-to-follow instructions – perfect for new fermenters!
Quick and easy to make, a warm mug of tea is a soul-soother in itself. Although for anxious people, it does need to be caffeine free – there’s no wriggle room on that! This is because even decaffeinated versions of tea can contain enough caffeine to stimulate the stress response and aggravate anxiety.
Herbs offer some wonderful infusions for anxiety. Try these teas either as single-herb teas or in combinations. For example, chamomile and lemon balm blend well together:
Gluten-free bread has gained a bit of a reputation for being crumbly and tasteless.
Because of this, many gluten-free home bakers have taken matters into their own hands and created their own delicious recipes.
Step forward Reg. Nutritionist Abby Foreman and her gluten-free seeded bread rolls!
As a Coeliac, Abby knows only too well the pitfalls of gluten-free breads. In the quest for better breads, she’s created these seeded bread rolls packed with fibre, vitamins, and minerals. They can even be batch cooked and frozen. Simply reheat in a warm oven – perfect for when you really need a bread bun with your lunchtime soup!
1 cup quinoa flakes
1 cup buckwheat flour
1 1/2 cup pumpkin seeds
1/2 cup sunflower seeds
3 tbsp psyllium husks – this is the vital ingredient for making the dough sticky and held together
2 tbsp mixed herbs
2 tbsp whole chia seeds
2 tbsp whole flax seeds
2 tbsp salt
600ml fresh water
Put the quinoa flakes and 1 cup of the pumpkin seeds in a food processed. Blend into a fine flour. Place all the dry ingredients into a bowl with the flour and combine well. Stir in the water, and mix everything together well. Let the mixture sit for an hour to absorb the water.
Preheat the oven to 180 c fan and line a baking tray (or two) with some greaseproof paper. Take a fist full of the dough and shape into a bread roll before placing it on the baking tray.
Bake the rolls for around 45 minutes until golden and crispy on the outside.
The rolls are best eaten when warm. You can store in an airtight container in the fridge for a few days, or in the freezer for a couple of months. Simply place the roll in the oven to heat through.
For more recipes from Abby and to find out about her 1-1 consultation services and online packages go to www.afnutrition.co.uk
April is the ideal month for gathering fresh new nettles. It’s early May as I write this, but I still managed to find some tender young plants to gather the top few leaves from.
The combination of nettles + leeks + baby spinach delivers a light creamy flavoured soup, packed with magnesium, calcium, potassium, vitamin C, beta carotene, vitamin K, folate, quercetin and more. All Good Things for energy, levels, mental wellbeing, and coping with stress.
These ingredients made 4 servings of soup:
25g butter (or a dessertspoon of coconut oil if avoidng dairy)
1 medium leek, sliced
1 white onion, chopped
1 teaspoon of minced garlic / 1-2 cloves chopped
2 medium white potatoes cut into cubes
Roughly 80g baby spinach
A bowlful of thoroughly washed nettle tops (the first 4-6 leaves from the top of the stem) – this was about a cereal bowl sized bowl-full
1- 1.5 litre vegetable stock (depending on if you like your soup thick or runny)
Melt the butter in a large pan. Add the onion, leek and garlic and sweat them over a low heat for 5-6mins. Add the spinach, nettles, potato, and stock and simmer for 10mins until the potatoes are soft. Blend, and serve topped with toasted pumpkin seeds or pine nuts.