Perimenopause – Your Questions Answered

Perimenopause – Your Questions Answered

 

Perimenopause is a different experience for each of us, yet there are several common themes and questions.

Fortunately, nutrition and lifestyle medicine can be a big help at this time of transition.

From hot flushes and anxiety to low mood and vaginal dryness, making changes to what we eat and how we live can make a powerful difference during perimenopause.

This blog answers some common perimenopause questions, and you can find out more in my new book ‘Natural Nutrition for Perimenopause – What to eat to feel good and stay sane’ available from Amazon, YPD Books, Waterstones online, and Tullivers in York.

 

Natural Nutrition for Perimenopause - What to eat to feel good and stay sane book cover by Sally Duffin Perimenopause Nutritionist

Heavy Periods

Q. My periods are getting heavier and I’m starting to experience a lot more irritability and anxiety. I’ve just turned 41 – could this be perimenopause?

A. Yes. Some of the first signs of perimenopause are changes to moods, period frequency, and/or period 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.
Fluctuating oestrogen levels affect our brain just as much as the ovaries and womb lining. There are oestrogen receptors throughout the brain, and each area responds differently to changes in oestrogen levels. For example, if the amygdala doesn’t receive enough oestrogen we can feel more anxious and fearful. If the hypothalamus (our central temperature regulator) is affected we can experience hot flushes.

Try keeping track of your symptoms to see if they fit into any kind of monthly pattern. To help manage the anxiety. follow the tips below in the Q&A for Anxiety & Low Mood.

Heavy periods can increase your iron loss, so be mindful of regularly including iron-rich foods throughout your cycle:

– Haem iron (animal source) is the most bioavailable form for us to absorb and use, and is found in red meat, poultry, fish, and eggs.
– Non-haem iron is found in animal foods too, and also in vegetables – especially dark green leafy veg; pulses, dried fruits, nuts, wholegrains, and Blackstrap molasses. Combine vitamin C rich foods with non-haem iron sources to aid absorption.

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.

Hot flushes

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 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.

Phytoestrogens

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.

Gut, brain, hormones & immunity – it’s all connected!

Gut, brain, hormones & immunity – it’s all connected!

One of the most important things I’ve learned from both naturopathic nutrition and Yoga is that every part of the body is connected. We are one big moving part. Nothing in the body exists in isolation. Gut, brain, heart, hormones, immunity, muscles, bones, lungs, liver, skin; every organ and system is communicating with one another.

Whether its via hormonal messages, nerve fibres, fascia, or microbial metabolites: communication is constant.

I recently had the pleasure of talking about these incredible interconnections for a podcast (more details to follow on this). The podcast focuses on the links between the gut, brain, hormone balance, and the immune system. I like to make notes before I do any kind of talk, so I drew a mind-map of the links between these areas. It ended up large and colourful…

mind-map of links between gut, brain, immunity and hormones

And this is just the basic links, there are plenty more that wouldn’t fit on the page!

The Gut is the Foundation

The gut is always the first place to start when looking at a health issue. Whether its mental health, low immunity, hormone imbalance, or any kind of inflammation – look at the gut first. As the mind-map shows, this is where nutrient absorption takes place, and the elimination of waste (including old hormones). You can eat all the right foods and take top quality supplements, but if you’re not absorbing them well enough, or clearing out your waste each day, improvement will be very slow.

Our gut microbes (the microbiome) play a huge role in regulating our immune response, managing inflammation, and influencing mood. They communicate with the brain via the vagus nerve, the ‘super highway’ communication channel between gut and brain. Anything that upsets the microbiome – stress, infection, antibiotics – can affect mood and immunity.

Hormones

Hormones are the chemical messengers zooming instructions around the body. When it comes to stress, cortisol is the main player. Ongoing high levels of cortisol can compromise our digestion making us more prone to gut problems like bloating, indigestion, and Irritable Bowel Syndrome. It also affects immunity, increasing the risk of infections, and hampering recovery. If we don’t learn how to manage ongoing stress, our mental resilience starts to wear thin too. Eventually this can lead to anxiety, depression, and burn-out.

Fluctuating oestrogen levels during the pre-menstrual phase (PMS) and perimenopause can affect gut health and mental wellbeing. High levels of oestrogen can be a triggering factor for migraines and PMS, while low levels lead to different symptoms depending on which part of the brain is affected. For example hot flushes, one of the characteristic symptoms of perimenopause, are triggered when there isn’t enough oestrogen reaching the hypothalamus, our central temperature regulator. Too little oestrogen in the amygdala can lead to anxiety, which in turn increases our sense of feeling threatened and stressed and upregulates cortisol production.

Balancing the connections

If you can make out my scrawls on the diagram, you’ll notice there’s a lot of crossover between the nutrients that support each area – gut, mental health, hormones, and immunity. Including these nutrients on a daily basis supplies your body with the tools it needs to:
– Build hormones
– Manage inflammation
– Maintain immune balance
– Support neurotransmitters
– Detoxify hormones
– Nuture the gut microbiome

Food connects us with ourselves, and enables our internal communications to run smoothly.

If you’re dealing with symptoms in any of the areas mentioned on the diagram, look at your food choices and see where you can make some simple swaps to include more of these key nutrients. This table lists some of the top sources so you can mix and match and enjoy the variety…

Table of food sources of key nutrients for gut, brain, hormone and immune health

Supporting Vagal tone

Alongside all these good foods, think about ways to incorporate more relaxation and mindfulness into your daily life. When we’re busy and stressed we are spending the majority of our time in the fight-flight-freeze response; the sympathetic nervous system. For our health, we need to balance this by switching to the parasympathetic response: rest-digest-heal. The vagus nerve plays a big role here, and anything that activates it will help. Taking a few slow deep breaths is the quickest and easiest way to do this because the brain thinks “ah, we can’t be in immediate danger, we’re breathing too slowly!” Singing is another good technique (not always practical in the middle of a work meeting though) and doing meditative movements such as yoga and Qi Gong.

Look at ways to fit pockets of relaxation time into your day. A short walk in the park at lunchtime, ten minutes of mindful meditation after work, taking 5 slow deep breaths before each meal – that sort of thing. The benefits of these little pockets soon builds up and you’ll feel calmer and more resilient.


Enjoyed this post? You might also like:

Top 5 Foods for Anxiety
Depression & Anxiety – What to Eat to Feel Good
Perimenopause – Your Questions Answered

Louise’s Green Soup

Louise’s Green Soup

This delicious recipe comes from nutrition student Louise North.  It’s a simple, 5-ingredient soup, packed with Good Stuff including:

Fibre
Broccoli and leek provide plenty of soluble fibre.  Gut bacteria ferment this fibre and produce short-chain fatty acids.  These fatty acids are vital fuel for cells lining the gut.  Clever, eh!

Quercetin
Broccoli (and other dark green veggies) contain quercetin, a powerful anti-inflammatory flavonoid.  Research shows quercetin to be useful in managing inflammation, particularly when associated with obesity, and allergic reactions.

Glucosinolates
Broccoli comes up trumps again with its high levels of glucosinolates – sulphur containing compounds found in cruciferous vegetables.  Glucosinolates are activated by an enzyme called myrosinase which converts them into isothiocyanates and indoles.  Both these compounds support hormone biotransformation pathways in the liver and can be helpful for managing oestrogen levels.

 

Quick tipChopped broccoli on a chopping board to make soup

The enzyme myrosinase is activated when cruciferous veggies like broccoli are chopped and diced.  Let the diced broccoli sit for 10-15mins before adding it to the soup to give the enzyme time to work more effectively.

 

Ingredients (makes 4 servings)

2 large leeks

1 large head of broccoli

1 large onion

25g butter OR 1 tablespoon olive oil

1 litre veg stock

Wash and chop the leeks and onion.  Chop the broccoli, including the stalk – no stalk wasting here!  In a large pan gently heat the butter/oil and sweat the leeks and onion until soft.  Add the stock and allow to simmer for ten minutes. Add the chopped broccoli and simmer until it’s al dente: cooked but not mushy.  Allow the soup to cool slightly then blend until smooth – or leave a few bits in, the choice is yours!

Seed cycling for hormone balance – is it worth it?

Seed cycling for hormone balance – is it worth it?

Seed cycling – have you heard of it?

It’s a technique of eating certain combinations of seeds during the menstrual cycle to help support hormone balance. 

Many women say seed cycling relieves PMS symptoms and helps maintain a more regular cycle.  It’s an easy technique to practise – so long as you enjoy eating seeds!


How seed cycling works

Based on an average cycle length of 28-30 days, the pattern for eating the seeds goes like this:

Chart for seed cycling

The plan is based upon the idea that the different nutritional qualities of the seeds support the variations in hormone levels over the course of the month.  But, is it really necessary to seperate the seeds out like this?  Does it matter if you eat a mixture of each seeds every day?

To date, there are no research trials looking at the impact of seed cycling.  However, there are several studies examining the nutritional qualities and actions of some of these seeds individually – particularly flaxseed.  Flax is packed with nutrients (see below) that can be incredibly helpful when dealing with PMS symptoms or perimenopausal hormone fluctuations.

 

How are the seeds helpful?

Flax: contains high levels of compounds called lignans.  Our beneficial gut bacteria can convert these lignans into phytoestrogen compounds which have a modulating effect on oestrogen receptors.  When natural oestrogen levels are too low, phytoestrogens can support them.  At the other end of the scale, if you’re oestrogen dominant (which is often the case in endometriosis, PMT, PCOS, and early perimenopause) the phytoestrogens block the actions of natural oestrogen, helping to reduce its activity.  Alongside the lignans, flax provides protein and the omega-3 essentail fatty acid alpha-linolenic acid (ALA) which converts into anti-inflammatory compounds called prostaglandins.

*Flax is best eaten ground as the tiny seeds are difficult to chew and can pass straight on through your digestion!

Pumpkin: excellent source of omega-3 ALA, zinc, magnesium, fibre, and protein.

Sesame seeds: naturally rich in calcium to support bone health and may also relieve some symptoms of PMS.

Sunflower seeds: packed with vitamin E; a powerful antioxidant and shown to help relieve hot flushes in perimenopausal women.

 

Seed cycling or seeds everyday?

There’s no firm agreement on this question.  If you are keen to try seed cycling, go for it!  If you are new to eating seeds start with 1/2 a tablespoon of each seed and work up to the full tablespoon to give your digestive system time to adjust to the increase in fibre intake.

If seed cycling sounds a bit too much like hard work, keep things simple and focus on including ground flaxseed each day instead.  However you decide to include more seeds, remember to increase your water intake too.  These seeds are rich in fibre that soaks up fluid in the digestive tract and keeps waste matter moving steadily along.  More water is essential to prevent the seeds causing constipation!

 

How to include the seeds in your diet

  • Smoothies – blend the ground seeds with fruit, dairy or non-dairy milk, veggies, and a dollop of nut butter for a satisfying smoothie
  • Salads – sprinkle them into salads made up of a mixture of roasted veggies, salad leaves, meat or fish or egg, lentil pate, and a couple of tablespoons of a grain such as brown rice or buckwheat
  • Add to yoghurt and fruit for a snack
  • Mix with quinoa, cooked lentils, egg, baby tomatoes, chopped herbs, and a handful of baby spinach for a protein-rich lunch
  • Mix with chopped dried apricot, raisins, nuts and coconut flakes as a trail-mix-style snack
  • Add to homemade bread, muffins – or try this Menopause Cake recipe – yes, cake really can help you get through menopause!

 

Have you tried seed cycling?

What are your favourite tips for using seeds in recipes?

Share your ideas and discover more tips over in the Facebook group – Nutrition in York!