The Menopause The Three Stages of Menopause The menopause can be one of the most disruptive and bewildering times in a woman’s life. Although the focus of much discussion regarding the menopause tends to centre around the female hormones, oestrogen and progesterone, it would serve us well to extend our conversation to exactly what those hormones do, and what implications the changes have throughout the body. With understanding of the myriad of changes that occur, it becomes possible to tailor our lifestyle to offset many of the uncomfortable menopausal symptoms, like hot flushes, fat gain around the tummy, brain fog, emotional upheaval and digestive distress, to name a few.

At around the age of 50-55 years, the UK average age is 51, a woman’s monthly cycle stops completely – no more ovulations, no more periods and no more pregnancies. Once you have had no periods for 12 months - this is the menopause. However, it’s not quite that simple. The process that most women refer to as the “menopause”, can actually be divided into three parts: perimenopause, menopause and postmenopause. While not every woman going through the stages of menopause experience side effects or any decrease in quality of life, many do. The degree to which you struggle with the symptoms of perimenopause and menopause has a lot to do with the several factors that make your body unique, including your personal medical history, genetics, the quality of your diet, how active you are and your stress levels.

In this module we will delve a little deeper into what actually happens during the menopause but let’s start by looking briefly at each stage.

Perimenopause Perimenopause is considered the time period before menopause starts, prior to cessation of menstruation for 12 consecutive months. The average age for perimenopause to begin is the mid 40s and it can last for several years (the average is 4 years but it can last up to 10 years or as little as 4 months). During perimenopause, ovarian function and oestrogen production start to become erratic and therefore a woman’s cycle is usually somewhat unpredictable. Many women see this stage as the biggest time of change, in terms of behaviour and symptoms, because this is when oestrogen and progesterone fluctuate the most. However, for some women, perimenopause can come on so gradually and in the midst of many other life changes, the symptoms mostly go unnoticed, even for several years. The most common signs and symptoms include:

Menopause The symptoms of menopause are very similar to those experienced in the perimenopausal stage. At around the age of 50-55 years a woman’s monthly cycle stops completely – no more ovulations, no more periods and no more pregnancies. Once you have not menstruated for 12 months - this is the menopause. The menopause is

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• Dry skin • Changes in breast tissue • Mood swings • Heart palpitations • Migraines & frequent headaches • Poor concentration • Thinning hair

• Irregular periods • Hot flushes & night sweats • Insomnia • Gradual weight gain • Increased abdominal fat • Changes in sex drive • Vaginal dryness

not seen as a period of time but can rather be defined as a single moment, a single day. So on day 366 you are post-menopausal and this is then a permanent state.

Postmenopause At postmenopause your hormone levels will not fluctuate to the same extent that they did during the lead-up to menopause, which means that many postmenopausal women find relief from some of the symptoms, such as hot flushes. After going through years of decline, your levels of oestrogen and progesterone will now remain at low levels, introducing new health needs for your body as it gets older. For instance, low levels of oestrogen put postmenopausal women at an increased risk of osteoporosis and heart disease. However, with attention to diet and lifestyle, these risks can be managed, keeping you happy and healthy as you age.

What Happens At Menopause Let’s briefly look at the “general” female cycle before menopause. From the start of the cycle, day 1 to day 14, there is more oestrogen (orange line) relative to progesterone (green line) and then after ovulation, from day 15 to day 28, it’s a time when both progesterone and oestrogen are higher but progesterone is higher than oestrogen. Oestrogen and progesterone have an impact on some of your fat burning and fat storing hormones, especially oestrogen, making your body more insulin sensitive. Being insulin sensitive means that when oestrogen is around in higher amounts, the carbohydrates that you eat have less of an impact on fat storing. Both oestrogen and progesterone make women less responsive to cortisol (a stress hormone) which can also keep you from storing fat. Oestrogen an progesterone together decrease fat storage from around the middle, this is why women naturally have smaller waists than men.

Now during perimenopause, progesterone starts to decline first so you will have times when ovulation doesn’t occur. Oestrogen exposure will be greater, without much progesterone exposure. Progesterone works together with oestrogen to burn fat and keep your waist small because together they block the harmful effects of cortisol and help to keep your mood balanced.

As you move on towards the menopause, there is no ovulation and low progesterone, so oestrogen starts to decline as well. Both oestrogen and progesterone fall at menopause but there are periods of time where there is greater oestrogen than progesterone. This is different to younger women, where there are times when oestrogen is dominant (in the first 14 days) and then progesterone is dominant (day 15 to 28).

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The formula for fat gain at menopause is a result of: 1) Progesterone decreasing 2) Oestrogen decreasing 3) An increase in testosterone (testosterone has fallen too but there is a relative increase in testosterone in

relation to oestrogen and progesterone. Oestrogen and progesterone would have been much much higher than testosterone in a younger woman but now they are not as high in comparison.)

4) More stress reactivity due to the effects of cortisol and insulin.

Another change that can be seen at menopause is the impact it has on the main brain chemicals or neurotransmitters, dopamine, serotonin and GABA. These all decrease at menses (pre-menopause, when you have your periods) and at menopause. This is because there are receptors for both oestrogen and progesterone all over the body, including the brain, which cause mood swings and cravings. This is turn makes it more difficult for women at menopause to stay on track with the diet like they once were able to. So, hormone changes, metabolism changes and brain changes all LEAD to weight gain around the middle.

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MenopauseFat Gain

Especially around the middle

More Stress Reactive More Insulin

ResistantFat Gain

Decrease in Oestrogen

Decrease in Progesterone

Increase in Testosterone

GABA

Dopamine

Serotonin

All fall at menses &

Cravings!

Progesterone First to decrease at peri-menopause

Oestrogen Next to fall

Rise and/or become less sensitive Testosterone, Insulin, Cortisol

GABA - Major relaxing neurotransmitter Dopamine - Brain chemical that focuses the mind Serotonin - Self-esteem and relaxing neurotransmitter

Introduction To Female Hormones Woman produce a number of different sex hormones including oestrogen, progesterone and testosterone, all of which naturally begin to diminish in quantity during the menopause.

Oestrogen Oestrogen is a powerful sex hormone that regulates many aspects of our lives. It is a growth hormone and initially makes girls develop into women at puberty, by stimulating breast growth, thickening of the uterine lining, laying down fatty deposits, thickening the vagina and causing it to secret mucous. Oestrogen is a hormone that is really responsible for many things growth-wise and can even impact the growth of muscle and brain cells. It effects how our skin looks, whether our bones are strong and healthy and it can protect us against heart disease. So oestrogen is not just about reproduction, it’s about healthy growth all over the female metabolism.

Oestrogen increases GABA, the major relaxing neurotransmitter (brain chemical), as well as dopamine (a focusing brain chemical), so when oestrogen is lost mood can change and this will happen month to month in a young female’s cycle but also around menopause when oestrogen start to drop off.

More importantly and in relation to this plan, oestrogen has an impact on fat distribution. Oestrogen makes the female metabolism insulin sensitive and less stress reactive, so from the stand point of fat loss during a woman’s younger years, it keeps them thinner all over because it causes fat loss globally. However, when oestrogen declines, particularly at the time of menopause, fat distribution changes and women are more likely to gain weight, especially right around the middle. It can also cause fat gain in the lower body because it impacts certain receptors that slow fat loss from the hips, bum and thighs. Oestrogen opposes the action of testosterone which is why women have the curvy hour glass shape as opposed to the male v-shape.

An important female hormone, Oestrogen impacts another hormone, insulin. Insulin takes sugar out of the blood and puts it into the cells to be burned for energy. Oestrogen helps keep you sensitive to insulin, meaning that you will require smaller amounts of insulin to lower blood glucose levels, which is a positive thing. When oestrogen declines sensitivity to insulin declines too and you become more resistant to insulin by the very action of going through the menopause. Insulin resistance is when the cells in the body do not respond properly to it or they no longer hear the message that insulin is trying to get across. When this happens sugar in the blood is more likely to build up leading to high blood sugar levels, the body then tries to cope with the high levels of sugar by producing more insulin. Your body will not get as much sugar into the cells, turning it aside and sending it to fat storage instead. This is one mechanism, for weight gain and belly fat, associated with the menopause. Through no fault of your own, you are biochemically and physiologically less equipped to handle the amount of carbohydrates you could before.

As such, women in perimenopause and menopause need to find their new carbohydrate tipping point. You would be well served to adjust carbohydrate consumption in volume or timing (or both), and to emphasise fibre and adequate protein. This will help improve insulin sensitivity.

The other thing to understand about oestrogen is its unique relationship to progesterone and thyroid. Oestrogen and progesterone both need each other to function well. Oestrogen primes progesterone receptors and vice-versa - receptors are how the cell gets the signal from the hormone and so oestrogen needs enough

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progesterone to function optimally and again vice-versa. Because it blocks the action of thyroid, too much oestrogen is not good, too little oestrogen is not good either.

Progesterone If oestrogen is growth producing, progesterone balances growth, in the breast, uterine lining etc. Progesterone really balances the effects of oestrogen. It also has an impact on mood and may be the best hinge to use for anti-anxiety.

Oestrogen and progesterone both keep the female waist small. Progesterone helps you buffer the negative effects of cortisol because it opposes cortisol’s action and can act as a shield between the stressed-out feelings cortisol can induce and your nervous system. Cortisol is a rather infamous hormone, connected with the stress response and it is not inherently bad or good, but in menopause it becomes a big player. If left unopposed by progesterone, it will strip muscle in the arms and legs and deposit fat around your middle. This, combined with increased insulin resistance, is a perfect one-two punch to gain belly fat. Not only are women more prone to gain belly fat under this hormonal environment, they also become more sensitive to the effects from stress. They feel it worse. It sticks around longer; they can’t recover from it as well. You may notice things that never bothered you before bothering you more. You may also notice that you are becoming forgetful.

To help oppose cortisol, soothe the nervous system and reverse the loss of your waistline, transitioning your movement and exercise routine becomes important. Swap medium intensity/medium duration exercise – which promote an exaggerated cortisol response – for a combination of long, slow movements like walking and a combination of resistance training and sprint or interval style training. Shorter, more intense workouts will release hormones like testosterone, human growth hormone (HGH) and IL-10, which blunt the action of cortisol.

Progesterone might be the first hormone that’s depleted during perimenopause (or prolonged stressful times) and whereas oestrogen has thyroid damaging effects or thyroid interrupting effects, progesterone has some thyroid benefits, allowing it to work more efficiently and keeping your energy levels up.

Testosterone Women have testosterone too! Testosterone for a woman is mainly about libido, especially when you are looking at signs and symptoms of the menopause, but it also impacts your mood, it helps to keep your mood elevated and can help sharpen the mind. Of course it impacts fat distribution and offers some muscle storing benefits too. In perimenopasue the body will often recruit testosterone to help with some of progesterone’s duties – like keeping the waist trim.

Testosterone levels in women will peak in their twenties and then gradually start to decline. At menopause oestrogen falls, progesterone falls and testosterone levels fall too but there is a relative increase in testosterone in relation to oestrogen and progesterone. Low levels of oestrogen and progesterone compared to testosterone in women is not a great thing to have as far as body composition goes and can cause fat storage around the middle. Oestrogen and progesterone would have been much much higher than testosterone in a younger woman but in menopause they are not as high in comparison.

Lifting weights and incorporating resistance training helps increase testosterone naturally, it can help take inches off the waistline and give you a mental boost. Resistance training is critical for women, not simply for these hormonal benefits, but also to increase bone density and help balance insulin. Pushing heavy weights around really makes your muscles soak up some sugar, and thus, increase insulin sensitivity.

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