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Menopause is having a moment. How a new generation of women are shaping cultural attitudes

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/bridgette-glover-2232638">Bridgette Glover</a>, <a href="https://theconversation.com/institutions/university-of-new-england-919">University of New England</a> From hot flashes to hysteria, <a href="https://rowman.com/ISBN/9780739170007/Periods-in-Pop-Culture-Menstruation-in-Film-and-Television">film and TV</a> have long represented menopause as scary, emotional and messy. Recently, celebrities have been sharing their personal menopause experiences on social media, helping to re-frame the conversation in popular culture. We are also seeing more stories about menopause on television, with real stories and depictions that show greater empathy for the person going through it. Menopause is having a moment. But will it help women? <h2>The change onscreen</h2> This is not what we’re used to seeing on our screens. Countless sitcoms, from All in the Family (1971–79) to Two and a Half Men (2003–15) have used the menopause madness trope for laughs. Retro sitcom That ‘70s Show (1998–2006) used mom Kitty’s menopause journey as comedic fodder for multiple episodes. When she mistakes a missed period for pregnancy, Kitty’s surprise menopause diagnosis results in an identity crisis alongside mood swings, hot flashes and irritability. But the audience is not meant to empathise. Instead, the focus is on how Kitty’s menopause impacts the men in her family. Having to navigate Kitty’s symptoms, her veteran husband likens the experience to war: “I haven’t been this frosty since Korea”. <figure><iframe src="https://www.youtube.com/embed/mPLJBZiKV4U?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Even when male characters are not directly involved, women are determined to reject menopause because they see it as a marker of age that signals a loss of desirability and social worth. In Sex and the City (1998–2004), Samantha describes herself as “day-old bread” when she presumes her late period signifies menopause. This is a popular framing of menopause in <a href="https://www.tandfonline.com/doi/full/10.1080/14680777.2018.1409969">post-feminist TV</a> of the 1990s and early 2000s. While the <a href="https://www.tandfonline.com/doi/full/10.1080/14680777.2012.712373#d1e783">menstruating body</a> is constructed as uncontrollable and in need of management, the menopausal body requires management and maintenance to reject signals of collapse. These storylines erase the genuine experiences of confusion, discomfort and transformation that come with menopause. <h2>A cultural moment arrives</h2> <a href="https://www.npr.org/sections/health-shots/2015/12/31/460726461/why-2015-was-the-year-of-the-period-and-we-dont-mean-punctuation">Since 2015</a>, stories of menstruation have increased in popular culture. Series like comedy Broad City (2014–19) and comedy-drama Better Things (2016–22) directly call out the lack of menopause representations. When Abbi in Broad City admits she “totally forgot about menopause”, a woman responds “Menopause isn’t represented in mainstream media. Like, no one wants to talk about it”. Similarly, in Better Things, while watching her three daughters stare at the TV Sam laments: “No one wants to hear about it, which is why nobody ever prepared you for it”. And lack of preparation becomes a key theme for perimenopausal Charlotte in the Sex and the City reboot, And Just Like That … (2021–) when she has a “flash period”. <figure><iframe src="https://www.youtube.com/embed/9AmwXuHo-2w?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fleabag (2016–19) included a groundbreaking monologue about menopause delivered by Kristen Scott-Thomas, playing a successful businesswoman. She describes menopause as “horrendous, but then it’s magnificent”. <blockquote> […] your entire pelvic floor crumbles, and you get fucking hot, and no one cares. But then you’re free. No longer a slave. No longer a machine with parts. </blockquote> <figure><iframe src="https://www.youtube.com/embed/RZrnHnASRV8?wmode=transparent&start=13" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Scripted by Phoebe Waller-Bridge, this <a href="https://www.latimes.com/entertainment/la-et-menopause-20190524-story.html">celebrated</a> monologue critiques the post-feminist notion of striving to be the “<a href="https://www.tandfonline.com/doi/full/10.1080/14680777.2012.712373#d1e783">idealised feminine body</a>”. Through this new feminist lens, menopause is acknowledged as both painful – physically and emotionally – and necessary for liberation. <h2>Today’s menopause on screen</h2> Alongside more recent series like The Change (2023), multiple documentaries including <a href="https://www.tamsenfadal.com/the-m-factor">The (M) Factor</a> (2024), and <a href="https://theconversation.com/there-is-no-future-for-ageing-women-how-the-substance-uses-body-horror-in-a-feminist-critique-239729">arguably</a> even films like The Substance (2024), social media has become a prolific space for raising awareness about menopause. Celebrities use social media to share tales of perimenopause and menopause, often in real time. Last year, actor Drew Barrymore experienced her “first perimenopausal hot flash” during her talk show. And ABC News Breakfast guest host, Imogen Crump, had to pause her news segment, saying <blockquote> I could keep stumbling through, but I’m having such a perimenopausal hot flush right now, live on air. </blockquote> Both Barrymore and Crump shared clips of their live segments to their social media pages, to challenge stigma and create conversations. Crump even posted to <a href="https://www.linkedin.com/posts/imogen-crump-6b74b726_perimenopause-activity-7127788484861300736-mhHh/">LinkedIn</a> to raise awareness in a professional setting. In a podcast interview clip shared to Instagram, writer and skincare founder, Zoë Foster Blake describes perimenopause as a “real mental health thing”, because of the lack of awareness. Recalling conversations with other perimenopausal women, Foster Blake says “We all think we’re crazy. We don’t know what the fuck is going on”. Feeling “crazy” is a constant theme in these conversations. As actor and <a href="https://stripesbeauty.com/pages/founder-story">menopause awareness advocate</a> Naomi Watts points out, this is largely thanks to Hollywood. Despite the stigmatising media stereotype of “crazy lady that shouts”, <a href="https://www.youtube.com/watch?v=TQ3BN9rS_7g">Watts argues</a> that with “support and community”, women experiencing perimenopause and menopause “can thrive”. In fact, Watts believes menopause should be celebrated: “we know ourselves better, we’re wiser for our cumulative experiences”. Medical professionals like American doctors <a href="https://www.instagram.com/p/DBUCPW5OUTf/">Marie Clare Haver</a> and <a href="https://www.instagram.com/p/C7IfaHDgXMY/">Corinne Menn</a> have been well-positioned to share their expertise and experiences via social media. They are catching and helping fuel a wave of advocacy and awareness for midlife women’s health. <h2>Building community</h2> After watching the menopause madness trope on our screens for decades, we are now seeing perimenopause and menopause depicted with more empathy. These depictions allow viewers – those who menstruate, who have menstruated, and who know menstruators – to feel seen and be informed. By sharing their experiences on social media and adding to these new screen stories, celebrities are building a community that makes the menopausal journey less lonely and helps those on it remember their worth.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/241784/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/bridgette-glover-2232638">Bridgette Glover</a>, PhD Candidate in Media and Communications, <a href="https://theconversation.com/institutions/university-of-new-england-919">University of New England</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/menopause-is-having-a-moment-how-a-new-generation-of-women-are-shaping-cultural-attitudes-241784">original article</a>. </div>

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Is there anything good about menopause? Yep, here are 4 things to look forward to

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Menopause is having a bit of <a href="https://journals.sagepub.com/doi/full/10.1177/13675494231159562">a moment</a>, with less stigma and more awareness about the changes it can bring. A recent senate inquiry <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Menopause/Report">recommended</a> public education about perimenopause and menopause, more affordable treatments and flexible work arrangements. But like many things in life the experiences of menopause are on a continuum. While some women find it challenging and require support, others experience some physical and emotional benefits. These are rarely reported – but we can learn from the research available and, importantly, from people’s lived experiences. Here are four changes to look forward to once you reach menopause. <h2>1. No more periods or related issues</h2> <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">Menopause</a> is considered “complete” 12 months after the final period of a woman (or person assigned female at birth) who previously menstruated. Perhaps unsurprisingly, the benefit at the top of the list is no more periods (unless you are taking hormone therapy and still have your womb). This can be particularly beneficial for women who have had to manage <a href="https://www.mdpi.com/1660-4601/18/4/1951">erratic, unpredictable and heavy bleeding</a>. At last, you don’t need to keep sanitary protection in every bag “just in case”. No more planning where the bathroom is or having to take extra clothes. And you’ll save money by not purchasing sanitary products. There is also good news for women who have had heavy bleeding due to uterine fibroids – common benign gynaecological tumours that affect up to 80% of women. The evidence <a href="https://journals.lww.com/menopausejournal/abstract/2020/02000/uterine_fibroids_in_menopause_and_perimenopause.17.aspx">suggests</a> hormonal changes (for women not taking hormone therapy) can lead to a reduction in the size of fibroids and relieve symptoms. Women who suffer from menstrual migraine may experience an improvement in migraines post-menopause as their hormonal fluctuations begin to settle – but the timeframe for this <a href="https://www.maturitas.org/article/S0378-5122(20)30329-7/abstract">remains unclear</a>. For some women, no more periods also means more participation in social activities from which they may have been excluded due to periods. For example, <a href="https://www.tandfonline.com/doi/full/10.1080/08952841.2014.954502">religious activities or food preparation</a> in some cultures. <h2>2. Getting your body and your groove back</h2> Throughout their reproductive lives, women in heterosexual relationships are usually the ones expected to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115298/">proactive about preventing pregnancy</a>. Some post-menopausal women <a href="https://www.tandfonline.com/doi/full/10.1080/08952841.2018.1396783">describe</a> a re-emergence of their sexuality and a sense of sexual freedom that they had not previously experienced (despite contraceptive availability) as there is no longer a risk of pregnancy. A participant in my research <a href="https://eprints.soton.ac.uk/451254/">into women’s experiences of menopause</a> described the joy of no longer being child-bearing age: <blockquote> I’ve got a body back for me, you know, coz I can’t get pregnant, not that I haven’t enjoyed having [children] and things like that and it was a decision to get pregnant but I feel like, ooh my body isn’t for anybody now but me, people, you know? </blockquote> For women who have chosen to be child-free there may also be a sense of freedom from social expectations. People will likely stop asking them when they are planning to have children. <h2>3. A new chapter and a time to focus on yourself</h2> Another participant <a href="https://eprints.soton.ac.uk/451254/">described</a> menopause as an unexpected “acceleration point” for change. Women told us they were more accepting of themselves and their needs rather than being focused on the needs of other people. Researchers have previously <a href="https://sk.sagepub.com/books/individualization">tracked this shift</a> from “living for others” to “a life of one’s own”. Some women find the strength of emotions at this time a challenge, whereas others find their potency can <a href="https://doi.org/10.1145/3290605.3300710">facilitate liberation</a> – enabling them to speak their minds or be more assertive than at any other time in their lives. <h2>4. Increased self-confidence</h2> A new sense of liberation can fuel increased self-confidence at menopause. This has been <a href="https://doi.org/10.1145/3290605.3300710">reported</a> in studies based on in-depth <a href="https://doi.org/10.1080/0167482X.2016.1270937">interviews with women</a>. Confidence boosts can coincide with <a href="https://eprints.soton.ac.uk/451254/">changes in career and sometimes in relationships</a> as priorities and self-advocacy transform. <h2>Life on the other side</h2> It can be hard to think about what is good about menopause, particularly if you are having challenges during perimenopause – but these can get better with time. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910086/">cultures where women are valued as they become older</a>, women describe themselves as positively contributing to the community. They find they gain power and respect as they age. We need to work towards more positive societal attitudes on this front. Our bodies change across the lifespan and are remarkable at every stage, including menopause.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/239725/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, Nurse, Lecturer & Director of Post-graduate Studies in the School of Nursing and Midwifery, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/is-there-anything-good-about-menopause-yep-here-are-4-things-to-look-forward-to-239725">original article</a>. </div>

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How you experience the menopause may have a lot to do with your family

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/megan-arnot-416253">Megan Arnot</a>, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> The <a href="https://www.ncbi.nlm.nih.gov/pubmed/30346539">menopause</a> happens around the age of 50, and for many women, the end of their fertile life is accompanied by uncomfortable symptoms, such as hot flashes, night sweats and anxiety. In the West, it is generally taken as read that these symptoms are a normal part of the menopause. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/11330770">cross-cultural research</a> suggests that menopause symptoms are not necessarily inevitable. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/18521049">Japanese women</a> rarely report hot flashes, whereas for European women they are a common complaint. As a result, scientists have begun to focus on what causes this difference in experience and the potential impact that behavioural and lifestyle factors, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/16735636">smoking</a>, might have. Our latest <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ece3.5705">study</a> adds to this knowledge. We found that living away from your genetic family may worsen the menopause. <h2>Family matters?</h2> Where people live once they’re married varies across cultures. To investigate whether these different living arrangements affect menopause symptoms, we travelled to south-west China to collect data. In this region, there are groups with distinct living arrangements. First, the Han and the Yi, in which women typically leave their family after they’ve got married and live with their husband’s family. Second, the Mosuo and Zhaba, who engage in the practice of zou hun (“<a href="https://www.ncbi.nlm.nih.gov/pubmed/23486437">walking marriage</a>”), where the husband and wife live separately with their own related families, and only visit each other at night. We found that women who remained living with their own family following marriage had significantly less severe menopause symptoms than those who went to live with their husband’s family. <h2>In-law conflict</h2> Many anthropologists are interested in how different levels of relatedness within households can have behavioural and physiological implications. For the menopause, we think the difference in symptom severity between the groups may be the result of the different levels of conflict that result from being more or less related to other members of your household. If a woman lives with her husband’s family, then until she has children, she is unrelated to anyone in the household. This lack of relatedness can cause <a href="https://link.springer.com/article/10.1007/s40806-017-0114-8">tension</a> between the new wife and her husband’s relatives as they have little direct genetic interest in her. As well as conflict with non-related household members, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/evan.20226">earlier research</a> has shown that women who live with their husband’s family tend to argue with their partners more and are also more likely to get divorced. Additionally, rates of domestic violence are <a href="https://www.ncbi.nlm.nih.gov/pubmed/27279077">higher</a> when women live away from their genetic family. But how does this relate to the severity of menopause symptoms? We think that increased levels of household conflict would result in the woman being more stressed. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795524/">Stress</a> is known to worsen pain perception and so could aggravate menopause symptoms. In contrast to women who leave their kin group, women who live with their own family once they’re married also tend to have higher levels of <a href="https://scholar.harvard.edu/slowes/publications/matrilineal-spousal-cooperation">social support</a>. There are more people to help with childcare and more shoulders to cry on. This can help to lower stress and thus soften the mental and physical burden of the menopause. <h2>Global perspectives</h2> While our research was conducted in China, globally, we see a wide range of living arrangements, which themselves can bring different levels of conflict and social support. In the West, many women live away from their families, which may mean that they lack social support, perhaps contributing to more turbulent menopause symptoms. Distance from one’s own family can also be seen to increase <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1741-3737.2005.00155.x">conflict</a> within the household – be it between a husband and wife, or wife and in-laws. These results aren’t an excuse to visit your in-laws less, but they show that menopause symptoms are not only about hormonal irregularities. They may also be a product of your social environment, which should be worth bearing in mind when approaching and going through the menopause.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/123621/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/megan-arnot-416253">Megan Arnot</a>, PhD Candidate, Evolutionary Anthropology and Behavioural Ecology, <a href="https://theconversation.com/institutions/ucl-1885">UCL</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-you-experience-the-menopause-may-have-a-lot-to-do-with-your-family-123621">original article</a>. </div>

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Menopause can bring increased cholesterol levels and other heart risks. Here’s why and what to do about it

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Menopause is a natural biological process that marks the end of a woman’s reproductive years, typically between 45 and 55. As women approach or experience menopause, common “change of life” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9244939/">concerns</a> include hot flushes, sweats and mood swings, brain fog and fatigue. But many women may not be aware of the <a href="https://pubmed.ncbi.nlm.nih.gov/32705886/">long-term effects</a> of menopause on the heart and blood vessels that make up the cardiovascular system. Heart disease accounts for <a href="http://world-heart-federation.org/what-we-do/women-cvd/">35% of deaths</a> in women each year – more than all cancers combined. What should women – and their doctors – know about these risks? <h2>Hormones protect hearts – until they don’t</h2> As early as 1976, the <a href="https://pubmed.ncbi.nlm.nih.gov/970770/">Framingham Heart Study</a> reported more than twice the rates of cardiovascular events in postmenopausal than pre-menopausal women of the same age. Early menopause (younger than age 40) also <a href="https://pubmed.ncbi.nlm.nih.gov/25331207/">increases heart risk</a>. Before menopause, women tend to be protected by their circulating hormones: oestrogen, to a lesser extent progesterone and low levels of testosterone. These sex hormones help to relax and dilate blood vessels, reduce inflammation and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503403/">improve lipid (cholesterol) levels</a>. From the mid-40s, a decline in these hormone levels can <a href="https://pubmed.ncbi.nlm.nih.gov/10362825/">contribute to unfavourable changes</a> in cholesterol levels, blood pressure and weight gain – all risk factors for heart disease. <h2>4 ways hormone changes impact heart risk</h2> 1. Dyslipidaemia– Menopause often involves <a href="https://pubmed.ncbi.nlm.nih.gov/38002671/">atherogenic changes</a> – an unhealthy imbalance of lipids in the blood, with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL-C), dubbed the “bad” cholesterol. There are also reduced levels of high-density lipoprotein (HDL-C) – the “good” cholesterol that helps remove LDL-C from blood. These changes are a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503403/">major risk factor for heart attack or stroke</a>. 2. Hypertension – Declines in oestrogen and progesterone levels during menopause contribute to narrowing of the large blood vessels on the heart’s surface, arterial stiffness and <a href="https://pubmed.ncbi.nlm.nih.gov/35722103/">raise blood pressure</a>. 3. Weight gain – Females are born with one to two million eggs, which develop in follicles. By the time they <a href="https://www.thewomens.org.au/health-information/fertility-information/getting-pregnant/ovulation-and-conception">stop ovulating</a> in midlife, fewer than 1,000 remain. This depletion progressively changes fat distribution and storage, from the hips to the waist and abdomen. Increased waist circumference (greater than 80–88 cm) has been <a href="https://pubmed.ncbi.nlm.nih.gov/18359190/">reported to contribute to heart risk</a> – though it is <a href="https://theconversation.com/good-news-midlife-health-is-about-more-than-a-waist-measurement-heres-why-226019">not the only factor to consider</a>. 4. Comorbidities – Changes in body composition, sex hormone decline, increased food consumption, weight gain and sedentary lifestyles impair the body’s ability to effectively use insulin. This <a href="https://pubmed.ncbi.nlm.nih.gov/11133069/">increases the risk</a> of developing metabolic syndromes such as type 2 diabetes. While risk factors apply to both genders, hypertension, smoking, obesity and type 2 diabetes confer a greater relative risk for heart disease in women. <h2>So, what can women do?</h2> Every woman has a different level of baseline cardiovascular and metabolic risk pre-menopause. This is based on their genetics and family history, diet, and lifestyle. But all women can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351755/">reduce their post-menopause heart risk with</a>: <ul> <li>regular moderate intensity exercise such as brisk walking, pushing a lawn mower, riding a bike or water aerobics for 30 minutes, four or five times every week</li> <li>a healthy heart diet with smaller portion sizes (try using a smaller plate or bowl) and more low-calorie, nutrient-rich foods such as vegetables, fruit and whole grains</li> <li>plant sterols (unrefined vegetable oil spreads, nuts, seeds and grains) each day. A review of 14 clinical trials found plant sterols, at doses of at least 2 grams a day, produced an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This could reduce the risk of heart disease by <a href="https://pubmed.ncbi.nlm.nih.gov/10731187/">25% in two years</a></li> <li>less unhealthy (saturated or trans) fats and more low-fat protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy</li> <li>less high-calorie, high-sodium foods such as processed or fast foods</li> <li>a reduction or cessation of smoking (nicotine or cannabis) and alcohol</li> <li>weight-gain management or prevention.</li> </ul> <h2>What about hormone therapy medications?</h2> Hormone therapy remains the most effective means of <a href="https://pubmed.ncbi.nlm.nih.gov/15495039/">managing hot flushes and night sweats</a> and is beneficial for <a href="https://pubmed.ncbi.nlm.nih.gov/18418063/">slowing the loss of bone mineral density</a>. The decision to recommend oestrogen alone or a combination of oestrogen plus progesterone hormone therapy depends on whether a woman has had a hysterectomy or not. The choice also depends on whether the hormone therapy benefit outweighs the woman’s disease risks. Where symptoms are bothersome, hormone therapy has <a href="https://pubmed.ncbi.nlm.nih.gov/33841322/">favourable or neutral effects on coronary heart disease risk</a> and medication risks are low for healthy women younger than 60 or within ten years of menopause. Depending on the level of stroke or heart risk and the response to lifestyle strategies, some women may also require medication management to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351755/">control high blood pressure or elevated cholesterol levels</a>. Up until the early 2000s, women were underrepresented in most outcome trials with lipid-lowering medicines. The <a href="https://pubmed.ncbi.nlm.nih.gov/25579834/">Cholesterol Treatment Trialists’ Collaboration</a> analysed 27 clinical trials of statins (medications commonly prescribed to lower cholesterol) with a total of 174,000 participants, of whom 27% were women. Statins were about as effective in women and men who had similar risk of heart disease in preventing events such as stroke and heart attack. Every woman approaching menopause should ask their GP for a 20-minute <a href="https://www.health.gov.au/news/heart-health">Heart Health Check</a> to help better understand their risk of a heart attack or stroke and get tailored strategies to reduce it. <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/menopause-can-bring-increased-cholesterol-levels-and-other-heart-risks-heres-why-and-what-to-do-about-it-228010">original article</a>. </div>

Body

The menopause: dreaded, derided and seldom discussed

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/isabel-de-salis-413715">Isabel de Salis</a>, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Women experience the menopause between the ages of around 45 and 55, but their experiences of this significant stage of life are diverse. Each woman’s menopause is unique. Common themes run through women’s stories, however. From <a href="http://www.bris.ac.uk/social-community-medicine/people/isabel-o-de-salis/pub/124277454">our research</a> talking with women in midlife, we found that they often talk about menopause as a normal, inevitable and natural process, which of course, it is. Seeing menopause in this way allows women to minimise symptoms and behave stoically. “It’s no big deal,” one woman told us. “You just get on with it.” But this positive approach can also be a rebuttal of a <a href="http://www.charis.wlc.edu/publications/symposium_spring02/fecteau.pdf">common perception in society</a> of the menopause as a negative event – a view which leads to denigrating women who react differently to the menopause. Because for some, menopause is considered a loss, a struggle. Bodily sensations such as mood swings or hot flushes can be overwhelming and embarrassing. The negative images many often associate with menopause can be distressing – a barren land signalling the end of fertility, youthfulness and sexuality. Women may mourn the passing of a phase of life when their biological usefulness is over – menopause is seen as “a marker of getting old”. One told us: "I feel like my life’s over. It marks the end of being young and attractive and fertile." Some of those with no close female network and who worked in predominantly male environments, felt unable to share their experience. Women often felt foolish asking for help – that they would be wasting their GP’s time or admitting incompetence to a boss. The stigma of menopause, with its <a href="https://www.ncbi.nlm.nih.gov/pubmed/20693828">associations of hysteria and incompetence</a>, the shame of ageing, and the taboo about revealing menopausal symptoms, compounds the distress and struggle. Stigma can become internalised so that beliefs about other people’s reactions to menopausal symptoms such as hot flushes <a href="https://www.ncbi.nlm.nih.gov/pubmed/21339056">can be unduly negative</a>. Less commonly, menopause is treated as a positive marker of “moving on” to the next stage – a time of “new beginnings” and renewed libido. For these women, menopause is a “rite of passage” involving both social and psychic transformation whereby a sense of self emerges anew from loss, grief and shame. Another different experience occurs when bodily sensations like hot flushes are actually welcomed. Some described the physical side of menopause as feeling “nice and toasty”, and “helping me move on to another stage in life”. So although menopause is frequently perceived negatively, as something to be ignored or dreaded, we heard positive perceptions. This is important. One woman commented: "It’s kind of a gateway isn’t it, in to the next stage of your life? It sets a point in the sand about how long you’ve been on the earth." Women with more negative attitudes towards menopause report more symptoms <a href="https://www.ncbi.nlm.nih.gov/pubmed/19954900">during the transition</a>, and we know from <a href="https://www.ncbi.nlm.nih.gov/pubmed/11400220">cross-cultural research</a> that experiences of menopause are socio-culturally shaped and not universal. The most <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev-anthro-081309-145641">common reported symptom among Japanese women</a>, for example, is not hot flushes or night sweats, but chilliness. Menopause can be experienced particularly negatively where fertility status is highly valued <a href="https://www.ncbi.nlm.nih.gov/pubmed/14559382">as in rural Iran</a>. But where post-reproductive status is seen as positively transforming, as <a href="https://www.ncbi.nlm.nih.gov/pubmed/11833972">among Taureg women</a> in the Sahara desert, or <a href="http://www.sciencedirect.com/science/journal/03785122/4/3?sdc=1">Rajput women</a> in India, it is welcomed. Contrasting lifestyles, physiology, diet, genetics, reproductive history and physical environment all contribute to the variety of experiences worldwide. But we need also to acknowledge how important are the expectations and meanings of menopause, and the attitudes towards fertility loss and ageing. <h2>Reclaiming the menopause</h2> Many women want and need more support going through menopause. They want reliable information. There is now more discussion about <a href="https://theconversation.com/three-reasons-employers-need-to-recognise-the-menopause-at-work-82543">what can be done in the workplace</a> to support women through menopause, especially if they have difficult symptoms. A <a href="https://www2.le.ac.uk/offices/press/press-releases/2017/august/workplace-menopause-study-finds-2018women-feel-they-need-to-cope-alone2019">recent report</a> from the University of Leicester acknowledged that gendered ageism is a significant concern for women at work. The <a href="https://www.nice.org.uk/guidance/ng23">official guidelines on menopause</a> may enable the health sector to address women’s health matters seriously. Can we reclaim the menopause as a powerful and positive process in women’s lives? It is difficult to experience menopause as transformative when it is primarily considered as degeneration and decline, and the <a href="https://books.google.co.uk/books?id=dfBHoWeU9bcC&pg=PT21&lpg=PT21&dq=the+left+hand+of+the+goddess:+the+silencing&source=bl&ots=0GONJu1QsZ&sig=_ur-ybuCgGvn-Vzh6FDHeZUOC8M&hl=en&sa=X&ved=0ahUKEwjj5pHHsffWAhVJBsAKHfpdCEMQ6AEILTAB#v=onepage&q=the%20left%20hand%20of%20the%20goddess%3A%20the%20silencing&f=false">multiple meanings of menopause are hidden</a>. As part of our research at the University of Bristol, we are <a href="https://www.eventbrite.co.uk/e/our-menopauses-the-great-menopause-event-tickets-38138665776">inviting women</a> to share their experiences with us. Menopause is a political issue that is rarely discussed. Imagine, for example, a society that accepts women having hot flushes in the boardroom or in which post-reproductive status is valued. Perhaps even a society which allows for women to welcome the menopause. Fundamentally, we need to value all women’s diverse menopausal experiences without assuming they are hysterical, incompetent, or “past it”. We need to end the silence that surrounds a stage of life that half of humanity go through.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/85281/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/isabel-de-salis-413715">Isabel de Salis</a>, Research Fellow in Medical Anthropology, <a href="https://theconversation.com/institutions/university-of-bristol-1211">University of Bristol</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-menopause-dreaded-derided-and-seldom-discussed-85281">original article</a>. </div>

Caring

Keeping intimacy alive after menopause

When sex is no longer enjoyable due to the changes brought on by menopause, many women sadly give up, wrongly believing there is no solution. This can result in loneliness within a relationship even leading to separation or divorce. But there is help available and it comes down to addressing genitourinary syndrome of menopause (GSM), a syndrome no one talks about despite the fact it affects all post-menopausal women and unlike hot flushes, doesn’t go away. GSM covers a range of menopausal symptoms including incontinence, burning, stinging or itching of the vagina, delayed or impaired orgasm and reduced libido. The good news is, there is help available, even for women who are unable to use hormone therapy and it’s never too late to seek help and take action. Treat the pain Pain and discomfort during intimacy is often the result of vaginal dryness. This can be addressed in many ways including the use of lubricants or vaginal moisturisers but it’s worth talking to your GP about a longer term solution. For many women, menopause hormone therapy (MHT) will help. An alternative to MHT is radiofrequency treatment with <a title="https://www.inmode.com.au/pages/empower-rf" href="https://www.inmode.com.au/pages/empower-rf" data-outlook-id="5a8b7279-e5dc-4ab9-9f3d-b788bb0310ee">EmpowerRF</a> to rejuvenate the tissue and increase collagen and elastin. Take it slowly Often women want to rekindle intimacy with their partner but are not sure how to go about it and fear often inhibits them initiating any intimacy at all. A staged return to intimacy can help. This is achieved by an agreement to limit the intimacy to non-sexual cuddles, no matter the level of desire, for an agreed period of time such as two weeks. It’s a great way to reignite that spark in a comfortable way, before taking things to the next level when both partners are ready. Try new positions Laying side by side can give the woman greater control over the rate of entry and the depth of penetration. If there is pain, stop at that point and breath and only increase penetration once the tissues have relaxed. If pain is still preventing penetration, it is important to seek professional help to find a solution. An examination will determine whether there is any other reason for the pain. A doctor can discuss options including estrogen cream, radiofrequency treatment and even Botox to help relax the muscles. Address incontinence One in two post-menopausal women experience incontinence, which can be a large barrier to sexual intimacy. I have helped many women overcome their struggles with incontinence, using electrical muscle stimulation treatment (V Tone) and radiofrequency technology (Forma V and Morpheus8V) to rejuvenate the tissues and strengthen the pelvic floor muscles. It can be life changing. Dr Judy Craig is a Perth-based GP and cosmetic physician. She has practiced medicine for over 40 years. Image credits: Getty Images

Relationships

How tracking menopause symptoms can give women more control over their health

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them. People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important. <a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry. There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” <h2>Why does monitoring symptoms help?</h2> One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms. Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209004/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">original article</a>. </div>

Body

What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

How long does menopause last? 5 tips for navigating uncertain times

<a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Around half of the world’s population are women or people who menstruate – yet the way their body works can be a mystery, even to them. Most women will experience periods roughly every month, many will go through childbirth and those who live into midlife will experience menopause. While menopause is a significant time of change, it isn’t talked about much, other than as a punchline. This may contribute to keeping it a <a href="https://www.theguardian.com/membership/2019/sep/21/breaking-the-menopause-taboo-there-are-vital-stories-we-should-continue-to-pursue">taboo topic</a>. So, what happens during menopause? How do you know when it is happening to you? And – the thing most women want to know – how long will it last? <h2>What is menopause?</h2> Menopause is <a href="https://www.nia.nih.gov/health/what-menopause">defined</a> as the permanent cessation of menstruation, which is medically determined to be one year after the final menstrual period. After this time women are considered to be postmenopausal. The <a href="https://pubmed.ncbi.nlm.nih.gov/26598775/">average age</a> of “natural menopause” (that is not caused by a medical condition, treatment or surgery) is considered to be around 51 years. However, natural menopause does not occur suddenly. <a href="https://www.researchgate.net/profile/Riitta-Luoto/publication/46425690_Prevalence_of_menopause_symptoms_and_their_association_with_lifestyle_among_Finnish_middle-aged_women/links/5c5704ac458515a4c7553c7b/Prevalence-of-menopause-symptoms-and-their-association-with-lifestyle-among-Finnish-middle-aged-women.pdf">Changes can begin</a> a number of years before periods stop and most often occur in a woman’s 40s but they can be earlier. Changes <a href="https://pubmed.ncbi.nlm.nih.gov/25686030/">can continue</a> for 10 years or more after periods have stopped. Using hormones such as the oral contraceptive pill or hormone intrauterine devices may make it more <a href="https://pubmed.ncbi.nlm.nih.gov/31934948/">difficult to determine</a> when changes start. Menopause that occurs <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">before 45</a> is called “early menopause”, while menopause before 40 is called “premature menopause”. <h2>What about perimenopause?</h2> Various <a href="https://www.menopause.org.au/hp/information-sheets/glossary-of-terms">terms</a> are used to describe this period of change, including “menopause” or “the menopause”, “menopausal transition”, “perimenopause” or “<a href="https://pubmed.ncbi.nlm.nih.gov/12188398/">climacteric</a>”. These terms tend to refer to the period before and after the final menstrual period, when changes are considered to be related to menopause. The difficulty with the definition of menopause is it can only be decided retrospectively. Yet women can experience changes many years before their periods stop (a lead up usually called “perimenopause”). Also, any <a href="https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S0889854518300627/first-page-pdf">changes noticed</a> may not be associated with menopause (because people might not be aware of what to expect) or changes may be associated with a combination of factors such as stress, being busy or other health issues. <h2>So, what is going on?</h2> Through a feminist lens, menopause can be seen as a <a href="https://www.researchgate.net/publication/354652248_The_volcano_within_a_study_of_women's_lived_experience_of_the_journey_through_natural_menopause">complex and diverse experience</a>, influenced by biological, psychological, social and cultural aspects of women’s lives. However, it is usually viewed from the biomedical perspective. This sees it as a biological event, marked by the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">decline</a> in ovarian hormone levels leading to a reduction in reproductive function. The female reproductive system operates because of a finely tuned balance of hormones managed by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466056/#:%7E:text=The%20hypothalamic%2Dpituitary%2Dovarian%20(HPO)%20axis%20must%20be,priming%20the%20endometrium%20for%20implantation.">hypothalamic-pituitary-ovarian axis</a>. International <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340903/">experts</a> have developed a staging system for female reproductive ageing, with seven stages from “early reproductive” years to “late postmenopause”. However, female reproductive hormones do not just affect the reproductive system but <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">other aspects</a> of the body’s function. These include the <a href="https://pubmed.ncbi.nlm.nih.gov/26007613/">neurological system</a>, which is linked to hot flushes and night sweats and disrupted sleep. Hormones may also affect the <a href="https://www.nature.com/articles/nrdp20154">heart and body’s blood circulation</a>, bone health and potentially the <a href="https://www.sciencedirect.com/science/article/pii/S0091302220300418">immune system</a>. Menopausal hormone changes may <a href="https://www.thewomens.org.au/health-information/menopause-information/menopause-symptoms/">cause</a> hot flushes, night/cold sweats, mood swings, sleep disruption and tiredness, vaginal dryness. Medical confirmation of menopausal changes in women over 45 years is based on two biological indicators: vasomotor symptoms (those hot flushes and night sweats again) and an <a href="https://www.womenshealth.gov/menopause/early-or-premature-menopause#:%7E:text=Menopause%20that%20happens%20before%20age,to%20come%20earlier%20than%20usual.">irregular menstrual cycle</a>. In early perimenopause the changes to the menstrual cycle may be subtle. Women may not recognise early indicators, unless they keep a record and know what to watch for. <h2>How long does it last?</h2> The body demonstrates an amazing ability to change over a lifetime. In a similar way to adolescence where long-lasting changes occur, the outcome of menopause is also change. Research suggests it is difficult to give an exact time frame for how long menopausal changes occur – the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">average</a> is between four and eight years. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085137/">Penn Ovarian Ageing Study</a> found 79% of the 259 participants experienced hot flushes starting before the age of 50, most commonly between 45 and 49 years of age. A later report on the same study found one third of women studied experienced <a href="https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0014-2">moderate to severe hot flushes</a> more than ten years after their periods had stopped. A <a href="https://journals.lww.com/menopausejournal/Abstract/2017/03000/Cultural_issues_in_menopause__an_exploratory.11.aspx">2017 study</a> found a small number of women continued to experience hot flushes and other symptoms into their 70s. So overall, the research cannot offer a specific window for perimenopause, and menopause does not appear to mark the end of changes for everyone. <h2>5 tips for uncertain times</h2> Shifts and changes can be recognised early by developing knowledge, paying attention to changes to our bodies and talking about menopause and perimenopause more openly. Here are five tips for moving from uncertainty to certainty: 1. talk to people and find out as much information as you can. The experiences of mothers and sisters may help, for some women there are familial similarities 2. notice any changes to your body and make a note of them, this will help you recognise changes earlier. There are <a href="https://www.redonline.co.uk/wellbeing/a36980118/menopause-apps/">menopause tracking apps</a> available 3. keep a note of your menstrual cycle: start date, duration, flow and note any changes. Again, an app might help 4. if you are worried, seek advice from a GP or nurse that specialises in women’s health. They may suggest ways to help with symptoms or refer to a specialist 5. remember changes are the indicator to pay attention to, not time or your age. Menopause is a natural process and although we have focused here on the time frame and “symptoms”, it can also be a time of freedom (particularly from periods!), reflection and a time to focus on yourself.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/195211/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <figure><iframe src="https://www.youtube.com/embed/lhosPUwWhfI?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Women speak about their experiences of menopause.</figcaption></figure> <a href="https://theconversation.com/profiles/yvonne-middlewick-1395795">Yvonne Middlewick</a>, Nurse & Lecturer, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">original article</a>.

Body

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

<a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Menopause is the stage of life where the ovaries stop releasing eggs and menstrual periods cease. Most Australian women go through menopause between <a href="https://www.nature.com/articles/nrdp20154">45 and 55</a> years of age, with the average age being 51 years, although some women may be younger. Hot flushes and night sweats are <a href="https://www.nature.com/articles/nrendo.2017.180">typical symptoms</a> of menopause, with vaginal dryness, muscle and joint pains, mood changes and sleep disturbance also commonly reported. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">75% of women</a> experience menopausal symptoms, with nearly 30% severely affected. These symptoms can negatively impact day-to-day life and wellbeing. The main therapies available include menopausal hormone therapy (MHT) and non-hormonal prescription therapy. Some women will elect to try complementary and alternative medicines, such as herbal medicines and nutritional supplements. Black cohosh is one of them. <h2>What causes hot flushes</h2> The cause of hormonal hot flushes (also called hot flashes) still isn’t completely understood, but the decline in oestrogen at menopause appears to play a role in a process that involves the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833827/">area of the brain that regulates temperature</a> (the hypothalamus). Factors linked to a greater likelihood of hot flushes include <a href="https://pubmed.ncbi.nlm.nih.gov/19675142/">being overweight or having obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">smoking</a>. MHT, previously known as hormone replacement therapy (HRT), usually includes oestrogen and is the <a href="https://pubmed.ncbi.nlm.nih.gov/26444994/">most effective treatment</a> for menopausal symptoms, such as hot flushes. But women may choose complementary and alternative medicines instead – either because they shouldn’t take hormone therapy, for example because they have breast cancer, or because of personal preference. Close <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">to 40%</a> of Australian women report using complementary and alternative medicines for menopausal symptoms, and up to 20% using them specifically to treat hot flushes and sweats. <h2>A long history</h2> Complementary and alternative medicines have a long history of use in many cultures. Today, their potential benefits for menopausal symptoms are promoted by the companies that make and sell them. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/">complementary and alternative medicines</a> women often try for menopausal symptoms include phytoestrogens, wild yam, dong quai, ginseng and black cohosh. Black cohosh (plant name Cimicifuga racemosa) was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">traditionally</a> used by Native Americans to treat a variety of health concerns such as sore throat, kidney trouble, musculoskeletal pain and menstrual problems. It is now a popular herbal choice for hot flushes and night sweats, as well as vaginal dryness and mood changes. There are <a href="https://pubmed.ncbi.nlm.nih.gov/37252752/">many theories</a> for how the active ingredients in black cohosh might work in the body, such as acting like oestrogen, or affecting chemical pathways in the brain. But despite extensive research, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">evidence to support these theories remains inconclusive</a>. It is also not clear whether black cohosh is effective for hot flushes. Results from individual studies are mixed, with <a href="https://pubmed.ncbi.nlm.nih.gov/17565936/">some</a> finding black cohosh improves hot flushes, while <a href="https://pubmed.ncbi.nlm.nih.gov/18257142/">others</a> have found it doesn’t. A 2012 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">review</a> combined all the results from studies of menopausal women using black cohosh to that date and found overall there was no proof black cohosh reduces hot flushes more effectively than an inactive treatment (placebo). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">This review</a> also revealed that many studies did not use rigorous research methods, so the findings are hard to interpret. A more recent <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review</a> of clinical trials claimed black cohosh may ease menopausal symptoms, but the included studies were mostly small, less than six months long, and included women with mild symptoms. There is also no meaningful evidence black cohosh helps other symptoms of menopause, such as vaginal symptoms, sexual problems, or poor general wellbeing, or that it protects against bone loss. Evidence for how black cohosh is absorbed and metabolised by the body is also lacking, and it is not known what dose or formulation is best to use. More good quality studies are needed to decide whether black cohosh works for hot flushes and other menopausal symptoms. <h2>Is it safe to try?</h2> A <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review of studies</a> suggests black cohosh is safe to use, although many of the studies have not reported possible adverse reactions in detail. Side effects such as gastrointestinal upset and rashes may occur. While there have been <a href="https://www.mja.com.au/journal/2008/188/7/liver-failure-associated-use-black-cohosh-menopausal-symptoms#0_i1091948">rare reports of liver damage</a>, there is <a href="https://pubmed.ncbi.nlm.nih.gov/21228727/">no clear evidence</a> black cohosh was the cause. Even so, in Australia, black cohosh manufacturers and suppliers are required to put a warning label for the potential of harm to the liver on their products. It is recommended black cohosh is not used by women with menopausal symptoms <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes/menopause/treatments-menopausal-symptoms">after breast cancer</a>, as its safety after breast cancer is uncertain. All women should consult with their doctor before using black cohosh if they are taking other medications in case of possible drug interactions. Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo. Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211272/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, Research fellow, Chronic Disease & Ageing, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272">original article</a>.

Body

Don’t believe the hype. Menopausal women don’t all need to check – or increase – their testosterone levels

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Ever heard “low testosterone” blamed for low mood, brain fog and loss of vitality? Despite all evidence to the contrary, social media influencers are increasingly promoting testosterone therapy as an elixir for women experiencing troubling symptoms of menopause. In a series of documentaries and <a href="https://www.dailymail.co.uk/health/article-11792553/Davina-McCall-effect-sparks-menopause-testosterone-treatment-rush-putting-women-risk.html">social media posts</a> about menopause in 2021 and 2022, British TV presenter Davina McCall promoted the use of testosterone therapy in addition to standard <a href="https://www.menopause.org.au/hp/information-sheets/combined-menopausal-hormone-therapy-mht">menopausal hormone therapy</a>. The “<a href="https://www.telegraph.co.uk/news/2023/02/17/davina-effect-fuels-surge-menopausal-women-using-testosterone/#:%7E:text=Chelsea%20Magazine%20Company-,'Davina%20effect'%20fuels%20surge%20in%20menopausal%20women%20using%20testosterone,NHS%20prescriptions%20for%20the%20hormone">Davina effect</a>” has helped fuel a <a href="https://pharmaceutical-journal.com/article/news/nhs-testosterone-prescribing-in-women-rises-ten-fold-in-seven-years#:%7E:text=The%20number%20of%20women%20in,The%20Pharmaceutical%20Journal%20has%20revealed">ten-fold increase</a> in prescribing of testosterone for women in the United Kingdom since 2015. Data isn’t available for Australia, but in my clinical practice, women are increasingly asking to have their testosterone level checked, and seeking testosterone to treat fatigue and brain fog. But while testosterone continues to be an important hormone before and after menopause, this doesn’t mean women should be having a blood test to get their testosterone levels checked – or taking testosterone therapy. <h2>What does testosterone do?</h2> Testosterone is an important hormone in women’s bodies, affecting the blood vessels, skin, muscle and bone, breast tissue and the brain. In both women and men, testosterone can act on its own or be converted into estrogen. Before menopause, testosterone is made in the ovaries, where it helps developing eggs grow and aids in estrogen production. The ovaries release both testosterone and estrogen into the bloodstream, and the levels of the two hormones in the blood peak around ovulation. Some of the testosterone measured in blood is also produced outside the ovaries, such as in fat, where it is made from “pre-hormones” secreted by the adrenal glands. This source of production of testosterone takes over after menopause. <h2>Do we have more testosterone before menopause?</h2> The claim is often made that pre-menopausal women have more testosterone in their bloodstream than estrogen, to justify the need for testosterone replacement after menopause. But, when sex hormones have been measured with precision, studies have shown this is not true. <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">Our research</a> found estrogen levels are higher than testosterone levels at all stages of the menstrual cycle. Blood testosterone levels <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">fall</a> by about 25% between the ages of 18 and 40 years in healthy women. The fall in testosterone coincides with the decline in eggs in the ovaries but whether this is a marker of the decline, a consequence, or a cause of the decline is not known. From around 40, the rate of decline slows and blood testosterone levels don’t change when <a href="https://www.menopause.org.au/hp/information-sheets/what-is-menopause">menopause</a> occurs naturally. Studies have not shown testosterone levels change meaningfully during the menopause transition. <h2>Can blood tests detect ‘low testosterone’?</h2> Some influencers claim to have a condition called “testosterone deficiency syndrome” or low levels of testosterone detected in blood tests. But there is no “normal” blood level below which a woman can be diagnosed as having “testosterone deficiency”. So there’s no such thing as having a testosterone deficiency or testosterone deficiency syndrome. This is also in part, because women have very low testosterone concentrations compared with men, and most commercial methods used to measure testosterone cannot separate normal from low levels in women with any certainty. Pre-menopausal women might also be told they have “low” testosterone if blood is drawn early in the menstrual cycle when it is normal for testosterone to be low. (However, it would only be clinically necessary to do this type of blood test to look for high testosterone, in someone with with excessive hair growth or severe acne, for example, not for low testosterone.) In post-menopausal women, much of the action of testosterone occurs in the tissues where it is made, after which testosterone is either converted to estrogen or broken down before it leaks back into the circulation. So blood testosterone concentrations are not a true reflection of tissue concentrations. Further complicating the picture is the enormous variability in the effects of testosterone. At a given blood level of testosterone, some women might have oily skin, acne, increased body hair growth or balding, while others will have no such effects. So, looking for a “low” blood testosterone in women is not helpful. <h2>Can testosterone improve sexual desire? What about other conditions?</h2> There is sound evidence that testosterone therapy may improve sexual desire in post-menopausal women who have developed low sexual desire that bothers them. This was <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">confirmed by</a> a <a href="https://pubmed.ncbi.nlm.nih.gov/31353194/">systematic review</a> of clinical trials comparing testosterone with a placebo or an alternative. These trials, all of which involved a treatment time of at least 12 weeks, showed testosterone therapy, overall, improved desire, arousal, orgasm and sexual satisfaction in post-menopausal women with low desire that caused them distress. Treatment is only indicated for women who want an improvement in sexual desire (after excluding other factors such as depression or medication side effects) and its success can only be determined by each woman’s personal self-reported response. But there is <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">not enough evidence</a> to show testosterone is beneficial for any other symptom or medical condition. The overall available data has shown no effect of testosterone on mood or cognition. As such, testosterone therapy <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">should not be used</a> to treat symptoms such as fatigue, low mood, muscle weakness and poor memory, or to prevent bone loss, dementia or breast cancer. However research continues to investigate these potential uses, including from my <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth">research team</a>, which is investigating whether testosterone therapy can <a href="https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.534">protect against bone density loss and muscle loss after menopause</a>. You can learn more about participating in one of our studies <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth/join-a-study">here</a>. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209516/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/dont-believe-the-hype-menopausal-women-dont-all-need-to-check-or-increase-their-testosterone-levels-209516">original article</a>.

Body

“I was spiralling”: Naomi Watts’ candid menopause admission

Naomi Watts has spoken candidly about how her life drastically changed when she started going through early menopause at the age of 36. The Aussie actress, now 54, said going through such a big change at such a young age “wasn’t easy”, and found it difficult to access information about what she was going through, both physically and mentally. Speaking candidly to <a href="https://www.hellomagazine.com/healthandbeauty/health-and-fitness/498161/naomi-watts-marriage-menopause-hollywood-age-exclusive/">Hello magazine</a>, she said, “Going through menopause at such a young age was not easy, especially during a time when there was so little information available about it.” “Mood swings, night sweats, and migraines … I was feeling like I was spiralling out of control,” she added. According to the <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397">Mayo Clinic</a>, menopause typically occurs at the age of 50, when a woman experiences her last period. Despite the change coming on much earlier than anticipated, Watts said learning to cope with the hormonal changes helped her feel more liberated. “Going through this journey led me to a deeper understanding of myself, and I came out on the other side feeling more authentically me,” she told <a href="https://pagesix.com/2023/07/24/naomi-watts-i-was-spiraling-out-of-control-during-menopause/">Page Six</a>. “A lot of freedom came in the self-acknowledgment.” She continued, “I had those voices in the back of my mind reminding me how old women are let out to pasture, but there was a lure to this desire to be authentic, to crawl from behind the invisible wall and just acknowledge for myself something that everyone could have probably guessed.” Watts’ personal experience led her to partner with Menopause Mandate, a non-profit organisation that aims to revolutionise midlife support available for American women. “I truly believe that if menopause hadn’t been such an off-limits topic when I first started experiencing symptoms, I would’ve had an easier transition,” she said. “I was part of a cycle that desperately needed to be broken.” Image credits: Getty Images

Body

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

<a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. But do they work? Or are they a waste of time and considerable amounts of money? <h2>What’s on the market?</h2> The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. <h2>What are phytoestrogens?</h2> Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" /></a><figcaption>Phytoestrogens can be consumed in foods like tofu or soy milk. <a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></figcaption></figure> <h2>What does the evidence say?</h2> In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries. However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. <h2>Can phytoestrogens help the psychological symptoms of menopause?</h2> Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog. <h2>The bottom line</h2> At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate Professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, Senior Research Dietitian in the Department of Gastroenterology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hot-flushes-night-sweats-brain-fog-heres-what-we-know-about-phytoestrogens-for-menopausal-symptoms-204801">original article</a>. Images: Getty

Body

Why weightlifting is beneficial before and after the menopause

<a href="https://theconversation.com/profiles/athalie-redwood-brown-1298061">Athalie Redwood-Brown</a>, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> and <a href="https://theconversation.com/profiles/jennifer-wilson-1436440">Jennifer Wilson</a>, <a href="https://theconversation.com/institutions/university-of-derby-758">University of Derby</a> Many women begin experiencing symptoms of the menopause around age 50. As hormones begin to fluctuate and change, women might start experiencing a range of symptoms, such as hot flushes, joint pain, low mood and vaginal dryness. The menopause can also be accompanied by a range of physical changes too – including loss of muscle mass, loss of bone density and a slowed metabolism. Fortunately, regular exercise – specifically <a href="https://bjsm.bmj.com/content/43/12/898.short?casa_token=HOnkvcc7R6QAAAAA:u1D2xvhIRLNsaA_STgiJiGRY-z1tXnuQqw6Sc4uRn0B5b-vMeXxjcn17m457MdY0Q9ffSpGAUPSl">weightlifting</a> – can help <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">mitigate these changes</a> somewhat and improve overall health and wellbeing. Here are just some of the ways weightlifting can be beneficial to women going through the menopause. <h2>1. Increases bone density</h2> Not only does weightlifting challenge your muscles, it also challenges your bones. In fact, resistance exercises (such as weightlifting) are shown to stimulate the formation of <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">new bone tissue</a>, which can increase bone density. This may be particularly beneficial to women who are postmenopausal and at risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/">osteoporosis</a> (brittle bones). Research has shown women who <a href="https://www.sciencedirect.com/science/article/abs/pii/S8756328206009495?casa_token=kx_1iDoGr28AAAAA:apeExle4xzT-csJD2kqhdVq4Y5bq7hNIUYBvuhyJIEXAT9iyOvPR6LBtOW2h5A6SDli4Gr0zgqg">regularly resistance train</a> had significant increases in <a href="https://link.springer.com/article/10.1007/s00198-003-1436-x">bone mineral density</a>, including in the <a href="https://bjsm.bmj.com/content/43/12/898.short?casa_token=Hgh5Huim8ocAAAAA:TGeAWPEh-sEHmBw40iJmP_X1lehvFEZ0QhQvY6ag4lcZ_zTkZv1jLbA6Apzopb85PU4EaqC4XoGl">hip and spine</a>. Greater bone density may also reduce the risk of osteoporosis. <h2>2. Maintains muscle mass</h2> As women age, they tend to lose muscle mass and strength, which can increase the risk of <a href="https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/j.1532-5415.2004.52014.x?casa_token=jhMt3SVQFCIAAAAA%3AsfVYMh2ExMyyw1cu4BGLhwiDkuIdMvABMv5imzHqSamdfb0OoFpWcIVbJ9c111K4_pCWwRmgC_On_P_-">falls, fractures and injury</a>. The menopause may contribute to this <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956097/#:%7E:text=Sarcopenia%2C%20the%20age%2Drelated%20decline,%2Daged%20adults%20(2).">loss of muscle mass</a>. But research shows that weightlifting is an effective way for older adults – including women – to maintain and even increase their <a href="https://europepmc.org/article/med/19949277">muscle mass</a> and strength. For postmenopausal women, research has shown that those who participate in regular resistance training are less likely to experience losses in <a href="https://pubmed.ncbi.nlm.nih.gov/34167695/">muscle mass and strength</a> compared to those who participate other forms of exercise, such as <a href="https://link.springer.com/article/10.1007/s11357-013-9586-z">stretching and mobility</a>. Other research has also found that weight training may be beneficial for women in the perimenopause period, too. The study found that perimenopausal women who <a href="https://academic.oup.com/ajcn/article/86/3/566/4754063">regularly weight trained</a> – as opposed to doing standard aerobic exercise (such as running or walking) – over a two-year period gained around three times less stomach fat on average. <h2>3. Boosts metabolism</h2> Weightlifting can increase lean muscle mass, which in turn can help boost metabolism and <a href="https://pubmed.ncbi.nlm.nih.gov/17823418/">burn more calories at rest</a>. This can be especially important for women just before and after the menopause, as hormonal changes can lead to a decrease in metabolism and an <a href="https://pubmed.ncbi.nlm.nih.gov/14567150/">increase in body fat</a>. In one study published in the Journal of Strength and Conditioning Research, postmenopausal women who participated in a 12-week resistance training programme had significant increases in <a href="https://pubmed.ncbi.nlm.nih.gov/31343601/">resting metabolic rate</a> which can help to manage excess weight gain. <h2>4. Improves mood</h2> Women going through the menopause may experience <a href="https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause-and-your-mental-wellbeing#:%7E:text=Changes%20in%20your%20hormones%20during,anger%20and%20irritability">mental health issues</a>, including depression and anxiety. But exercise – including weightlifting – may have numerous benefits for mental health, including reducing symptoms of depression and anxiety. One study found women who participated in a 16-week combined resistance training programme reported improved mood and <a href="https://pubmed.ncbi.nlm.nih.gov/33739319/">emotional wellbeing</a> when compared to a programme which only included guidance on a healthy lifestyle. Furthermore, self-esteem, mood and fatigue have also been shown to improve following <a href="https://journals.lww.com/acsm-csmr/fulltext/2012/07000/resistancetrainingismedicineeffectsof.13.aspx">prescribed resistance training</a> in older adults – suggesting weightlifting can have a positive effect on quality of life. Although this particular study wasn’t conducted on menopausal women specifically, it’s likely exercise may have a similar effect. Women who experience disturbed sleep and hot flushes may also experience reduced <a href="https://pubmed.ncbi.nlm.nih.gov/22809134/">quality of life</a> and mood. But resistance training is shown to be an effective tool in <a href="https://www.sciencedirect.com/science/article/pii/S0378512218307618">regulating body temperature</a>, which may improve emotional wellbeing. The effects of weightlifting on mood may be due to the <a href="https://ijogi.mums.ac.ir/article_11631_en.html">release of endorphins</a>, which are natural painkillers and mood-boosting chemicals in the brain. <h2>Getting started</h2> Given how many benefits weightlifting can have for women going through this period of their lives, you may be eager to get started. But if you’ve never tried resistance training or weightlifting before, here are a few things to bear in mind: <ol> <li>Start with a qualified trainer: Working with a qualified personal trainer or strength and conditioning coach can be beneficial especially right at the start of your fitness journey. They can help you learn proper lifting techniques, establish a safe and effective exercise programme and progress at a pace that’s appropriate for your fitness level and goals.</li> <li>Focus on form: Proper form is crucial when lifting weights, especially as you age. Poor form can increase your <a href="https://www.tandfonline.com/doi/abs/10.3810/psm.2009.06.1716">risk of injury</a> and prevent you from seeing the benefits of weightlifting. Take the time to learn proper technique and start with lighter weights until you feel comfortable and confident. Using a mirror or videoing yourself during workouts can help ensure your form is good.</li> <li>Start with compound exercises: Compound exercises are exercises that work multiple muscle groups at once. These exercises are great for building overall strength. Some examples include squats, deadlifts and bench presses. Try doing these around 2-3 times a week. Once you have a good foundation of these compound exercises, start to include exercises which focus on one specific muscle or work to help stability – such as shoulder press or lunges.</li> <li>Progress gradually: As you become more comfortable with weightlifting and feel the weights you’re lifting aren’t as challenging as they used to be, you can gradually increase the weight or intensity of your workouts for <a href="https://paulogentil.com/pdf/Fundamentals%20of%20Resistance%20Training%20Progression%20and%20Exercise%20Prescription.pdf">progression</a>. Just be sure not to progress too quickly, as this may increase your risk of injury.</li> </ol> Weightlifting can have many benefits – and doing it consistently may help you maintain good physical and mental health not only before and after the menopause, but as you get older too. Just be sure to consult your healthcare provider before starting any new exercise programme, especially if you have pre-existing health conditions or concerns.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204846/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/athalie-redwood-brown-1298061">Athalie Redwood-Brown</a>, Senior Lecturer in Performance Analysis of Sport, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a> and <a href="https://theconversation.com/profiles/jennifer-wilson-1436440">Jennifer Wilson</a>, Programme Leader for BSc (H) Sport Therapy and Rehabilitation, <a href="https://theconversation.com/institutions/university-of-derby-758">University of Derby</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-weightlifting-is-beneficial-before-and-after-the-menopause-204846">original article</a>.

Body

Is menopause making me put on weight? No, but it’s complicated

It’s a question people ask often: does menopause cause weight gain? Women commonly put on weight as they enter menopause. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569454/">Research</a> shows women aged 46-57 gain an average of <a href="https://pubmed.ncbi.nlm.nih.gov/11910598/">2.1kg over five years</a>. But like many things related to weight, all is not what it seems, and the relationship between menopause and weight gain is not straightforward. Here’s everything you need to know about menopausal weight gain and what you can do about it. <h2>What typically happens to women’s bodies during menopause?</h2> Menopause marks the natural end of the reproductive stage of a woman’s life. It officially starts when a woman has not menstruated for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673698053525">12 months</a>, and most women reach menopause between the ages of <a href="https://academic.oup.com/ije/article/43/5/1542/695928?login=false">45 and 55</a>, but it can happen much earlier or later. The transition to menopause, however, typically starts four years prior, with perimenopause marking the time when a woman’s ovaries start slowing down, producing less oestrogen and progesterone. Eventually, these hormone levels fall to a point at which the ovaries stop releasing eggs and menstruation stops. The symptoms associated with the menopausal transition are many and varied, and can include irregular periods, breast pain, vaginal dryness, hot flashes, night sweats, fatigue, difficulty sleeping, and changes in mood and libido. <h2>So does menopause cause weight gain?</h2> The short answer is no. But it’s complicated. When it comes to menopause and weight, it’s weight redistribution – not weight gain – that is actually a symptom. <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/fulltext">Research</a> has confirmed menopause is linked to an increase in belly fat but not an increase in overall weight. This is because the hormonal changes experienced during menopause only prompt a change in <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937896701114">where the body stores fat</a>, making women’s stomachs and <a href="https://www.ajog.org/article/S0002-9378(19)30588-5/fulltext">waists</a> more prone to weight gain. <a href="https://pubmed.ncbi.nlm.nih.gov/10702775/">Research</a> shows visceral fat (deep belly fat) increases by nearly 50% in postmenopausal women, compared with premenopausal women. It’s also important to recognise some menopause symptoms may indirectly contribute to weight gain: <ul> <li> sleep issues can lead to sleep deprivation, disturbing the body’s <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23616">appetite hormones</a>, increasing feelings of hunger and triggering food cravings </li> <li> some mood changes can activate the body’s stress responses, increasing the production of the hormone cortisol, promoting fat storage and triggering unhealthy food cravings. Mood can also impact the motivation to exercise </li> <li> fatigue, breast pain and hot flushes can make physical activity challenging or uncomfortable, also impacting the ability to exercise. </li> </ul> <h2>The truth? Ageing is the real cause of menopausal weight gain</h2> You read that right – the weight gain often associated with menopause is a <a href="https://www.sciencedirect.com/science/article/pii/S1568163709000415">byproduct of ageing</a>. As the body ages, it stops working as efficiently. It experiences an involuntary loss of muscle mass – referred to as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0070215305680052">sarcopenia</a> – and fat levels begin to increase. Because muscle mass helps determine the body’s metabolic rate (how much energy the body burns at rest), when we lose muscle, the body starts to burn fewer calories at rest. Ageing also means dealing with other health issues that can make weight management more complex. For example, <a href="https://www.ncbi.nlm.nih.gov/books/NBK537590/">medications</a> can impact how the body functions, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529154/">arthritis</a> and general aches and pains can impact mobility and the ability to exercise. In short – the body’s ageing process and changing physicality is the real reason women experience menopause weight gain. <h2>It’s not just weight gain</h2> While menopause doesn’t make you put on weight, it can increase a woman’s risk of other serious health conditions. The redistributed weight that leads to more fat being carried in the belly can have long-term effects. Belly fat that lies deep within the abdominal cavity (visceral fat) is an especially unhealthy fat because it’s stored close to the organs. People with a high amount of visceral fat have a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-5491.2011.03503.x">higher risk</a> of stroke, type 2 diabetes and heart disease than people who hold body fat around their hips. The reduction in the amount of oestrogen produced by the ovaries during menopause also increases a woman’s risk of heart disease and stroke. This is because oestrogen helps keep <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637768/">blood vessels dilated</a> – relaxed and open – to help keep cholesterol down. Without it, bad cholesterol can start to build up in the arteries. Lower oestrogen can also result in a loss of bone mass, putting women at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297264/">greater risk of osteoporosis</a> and more prone to bone fractures and breaks. <h2>The bottom line: can we prevent weight gain during menopause?</h2> Menopause itself does not cause weight gain; it unfortunately just occurs during a stage of life when other factors are likely to. The good news is weight gain associated with ageing is not inevitable, and there are many things women can do to avoid weight gain and health risks as they age and experience menopause. Start with these six steps: <ol> <li> incorporate daily exercise into your routine, with a mixture of intensities and variety of exercises, <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians">including body-strengthening exercises</a> twice a week </li> <li> stop dieting. Dieting drives up the weight your body will strive to return to (your “<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">set point</a>”), so you’ll end up heavier than before you began. You’ll also slow down your metabolism with each diet you follow </li> <li> curb your sugar cravings naturally. Every time you feel an urge to eat something sugary or fatty, reach for nature first – fruits, honey, nuts, seeds and avocado are a few suitable examples. These foods release the same feelgood chemicals in the brain as processed and fast food do, and leave us feeling full </li> <li> create positive habits to minimise comfort-eating. Instead of unwinding in the afternoon or evening on the couch, go for a walk, work on a hobby or try something new </li> <li> eat slowly and away from distractions to reduce the quantity of food consumed mindlessly. Use an oyster fork, a child’s fork or chopsticks to slow down your eating </li> <li> switch off your technology for a minimum of one hour before bed to improve sleep quality. </li> </ol> This article originally appeared on <a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308" target="_blank" rel="noopener">The Conversation</a>. Images: Getty

Body

“I didn’t know how to ask for help”: Naomi Watts shares important message on ageing

Naomi Watts got candid about the topic of menopause and how the word used to “freak her out” in a bid to normalise conversations about this aspect of every woman’s life. The 53-year-old took to Instagram to tackle the topic, which she describes as “a natural phase in life”, sharing her own experience and revealing that it began earlier than she expected. “When I was in my late 30s, I was finally ready to start thinking about creating a family. Then the M word swiftly blew my doors down, it felt like a head-on collision with a Mack truck.🚚💥,” she began. “How could I figure this out when no one was talking? I was earlier to it than my peers. My mentors and mum didn’t seem up for discussing it, I didn’t know how to ask for help and they didn’t know how to provide… even doctors had little to say. “It’s oddly like an unwritten code of silence: women should suck it up and cope, because that’s how generations past have done it.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CejRzoprP0H/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CejRzoprP0H/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Naomi Watts (@naomiwatts)</a> </div> </blockquote> Watts then called for more representation of women “in this phase of life” and age group in the media. “We’ve been under-served in media, stories and marketing for far too long”, she continued. “Particularly since 1 billion people worldwide will be menopausal by 2025… “When you spotlight uncomfortable conversations, they get easier. Progress is made. Why has this particular one taken so long?” She concluded the post by urging everyone to “conquer the stigma” and “address the secrecy and shame” for the sake of generations to come. “Getting older is a privilege and a time for us to feel proud of our cumulative experiences - to feel empowered, unapologetically so,” she wrote. “I think being part of a change-maker generation is exciting. No more walking through this alone.” Watts, who became a mother at the age of 38, hinted that she is “working on something” she is “super proud of”, with more details to come soon. Image: @naomiwatts (Instagram)

Caring

Misdiagnosis of menopause is more common than you think

Menopause is a life-stage that affects half of the population at a certain point in life, but a lack of attention and awareness of it can result in misdiagnosis and improper care for women. While hot flushes and vaginal dryness are symptoms frequently associated with menopause, others such as mood fluctuations, disturbed sleep, and poorer daily function are less well-known and can be misdiagnosed as symptoms of a mental health condition instead. To address this issue, insurance company AIA Australia has partnered with the Australasian Menopause Society (AMS) to raise awarness and increase the discourse around menopause. “AIA and AMS want to drive awareness and better understanding about the commonly overlooked life stage of menopause,” Stephanie Phillips, the Chief Shared Value and Marketing Officer at AIA Australia, tells OverSixty. “AIA has a strong belief in the importance of early intervention and considers it crucial that Australian women can access the right treatment in a timely fashion. “Partnering with AMS is an opportunity for us to empower women experiencing menopause so they know that they are not alone, and that there is a wide range of support available if they need it.” Menopause can still affect women over the age of 55 Women first begin experiencing menopause, the term referring to a woman’s final menstrual period, between the ages of 45 and 60, though some symptoms can begin before then, during a period called perimenopause. “The average age of menopause is 50-51, but some women can continue to have periods up to the age of 55,” gynaecologist Dr Peter Ganter and endocrinologist Dr Christina Jang, of Queensland Health, tell OverSixty. “It is less common for women to be having periods after the age of 55,” they add. Though every woman goes through menopause, the symptoms they experience can differ from person to person and can even be experienced for years. “Many women experience symptoms of menopause such as hot flushes, sweats, poor sleep while others are fortunate to have no symptoms at all,” Dr Ganter and Dr Jang say. “Women troubled by menopause may continue to experience symptoms into their 60s and sometimes 70s.” Women in the perimenopause and menopause periods are more likely to experience feelings of anxiety and depression due to changes in hormone levels, as reported by <a href="https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/" target="_blank" rel="noopener">Cleveland Clinic</a>. According to AIA, the highest rate of suicide in 2020 was among women in the 45-49 age bracket, while those in the 45-55 bracket are 50 percent more likely to experience depression or anxiety than men, which the insurer argues could be to do with menopause. “While deterioration in mood can be diagnosed by a medical practitioner, often it is not considered that a contributing factor could be menopause, meaning that symptoms may be treated pharmacologically with antidepressant medications in the first instance,” AIA said in a statement. Dr Karen Magraith, the President of AMS, says healthcare providers should help women manage their symptoms in a “multi-faceted” way. “For women experiencing symptoms of menopause, a comprehensive assessment and multi-faceted management plan is recommended,” Dr Magraith says. “For women with symptoms of depression and anxiety, this may involve psychological therapies, and attention to healthy lifestyle changes. “Some women may need medication as part of their treatment plan. Whether this should involve menopausal hormone therapy, antidepressant medication, or other treatment is an individual clinical decision depending on the particular circumstances of the woman, and should be a shared decision with her doctor. “Women having treatment need follow up and tailoring of treatment to meet their needs, and generally need several consultations to enable this to occur.” What should you do if you’re concerned? Dr Magraith recommends women reach out to their GP if they are experiencing any symptoms during perimenopause or menopause. “In some cases, women may need to seek help from a doctor with a special interest in menopause,” she says. For those women who do need to find a doctor, the AMS website’s <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor" target="_blank" rel="noopener">search function</a> can help them find a doctor in their area. As for women looking for more information about menopause, Dr Magraith says there are several resources women can access, including: <ul> <li dir="ltr" aria-level="1"> The <a href="https://www.menopause.org.au/" target="_blank" rel="noopener">Australasian Menopause Society</a> website </li> <li dir="ltr" aria-level="1"> <a href="https://www.jeanhailes.org.au/resources" target="_blank" rel="noopener">Jean Hailes for Women’s Health </a> </li> </ul> Image: Getty Images

Body

‘Brain fog’ during menopause is real – it can disrupt women’s work and spark dementia fears

For nearly two-thirds of women, menopause comes with an undesirable <a href="https://www.liebertpub.com/doi/10.1089/152460901750269670">change in memory</a>. Despite great progress in understanding the medical aspects of <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menopause#what-is-menopause">menopause</a> – a natural part of life that occurs when a woman has not had a menstrual period for 12 months – we are only beginning to recognise the experience and impact of <a href="https://www.frontiersin.org/research-topics/17042/the-psychology-of-menopause#overview">cognitive changes during menopause</a>. In most cases, it appears cognitive changes – that is, problems with thinking, reasoning or remembering – during menopause are subtle and possibly temporary. But for some women, these difficulties can negatively impact work productivity. And for others, they can raise concerns about developing dementia. <h2>The Big M</h2> Menopause marks the end of reproductive years. It can happen naturally, at an average age of 49 years, when the hairlike follicles in the ovaries are exhausted. Menopause can also happen surgically, with the removal of both ovaries (for example to reduce the risk of ovarian cancer). The change from reproductive to postmenopausal years, referred to as “perimenopause” usually lasts four to ten years. The symptoms of menopause, which can include vasomotor symptoms (hot flashes and night sweats), vaginal dryness, sleep disturbance, depression, anxiety and “brain fog” can span perimenopause and last for up to ten years. <h2>What kind of foggy thinking?</h2> Just over 60% of women <a href="https://www.liebertpub.com/doi/10.1089/152460901750269670">report cognitive difficulties</a> during their menopause transition. Women describe difficulties remembering people’s names or finding the right word in conversation. Some describe difficulties with concentrating or making decisions. As discussed in our <a href="https://www.sciencedirect.com/science/article/abs/pii/S0083672920300686?via%3Dihub">recent review</a>, these “subjective cognitive difficulties” appear to be linked to performance on tests of memory, recall and processing. Difficulties on tests of verbal memory (learning and remembering information new words you have heard), verbal fluency (quickly retrieving words from your memory) and attention are seen in perimenopausal women. <h2>Women at work</h2> While the degree of cognitive decline is subtle and performance generally remains within the normal limits of functioning, the symptoms can be bothersome for the individual. For many women, menopause coincides with the prime of their productive lives, when the load of caring for young children has eased and they’ve garnered experience and seniority in the workplace. <a href="https://images.theconversation.com/files/436857/original/file-20211210-141979-g7ejsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/436857/original/file-20211210-141979-g7ejsn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="Woman in glasses" /></a> Women might be hitting their professional peak just as menopause affects their cognition. <a href="https://images.unsplash.com/photo-1559856553-823ca11d1518?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2108&q=80" class="source">Unsplash/Maria Lupan</a>, <a href="http://creativecommons.org/licenses/by/4.0/" class="license">CC BY</a> There is growing interest in the impact of <a href="https://www.sciencedirect.com/science/article/pii/S2214911221000242?via%3Dihub">menopausal symptoms in the workplace</a>. Research suggests menopause symptoms can <a href="https://pubmed.ncbi.nlm.nih.gov/25830628/">adversely affect</a> work productivity and work satisfaction. Contributing factors include poor concentration and poor memory. The retention of menopausal female workers is important, for women themselves, but also to ensure we continue to strive for workforce diversity within our modern workforce. <h2>What causes menopausal brain fog?</h2> “Brain fog” is not a medical or psychological term, but a lay term that aptly describes the fogginess in thought experienced by many women during menopause. Menopause related cognitive changes are not just age-related cognitive decline. Rather, fluctuating and eventual decline of ovarian hormone production associated with menopause is likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763981/">play a key role</a>. Hormones produced by the ovaries, estradiol (a type of estrogen) and progesterone, are potent brain chemicals that are thought to protect the brain and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162653/">enhance thinking and memory</a>. The fluctuations and eventual loss of estradiol has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162653/">suggested</a> to contribute to cognitive difficulties. Cognitive symptoms can occur in the <a href="https://academic.oup.com/aje/article/171/11/1214/102233">absence of other menopausal symptoms</a>. This means other menopausal symptoms are not responsible for cognitive symptoms. However, menopause related depressive and anxiety symptoms, sleep disturbance and vasomotor symptoms <a href="https://academic.oup.com/aje/article/171/11/1214/102233">may make cognitive symptoms worse</a>. <a href="https://images.theconversation.com/files/436861/original/file-20211210-17-qacocb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/436861/original/file-20211210-17-qacocb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="Working women share coffee" /></a> More research is needed to determine if lifestyle changes could buffer cognitive problems related to menopause. <a href="https://images.unsplash.com/photo-1590650046871-92c887180603?ixlib=rb-1.2.1&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1770&q=80" class="source">Unsplash</a>, <a href="http://creativecommons.org/licenses/by/4.0/" class="license">CC BY</a> <h2>Is there a link with Alzheimer’s disease?</h2> Alzheimer’s disease is the <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia">most common form of dementia</a> and <a href="https://www.alz.org/blog/alz/february_2016/why_does_alzheimer_s_disease_affect_more_women_tha#:%7E:text=Women%20are%20disproportionately%20affected%20by,with%20Alzheimer's%20disease%20are%20women.">being female is a risk factor</a>. The greater longevity of women does not explain this increased risk. Instead, the loss of estradiol associated with menopause has been suggested to play a role. Early menopause, such as surgical menopause before the age of 45 years, <a href="https://www.sciencedirect.com/science/article/pii/S0306453018311478?casa_token=v6m5g8k3kCcAAAAA:cW3RhpbLs2tAD7o2hcIXTR_e-LCQAv77WMpnciHZ8Rgp2cLJhwW74evz28z0Uf47JjZeF9V16c-U">has been associated</a> with an increased risk of dementia later in life as well as a faster rate of cognitive decline. Because similar symptoms may present during menopause and the early stages of Alzheimer’s disease (forgetfulness and word-finding difficulties) perimenopausal women can become concerned about dementia. Women should be reassured that dementia that begins before age 65 – called young onset dementia – is not common (unless there is a family history of early-onset dementia). Forgetfulness and other cognitive difficulties during the menopausal transition are common and a normal part of menopause. <h2>What can help?</h2> Although fluctuations and an eventual decline in estrogen play a role in cognitive difficulties, the use of hormone therapy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394691/">does not appear to have a clear benefit</a> on cognitive function (but evidence remains limited). More research is needed to determine whether lifestyle factors can help menopausal brain fog. We do know exercise can improve cognition during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907999/">midlife</a>, mindfulness and meditation may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125424/">helpful</a>. At Monash University, we are currently conducting an <a href="https://redcap.link/menopause">online survey</a> for women aged 45 to 60 to better understand cognitive symptoms during menopause. Avoiding illicit drugs, prescription medication overuse, smoking and excessive alcohol may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293659/">protective</a>. A diet that includes plant-based unprocessed foods (such as a Mediterranean diet), close social bonds and engagement, and a higher level of education have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8624903/">broadly linked</a> to better cognitive functioning during later life.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173150/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/chen-zhu-1298027">Chen Zhu</a>, , <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/shalini-arunogiri-385503">Shalini Arunogiri</a>, Addiction Psychiatrist, Senior Lecturer, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">original article</a>. Image: Unsplash/Gantas Vaiciulenas

Mind

EXCLUSIVE: Claudine Ryan talks hormones, PMS and the brain

If you have ever had your feelings of anger dismissed because you are dealing with fluctuations in hormones - whether that’s around your period, pregnancy-related or due to menopause - you’re not the only one. While the vast majority of women experience these dips and peaks in hormones without many severe symptoms, the dismissal of symptoms as a side effect of hormones can have severe consequences. Between 2009 and 2018, suicide was the <a rel="noopener" href="https://www.theguardian.com/society/2021/may/09/the-chemical-question-does-focusing-on-hormones-undermine-mental-healthcare" target="_blank">third-highest cause</a> of mortality among women who had recently given birth. For women entering menopause, the incidence of depression <a rel="noopener" href="https://www.health.harvard.edu/womens-health/menopause-and-mental-health" target="_blank">doubles</a>, and those who have experienced mental illness in the past may see their symptoms return. Claudine Ryan is one half of the duo behind the popular podcast Ladies, We Need To Talk, alongside host and co-creator Yumi Stynes. Claudine spoke to OverSixty about the pair’s latest book - named after their podcast - which tackles the thorniest of issues relating to women’s health, biology, and sex lives. In particular, she shared her thoughts on the overlap between hormones, PMS. and mental health, as well as advice for those navigating these issues with friends and family. O60: Throughout Ladies, We Need to Talk there’s a core message of opening up conversations on ‘taboo’ topics to improve awareness and help women feel less alone. Do you have particular hopes about how the awareness of and conversations around mental health and hormones will change? When it comes to our hormones and mental health, every woman is different. For reasons that aren't totally understood, some of us can really feel the impact of changing levels of certain hormones at certain times during our cycles or at certain times in our lives. So some of us experience really severe hormonal symptoms (severe insomnia, trouble concentrating, depression and even suicidal thoughts), while others find their hormones have no noticeable impact on their mood. [My] version of PMS looks different to Yumi's. But when we share our stories with each other we can start to see that there is a range of different women's experiences and this can help us to place our own somewhere on this spectrum. One hope is that these conversations foster a rich and diverse community of people who understand each other so that fewer of us feel alone or isolated, and also so we have a better understanding of what this spectrum of normal is. Another hope is that these conversations give women courage to speak out and ask for help when something does seem right for them. We have heard so many stories of women's symptoms being dismissed, or them being what they are living with is in their head. Understanding how your experience fits in with others can help you to know that what is happening for you is real and that if someone isn't listening to you, then you need to find someone who will. O60: In chapter six you both talked about anger and how it surfaces around the same time as other PMS symptoms, how do you feel about the association between anger and other ‘uglier’ emotions with being hormonal? It is very infuriating to have your feelings or frustrations dismissed as being purely hormonal. But it is also very helpful to understand that there might be certain times when your mood might be really low or you might be more inclined to feel frustrated by pee on the toilet seat or a sink full of dishes. For some women, just understanding how their hormones may affect their mood is all they need. But for others, knowing their hormones are making them miserable is the first step in figuring out what their options are to get some relief. It's important to acknowledge, as is the case with many many women's health issues, there needs to be more research for us to better understand the relationship between our hormones and our moods. O60: Do you have any advice for other women struggling with family/friends/partners/colleagues/strangers commenting on their mental health and being hormonal or dealing with PMS? You could swear at the person, and that is a legitimate response. You could explain to them these conditions are recognised by leading women's health experts and that for those who experience symptoms on the more severe end there are treatment options available. You could take the approach of women's health psychologist Professor Jane Ussher, who's spent decades researching PMS. Over the years many women have told her that when they are on holidays or away from the usual stress and pressures of their lives that they are much less likely to have PMS. But when life is as normal, all the crap they normally put up with just becomes too much. Women tell her that it's their real feelings that are coming out when they get PMS. So for three weeks of a month they can play nice and bottle it all up, but then at that point in their cycle they don't have the energy to keep up this front. These women often then ask those around them to help out a bit more so they don't get so worn out and frustrated. <a rel="noopener" href="https://www.hardiegrant.com/au/publishing/bookfinder/book/ladies_-we-need-to-talk-by-yumi-stynes/9781743797518" target="_blank">Ladies, We Need To Talk</a>, published by Hardie Grant, is now available to purchase. Image: Supplied

Mind

15 body signs no one tells you will come before menopause

Unexpected symptoms Changes like bruises and extra hair are just a few of the unexpected symptoms of premenopause and perimenopause, the latter being the last four or so years before a woman enters menopause. Breast pain Pesky menopause changes and hormonal fluctuations can cause cyclical breast tenderness (ranging from bothersome to unbearable) even when Aunt Flo isn’t due for a visit. What’s more, since perimenopause causes irregular cycles, it’s nearly impossible to know when your breasts are going to begin throbbing, according to the National Cancer Institute. Your breasts may also feel “more lumpy” than they did before, notes Ellen Dolgen, Menopause Mondays blogger and author of the free eBook, The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause. Unexpected bruises Perimenopause causes some women to become a bit clumsy – and those minor bumps can quickly turn into big bruises. This is because fluctuating hormones can make skin thinner, making you bruise easier. Dry eyes Strangely, excessive tearing is a sign that your eyes are desperately trying to make up for a lack of moisture. And you can thank menopause changes and plummeting hormones for those “Cheech and Chong”-style eyes, Dolgen says. Hormones affect the ocular tissues and the composition of tears your eyes produce, resulting in excessively dry eyes and changes in vision (going from near-sighted to far-sighted, for example). Chin hair Don’t be surprised if your tweezers become your new best friend, Dolgen says. For a lucky 15 percent of women, “super human” hair on your chin, upper lip, or cheeks is an all-too-common symptom of perimenopause. And, perhaps what’s worse, the hair on your head may become thin, dry, or brittle. Heart palpitations The sudden speeding-up or irregularity of your heart rate is a common yet not often talked about symptom of perimenopause. Studies show that epinephrine and norepinephrine, the neurotransmitters that regulate heart rate and blood pressure, tend to fluctuate in menopausal women, David Portman, MD, a gynaecologist and Women’s Health expert told everydayhealth.com. Urinary urgency or leakage Pee a little when you do jumping jacks or leak when you cough or sneeze? Gotta hurry up and go right now? It’s likely due to stress urinary incontinence (SUI) or urge urinary incontinence (UUI) – both common menopause changes. Lower oestrogen levels cause the lining of the urethra to thin, says JoAnn V. Pinkerton, MD, executive director of the North American Menopause Society (NAMS). And weakened pelvic floor muscles, often a result of a vaginal childbirth, are also to blame. Dry skin Less oestrogen equals acne and dry and thinning skin for many women in entering menopause, which Dr Pinkerton likens to “reverse puberty.” It’s also common to experience flare-ups or new cases of allergies and eczema during this time, adds Dolgen, whose swears by coconut oil for softer skin and smaller pores. Body odour Of course, the excessive sweating that accompanies night sweats and hot flashes can create an unpleasant odour. But there’s another explanation, too: A drop in oestrogen levels tricks your hypothalamus gland into thinking you’re overheated, signalling your body to sweat more. Migraines Migraines may start for the first time, or worsen, when you start going through menopause because of new hormonal fluctuations, says Dr Pinkerton. The good news, however, is that hormonal migraines usually stop or vastly improve after menopause, when levels are consistently low. In fact, only 5 percent of women suffer migraines after age 60, according to the Migraine Research Foundation. Vaginal dryness Sex-stifling vaginal dryness was one of the most difficult symptoms for Dolgen. “Your vagina takes a trip to the desert and takes your eyes and skin along with it,” she says. Menopause changes, such as lower oestrogen levels, cause thinner, drier and less-elastic vaginal tissue and decrease blood flow to the area. The result: vaginal dryness, itching and painful sex. Hot flashes Sure you’ve heard about hot flashes, but you may not know that they can be different for every woman. Some even experience them for decades, starting in perimenopause. Caused by a drop in oestrogen levels, which affects the gland that regulates body temperature, hot flashes can happen during the day or at night – or both. They can be mild, lasting seconds, or severe and stick around for a half hour or longer. Weight shifts Whether you call it meno-pot, meno-pudge, or middle-age spread, extra fat in the abdominal region is a reality for many women in perimenopause. “A woman’s weight throughout her menopausal journey is impacted by five factors: hormones, diet, exercise, stress and genetics,” Dolgen explains. And you can also lose muscle mass – 0.6 percent per year or more if you’re not physically active and don’t get enough protein, Dr Pinkerton adds. Irregular periods Is your period shorter and lighter one month and heavy with cramping the next? This is part of perimenopause, explains Pinkerton. In addition to being a nuisance, irregular periods also up your pregnancy risk. “The second highest unintended pregnancy time for women is during your 40s,” Dr Pinkerton says. “And pregnancy remains a risk until you haven’t had a period for a year.” Bone loss The less oestrogen your ovaries produce, the more bone loss may accelerate. This can put you at a greater risk for osteoporosis, or bone thinning, which increases your risk of fracture. “You can lose up to 20 percent of your bones during the first five years of menopause,” Dr Pinkerton says. Fuzzy thinking Hormonal changes – along with premenopausal symptoms like mood swings and sleep problems – may make you more forgetful and less focused. Stress also plays a role. “It’s hard to relax, especially when you’re going through the trials of perimenopause,” Dolgen says, “but it’s important for your mind and body to decompress.” Written by Susan Jara. This article first appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/15-body-signs-no-one-tells-you-will-come-before-menopause?pages=1">Reader’s Digest</a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.com.au/subscribe">here’s our best subscription offer</a>.

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