Access as much evidence -based information as possible to enable you to feel informed and empowered to make decisions about your care. A great place to start is www.womens-health-concern.org which is part of The British Menopause Society
Get and stay connected: maintaining strong social networks of supportive friends and family can help you feel less isolated and alone. Sharing experiences can also help improve mindset and provide an opportunity to share ideas and learn from others.
Prioritise your sleep. Lets be honest things never feel as good or go as well when we are sleep deprived. Sleep disruption is a common symptom in menopause and perimenopause and the first step to improving sleep is not to leave it at the end of your to-do list. Try to achieve 7-9 hours per night; avoid late-night screen time; get early morning exposure to light; avoid caffeine and alcohol; keep your room cool (16 degrees) and consider a hot shower or hot drink before bed to drop your core body temperature; chose light breathable nightware and bed clothes and maybe separate duvets to your partner as well as eye masks, and ear plugs if necessary. Consider using CBTi using apps such as Calm, Sleepio or Sleepful
Nourish your body. Weight gain is common in midlife, perimenopause and menopause but caloric restriction can often make the situation worse. Ensure you are eating sufficient calories for your needs and prioritising high quality protein (25-30g daily); oily fish twice weekly (of fish oil supplements); 30 different plants per week to ensure adequate fibre, antioxidant and prebiotic exposure; try to avoid big swings in blood sugar as this can make symptoms worse: eat savoury first and if you need something sweet have it after a meal to reduce the sugar “spikes and dips”; consider “time restricted eating” keeping to an eating window of 12 hrs per day to provide your body with time to metabolise and catabolise adequately; do not deny yourself things you enjoy and don’t use your nutrition to “treat or punish”; consider eating to 80% full and moving after meals e.g. a stroll after supper.
Think about your alcohol intake. If you drink alcohol, what is your relationship with it? If you are drinking to soothe or solve try to find alternative ways to meet those needs. Max recommended alcohol for women is 14 units per week (125ml glass of 12% wine is 1.5 units) but this may be impacting sleep quality and quantity, contributing to flushes and night sweats, harming liver metabolism, impacting blood sugar levels, worsening mood or cognitive problems and increasing risk of many cancers including breast cancer. Trial a period of abstinence, or reduced alcohol intake. Aim to have at least 3 days alcohol free per week. Bec curious: try low sugar and low alcohol or non-alcoholic alternatives in social situations.
Hydrate. It is obvious but something so many of us overlook when we have “busy life syndrome” but when our cells have insufficient water they cannot function properly and everything slows down…including bowels which are important to keep moving in order to rid the body of unwanted toxins. Cognitive function also declines when dehydrated. Aim for 2L daily as minimum and increase to 3L if very active and sweating more. Remember than alcohol and caffeine are also both “diuretics”: this means they trigger your body to offload more fluid. So for every caffeinated or alcoholic drink you have ensure you have an extra glass of water.
Move. In whatever ways make you feel good. Walking, skipping, running, dancing, cycling, rowing, hiking, swimming...or all of the above. Weight bearing activity is particularly important for maintaining normal bone mineral density. Yoga, Pilates, weight lifting or body weight exercises are great for providing musculoskeletal strength and stability and building lean muscle mass which is important for metabolic and immune health and weight management. Variety is key to work as wide a range of muscles as possible.
Pause. Rest and reset. Take this opportunity to find who you are again, where you want to go and how you want to get there. Feel empowered to say “no” more often, put boundaries in place and hold space for yourself and protect your energy. Move away from things that drain you and towards things and people that nourish you. Consider proactive psychological therapy or coaching to work through any specific difficulties you are facing and develop a toolkit of strategies to move forward with positivity, purpose, and a plan.
Supplements and Sunshine. Most of us will not get adequate exposure to sunlight throughout the year to maintain normal vitamin D levels and as this is an important “hormone-like” vitamin responsible for normal bone growth and maintenance of bone mineral density as well as reducing inflammation, modulating cell growth for nerve, muscle and immune cell function and supporting normal glucose metabolism. So I recommend supplementing with Vitamin D3 1000iu daily as minimum for perimenopausal and menopausal women, but possibly higher doses in those with very low levels. Other supplements to consider are omega-3, B and, B12 if you are at risk of dietary deficiency (plant-based). There may also be benefit from use of magnesium for anxiety and sleep.
Hormone Replacement Therapy (HRT) or Menopausal Hormone Therapy (MHT) is the gold standard treatment for perimenopause and menopause involving combinations of oestrogen, progesterone and testosterone and should be the first-line treatment recommended by your clinician. Up to date research indicates that HRT/MHT is safe for the vast majority of women and not only beneficial for relief of symptoms but also for maintaining normal bone mineral density, metabolic and cardiovascular health which reducing risk of ill-health and may increase longevity. There are many regimes available with hormones delivered via patches, gel, spray, tablets, combined tablets and patches or vaginal tablets, rings. There is no “one size fits all” but body-identical regimes using micronised progesterone and oestrogen delivered through the skin (transdermal) are thought to be safest. The best and safest regime for you will depend on a number of factors individual to you so please talk to a clinician to explore all of your options.
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