There comes a time in every woman’s life when her ovaries no longer make the hormones oestrogen and progesterone and will no longer release an egg every month. Her periods will eventually stop and when those periods have naturally stopped for a full year , she would have arrived at a point in time known as MENOPAUSE. But for many years prior to that day, she would be experiencing a transition known as perimenopause. On average that transition starts at age 45 but has been known to begin even earlier. Please note that for women whose ovaries are surgically removed, the menopause begins immediately.
From my experience in clinical practice, I have seen many women enter peri-menopause at around age 40 and though it is a unique and individual experience for each of them , there are many symptoms that are commonly mentioned in their story – symptoms like hot flashes, night sweats, difficulty sleeping, memory lapses or “brain fog”, weight gain -especially around the belly and hips, irritability and mood swings , vaginal dryness with pain during intercourse, changes in skin texture, aches and pains in the muscles and joints , headaches especially in the premenstrual week and fatigue. Because many women in their forties are juggling the care of older relatives alongside attending to children and doing a balancing act between work and home life, their peri-menopause symptoms get neglected and placed on the back burner until the feeling of unwellness becomes overwhelming or they have an incidental discussion during a routine medical visit. But does this normal part of aging have to be as difficult and challenging for so many?
Once it has been established that your symptoms are due to perimenopause or menopause, what are the interventions that will allow you to thrive and dance through the fire ? Some of the proven strategies include starting an exercise regimen , stress management using techniques such as mindfulness meditation , yoga and cognitive behavioural therapy , reduction in the consumption of caffeine, alcohol and spicy foods and to quit smoking.
Based on several sources of data from large and small studies, we know that 150 minutes per week of light to moderate exercise can reduce hot flashes and mood swings and improve sleep quality and mental sharpness. That boils down to roughly 30 minutes of brisk walking daily for at least 5 days per week. The bonus is desirable weight loss, increased bone health, better cardiovascular health and opportunities for destressing and building social connections.
If medications become necessary for managing your menopausal symptoms you may be offered hormone replacement therapy in the lowest effective dose for the shortest duration necessary after discussing the risks versus benefits and possible side effects.. It is known that HRT use less than a year is safer than longer time spans especially more than five years of use.
Additionally your options may include non-hormonal medications such as low dose anti-depressants as there have been specific ones studied for the treatment of menopausal symptoms.
As for herbal remedies, such as evening primrose oil, soy-based phytoestrogens and black cohosh, the evidence has not been consistent or conclusive enough for routine prescribing nor do we have sufficient safety data to use them in conjunction with other medications.
For many years we have known that what we consume can influence the severity of our menopausal symptoms . Back in 2013 , a large study conducted by the University of Queensland, Australia looked at the dietary habits of 6040 women in natural menopause, followed over a 9 year timeline. In the final analysis, the women who consumed a Mediterranean diet- high in whole grains, vegetables, legumes, nuts , seeds, lean meat and the occasional sweet dessert were least affected by hot flashes and night sweats compared to women who ate mainly sugars and fats. More recently, in November of 2022, a study out of China , compared the composition of the gut microbiome in women with significant menopausal symptoms to those who were coping well. As in other studies, it showed that women who reported the most symptoms had a shift in their gut microbiome towards more disease-causing microbes and less beneficial bacteria- A condition we call Gut Dysbiosis.
The decline in female hormones as we go through perimenopause and enter menopause contributes to the shift in our gut health and is considered a possible explanation as to why a woman’s risk of heart disease , diabetes, hypertension, abnormal cholesterol levels and strokes rises dramatically in the postmenopausal period.
Fortunately, you and I can fight this Gut Dysbiosis and reduce our menopausal symptoms while also reducing our risk of other diseases…we can do this by adapting the Mediterranean diet to our Caribbean Culture – what I like to call THE CARIBBEAN MEDITERRANEAN- to provide our gut microbiome with roughly 30grams of fiber daily from delicious meals using locally available whole grains, vegetables, fruits, legumes, nuts, seeds, fish and lean meat so that we can all enjoy the journey towards becoming heroes of our own health… To get more information , have a listen to the 13 episodes in Season one and join me again for another episode in Season 2 , as we eat to beat disease and embrace the concept that Food is Medicine…
