Dr Ghazala Aziz-Scott, specialist in integrative women’s health and bioidentical hormone balancing for The Marion Gluck Clinic, explains how our busy lives have affected our menopause
The proverbial glass ceiling was recently smashed in a historical milestone- the election of the first female vice president of the USA, a far cry from the women’s rights movement of the 19th century to establish the right to vote. Subsequent feminist movements have given us equal rights to employment, wages, education, access to health and full reproductive rights. But what is the reality? The female economic and social revolution needed to create equality both in the workplace and at home.
The 1970s superwoman message of “you can have it all” has become a false dream. Women have ended up slogging: working long hours in professional careers with the endless demands of the digital era, bearing the bulk of the domestic responsibility in a largely patriarchal world, delaying childbearing, and finally sandwiched between young children and ageing parents. So often, this is peppered with a pervasive sense of guilt and exhaustion at spreading oneself so thin. The grand finale- the fallout from the Covid pandemic! Sound familiar? So what is the impact of this on our health and navigating our natural hormonal changes as we approach the menopausal period.
Menopause
Menopause is defined as the absence of periods for 12 months and as such signifies the end of the fertile period for women. Levels of all the sex hormones, estrogen, progesterone and testosterone decline. The average age of menopause in the UK is 51. This is preceded by a much longer phase of hormonal imbalance called the perimenopause and can start 4 to 8 years before the menopause and as young as 35. We have all heard about hot flushes and night sweats, but symptoms can also include insomnia, anxiety, weight gain, libido changes, mood swings, irritability, loss of concentration and focus- “brain fog” and memory loss. It is a natural change that all women experience but it can significantly impair a woman’s ability to function and her quality of life. For many women, the process becomes overwhelming and triggers a midlife crisis.
The truth is our experience of menopause is influenced by a multitude of other factors such as stress, diet, lifestyle, health education, awareness of our bodies, cultural expectations, positive relationships, work environment and levels of empowerment to seek medical advice and support.
Psychological pressures
For women, the worst psychological pressure occurs between 35 and 50. Anxiety and low mood are at an all-time high, bang in the middle of the perimenopause. Stress is the real enemy in our frantic modern lifestyles. We were designed to produce cortisol, our stress hormone in short bursts as part of our flight and fight response but this has been hijacked and cortisol production is at a constant high. This flood spells physiological danger for our bodies. Cortisol is linked to survival and when we need extra cortisol, it is at the expense of our sex hormone balance resulting in irregular or no menstrual cycles.
Metabolic effects
High cortisol also has other metabolic effects, making the thyroid gland responsible for our metabolic rate sluggish and can cause high insulin levels resulting in weight gain. Cortisol naturally increases with age, so stress compounds this issue, creating a vicious cycle and sabotaging us. Cortisol is produced by the adrenal glands, which also produce sex hormones so adrenal burnout due to excessive stress can lead to depletion of these essential sex hormones. The adrenal glands are a key reservoir for sex hormones after our ovaries stop working in the menopause, so we need to moderate stress. Our hormone systems all need to be balanced to experience optimal health and wellbeing and make the transition to menopause as smooth as possible.
Contraceptive pill
One of the key issues towards ensuring our gender equality in the workplace was ensuring reproductive rights- all hail the oral contraceptive pill! As women strive in their careers, there is an inevitable delay in childbirth and being on the contraceptive pill for over two decades is common. Indeed, the pill has become the universal panacea to deal with most female hormonal issues! This masks the natural menstrual cycle with its ebbs and flows to a flatline of synthetic hormones with total predictability. The result-women are much less aware of natural hormone changes occurring in the perimenopause. The pill often does not provide enough synthetic estrogen which can affect mood and the synthetic progesterone stimulates other receptors such as testosterone and cortisol that dysregulate the stress response so compounding the symptoms of midlife hormone change. Indeed, the stress hormone profile of women taking the pill can mimic that of chronic stress.
Fertility
Women are having children later, both through choice and necessity. Hormone imbalances relating to the perimenopause may occur from 35 so this, combined with increasing egg age, mean that IVF and fertility treatments have increased exponentially. The journey of infertility has a profound emotional and psychological burden and let’s not forget the physical consequences of the repeated hormonal insults of the treatment cocktails: powerful hormones, steroids, blood thinners and drugs that suppress the immune system. This can trigger a dysregulated cortisol response making the changes of perimenopause occur earlier and with greater severity. Menopause coincides with the challenge of very young children.
Healthy diet & lifestyle
A healthy diet, low in refined carbohydrates, with good fats, quality protein and a range of phytonutrients found in fruits and vegetables is key to good hormone balance especially in midlife. Daily movement in the form of enjoyable exercise, moderating alcohol consumption and stress reduction techniques such as yoga and meditation are all important in our overall menopause experience. Our ability to have a healthy lifestyle is often not prioritised in a busy schedule and stress, overwhelm, lack of self-care, and not setting firm boundaries all play their part.
Average life expectancy has increased dramatically in the last century and a baby girl born in 2020 can statistically expect to reach 100 years of age. Women will therefore spend 50% of their lives in the menopause. There has now also been much research into the multiple roles of sex hormones and their roles in our long-term health such as cardiovascular, bone and brain health. We have estrogen receptors in 300 different cells! Menopause is now defined as a long term “chronic female hormone deficiency” which must be addressed. We also have societal expectations to be youthful, energetic and sexy forever. But is there much point in living to 100 without vitality and good health? Structural changes to society and the growing ageing population means the pensionable age is now 68 so we will have to work harder for longer and maybe have flexibility to straddle several careers.
Awareness and education of the importance of hormonal health and the impact of menopause is essential and many progressive institutions are providing support in the workplace. Be proactive and seek expert menopause advise – bioidentical hormone replacement can be life-changing, reducing symptoms and improving quality of life in terms of long-term health, slowing down ageing and vitality.
