GenX women-Do we know anything about our hormones?
I just read the most captivating article by Jessica Baumgartner reviewing a book I had to immediately read titled “Why we can’t sleep: Generation X Women’s New midlife crisis”. I so resonated with what I was reading as it spoke directly to me and to what I’ve been going through body physically, mentally, emotionally and spiritually. We were born riding the second wave of the feminist movement: confident that we were as capable as the boys and divorce rates reaching epidemic levels (yep my parents divorced when I was 7). Depending on luck, you might have just skated in on the free uni education still on offer and focussed on your career putting off children (if you wanted them) until your mid/late 30’s only to discover the fertility epidemic that no one talked about was upon us (also me). Many of our kids have higher rates of ADHD and autism (or other special needs) and we are raising those kids (and absorbing the additional costs of that) whilst dealing with ageing parents. We are living the dream!
I haven’t even mentioned the fact that whilst all this is going on we get hit with Perimenopause. That potentially 12 year long period prior to menopause when your hormones are behaving like they did when you were a teenager. Fabulous. This happened to me. I had a baby at 40 (after struggling with my fertility for a decade) and then after I stopped breastfeeding I crashed into Perimenopause (but didn’t know that for awhile). I’m sure I’m not along in this.
I am now 51 and most of my friends are over 45 and so are my clients and patients so, it makes sense that I would be talking a lot about GenX women and Perimenopause/Menopause. At this point I’m joking about it and complaining loudly to my children about my “brain that doesn’t seem to work anymore” amongst the many other symptoms: The brutality is real.
Why this blog? Because I am having more and more conversations with friends and patients about their Perimenopause symptoms and most of them (a) don’t even know when Perimenopause starts/finishes and (b) don’t really know that any of what they’re experiencing is related to their hormonal fluctations (c) don’t know the names of most of the hormones and (d) don’t realise there is stuff they can do about it. The final straw for me was when a friend of mine went to her GP (on my suggestion) because I thought she should be reviewed for some Progesterone and came back with her (female GenX aged) GP having recommended that she take an anti-depressant. This is not the first time I’ve heard this story. Just take an anti-depressant. Firstly, an anti-depressant and progesterone do not do the same thing in the body in terms of symptom alleviation and, secondly, antidepressant have mental health risks before they start working and issues with withdrawal if you ever get off them so they should be prescribed accordingly. Suffice to say, she got a second opinion and had a very different result. Sidebar: I am not against antidepressant medication at all but I feel that it’s being prescribed to women without any other conversations about what else might be going on that could be addressed with non-invasive low risk therapies for symptom alleviation.
Until now, I haven’t written or talked about it much because I felt like compared with the Goddesses that I follow in this space, what would I have to offer? Well, most of my friends and patients have NEVER heard of any of them so I am the link to all that amazing information that needs to be disseminated further. The more voices the better.
Have you heard of the term Body Literacy? I sought out one of the women in natural medicine that I turn to when I want to clarify anything to do with periods, perimenopause and menopause. I have been complaining to my husband, my friends and anyone else who will listen over the past few years, and nearly daily over the last few weeks about the levels of female hormone illiteracy that exists amongst GenX women. It’s been born out of conversations with friends and patients about how they are managing perimenopause. Long story short – they’re NOT!
I assumed that my peers were more well educated about their female hormones/repro cycles than they are and I was genuinely SHOCKED. As I read this outline on Lara’s website about Body Literacy (see here https://www.larabriden.com/body-literacy/) the revelation came to me that our generation did not discuss periods and we kind of still don’t (much). I had no idea until I finally got a diagnosis for my endometriosis when I was in my 30’s that what I had experienced my whole life was NOT NORMAL.
We are the “suck it up and get on with it”, “stop your whinging” and “white knuckling” generation and I feel like we are approaching perimenopause and menopause in the same way. I want to change that. I want to share both my own journey but also my view as a Nutritionist, Yoga Teacher and PT about what women should know about Peri and Meno so that they can make informed decisions about whether they want to white knuckle it, or whether they would like a different (and more enjoyable) approach.
I have been taking HRT since I was in my early 40’s. I have a fantastic Integrative GP and have been working with her with a number of things (including hormones) for a long time. I started with (bio-identical) progesterone only and as I got deeper into Perimenopause added in some DHEA and Oestrogen.
Signs and symptoms that GenX women typically reason away as stress, busyness, lack of exercise etc because we think we are too young for Menopause (that’s for old ladies)
Heavy periods
Mood swings/irritability
Weight gain
Sleep disruptions
Low libido
Hot flushes
Changes in bone health
Thyropause (lowered thyroid function
The weight management struggle is real -right?
This can be a lifelong challenge for some women, but can become more noticeable in perimenopause (it did for me!). The same things that I had always done if my weight started creeping up were providing diminishing results and those numbers on the scales just kept going up. What was worse – when I did start working out more, I could not lose weight. WHY? Because I was insulin resistant. I could feel it in my body, but I didn’t understand at the time why – I was 1 year into my nutrition training and 18 months postpartum and the heaviest I had ever been in my life. It was not fun. I thought maybe this was my new normal. It honestly didn’t occur to me that I was perimenopausal and nor did I understand at the time how my chronic sleep deprivation due to a sick child was contributing to a perfect storm.
I now understand why I had become insulin resistant:
Changing hormones. At age 42 my hormones had already started to fluctuate.
I had a sick child and had hardly slept more than 10 minutes at a time for nearly 18 months.
Because of the chronic sleep deprivation, I was exhausted, depressed and and burned out (another factor leading to insulin resistance)
I had reverted back to my old methods of weight management – exercise as much as you can and eat less – not the right approach given my age, exhaustion, hormones and insulin resistance. I was flogging myself and getter bigger!
What is Perimenopause?
The period of time (2-12 years) prior to menopause when women start experiencing changes in hormonal balance (especially progesterone and oestrogen) and insulin metabolism-beginning with low progesterone paired with temporarily high oestrogen and finally low oestrogen with some significant changes to our blood sugar management. Menopause is the period 1 year after your last period. That’s’ a long time isn’t it – 2-12 years. Average age of menopause is 51 so therorectically some women start Perimneopause aged 39
INSULIN is a hormone that regulates metabolism and is made in your pancreas. Insulin is secreted into your bloodstream primarily in response to glucose but many other hormones including melatonin, oestrogen, leptin and others also regulate secretion of insulin. We will focus mainly on the glucose but it’s useful to know that other hormonal alterations in the body can contribute to issues with insulin sensitivity.
Insulin works by communicating with receptors on our cells to encourage the doors to open and allow glucose to enter. Insulin also acts on muscle, liver and fat cells where glucose is stored as glycogen and triglycerides for later use. Glucagon is a hormone released by the pancreas in response to low blood sugar levels, mobilising stored glucose from liver, muscle and fat cells.
Insulin Resistance
A condition where cells have reduced sensitivity to insulin (imagine the cell is wearing headphones and can’t hear insulin knocking on the door), so insulin remains elevated in your bloodstream. Chronically elevated insulin levels can lead to diabetes, metabolic syndrome and is a major contributor to abdominal and visceral weight gain.
Insulin resistance can also affect fat cells, as the message to continue to hold the fat is not being heard and the fat cells release stored triglycerides back into circulation, potentially causing elevated blood triglycerides (a cardiovascular risk factor).
High Cortisol and Insulin Resistance
In “Rushing woman's syndrome” Dr Libby discusses the interplay of cortisol and stress. When we are stressed our “fight or flight” system is engaged. This is meant to mobilise many systems in our body for the purpose of RUNNING from imminent danger (Tiger). When the danger passes that system should switch off and we should return to a parasympathetic state (rest and digest).
Unfortunately, many of us GenX women live with chronic stress which impacts many systems including digestion. Chronic Stress=chronically elevated cortisol (the mechanism never switches off) =glucose mobilised from storage but there’s no animal to run from so the glucose is not needed so more insulin is released to get rid of the sugar back to storage and around and around we go-decreasing cell insulin sensitivity and increasing systemic inflammation. A very damaging cycle.
Over time the whole process becomes dysregulated but can also lead to fat loss resistance. Fat cells are metabolically active tissue (did you, like me, think they were just useless bits of tissue?) Fat tissue is considered an endocrine organ capable of exerting body wide metabolic influence making hormones and cytokines called adipokines. The most well known one is Leptin with its effect on appetite regulation, but many others are indicated in the development of insulin resistance, obesity and type 2 diabetes.
CORTISOL AND PROGESTERONE-The Great Progesterone steal
Progesterone is a steroid hormone (made from cholesterol – yes, we need cholesterol) and it’s made in the Corpus luteum (eggshell), adrenal glands and by your placenta from 8-12 weeks of pregnancy.
Progesterone is mainly secreted by the corpus luteum (The Egg Shell) in the second half of your menstrual cycle. If you are not ovulating or have an anovulatory (no egg released) cycle, then there is no corpus luteum to make progesterone. You won’t necessarily notice this as your period may come in a similar manner.
Perimenopause and anovulation (no egg released) = less progesterone AND if you’re already more agitated/stressed = the progesterone that is being made by other sources is being STOLEN to be turned into cortisol. That is NOT helpful. Progesterone is a precursor molecule to cortisol. This explains why so many women have low progesterone. I find it’s an epidemic amongst my patient group (the over 40’s lady) What kind of symptoms can be caused by low progesterone?
-anxiety/irritability
-depression/poor mood
-low libido
-fatigue
-hot flush
-migraine/headaches
-heavy periods
THE cortisol/insulin/cortisol problem
When you have chronically elevated cortisol this can lead to insulin resistance as discussed earlier but, here’s another twist, insulin resistance can lead to increased cortisol release as it is perceived as a stress by the body. Can we get off this roundabout already?
SO BACK TO OESTRADIOL (oestrogen)
As we try to reduce very complex metabolic processes (think hundreds of chemicals, receptors, interactions) to very simple explanations - we can say that a loss of circulating Oestradiol induces rapid changes in whole body metabolism, fat distribution (did anyone say belly fat?) and insulin action.
Enough of the bad news - what can we do?
Appropriate exercise can help alleviate symptoms, manage weight, protect brain health, reduce metabolic disease risk (including dementia) and minimise bone loss during menopause (the riskiest time).
All exercise is great but specifically:
Resistance Training-amazing for so many reasons but specifically for improving insulin sensitivity. How? Having more muscle cells increases the amount of energy you need expanding your storage capacity and while you are exercising your cells are able to remove glucose from the bloodstream without insulin as the mediator. Less glucose in circulation means less insulin means the cells can take off their headphones because it isn’t so noisy.
There are many other very complex mechanisms by which insulin sensitivity is improved but they are all positively influenced by exercise.
A 2001 Study on menopause and exercise in the Journal of midlife health found what you all probably know. Women should be doing
Resistance Training
Aerobic exercise
Balance training
Stress management
Breathwork/Yoga
What about Nutrition?
Again, common sense mostly prevails here:
avoid refined carbohydrates that break down quickly into glucose and are high in glucose with low satiety meaning you eat a lot more of them and you will likely be “hungry” again quickly.
Focus on eating whole food, high fibre complex carbohydrates
Low GI foods and a low Glycaemic load diet overall
Eat protein with every meal and snack
Focus on the “healthy plate” – ½ plate non starchy veg, ¼ protein and ¼ starchy carbs with a good dollop of healthy fat
don’t graze “all day” – our digestive system needs a break. Unless snacks are needed try and stick to eating around every 4-5 hours to give our body a break from food and insulin production.
Increasing foods high in B vitamins, zinc and vitamin C including lean read meat, lentils, chickpeas, pumpkin seeds, sunflower seeds, almonds, salmon, green vegetables, dark chocolate.
Minimise caffeine – 1-2 cups or equivalent max per day. If you are an over responder then reduce even more
keep alcohol to minimum-the evidence is not favourable for perimenopausal and menopausal women and alcohol.
2 Body systems to support to optimise ALL of your hormones: sex hormones and metabolic
Support your LIVER the epicentre of detoxification (including hormones). Reduce the burden on the liver by minimising toxins: alcohol, drugs (including OTC medications), herbicides & pesticides which reside on most commercially grown food, toxins in skincare & body products and make up.
Prioritise your Gut Health and MICROBIOME – performs more metabolic functions than the liver and most of my patients don’t even know what this organ is (do you?). Decreases in oestrogen can alter the microbiome leading to decrease in beneficial bacteria and increasing the abundance of inflammation causing bacteria. This can contribute to “leaky gut” and can increase inflammation in the gut and systemically. An imbalanced microbiome can also lead to recirculation of detoxified substances that should be leaving the body (and go back in circulation increasing inflammation)
Natural Therapies and supplements to support you during Perimenopause and menopause
Zinc: most women are not getting enough. Zinc helps to maintain collagen and elastin and relieve vaginal dryness. A dose up to 30mg per day is safe and best forms are zinc citrate, glycinate or picolinate. A dose over 80mg per day for 12 months or more may deplete copper. Have with a meal as it can cause nausea.
Cod liver oil: a great source of EPA/DHA, vitamin A and Vitamin D. 1 tsp with dinner with optimise absorption. Obviously not suitable if you have a seafood allergy.
Vitamin C: a great all rounder for supporting inflammation. 1-3000mg per day in split doses to optimise absorption.
High quality B complex
Calcium: 1000mg per day from food or a supplement. To ensure calcium is directed to where you want it to go: Vitamin D levels must be adequate and magnesium intake daily should be 350-400mg from food/supplements.
Vitamin D/K2: I always prescribe these two concurrently as vitamin K2 help to shunt Calcium into the bones where we want it.
Magnesium: see below under sleep. I prescribe this as a daily supplement to almost ALL GenX women.
Stress management-this makes for a whole topic but can include Yoga, regular exercise, managing your blood sugar, getting out in nature, meditation, breath practices etc. Remembering
Stress management has a mindset component – if the above techniques aren’t providing relief seek counselling or psychology.
Increasing fibre intake to optimise oestrogen/progesterone balance (by ensuring oestrogen detoxification). Minimum 30grams per day. There are many food tracking apps that now track fibre too.
What else?
SLEEP-Unfortunately, perimenopause and menopause are a time that commonly introduce sleep dysregulation to women that may have never had any issues. Sleep disturbance is the second most common symptom reported after hot flushes. The problem can be both with falling asleep and staying asleep. What are the causes?
-high histamine during the high-oestrogen stage and disruption (change) of the sleep centres of the brain due to the drop in progesterone and estradiol (oestrogen).
-altered circadian rhythms due to a drop in estradiol.
-reduced melatonin production
-impaired stress tolerance
-sleep disturbing symptoms like hot flushes, increased need to urinate, fibromyalgia and restless legs syndrome
-sleep apnoea.
Nutritional and naturopathic medicine have many low intervention options for managing sleep disturbances. Sleep apnoea should be evaluated by a qualified medical professional so refer to your GP if you suspect sleep apnoea.
Sleep hygiene is the best place to start and should include:
-getting light exposure first thing in the morning (without sunglasses) – this helps to regulate your circadian rhythm and contributes to better sleep.
-Reduce blue light exposure for a couple of hours before bed. If you can’t get off your computer or tablet, consider wearing blue light blocking glasses. Blue light interrupts melatonin production.
-consider stimulants like coffee and alcohol – they can both interrupt sleep. Remembering that what you could get away with prior to perimenopause may no longer apply.
-Consider a low histamine diet if you are showing signs of poor histamine tolerance. You can try this yourself but you may want to get support with a Nutritionist or Naturopath
-consider eating adequate good quality carbs with your evening meal as this can be calming to your nervous system.
Rescue remedy for sleep:
Magnesium (glycinate or citrate). 350mg per day
Taurine: up to 3000mg per day
Inositol: up to 3000mg per day
What else might you be going through during this time directly related to changes in your sex hormones?
Increased susceptibility to UTI’s
Changes to pelvic floor function (including leakage)
Vaginal dryness- can be very uncomfortable
Mood changes: irritability, anxiety, depression, fatigue
Joint and muscle aches and pains
Painful intercouse - due to dryness and thinning of the tissues lining the vagina
Irregular menstrual cycles.
Okay, so it feels like bad news but it’s not. You just have to do more things well. You can’t get away with treating yourself like you did 20 years ago and thinking the effects will be the same. They aren’t. You can’t go on a diet, overexercise, drink too much alcohol and coffee, get by on 3 hours sleep, be stressed out and not exercise enough without consequences and those really suck. I’ve had many of them and I can tell you from personal experience they are all made worse by the above combo. So what works?
The opposite of the above. Eat well and not too much. Exercise. Sleep well. Do yoga. Manage your stress. Drink less coffee and alcohol. Get some sun. Take your supplements and have some fun.
If you try that and you’re not happy with the results or you want someone to just tell you what to do to lose weight and feel better-reach out. I will tell you about what I think is my life changing program for GenX women: 12 Weeks to WOW program.
More Resources for you
Lara Briden: The Hormone Repair Manual
Dr Libby: Rushing Woman's syndrome
https://www.larabriden.com/8-ways-that-magnesium-rescues-hormones/
https://www.larabriden.com/rescue-prescription-menopause-perimenopause-feel-better-fast/
Low tox Life by Alexx Stuart to help reduce toxic load in your life and her podcast is also fantastic.
Low-Histamine Diet: Which Foods Should I Avoid? (healthline.com)