The Menopause Medic – 7 menopause questions answered

I was very lucky to have the chance to speak to Fionnuala Barton (aka The Menopause Medic), who has recently opened a clinic for perimenopausal and menopausal women in St Albans. I asked her some questions about perimenopause and menopause that are some of the top ones in my mind and I think you will find extremely helpful.

Fionnuala’s holistic approach at The Menopause Medic aligns perfectly with the way I work at Centred Mums – do take the time to read this fully as it contains some excellent advice and information.

1.      What are the big menopause myths that women come to you with most regularly?

The most common myths that need dispelling in The Menopause Medic clinic are around HRT. Many women have been advised they “cannot have” oestrogen treatment because of a history of migraine, blood clots, liver problems, raised blood pressure or heart disease or if they have a strong family history of these.

In fact, oestrogen is important to help support these conditions as we move through perimenopause and into menopause and using transdermal oestrogen via the skin does not increase risk.

Similarly many women remain concerned that HRT will significantly increase risk of breast cancer; for example if they have had a family history of breast cancer or breast symptoms themselves. I spend time discussing risks specific to them and, for the vast majority of women, the benefits of hormone therapy will outweigh risk, even if baseline risk of breast cancer is higher due to genetics and family history.

Finally, myths around the age of menopause are still rife: many younger women in their 30s and 40s have been told they are “too young” to be in perimenopause, even if they have many problematic symptoms. Many older women who did not take HRT at the time of their menopause have been told it is “too late” for HRT and this is not true either!

2. Perimenopause can be a bit of a mystery—how do you know if it’s that or something else going on?

This is a common and rather difficult conundrum.

In the first instance, a thorough review of clinical symptoms, background and timing of symptoms is helpful to rule out other hormone disorders such as PMS, PMDD, PCOS and endometriosis. But if the diagnosis is uncertain and for women under 45 it is important to rule out other causes with blood tests and specialist investigations if necessary.

It is also important to explore the context of symptoms to determine if lifestyle factors such as stress, burnout, disordered eating or metabolic dysfunction are contributing also.

3. HRT—there’s so much talk about it! How does it actually help, and is it the right choice for everyone?

It is not the right choice for everyone: for some women it is not safe (active or history of oestrogen sensitive cancer such as breast, ovarian or womb cancer), some women do not tolerate hormone therapy and find the benefits do not outweigh the side effects or risks and many women prefer not to take medication if there are more natural approaches that are working for them.

That said, Hormone therapy is the intervention with the strongest evidence-base for benefit in alleviating suffering from symptoms but also protecting bone density and cardiometabolic health and thereby safeguarding future health and ultimately longevity.

It helps by providing a source of oestrogen, progesterone and sometimes testosterone in the absence of sufficient levels of these hormones from the ovaries. The hormone molecules in HRT then act at the receptors on all the cells of the body that rely on them for normal function – most cells in the body! Thus, support normal cellular and organ-system function to improve symptoms.

 4. Beyond medication, are there any natural or lifestyle changes that can really make a difference with menopause symptoms?

Yes! I recommend all my patients at The Menopause Medic to consider changes that can be made to support sleep and stress management whilst optimising nutrition and movement or exercise regime. Whether you chose to take HRT or not small tweaks across these 4 “pillars” of wellbeing have scope to make a big impact.

5. If you could give one piece of advice to women in their 30s and 40s about preparing for menopause, what would it be?

Don’t fear it: get informed and go in armed. Start listening to what your body is telling you, track symptoms as well as cycles. Approach with a new sense of self-compassion and really dial into your intuition.

If we know what we are up against, are empowered with information and tools we can remain in control and ,actually, perimenopause can be an incredibly positive transition and awakening to embrace the next chapter with optimism, clarity and purpose.

6. Does what we eat and how we move really affect menopause symptoms? Any must-have foods or go-to exercises?

Absolutely, more so than in our younger years. And the “Old strategies” of “move more eat less” simply no longer stack up.

As above, tune in and be intuitive: in perimenopause your body is still experiencing cycles (sometimes wild ones) and adjusting your training to how you are feeling physically and emotionally is important. You may want to focus on more high intensity work in the first 2 weeks of cycle and lower intensity conditioning and strengthening work in the second half of the cycle.

I would highly recommend that everyone aims to increase their “Non exercise activity” (walking to the shops, standing at your desk, taking the stairs not the lift etc) and doing as much walking daily as  possible. Also focussing on exercise such as Pilates with resistance training and conditioning to support maintenance and building of lean muscle mass, which declines rapidly in midlife and after menopause.  We need to keep our skeletons strong and functional but is also crucial for our metabolic health and ability to maintain a healthy weight.

If you love running, go running. If you love wild swimming, wild swim!

Do the exercise that lights you up and makes you smile and want to keep going back again and again. But don’t over-focus on the high intensity cardio stuff if you loathe it. Now is no longer the time for punishment!

If you are training it is so important that you are also ensuring you are well-nourished and fuelled for training – to provide the amino acids and energy required to repair after exercise and not end up overly depleting you.

Aim for 40:30:30 ratios of carbs, protein and fats ideally including a wide variety of plants to increase microbial diversity and to achieve a target of 30g fibre daily as well as 1-2-1.6g/kg of protein daily and plenty of healthy fats e.g. oily fish/avos/olive oil.

Pay attention to portion sizes and timing of meals – avoid eating too late in the evening but I would not recommend prolonged fasting (there is no evidence it helps with weight loss). Reduce added salt, refined sugars and cut down or cut out alcohol. Approach with an 80:20 mindset to make it achievable.

7. Menopause and pelvic floor health—what’s the connection, and what should women be looking out for?

When ovaries stop producing oestrogen and testosterone at menopause this causes a number of changes in the pelvis: we lose muscle tone, mucosal surfaces become dryer and more irritated and collagen and elastin levels decline meaning structures are less robust and flexible.

Weakness in other important core muscle groups can contribute to pelvic floor dysfunction and pain both in the pelvis but also hips and back further impairing mobility, function and strength.

Maintaining core and pelvic floor connection and control can be enormously helpful in avoiding leakage symptoms, pain and sexual dysfunction after menopause. Vaginal oestrogen is a really important tool for supporting pelvic health in perimenopause and after menopause too and is safe to use by everyone at any age!