Preparing for perimenopause menopause

Getting Ready for the PERIMENOPAUSE & MENOPAUSE!

By Dr. Nitu Bajekal, MD Senior Consultant Obstetrician and Gynaecologist

Every aspect of health at every age and stage of life benefits from nutrition and lifestyle changes but very few women are equipped with the right tools to build positive habits.

This is especially true for menopause, a phase in our lives where we hopefully spend several decades, given that periods completely stop for most people between ages 45-55 and life expectancy for women in the UK is currently around 83 years. I use the term woman/women here as an inclusive term to include everyone assigned female at birth (AFAB), however, they may choose to identify.

Dementia is now the commonest cause of death for women in the UK, with increasing rates of heart disease, certain cancers such as breast, bowel, ovarian and womb and osteoporosis also contributing to death rates (mortality) and suffering (morbidity).

Perimenopause is the lead up to menopause and can last for two-eight years, with hormonal fluctuations and symptoms similar to the menopause such as hot flushes, reduced sex drive, unwanted weight gain, mood changes as well as erratic periods, starting as early as in the late thirties for some (3951 years). Symptoms of perimenopause may start long before periods stop, impacting both mental and physical health. Menopause and perimenopause affect half the world’s population yet there is still a lot of stigma, especially in the workplace which means people often don’t know where to turn for help (The British Medical Association survey of 2000 women doctors recently confirmed this).

Lack of investment in public education as well as a failure to communicate information clearly by health professionals, schools and workplaces can have a tremendous impact on how women approach the menopause. There needs to be change urgently as otherwise misinformation and myths thrive, pushing women to seek dubious supplements and unproven medications.

Lifestyle Medicine is a discipline that runs alongside western medicine and involves the use of evidence-based lifestyle approaches for the treatment, prevention and sometimes reversal of lifestyle-related chronic disease. Self-care and self-management are key, allowing you to be in the driving seat. Making behaviour and lifestyle changes can go a very long way both in the short term and long term, helping one often avoid unnecessary medications or surgery.

There are Six Pillars of Lifestyle Medicine that also help manage menopause

Eating a predominantly whole food, plant-based diet Regular physical activity Restorative sleep

Stress management Avoidance of risky substances

Positive social connection

My advice to anyone reading this is not to wait until you are 50 to make changes. It’s never too early (or too late) to eat healthily, stress less, move more, sleep better, avoid alcohol and smoking and build positive social networks to help you live your best life.

To reduce the symptoms such as hot flushes, night sweats and improve mood and sleep, simple changes such as ensuring a regular bedtime routine, going for a walk outdoors or doing a simple workout daily are usually achievable. Starting with one aspect of lifestyle tends to have a positive effect on the other aspects of one’s life. When you sleep better, you tend to stress less and make better food choices for example.

The biggest changes I see in my patients is when they avoid alcohol and smoking and switch to a colourful plant predominant diet. By this I mean, adopting a diet packed with whole plant foods such as antioxidant-rich, nutrientdense fruits and vegetables that help reduce the chronic inflammation associated with serious diseases, fibre-rich beans, soya and intact whole grains as well as healthy fats from nuts and seeds as they can help in reducing menopausal symptoms. Starchy vegetables such as sweet potatoes and potatoes with skin as well as mushrooms, herbs and spices are also excellent health-promoting foods. There are at least 34 symptoms of menopause which include depression, anxiety and one that distresses many women is one of unwanted weight gain that is harder to shed.

Weight loss where desired is a positive side effect as plant foods are also naturally lower in calories. This is important as excess weight is associated with an increased risk of heart disease, dementia and certain cancers as well as more severe menopausal symptoms especially hot flushes. Soya is a bean that has healthy plant oestrogens, fibre, protein, vitamins and minerals and is safe for all ages and is particularly good to lower the incidence of hot flushes, breast, ovarian and womb cancer and heart disease risks and can help with weight loss. All long living healthy societies around the world base the majority of their diet on whole or minimally processed plant foods.

Aiming for a wide diversity of plant foods allows for a healthy gut microbiome and better overall health. I suggest slowly building up over 3-6 months to allow your gut to adapt to all that nourishing fibre-rich foods. Starting these foods early in childhood is good as what and how you eat as a child and young adult has an impact on your later years and on how you deal with menopause.

There are really no separate diets for different conditions. The same way of eating that helps prevent cancer is also the same for managing menopausal symptoms and for losing weight healthily.

Helpful Links https://nitubajekal.com/menopause-nutritionadvice/ https://nitubajekal.com/menopause/ https://www.bma.org.uk/media/2913/bmachallenging-the-culture-on-menopause-forworking-doctors-report-aug-2020.pdf