An exciting close to 2019 was the opening in Cork of a clinic dedicated to POI & Menopause. It is great to see more clinics and GP's expanding their knowledge and spreading their wings throughout the country. I was thrilled to finally met Brenda after months of emails as she prepared to open her clinic in Cork.
Brenda is a UCC graduate and qualified GP - during her GP training she became interested in the area of sexual & reproductive healthcare and went on to study a Diploma of the Faculty of Sexual & Reproductive Healthcare (UK). It was while working in London as a portfolio GP encompassing part-time GP and part-time work in King’s College Hospital in the area of sexual health and forensic medicine ( sexual assault), that Brenda met Mr Haitham Hamoda (current Chairman-Elect of the British Menopause Society, consultant Gynaecologist and sub specialist in Reproductive Medicine). Keen to gain practical hands-on experience in menopause Brenda worked under the tutelage of Mr Hamoda at King’s Hospital. (King’s College Hospital is a large Tertiary Referral Centre in South London which has a long-running and comprehensive Menopause Clinic). Brenda was determined to bring this knowledge back to Ireland.
‘Over the past few years, I have observed the menopause getting much more well-deserved exposure in Ireland with regular media articles, on-line resources such as My Second Spring, menopause advocates such as Catherine O’Keeffe (Wellness Warrior) and there has been great initiatives by the Irish College of General Practitioners (ICGP) to improve menopause care by GPs and I think the message is getting through slowly. Every woman’s menopause transition and journey is different and it’s important that readily available access to up-to-date information in all aspects of menopause care is available so that women are well-informed and can avail of treatment options (if any) that most suit them.’ Dr Brenda Moran
Below you can read the interview with Dr Brenda Moran on discussing her new clinic, POI & Menopause.
Brenda talking POI:
Premature ovarian insufficiency (POI) refers to onset of the menopause or oestrogen deficiency under the age of 40. Early menopause refers to the onset of menopause or oestrogen deficiency between the age of 40 and 45. POI has a prevalence of 1%. Genetic factors, autoimmune factors, infections and iatrogenic causes such as chemotherapy, radiotherapy and surgery are reasons why women might have POI. However, in most cases no cause is identified.
In addition, there is an increasing prevalence of childhood and young adult cancer survivors following the advancements made in cancer treatments over the past 2-3 decades. Risk-reducing surgery such as bilateral oophorectomy (removal of both ovaries) to reduce the risk of ovarian cancer is on the rise following advancements in genetic testing resulting in the identification of BRCA carriers (BRCA carriers are at a very high risk of developing breast and/or ovarian cancer). Therefore, the number of women with POI is increasing.
The long-term complications of POI have been well documented in medical literature. These include reduced bone mineral density with resultant increased risk of developing osteoporosis and fractures, an increased risk of cardiovascular disease, reduced cognition and decreased life expectancy.
Hormone replacement has a beneficial role in maintaining bone and cardiovascular health as well as cognitive function in addition to symptom control and has been approved by the NICE guidelines as the treatment of choice for women with POI.
There is currently no national referral guideline or recommendation regarding the treatment of POI in Ireland. It is not uncommon to find women with longstanding POI not taking HRT, nor advised about HRT, nor linked with either a gynaecology or endocrinology clinic or closely monitored by their GP. It is essential that women with POI get access to the most up-to-date, evidence-based treatment and appropriate psychological support.
There is a clear lack of resources, support and awareness of this important condition which can have life-altering physical and psychological consequences for some women, especially when it impacts on fertility when a woman would like to conceive. We need to continue to advocate to improve resources for women with POI in Ireland, especially when it comes to accessing proper medical care, appropriate psychological support and access to funded assisted reproductive technology for fertility treatment.
The Daisy Network is a UK based charity dedicated to providing information and support to women with POI. It’s wonderful to now have an Irish representative for the Daisy Network in Catherine O’Keeffe. Catherine is now the Irish link to the Daisy network and can help to provide grass root support to women who need it. (See more details here.)
I am very happy to see and treat women with POI in my clinic. However, it’s important to note that I will be focusing solely on menopausal symptoms and consequences of POI and am not a substitute for one’s regular endocrinologist if there are other associated endocrine conditions albeit I can happily liaise with them in relation to POI.
You can contact Brenda at her clinic or through her website : www.danuclinic.ie.
When Menopause happened for you (if applicable)
I have yet to go through the menopause. However, one of the most challenging periods of my life to date has been the experience of 1st trimester pregnancy when I felt so generally unwell, and frankly didn’t recognise myself. I was expecting to be nauseous (and I didn’t have hyperemesis)– but I was not expecting to feel that I had lost complete control over my own body. I lost any extra reserve that I had, felt I was sub-performing in all aspects of my life and it was an acute personal realisation of the effect that hormones can have on a person’s body, and how the physiological response to the same type and level of hormone can differ hugely from person to person.
What are the most common issues women experience in menopause?
Menopausal symptoms: I am not going to list all the symptoms as they are listed on this website and elsewhere, but the most common ones I encounter in clinical practice are: (*of note, some women might have no symptoms; others might have 1, others might have several – it’s hugely variable)
The last few years has seen the advent of changes in clinical practice when it comes to HRT prescribing taking into consideration the cardiovascular “timing hypothesis”, “window of opportunity”, the role of transdermal oestrogen (oestrogen via the skin) as well as body-identical hormones.
The “timing hypothesis” and “window of opportunity” relate to the theory that if HRT is started within 10 years of the menopause or before the age of 60, the advantages generally outweigh the risks, particularly in terms of benefit to the heart, as well as bone protection and cognition (the latter only for women who are symptomatic in this regard, for example, are experiencing brain fog, forgetfulness and poor concentration which started around the menopause. It is not a treatment for dementia) as well as improving menopausal symptoms. Studies have shown that when HRT is started at a time interval of more than 10 years following a woman’s last menstrual period or over the age of 60, the same cardiovascular (heart) benefit doesn’t apply, although it still may improve symptom control.
Studies have also shown that transdermal oestrogen (oestrogen HRT via the skin) does not increase the risk of a venous thrombo-embolic event (VTE) or stroke. VTE is a clot in a vein, commonly the leg or the lung. Therefore, it has a lower risk of blood clots and strokes than oral HRT.
Prior to the publication of the Lancet Study during the summer, HRT use had increased again following the negative media publicity it had received following the publication of the WHI Trial in 2002 when it was associated with an increased risk of breast cancer, cardiovascular disease, stroke and clots ( of note, the majority of women enrolled in this trial were much older than the average woman starting HRT in the perimenopause and early menopause and therefore it wasn’t an accurate reflection of the usual cohort of women who start HRT under the age of 60).
Evidence from studies does suggest a small increased risk of breast cancer with HRT use which increases with duration of use and reduces on stopping. This came to light again with the publication of the Lancet Study in 2019 which concluded there were an extra 2 cases of breast cancer for every 100 women of average weight using continuous combined HRT (daily oestrogen and progesterone) for 5 years. The study suggests that the additional risk associated with combined oestrogen and progesterone may continue for longer than was previously thought after HRT is stopped.
However, it’s important to note this is a 2% absolute increased risk and the majority of women taking HRT will not go on to develop breast cancer as a result of taking HRT. In addition, the figure of 2% was lower for that of oestrogen-only HRT, sequential combined HRT (daily oestrogen and intermittent progesterone use) and no increased risk was seen with vaginal oestrogens. In addition, women should be counselled that other factors, including body weight and alcohol consumption, have a greater effect on breast cancer risk than HRT (NICE 2015).
In conclusion, HRT remains the most effective treatment option for severe menopausal symptoms. In general, the benefits outweigh the risks when started within 10 years of the last menstrual period or below the age of 60 when it comes to symptom control, reducing the risk of cardiovascular disease and for bone protection. There is a small increased risk of breast cancer which increases with duration of use and depends on the type of HRT used. This risk needs to be acknowledged but the overall benefits of HRT need to be taken into consideration. For every woman, it should be an individual choice.
Your treatment choice and reasons - please give as much detail as you can, to help other women consider their decisions
I discuss all treatment options with women and then it’s the individual woman’s decision as to which option she chooses. Often, it’s trial and error and women respond differently to different treatment options. Some women might just want advice on lifestyle changes, others are interested in non-pharmacological interventions such as psychological therapies and acupuncture, others might want advice on supplements or non-hormonal options and others want HRT. Sometimes people might start with non-hormonal options, and then build up to hormonal options if symptoms are not controlled with these measures.
Lifestyle changes. The perimenopause and menopause is an opportunity for every woman to look at their general lifestyle and consider introducing different habits and changes which will benefit their health in general, and often can help with mild to moderate menopausal symptoms.
Diet. Discussed ad nauseum and already mentioned on this website so I am not going to go into too much detail. Main take-home messages:
- Regular balanced meals.
- Complex carbohydrates such as whole grains, oats, beans and root vegetables. Avoid fast releasing high-GI carbs which give an initial burst of energy followed later by a slump caused by a reduction in blood glucose levels causing fatigue and lack of energy.
- Plenty of fruit and veg.
- Plant-based fats such as nuts, seeds and avocados.
- Plenty of fibre such as whole grains, brown rice, beans, bran.
- Plenty of protein such as lean meat, eggs, yoghurt, cheese, seeds, nuts, hummus, tofu.
- Two portions of oily fish per week or supplement with omega 3 fatty acid or algae-derived EPA+DPA (250mg daily) if you don’t eat fish.
- Minimise refined/ processed carbohydrates, red meat or processed meat, junk food, take-aways, caffeine, alcohol.
- Avoid hot spicy foods if prone to hot flushes.
Vitamin Supplements - There are lots of vitamin brands targeting the menopause on the market. I would always advise supplementing if confirmed deficient in certain vitamins. Any vitamin deficiency should be corrected (B12, folic acid, vitamin D, magnesium) along with iron (which is a mineral). Even with normal vitamin D levels, I would recommend supplementing over the winter months, and taking extra amounts if confirmed to have low bone mineral density. Magnesium supplements can help sleep symptoms in some women.
Will help to reduce the risk of cancer, cardiovascular disease and has been shown to improve vasomotor symptoms in some women.
Any form of aerobic exercise has been shown to improve psychological health, mood, quality of life, poor sleep - all areas that can suffer around the menopause.
Weight-bearing exercise (for example: brisk walking, running, dancing, resistance training, weights, tennis) is particularly good for bone health which can be affected by the menopause.
Moving and exercise have also been shown to reduce frailty which has a significant effect on general ageing. Exercise is a drug. Now is the time to consider taking up a new hobby or increasing your amount of exercise.
Stress Reduction (easier said than done) but taking a spotlight view of one’s typical work schedule and lifestyle can sometimes highlight where changes can be introduced. It might be a good time to consider changes in work practice or changing aspects of your life that are increasing stress (if possible, to do so).
Pilates and/or Yoga: may help with flexibility, muscle strength and toning. Yoga particularly can help with stress-reduction. Pilates can help with pelvic floor exercises which can help genitourinary symptoms as discussed previously
Mindfulness: Learning to live in the present moment.
Sleep Hygiene. Reducing screen time and stimulants such as caffeine and alcohol in the evening time, try to get up at the same time each morning including weekends aiming for 7-8 hours of sleep per night. Treat the bedroom as a sanctuary and remove all electronic devices. Consider the use of blue-light blocking glasses in the evening.
Paraphernalia such as fans, facial water sprays, loose-fitted cotton clothes and underwear. There are lots of small fans on the market that can help with vasomotor symptoms at home and work. Promensil do a good instant relief cooling spray for hot flushes and night sweats
What are your thoughts on complementary therapies?
There is more of an evidence base for phytoestrogens, black cohosh and St. John’s Wort (NICE guidelines 2015) than other complementary therapies but there can be variations in standards between different products. St. John’s Wort in particular, may interact with certain types of conventional medicines and should be avoided in these cases.
Phytoestrogens are naturally occurring substances that are present in plants which have similar but less potent effects to conventional oestrogens. They occur naturally in enriched foods and are available as supplements in health stores. They are divided into 2 main types (isoflavones and lignans). Isoflavones can be found in soybeans, chickpeas and red cover. Lignans can be found in oilseeds such as flaxseeds, bran, vegetables, legumes and fruit. If taking a supplement, I would advise getting a product with a traditional herbal registration as approved by the HPRA in a health store rather than an unregistered product over the internet as this product would have needed to meet certain standards in order to be registered.
It’s also important to note that the efficacy of these products would not have been tested in a similar manner to conventional medications via clinical trials and there is no guidance on whether these products should be used in women with a previous history of hormone-sensitive breast cancer and there have been reports of liver and kidney toxicity in rare cases.
CBT (Cognitive Behavioural Therapy) can be a very useful tool for those who want a more natural non-pharmacological intervention. It’s a form of psychological therapy focusing on challenging and changing your thought processes and behaviours and aims to help a person manage a problem by changing how they think and act. Unlike other forms of psychological therapy, it focuses on problems and difficulties you have now, rather than issues from the past. Some women report improvement in their menopausal symptoms, and ability to cope with their symptoms via this method.
Acupuncture may improve hot flushes, night sweats, mood irritability and increase general well-being in some women.
Non-hormonal oral medication is an option for women who want a prescribed medication option but where HRT might be contra-indicated or not desired. Examples include gabapentinoids, SSRIs, clonidine, propranolol which can improve vasomotor symptoms in some women. Melatonin can sometimes help with sleep problems and insomnia. I don’t recommend sleeping tablets such as the Z drugs or benzodiazepines. If no improvement is obtained after a few weeks, I would recommend stopping these medications.
Hormonal therapy, HRT (as discussed above) which remains the most effective treatment option for women with severe symptoms impacting significantly on quality of life and has other benefits including bone protection and reducing the risk of cardiovascular disease.
Vaginal moisturizers and lubricants, vaginal oestrogens and pelvic floor exercises can with genitourinary symptoms.
Vaginal dryness is a big issue in Ireland - do you feel women are tackling this or being shy to discuss it
Yes, most definitely - I think both women and doctors are shy in discussing it and it’s frequently not discussed or brought up by both women and doctors during consultations despite it being an important and common symptom of the menopause. Up to 1 in 2 women will suffer from what we call in medical terms “Genitourinary syndrome of the menopause” which means symptoms affecting the vagina and bladder. Vaginal dryness is one of the commonest genitourinary symptoms.
The reduction in oestrogen around the time of menopause can cause vaginal dryness resulting in painful sex, as well as an overactive bladder and recurrent urinary tract infections. This is because there are oestrogen and progesterone receptors on the musculature of the genital and lower urinary tract organs that are no longer activated by oestrogen, especially, causing the vagina to become thin, dry, itchy and less elastic. Vaginal mucus production decreases, further exacerbating symptoms, and causing reduced lubrication during sex. The lower urinary tract may also be affected causing symptoms such as an overactive bladder and recurrent urinary tract infections.
It responds well in particular to topical oestrogen which is taken vaginally via a pessary, cream or ring. Vaginal oestrogens are very effective at relieving symptoms and can be safely used in women who do not wish to take, or can’t tolerate, the usual methods of HRT. There is no need for womb protection with progesterone in this instance as vaginal oestrogens act on the vagina and lower urinary tract directly with minimal absorption into the bloodstream thereby not affecting the lining of the womb. It has also been endorsed by the Nice Guidelines as a treatment for genitourinary syndrome of the menopause.
Non-oestrogen-based treatments are also available for vaginal dryness. Lubricants (examples YES and Sylk) are applied before sexual intercourse, but it’s important to note that oil-based lubricants reduce the integrity of condoms. Vaginal moisturisers are longer acting, deliver continuous moisture, can be applied every few days, and don’t cause condoms to break (examples Replens, Regelle and Hyalofemme).
Please don’t be shy to speak about this important symptom with your doctor. Lubricants and vaginal moisturisers can be bought over the counter, vaginal oestrogens need a prescription from your doctor.
At what point should a woman talk to her doctor about vaginal problems she’s experiencing? Are any of these potentially dangerous?
A woman should be able to discuss any vaginal symptom with her doctor at any time. Vaginal symptoms are common around the menopause, especially vaginal dryness and itch.
Don’t be afraid to report any unusual changes in your menstrual cycle, particularly new bleeding in between your periods or bleeding after sex to your doctor at any time.
Postmenopausal vaginal bleeding should always be reported to a doctor – an episode of bleeding after an interval of 1 year for women over the age of 50, and for 2 years under the age of 50 as this will need further investigating in the form of a physical examination and potentially hospital based investigations to rule out endometrial (womb cancer), cervical cancer and vaginal cancer as a cause of this symptom. The incidence of endometrial cancer is increasing in Ireland. However, in most cases, a sinister cause for postmenopausal bleeding is not found.
What other areas of health should women in peri/menopause be aware of?
We have touched on some of these areas in previous questions but:
Cardiovascular disease – there is an increased incidence in CVD in women post-menopause, and indeed it is the leading cause of death in women.
Attending your GP annually for a BP check and blood test (to check glucose, HBA1C and lipids) can reduce your risk of getting CVD if abnormalities are picked up that can be addressed.
Lifestyle factors such as a healthy diet, exercise, maintaining a healthy weight, reducing alcohol intake, quitting smoking are also important modifiable factors that can reduce the risk of CVD.
Osteoporosis is a skeletal disorder caused by low bone mass resulting in increased bone fragility and susceptibility to fractures. Prevalence increases with age. Every person has a unique peak mass and “threshold value” under below which a bone can fracture after minor trauma. The inter-play between vitamin D, collagen and oestrogen receptors determines bone peak mass.
Peak bone mass usually occurs around the age of 30 years and begins to decline thereafter from mid 40s onwards. Menopause is associated with an accelerated period of bone mass of 2% annually. This rate of bone loss declines with age.
Women should consider getting a DEXA scan to assess their bone mineral density, particularly before their late 50s or early 60s when the accelerated level of bone mineral density around the time of the menopause begins to level off.
Adequate Vitamin D, calcium and plenty of weight-bearing exercise is important to maintain bone health (see the section above under lifestyle changes).
Calcium, unlike vitamin D can usually be obtained from dietary sources in adequate amounts, especially in dairy products. However, vegans and non-dairy eaters can also obtain adequate amounts of calcium via other dietary sources such as fortified cereals, tofu, leafy greens, seeds, beans and lentils. Consider calcium supplements if you don’t consume the mentioned dietary sources in moderate amounts.
Oestrogen is known to be protective to bones and one of the benefits of HRT is the protective effect that oestrogen has on bone mineral density which can protect against osteoporosis. It is also a treatment option for osteoporosis for women diagnosed around the time of the perimenopause or early to mid-menopause.
Sexual dysfunction is more prevalent in women than men, and this tends to increase around the menopause and perimenopause with women reporting problems with libido, vaginal dryness and inability to climax. Painful sex can then lead to avoidance of sexual activity, and anticipation of pain prior to sex can lead to lack of arousal. Women who are going through their menopause transition and women who are postmenopausal should be able to participate in an active sex life. Maintaining sexual health in the peri-and post menopause is an important part of menopause management by treating genitourinary syndrome of the menopause ( discussed previously) and addressing psychological problems which might also be contributing to symptoms. Perimenopausal and menopausal women deserve to have an active, fulfilling sex life.
During the perimenopause when a woman is still getting periods (even if infrequent), there is still a risk of pregnancy, albeit it is very low. The current recommendation is for women to continue with contraception for 1 year after the last menstrual period if aged 50 or older, and for 2 years after the last menstrual period if under 50 years of age. However, the last menstrual period is a retrospective diagnosis. Some women do not get menstrual periods with certain contraceptives, conversely, some contraceptives and HRT regimens will give women a monthly hormone withdrawal bleed. Hence it can be difficult to accurately determine the last menstrual period. Therefore, another recommendation is for women to continue with contraception regardless up until age 55 whereby most women will be postmenopausal. HRT (apart from the Mirena coil or IUS if used as the progesterone component of HRT), is not a contraceptive, and women are still advised to use a method of contraception until they are postmenopausal.
Safe sex principles still apply and it’s important to avail of STI screens if embarking on a new relationship and to use barrier contraception to reduce the risk of STIs.
Jo Divine’s website has helpful online articles exploring many wide-ranging aspects of women’s sexual health, including sex after cancer, vaginal dryness, low libido and painful sex: https://www.jodivine.com/articles/womens-sexual-health.
Engaging with Cancer Screening. Of note, there are limitations to screening. It won’t pick up all cancers and changes can start in between screening
Most women diagnosed with breast cancer are between the ages of 50-64 at diagnosis. It is common, affecting 1 in every 8 women. It’s important to make sure you are registered with Breastcheck in order to attend your free screening every 2 years from the age of 50 to 67. Also report any breast changes or areas of concern to your GP.
Women are also entitled to a free cervical smear with Cervical Check every 5 years from the age of 45-60 as cervical cancer can still occur in this age group. Make sure to report any concerns such as pelvic pain, bleeding in between your periods and bleeding after sex to your GP.
Bowel cancer is the 5th commonest cancer affecting women in Ireland. Screening involves taking a sample of your stool at home with a kit that’s posted to you which you then post back in a sealed envelope for testing in a laboratory. If the amount of blood found in your stool is above the screening limit, you will be referred for a colonoscopy. Free screening is available every 2 years from the age of 60-69 for both men and women.
Always make sure to report any blood in your stool or prolonged changes in your bowel habit to your GP, especially over the age of 50.
Increasing frailty is one of the biggest challenges of ageing. Good nutrition, exercise, and good cognitive health (keeping your mind active and staying connected with social activities, especially important after retirement) can all help to reduce the onset of frailty.
Do you think doctors should ask women about their sex lives, or is it better to wait for the woman to bring it up?
I ask women about their sex lives when discussing the menopause as menopausal symptoms often impact on women’s sex lives and I want to explore all potential symptoms that might be affecting women. However, I don’t persist if women feel uncomfortable.
I think any focused menopause consultation should always involve questions about genitourinary symptoms and lack of libido which are relatively non-invasive questions but might lead to more direct questions about sex if the woman feels comfortable. Women should never feel embarrassed to bring up the topic of sexual health with their doctor.
Do you think menopause should be covered in the secondary school curriculum and covered in more detail in medical school? If so why
Yes. Yes. Yes. Yes! X 100,000,000. For too long, the menopause has been one of the Cinderella’s of reproductive health, especially in Ireland. As the life expectancy for women in Ireland continues to increase, most women can expect to be postmenopausal or in a post reproductive stage for at least one-third of their life. Albeit the last part of a woman’s reproductive journey, it is still a significant part and deserves the same amount of education, attention and awareness as any other area of reproductive health and should be given equal status to that of other more prominent areas such as pregnancy and puberty. The WHO (World Health Organisation) states that good Sexual and Reproductive Health is a state of complete physical, mental and social well-being. The same should apply for women undergoing their menopause transition and women who are postmenopausal.
Best menopause resource or piece of advice and why?
Don’t be afraid to ask for help and there’s no such thing as a stupid question.
British Menopause Society
Brenda is working with women with POI, Menopause & PMS related issues. In Brenda's clinic she will be focusing solely on menopausal symptoms and consequences of POI and as such an endocrinologist is still required ( where there are other associated endocrine conditions).
You can contact Brenda at her clinic or through her website : www.danuclinic.ie.
Earlier I was talking about the importance of liver health and how this is often overlooked in perimenopause. Knowing the role of the liver, the next step is how best to look after yours....
What else can I do to help my liver ?
A great way to boost your liver is with the wonder herb - Milk Thistle, its antioxidant and anti inflammatory properties make it a great friend of the liver. It is worth taking this for a month at a time to detox and nourish your liver....a good time to start might be January! I use the Irish Botanica Milk Thistle which is excellent quality - make sure to take it away from food to get optimum benefits and twice a day is the recommended dosage.
Vitamin D could well be called the mood vitamin in my view; it is one of the key vitamins needed by the body to maintain balance. As we get older our body’s ability to activate Vitamin D will reduce which is the factor that causes a reduction in our ability to assimilate calcium, leading to increased risk of osteoporosis most especially in menopause.
Vitamin D has a close relationship with calcium both impacting the brain activity involved in the neurotransmitter processing and the adrenal and pituitary glands health. Hence if Vitamin D is deficient then calcium may lose its power, so it is worthwhile ensuring a diet rich in calcium and vitamin D.
Essential to ensure optimum brain function and we all need to supplement this into our diet every day. For years we have associated Vitamin D with stronger bones and teeth (due to its ability to help absorb calcium), it is now well known that Vitamin D plays a key role in both sex hormone production (when women are deficient in vitamin D, it reduces estrogen levels) and mood. A lack of Vitamin D diminishes the body's ability to produce feel-good brain chemicals including serotonin and dopamine, as such it is an essential aid to help reduce anxiety.
We can get Vitamin D from food sources but we are only able to take a very small amount from food of that which we require daily. The main food sources are eggs, oily fish, cod liver oil, shitake and button mushrooms and red meat. I would strongly suggest supplementing with an oral Vitamin D spray (a higher dose in winter and a lower dose in summer). As Vitamin D is an oil soluble vitamin there can be challenges in absorbing it which makes the spray more effective with rapid absorption into the bloodstream.
When next having a blood test it is worth getting your levels checked as most people these days are deficient in this vital vitamin.
Many of the symptoms of menopause can ebb and flow over time and we can often get a break from the intensity of symptoms by tweaks we make to our life style and/or medication. There is one symptom though that does not get better with time unless we proactively take steps to address it and possibly worse is the fact that we are not talking about it...AT ALL. I am finding women are not discussing this major symptom even with their closest friends and very often not even with their GP.
Yes it is the subject I have been raving on about on social media for the last while and one that needs to be talked about more. It is a taboo within a taboo if that is even possible....the dryness that can hit your body from top to toe as you progress from Perimenopause onto Menopause. Let's say it loud and clear so we start talking...Vaginal Dryness.
What is Vaginal Atrophy ? What really is Vaginal Dryness?
Vaginal Atrophy (atrophic vaginitis) is the thinning, drying and inflammation of the vaginal walls that can occur during perimenopause/menopause as oestrogen reserves decline. Vaginal atrophy is also referred to as vaginal dryness and both refer to the same condition - with perimenopause comes the gradual decline in oestrogen - this has a direct impact on the tissues that respond to oestrogen. We are well versed in the changes to the menstrual cycle we see as the uterine lining changes and eventually periods stop. It's not just the uterine lining that gets thinner but also the tissues of the vagina and the vulva as they too rely on oestrogen. The supply of oestrogen before perimenopause ensures the vaginal tissues are thick, moist and elastic, when the levels of oestrogen start to decline these tissues become thinner, less elastic and more susceptible to friction and in essence are more easily injured. Think of oestrogen as being your internal lubrication for all areas of your body. The drop in oestrogen reduces this much needed lubrication and these changes can cause vaginal dryness, itchiness, UTI's (urinary tract infections), more frequent toilet breaks, painful smears/sex and loads more symptoms.
Vaginal Dryness happens to 1 in 3 women in their lifetime
What to look out for:
Natural Oils & Vitamins:
Personal Choices: It is important to remember that your vulva may need extra moisturiser and/or lubricant - what you use here is a matter of personal choice. Many women report different success with a wide variety of products so trial and error until you find what works for you.
Smoking: if you smoke you should try stop. Smoking reduces blood circulation and your vaginal area needs a good blood flow.
Perfumed Products: Avoid perfumed toilet paper - we don't need it ! Same with sanitary pads - avoid perfumed.
Clothing: If you find your skinny jeans and underwear are uncomfortable then it is advisable to switch clothing until you have gotten a handle on the issue.
A few weeks ago I did a live chat on Instagram with Jane Lewis of My Menopausal Vagina and I will tell you it took me weeks to clear through all the comments and questions that came off the back of our chat. It has shown me yet again how big this symptom is and the one that we really need to get talking about more - Jane is doing tremendous work in the UK to open this up and we are all benefitting from this - I would highly recommend reading Jane's book - it is essential reading for all women!
I will be doing a Live Instagram with Eleanor from Yes Yes in January so keep an eye out for that and also a follow up with Jane Lewis.
For the Savour Kilkenny Food Festival I wanted to concentrate on the very easy breakfast recipes that can be made quickly the night before or in the morning. I will follow on from this with some nice warm winter breakfast as I know many prefer a warm bowl in the winter mornings.
Bang for your Buck
So called because of the great nutrition you get from Buckwheat and all the extras you can add to this recipe.
Ingredients: Serves 2
Buck & Yogurt (Natural, Greek or Soy)
More digestible and the nutrients are more easily available and absorbed. Saves time too! This is a new recipe and I am loving it !
Ingredients: Serves 2 - 3
Chia Flax Pud
Chia seeds - a complete protein and great source of Omega 3. Takes 5 mins to whip up before bed and off you go in the morning.
Ingredients: Serves 2
Mix everything together - make sure and give it a good stir so the seeds are well mixed. Refrigerate in a sealed jar.
To serve I generally add a teaspoon of Camu or Maca (but not essential), add fresh fruit, seeds, nut butter - really up to your what you like to add. This will last for 2 days in the fridge.
Super Green to Go
Ingredients: Serves 1
Place all the ingredients in your blender or Nutri bullet - whizz it for a few minutes to get it nice and smooth.
Top Tip to avoid the afternoon slump - this is a wee gem to add to you daily habits.
Hard working little seeds that are energizing, filling and great for digestion. Soaking they begin to sprout and makes their nutrients more ‘bioavailable’.
Simple & ready to go:
450ml / 2 cups water
1 tablespoon fresh lemon juice
1 tablespoon chia seeds
Optional: ½ tablespoon maple syrup
Give the ingredients a really good stir with a fork so the seeds mix well. When you see the seeds starting to float your boost is ready. I'll put up some photos of this over the next few days.
Store in airtight jar in the fridge for up to a week.
Similar to this you can make a great filling drink using the Sylliflor mentioned earlier and mix it into water and drink in the afternoon.
Any questions on any of the recipes just add a comment below.
A follow on from this will be the all important Phytoestrogens that we can access through our diet and the other foods to include.
After one of my talks this week I was chatting to a woman who told me she had recovered from magnesium deficiency. She literally was ticking all the symptoms and it took her some time to get to the bottom of what was wrong....when she did and started eating more magnesium foods and taking a supplement she said in her own words 'it was like a shadow was lifted off me and I became myself again'.
Anyone in Perimenopause might feel this at some point and in my view its important to rule out magnesium as a deficiency on your path to optimum health.
The last article outlined the various types of Magnesium available in supplement form. The two I work with mostly and receive amazing feedback on are - in oral form Magnesium Citrate & Magnesium Bisglycinate and topical - Magnesium Lotion.
Read back over the prior two articles to refresh your mind in terms of all things Magnesium - one of the most important points to remember is that Magnesium cannot be absorbed on its own but needs to be combined with another molecule -hence the twinning that you see in all the various sources of Magnesium.
My preference for Magnesium Citrate is MAG365 - firstly it is made up of Magnesium Carbonate that comes from seawater and citric acid from non-GMO Beetroot. When you put your teaspoon of powder into a glass and add water these two ingredients will make ionic magnesium citrate. The sweet deal here is the absorption this creates in our bodies - it gets transported to our cells nice and fast like on a super-jet! Dissolving in water too also enhances absorption in the gut.
It is important to understand ionic magnesium to understand the value of MAG365 - all minerals (including magnesium) have to be attached to a carrier to be transported into our bodies. The carrier can be an oxide, malate, citrate etc. Now for our bodies to be able to absorb the magnesium it needs to be able to detach (unplug) the magnesium from the 'carrier' eg the citrate and then get that magnesium ion absorbed (plugged) into your body. For a mineral to be ionic, it means there are ions readily available to attach to a carrier.
Let's follow the analogy of the plug/unplugged - some plugs as we know are harder to pull out than others - if we compare this to the mineral world this would equal a 'strong bond'. Magnesium citrate is one of the easier forms to unplug thereby allowing easier absorption. Magnesium Oxide on the other hand is one of the hardest forms to unplug - hence it is not absorbed effectively.
To get all this going and ionize a mineral, an acid is required - this helps your body unplug the magnesium from the citrate so your body can use it - this is where stomach acid comes into play. MAG 365 however is comprised of two ingredients - magnesium carbonate and citric acid and is actually ionized before it hits your stomach - then you add the hot water , the citric acid combines with the magnesium carbonate and the carbonate leaves (this is the fizz part) and you are left with a ionic solution of magnesium citrate - this mean ALL the magnesium is in the solution, already 'plugged' from the citrate and ready to 'plug' right into your body!
I have been using this myself for nearly two years and find it fantastic. I get weekly feedback on this too on how great women are finding it especially for the nervous system and aches & pains.
The key here is to learn and adapt your dosage - I take 1 teaspoon morning and evening and this works for me. Other women might find it stimulating at nighttime and prefer to take 2 teaspoons in the morning - the key is to chop and change and see what works best for you. It is brilliant to take the MAG365 BF after a work out or in the morning for an energy boost.
Note: Build it up slowly to avoid any small laxative effect.
Some people prefer to take a capsule and want to avoid the possible small laxative effects of Magnesium Citrate (if you build up slowly you will not get the laxative effect). The creme de la creme here is PrizMAG.
So why take this over Magnesium Citrate ?
The glycine in this partnership make for a fantastic attention to your body's nutrients. Glycine is responsible for the following:
Joining these two together creates superior absorption compared to other forms of magnesium. Magnesium Bisglycinate is a magnesium bound to two glycine amino acids with a 'clawlike bond' known as chelation ( like joining a link in a chain). Our bodies are very efficient at absorbing individual amino acids, and the amino acid glycine is the preferred molecule for creating organic chelated minerals. Glycine is readily identified and absorbed across the intestinal wall and glycinate chelates are small enough to transport right into the cells themselves!
Not all labeled chelates ( see more below on Reading your Labels) are true chelates and this can affect absorption and, ultimately, the typically-predictable, positive results. Just mixing a magnesium salt, glycine and hydrolyzed soy protein will not give a true chelated molecule. PrizMAG magnesium bisglycinate is made by a chelation process patented in the 1950s and involves precise chelation and spray drying.
I have seen this one work great for women who are having sleep issues, and /or stress and low energy. Also the impact on the nervous system encourages melatonin conversion, aids production of serotonin and dopamine all of which help with anxiety and stress.
Best time to take your Magnesium
For optimal absorption it is best taken away from food - the acid in your stomach is highest at this time and there aids absorption. Dividing the dose throughout the day is key and this is where you need to see what works best for you - remember too how great it is for restless leg syndrome and sleep so taking your second dose at bedtime is very effective for most women.
What is your sweet spot ?
To get to the dose that works best for you takes tweaking - it is best to start low and build up from there. Slowly increase until you see improvements or stop and reduce if you see side effects. Please note this will work with the better forms of magnesium only and will not for example work with magnesium oxide.
Note: If you have any issues with your kidneys you should consult your GP before starting magnesium.
Read your labels
Before you rush into buying your magnesium supplement make sure and read the label. Check for the following:
As you know I am really picky about my supplements and I have to be very honest I get super annoyed when I see marketing ploys and evasive labeling that sets products up to be something they are not. So please take the time and read your labels - Knowledge is Power.
I am beginning to feel like my journey with Magnesium is never ending ...LOL. As I researched this more and more questions come up but probably the biggest one is the relationship with Vitamin D Deficiency and Magnesium and also the Calcium/Magnesium relationship. So there will be more to come!
For now get shopping BUT read those labels ! The lovely team at MAG365 have given a discount code of WWEVENT that you can use to get 25% off - how nice is that ! Just click here for their website.
I'm so often asked how I became so passionate about perimenopause and how I ended up in this space. It's not a natural transition from Corporate Banking to talking about periods, hormones and sex ! I guess there wasn't a day or even a year where this all happened. It's been a culmination of events.... life, friendships, interests, homeopathy that have brought me down this route.
But how did the journey lead us to here and why now ?
When Aisling set up My Second Spring 6 years ago it was a seedling idea - from her personal experience and the lack of awareness that existed in Ireland. That labour of love started small. It grew fast and spread far and wide. Women from all over the world started asking for help, supporting each other and seeking advice....the comments grew daily and it was phenomenal to see the support and kindness women showed each other. The enthusiasm was contagious and many of Ireland's leading menopause experts have given so willingly of their time, and myself and Anna Mooney joined the team to help grow the website. As we watched the comments grow, we continued to research, to pull in experts, to educate ourselves and all the My Second Spring viewers on menopause.
What do we have in common?
We have great fun! We are 100% passionate about helping women, we want women to know they have choices. We have seen the ups and downs experienced by thousands of women and we want to help ensure lasting change to make these upheavals easier and to empower women of all ages with knowledge.
All three of us have different ideas and areas we are more passionate about - The Three Musketeers and Menopause! My passion is perimenopause and early menopause in particular (hence the younger women in the picture !), Aisling has a holistic approach to menopause and Anna likes to do a bit of future-scoping on how society is changing, and menopause with it.
What do we want for Ireland..it's very simple but a manifesto in its own right. The many and varied conversations we have had over the last few years all lead to the same end goal. Educating and supporting the women and families of Ireland.
How do we do this?
We change. We evolve. We talk.
Every conversation is a stepping stone to change.
And what do we talk about?
4 ways we can change the Irish approach to menopause:
And so over many conversations with so many interesting people, we have taken up that gauntlet and continue the work Aisling started 6 years ago….making lasting change in Ireland.
Diane Danzebrink one of our speakers at the M Word on October 11th is leading the charge for this in the UK - Together we are stronger. Take a look at the agenda www.themwordevent.com
Delving further into magnesium, the next step is to look at absorption and how it gets itself into and through our bodies. Absorption comes from magnesium rich foods and/or supplements. It is primarily absorbed into the small intestine, anything not absorbed here travels on to the large intestine, and here a smaller amount can be absorbed. Now here things get interesting - 40% goes to the small intestine, 5% to the large intestine and a whopping 55% leaves the body through waste. What's really important to understand here is that these figures are average and the amount absorbed will vary from one individual to the next depending on how magnesium (forms etc) is taken into the body. If we look at magnesium oxide for example, very little of this is absorbed into the body and a laxative effect is more commonly associated with this form.
How your body absorbs this essential mineral
Now without losing you to too much detail - it is known that magnesium can travel via two routes in the body. One of these routes is more effective and works better in an acidic environment - this reinforces the effect of magnesium absorption. This is the key route and is responsible for 80-90% of the intestine magnesium absorption. As this main route works more effectively in an acidic environment it is best to take magnesium on an empty stomach and away from other vitamins, minerals, medication.
How can you achieve higher magnesium levels in your body ?
Increase you intake, combine your approach so you target your intake on several levels - through foods, magnesium baths, body oils, or supplements.
How do you know if you need magnesium?
As there is only 1-2% in the blood this is not always an accurate reflection so for me the symptoms are the signposts here - you can look at your symptoms yourself or discuss with your medical practitioner. You can also send off to have more specific blood tests done to the US (the Magnesium RBC Test) and Germany.
Best food sources for magnesium
Maximising your magnesium intake and levels in your body has to be started by looking at your daily food habits. We know as per Part I that soil etc has reduced amounts but there are still many good foods which contain high levels of magnesium.
My personal favourites are as follows:
Pumpkin Seeds - the heavy hitters, a 1/4 cup gives a whopping 317mg of magnesium!
Sunflower seeds and/or butter
Dark green leafy vegetables
Note: The magnesium content of food will vary depending on the quality and mineral content of the soil in which the foods are grown.
Now to the vast world of magnesium supplements
This is where many are a world apart from each other in terms of what they contain, how they can help you and the quality. Marketing has a lot to answer for here!
You will see many forms of magnesium when you start looking at your labels - one important point to understand is that magnesium cannot be taken on it own. It has to be joined with another molecule to form an absorbable compound - so for example you will see magnesium oxide, magnesium carbonate etc. When magnesium is compounded like this to another molecule you will get different absorption levels and therefore different levels of aid/help to the body.
The most common forms you might see:
Magnesium Hydroxide - I have the most vivid and yes horrific memories of my mum chasing us around the house to take this on a regular basis...remember it tasted like chalk! Yes this is the one that commonly comes in the form of milk of magnesia and is used as a laxative. This is considered one of the least favourable if you are looking to enhance magnesium levels in the body - it is good as a laxative!
Magnesium Oxide - one of the most common ones I see on the labels of magnesium supplements. It is attractive to buyers due to its price, it is a cheaper form as it is cheaper to make this combination than most of the other compounds. It is considered one of the less desirable forms of magnesium with an absorption rate of around 5% and a strong laxative effect.
Magnesium Citrate - More commonly seen now and has a very good absorption rate into the body. Initially it may cause loose bowels and this is why it is good to build up your intake slowly. My preference here is for the powder form where the chemical reaction occurs before your eyes! These are referred to as Ionic Magnesium Citrate and enters the cells throughout your body very quickly and effectively. As with many supplements my personal preference is liquid where possible - liquids are more easily absorbed by the gut.
Magnesium Asparate - This is magnesium and potassium aspartates and is good for fatigue, it is used for low energy and chronic fatigue syndrome. A more common supplement in the US than in Europe.
Magnesium Glycinate - the creme de la creme ! You might see this marketed under the name Magnesium Bis glycerinate - it is magnesium compounded with glycinate which is an amino acid, best known for it’s calming effect. It has another benefit too with this coupling in that the glycine molecule helps absorption by reducing the impact of substances that might hinder absorption for example medication.It is often used for pain, anxiety, insomnia, and tight muscles. It is very good to balance moods, calm the body and also help the detoxification process. Minimal laxative effects.
Excellent for restless legs syndrome.
Magnesium Malate - this I mentioned earlier in relation to Fibromyalgia, this is the one best suited for those experiencing Fibromyalgia. As Malate (malic acid) is an amino acid this form is very well absorbed into the body with minimal digestive side effects. The energizing properties of this form make it ideal to take in the morning but not last thing at night.
Magnesium Orotate - not a very common form, it is used for heart health. It is used for high blood pressure, angina, overall heart health and athletic performance.
Magnesium Taurate - Taurine is an amino acid which is good for the heart, eyes, muscles and brain function. It has been shown to reduce heart attacks and to help balance blood sugar levels. It is hard to find a supplement that offers pure Mag Taurate without being mixed with other forms of magnesium.
Magnesium Threonate - when you hear of magnesium that cross the blood brain barrier this is the one you will often hear about. It is the best form of magnesium for it's impact on long and short term memory. There are no laxative effects but it does have a stimulating effect so best to take in the morning.
In the US currently there is alot of focus on this form of magnesium but from the research I have undertaken my personal view is that it is hard to get a supplement that gives the desired amount without taking several capsules and also I believe a good form of magnesium benefits the nervous system as much as Mag Threonate and often where you need a smaller intake in terms of capsules/powder.
I was informed of a study on humans in relation to this form of magnesium and dementia but I have been unable to source the clinical findings - there have been studies on animals in relation to this but my personal view is this is early days in terms of research.
Topical - Magnesium Chloride, Sulfate
You can incorporate magnesium flake baths, epsom salts bath and the use of body oil into your habits. I use the body oil after a long run if I have a part of my body that's feeling tight and sore - little oil goes along way. Best to use at night-time before bed but you can use whenever works for you.
Personally I see these as good but I would also combine with another form of magnesium to suit your individual needs. Epsom salt have absorbability through the skin. This would not have the same levels of absorption as some of those mentioned above even giving the great absorption rate of the skin.
It is very important to read you epsom salt labels…you can get man made versions of sulphuric acid which might be higher in heavy metals compared to the natural form. This is something people seem to be missing and is very important to bear in mind when shopping for your salts for your bath.
Please note experts would say the benefits of magnesium would outweigh any other heavy metals present and the potential negative side effects they may present.
In my opinion I would prefer to have the better source of epsom salts and know how it is derived. As you have heard me say many times Knowledge is power - know your labels.
Next Up - Where to shops, what sources to buy and the questions so often raised with magnesium.
Last May in a room full of warm hearted, funny and gregarious women Lesley let a roar from the back of the room about her jump into the world of Jazz....as I was talking about Passion & Purpose. Only the week before I had read a great article on how music is one of the most powerful tools to keep the brain healthy and thriving.
I was intrigued and hooked by her story. As we read earlier on My Second Spring this week, Menopause despite some pesky symptoms at times can be the most creative time in your life. Read all about Lesley's nudge into Jazz below and the 'catch in the voice that tears your heart in two'...listen to Leonard Cohen or Jeff Buckley's Hallelujah and you will know what I mean! That song never fails to move me. Not too sure my dog shares my love of singing this song out loud! She's just hidden under the desk :-)
Catherine is probably more familiar to me as a Mum at the school gates than in her professional guise as Perimenopause expert extraordinaire but I’m very glad I jumped out of my comfort Zone and opened my big mouth in the Radisson at ‘Perimenopause Unplugged’ back in May, which led me to connect with her and share my story of the JAZZ GALS conception.
As an actor I’m comfortable with performance, mainly drama, the odd bit of comedy and tragedy mixed in for good measure. I would have sung songs in plays along the way, but deep inside I’ve always held a torch for the smoky, bluesy heroines of the New York and Chicago Jazz scenes.
I can blame a boyfriend from my college days for that. On my 18th birthday I was presented with a stack of tapes – yes tapes, remember them, cassettes - of Billie Holiday, holding court over various troupes and orchestras – and I never looked back.
Now THIS was music! THAT was a voice unlike any other, a voice that weaved a spell with its casual phrasing and the unmistakable catch in the voice that tears your heart in two.
One dry stretch between acting jobs I happened upon a sign on a shop window advertising a 12-week Jazz Singing course with Edel Meade. It stopped me in my tracks.
And there it was, there was my niggle.
Because don’t we all have that?
The voice in our head speaking from our inner passions that we so frequently ignore?
‘You’ve always wanted to do this’ an excited voice screamed in my head, and I thought, ‘Why not?’
And so, I took a deep breath and signed up.
Jazz haven, JJ Smyth’s (now sadly gone) was the venue. I remember locking my bike outside, wondering what it would be like, a bit like the first day of school. And on that windy Tuesday evening I entered a room of 11 strangers and we all embarked on our 12-week singing adventure. Each week we’d learn a new song. Our homework was to listen to as many versions of the song as we could - which opened my eyes to the freedom of the form. Clicking on the off-beat and teasing each phrasing within the limit of the music bars suited my rebellious heart. And nothing feeds the soul as much as finding your very own version of a standard. I had landed, I found home.
On the cycle back, the people I passed from Aungier street to my front door would be treated to my jazz improvs of the song of the week. God help them!
Some songs I loved, some I hated. If ‘The Look of Love’ comes on the radio now, I leave the room! ‘Good morning heartache’ has a grove worn in my heart – check out Jamie Cullum and Laura Mvula’s version for sheer perfection.
And on the last night we sang for each other and we clapped and bowed and said goodbye. For like all good things, it had come to an end. And just like that it was over.
And now what?
What was going to fill my time between acting jobs? How could I make the dinner without practicing my songs for the week?
So, when the next term swung around I signed up for the higher level. A new group, a new batch of songs - a different venue - the beautiful Unitarian church on Stephen’s Green. If previously I had found my home, now I had found my religion.
You see, this gang of women were different, they were special.
There was a shine off them – I was inexplicably drawn to them and each week filled me with a need. More than the need to sing and be heard but a need to spend time with them and to share our singing journey.
As semi stalwarts of the game, the bar was raised and we were united in our desire to improve as singers. There were highs and lows. When we nailed a song, we celebrated. And on rare occasions we’d miss the mark, the sounds in our head not quite translating, and frustration would raise its head. But when the class was over, in the shelter of the church doorway, we’d be there for each other.
An arm on the shoulder, a silent nod, bolstering each other.
Each week the bonds growing stronger.
And so, it went. Another 12 weeks around the sun. Songs, support, satisfaction - and a surprise announcement from the pulpit (as such) that Edel was leaving Dublin and the classes would be suspended for a year – silence. So off we went to the pub to ‘wake’ the course. We downed wine and swigged gin and promises of ‘ah we’ll have to keep in touch’ were made – yeah, I’ve heard that one before. But this time, it was genuine. For hadn’t we carved our names in each others hearts, wouldn’t it be a sin not to follow through with this?
Once again feeding the niggle, I made a suggestion to keep on going ourselves and to commit to a concert as a deadline.
And thus, the Dublin Jazz Gals were born, all from a tipsy promise to organise a charity Christmas concert for the Because I am a girl campaign (how fitting).
And we did it! Booked the rehearsal room, the venue, the musicians.
And I’d be lying if it was just about the music and the songs. For me it’s about the connection, the patchwork make-up of this new tribe I’ve found.
One particular evening after rehearsal perfectly encapsulates it for me.
Over pizza we talked about our week, how our lives were going and how our dreams were panning out and as each bit became more personal and from the hip, I looked around the table and realised there were ‘delegates’ in their 20s, 30s, 40s and 50s. What a breadth of experience and knowledge we were for each other. I wish we had podcast it!
And there you have it. But word of warning. Be careful what you wish for! As I write I’m in the midst of preparation for a cabaret night.
And it’s all down to the path I’ve set before myself, starting with that ad in the shop window. The niggle that became the nudge… and I couldn't be happier.
Lesley Conroy is an actor, and communication coach. Check her out on linkedin
I started researching magnesium in more detail a month or two ago and I’ll be honest it’s never ending! There is so much to take into account when you enter the world of magnesium and it’s fascinating in its own right. I know one blog won’t do this justice so I am going to split it out - otherwise you wouldn’t get the important information we all need to know and take into account when it comes to Magnesium.
What is Magnesium?
Magnesium is a mineral – and one of the most important minerals on earth. To give you some background into its importance, it is one of the 19 minerals considered essential for life and the 4th most common mineral in the body. It is involved in over 300 enzyme reactions within the body - your body's spark plug! The word Magnesium comes from a region in Greece which happens to have a high concentration of magnesium ore in the surrounding area. Like other minerals it occurs in nature with other elements – for example, you have magnesium & sulphur which give you Magnesium Sulfate otherwise known as Epsom salts. Most of the magnesium in our bodies is in our bones and teeth roughly 60-65%, the balance in the rest of the body and finally our blood – our blood however only houses 1-2% of magnesium. Hence blood tests are not an accurate level of the magnesium count in your body at any given time. Magnesium is mostly utilized in the heart and brain, which in my opinion, explains some of the reasons why it is so important for the nervous system and sleep. You will see too when you look at the symptoms of low magnesium it is often affecting the heart and the brain. Now the interesting part is that many of the symptoms of magnesium deficiency tick the box of menopausal symptoms – this is one of the reason I see this as being essential to your toolkit at this stage. Dr Carolyn Dean author of the Magnesium Miracle calls magnesium ‘the spark of life’. This is a great name for this essential mineral as is so vital for so many processes that the body needs to complete on an hourly/daily basis.
How does Magnesium help you?
This is one food that I believe has to be incorporated into your diet at all stages in life, from children, growing teenagers, active sportspeople to perimenopause and beyond. It plays a vital role in heart health (blood pressure and steady heart beat), bone health, immune function, muscle function, brain health and energy transmission throughout the body. As you can see it is involved in several body functions, this vital role it plays can be seen in the vast number of symptoms that can be linked to sub optimal magnesium levels. The main conditions helped by magnesium are as follows:
Asthma – It’s powerful anti-inflammatory impact can be very beneficial to people suffering from asthma.
Fibromyalgia – I have written about this before and how important magnesium is if you have this condition. There is a link between Fibromyalgia and low magnesium. Magnesium Malate is the form of magnesium best used to help here.
Migraines & Headaches – the best relief for migraines is Magnesium & COQ10. Magnesium has been shown to alleviate the frequency and duration of migraines.
Heart Palpitations – our hearts contain the highest level of magnesium in our bodies. Optimum magnesium intake has been shown to have a positive impact on cholesterol and blood pressure.
Osteoporosis – as most magnesium is stored in our bones any shortage can result in reduced absorption of Vitamin D (essential also for bone health) .
PMT – Cramps along with your period can be very common and often create havoc for those few days of the month. The muscle relaxing effect of magnesium can be a great help here, it can also help the mood swings that come with PMT at any stage and during Perimenopause.
Depression – I will talk in more details about the brain and magnesium but magnesium is involved in the production of neurotransmitters and plays an important role in blood flow & reducing inflammation. All of this helps our brains function optimally. It has also been studied and continues to be, in relation to brain injury – when a brain injury or concussion occurs it can cause tissue magnesium levels to fall by up to 60% - magnesium can help restore this balance.
Diabetes – many people with Type 2 Diabetes can be deficient in magnesium due to an increased loss of this mineral through urine and also lower intake of magnesium through foods.
Aches, Pains & Inflammation – you will have often heard about the great benefit of an Epsom salt bath after rigorous exercise – I had many of these in my marathon training in 2018! Inflammation and pain go hand in hand – inflammation in the body causes pain. In addition tight muscles can lead to sensitive nerve endings and they are the messengers that send the message back to the brain to indicate pain is being felt. Magnesium helps here by relaxing the muscles and the nerves.
Why are we no longer getting as much magnesium as we need?
This is a vast subject and there are many factors influencing how much magnesium we absorb into our bodies – alcohol and caffeine can impact absorption due to their diuretic effect. If you’re doing a lot of exercise excess sweat will led to loss of magnesium. How food is processed and cooked can decrease magnesium levels – for example take white flour, magnesium is stored in the bran and the germ, and this is lost in the milling process of the whole grains. Sugar also drains magnesium - for every molecule of sugar you eat, it takes 54 molecules of magnesium for your body to process it!.
Possibly the single biggest impact is modern farming methods. Acid rain where it occurs takes calcium and magnesium from the soil, the infamous Roundup binds with magnesium which means plants can’t absorb it like they used to. Pesticides kill the good guys we need in the soil and they are no longer there to do the job of breaking down minerals so the plants can absorb them. Our water too has less magnesium due to filtering processes that now occur. Certain medication like acid blockers, antibiotics and diuretics can reduce absorption. If you experience a bout of vomiting, diarrhea, urinary infection etc this increased loss of urine will result in a loss in magnesium. For those who are coeliac or have low stomach acid you will not absorb magnesium as effectively from your food as others. Finally chronic stress impacts our gut health which will inhibit the absorption and action of magnesium. This is by no means a conclusive list but these are some of the key reasons why we are lower in this essential mineral in today’s world.
How do I know I am deficient?
As I said earlier many of the symptoms of low magnesium are similar to perimenopause symptoms - the most common tell take signs are as follows - you will see they can mirror many menopausal symptoms:
Magnesium Part II - How we absorb magnesium, the various forms and food sources
Magnesium Part III - Navigate the supplement world, a story & FAQ
If you can't wait for the next two parts....and are already eager to start incorporating please remember I am really picky about what to use if you are supplementing and a magnesium supplement in particular is one where HUGE amounts of money are being wasted on sub standard products. That's my personal view but it's based on extensive research and experience.
I am working to get the next two parts completed but if you are truly eager then please for now don't buy anything other than MAG365. I have used this for years, it's one of the best on the market and I have had great success with it. I am not affiliated with MAG365 and the girls there have kindly given me a great discount of 25% (type WWEVENT when buying - you need to register to to use the code) on any of their range so please use that if you are ordering BUT if you can please wait for the next two parts as you will then order in an informed way. As you know 'Knowledge is Power'.
Bringing you the latest research and health tips to help you navigate perimenopause and beyond