Chatting with Diane Danzebrink about the impact of stress on not only our mental health but our brain health. We also talk about the many practical habits you can incorporate into your daily life.
Motivational Monday with the inspirational Dr Mary Ryan - chatting here all things women's health, hormones, what to watch out for with your health and particularly your brain health.
A Fabulous Monday starting off with two super interviews today - Laura & I are chatting here about Dementia, Alzheimers and Carers - I will follow up later in the week with a list of full resources that are mentioned during all the interviews.
Our immune system is working hard everyday - and now more than ever. Our body’s immune system is extremely complex, it is comprised of constant interactions between our glands, hormones, proteins, chemicals, white blood cells and probiotics. These all work together to protect our bodies from infections - think of them like your personal warriors, their primary role is to ward off enemies. Your white blood cells are key to your immunity, think of these as operating on two levels, your wellness warriors and your gladiators. If your warriors cannot fight the infection the gladiators are called in and the body’s response steps up until the infection is destroyed. All of this requires the body to have good fuel/energy to allow it to perform this defensive role - this is where food, sleep, exercise, rest and the other lifestyle choices outlined below are essential.
To support our immune system the first place to start is with a good diet.
1. Food First:
Top foods to include in your diet that can help enhance immunity as follows: garlic, ginger, onions, turmeric, chicken or veg broth (ideally organic sources). Herbs - sage, thyme, oregano.
A special note on garlic - it is a potent tool against bacteria and viruses, stimulating those key warriors in our immune system. Use it as often as you can in your cooking or eat raw garlic.
Ginger - add this to breakfast, start your day off with the warm lemon and water and throw it up a notch by adding sliced fresh ginger.
Fruit & Vegetables - Look for the rainbow of these and ideally seasonal too - varying your intake of different fruits & vegetables will introduce different probiotics (see below) into your gut which is an added bonus for immunity. The more colourful the better - coloured foods contain flavonoids - these are very effective anti-oxidants that help protect our bodies from inflammation and oxidative damage. Always think of the rainbow and look for all colours when selecting your fruit and vegetables. The list is endless here but for some top foods include berries, kiwi’s, carrots, broccoli, dark green leafy veg like kale, spinach. If you can’t get fresh go for frozen.
Nuts & Seeds - they may look small but another great add to your daily nutrition. Brazil nuts, cashew, hazelnuts, chia, pumpkin, hemp, flaxseeds..the list is endless and you can include in breakfasts, lunches, dinners and for ready to go snacks.
I would encourage you to reduce sugar and processed foods where you can as they may encourage unwanted inflammation.
‘What is oxidative stress’
Before we go any further - let chat about anti-oxidants & what is oxidate damage/stress.
Anti - to fight against, to go against, to prevent.
Oxidant - an agent that causes oxidation of molecules in our bodies that create free radicals.
Free Radicals - by products of the every day working of our bodies. The cells in our bodies contain ‘mitochondria’ which are thousands of small powerhouses that work hard to burn oxygen to make energy. Think of all fuels - they come with a by product - this is called a Free Radical. These by products sometimes referred to as ‘unstable molecules’ can damage others cells in the body - this is called Oxidative Stress/Damage. Now free radicals are not all bad, they can play a role in fighting infections and help cells work effectively. However, left unchecked, they can cause issues. This is where anti oxidants comes into play - they neutralize the free radicals and you will be thrilled to know our bodies produce the key one which is ‘Glatathione’. However our levels can be depleted for several reasons, most common are poor diet, chronic stress, chronic disease and/or infection.When it comes to anti oxidants, like most things in life, they work best as a team - so a team of anti oxidants will have various jobs to complete and work together to achieve the desired end result - protecting your body . This is why variety is essential.
Antioxidant rich foods: Green tea, turmeric, strawberries, blueberries, raw cocoa. Antioxidants can also increase our bodies levels of good bacteria - especially Bifido and Lacto groups.
2. Move toward a stronger immune system - get outdoors - Daily.
Now more than ever we need nature - we need the calming impact that it creates on us. Regular daily exercise will help you through the next few weeks. When you are outdoors remember to be present, enjoy the fresh air, enjoy the sights and sounds of nature. Listen to the birds, listen to the wind in the trees, the water flowing. My routine currently is a 3 mile run in the mornings with the boys and it’s a great start for all of us to the day. Just remember to practise social distancing!
You can also practise yoga at home, do on line fitness class via youTube, brisk walking for 20-30 minutes - find what you enjoy and I would encourage you to incorporate it into your routine and ensure you get outdoors daily.
3. Sleep - maintain a routine
This isn’t a holiday - life is continuing as normal and it is important to keep a routine going. This will help you greatly in the weeks ahead. So don’t lie on, don’t binge watch Netflix - keep to your normal hours. Go to bed on time and get up at the same time every day, our sleep has its own routine and rhythm and circadian rhythm is more important now as it will allow our bodies to recover from the day and give our immune system the time to do it’s magic and keep us strong. Lack of sleep will increase cortisol levels which in turn adds to your stress so sleep is critical now. Also when your sleeping, your body is producing a protein called ‘cytokines’ which helps our bodies fight infection….so plenty of reasons to keep to a good sleep routine.
It’s not just sleep to think about when it comes to routine, it’s daily life. Try to stick to your normal routine before Covid19 entered our lives and this will help you on many levels. Keep your diary going and your to do list and have a daily plan of action/goals. All these small steps will help keep us moving forward.
If you are struggling with sleep have a read of the many articles I have written on magnesium as this may be of help to you now. Mag365 is an excellent addition at this time.
4. Mental Wellness
Given the current situation we are all going to feel an element of stress over the coming weeks. It’s time to delve back into your strategies and tools and retrieve those that you know have helped in the past. Stress, as we know, increases the levels of cortisol released by the adrenal glands. The stress hormones will reduce the effectiveness of our immune system by lowering the production of white blood cells that fight infection.
Some essentials are:
Breathing - taking a moment, go back to your breathing as much as you can. Taking deep breaths from your stomach and taking a few moments out of your day to relax. Keep in simple breath in for 4, breathe out for 7.
Meditation - continues to be one of the most effective ways to de-stress. It’s time to download those apps like Calm etc. or listen to some calming music. Several studies have shown that meditation can help protect your immune cells and reduce inflammation.
Magnesium - top up with magnesium rich foods or take Mag365, magnesium will help greatly at this time.
Be Positive - reduce the media content you are watching and remember like all things this too will pass.
What do you enjoy doing? It may be reading, listening to music, drawing, whatever it is start doing it now..
5. Be regular
A vital step in immunity is ensuring your bowels are regular, this will help release toxins from your body and keep your energy flowing as it should. Ideally a daily bowel movement without straining or any discomfort with the feeling of the bowel being totally empty. In theory we should have a bowel movement after every meal, the very act of eating creates a wave like effect to happen in our bowels which moves wastes product through our bodies down to our bowels. It’s long been ingrained to ignore these messages, so our digestive system becomes sluggish. If you think of a baby or young child, they will generally have a bowel movement after each meal - this changes as we get older as we hold on/control this process more. Also please ensure to go to the toilet when you need to and avoid putting it off - this is not good for your body and can in time led to constipation.
Water and fibre intake are essential steps in ensuring good bowel health, regular intake of water throughout the day will help here and will also keep your body well hydrated. Fibre goes back to ensuring a plentiful diet of fruit and vegetables enhanced with probiotics foods.
Probiotics are not just important for digestion, and good gut health - they reach much further across our entire bodies. The two heavy hitters - Lacto acidophilic and bifidobacteria, for instance, have been shown to have anti-viral properties and may help reduce the length of a viral respiratory infection. Probiotics produce antibodies and these anti bodies attach on to foreign/unknown bacteria or viruses and encourage your white blood cells to attack them. So, two key actions (1) production of antibodies that attach onto the virus and (2) releasing a chemical which encourage the production of white blood cells. White blood cells are key in helping the body fight against viruses and bacteria. When looking at foods think of prebiotics too - these are like fertilizers for probiotics.
Probiotics: fermented foods (yogurt, milk kefir, kombucha, kimchi, sauerkraut etc.), vegetables, fruits, grains, nuts, seeds. (I would encourage you to select natural yogurt with no added sugar).
Prebiotics: lentils, beans, garlic, leeks, bananas, broccoli, beetroot, parsnips, onions, artichoke and oats.
Simply at this time you want to load up on fresh fruit and vegetables, more fibre basically. Wholegrains are your friends too and if possible, use brown rice instead of white, try quinoa and other grains.
What else can I do to help my warriors & gladiators?
Zinc - An unsung superhero of the immune system
This is a trace mineral you want to pay attention to - your immune system cannot operate at peak performance if you lack zinc. Many chemical reactions in our bodies need zinc in order to perform effectively - over 200 in fact. A zinc deficiency therefore can impact several reactions in the body. It is well known as an important disease fighter and a protector of our immune system. It encourages our production of immune cells giving us a better defense against viruses. Also known for its ability to help with respiratory tract infections. It is worth noting our ability to absorb zinc declines as we get older, so a conscious effort is required to ensure we have enough in our diets. If you don’t have enough zinc in your body and infection hits, then inflammation can spread to other parts of your body.
Zinc rich foods: Pumpkin seeds, nuts, egg yolks, cheese, fortified foods, wholegrains, seafood especially oysters.
In the world of supplements Zinc is like Magnesium in some respects - Zinc Bisglycinate is a very good form and surpasses the various forms of zinc you might find in other supplements.
If you have a sore throat zinc lozenges can be very soothing.
‘Vitamin C and zinc play important roles in nutrition, immune defence and maintenance of health’
Our bodies do not produce Vitamin C so we need to get it through our diet - as a powerful antioxidant it is essential at this time. Vitamin C is always my go too at the first signs of a cold - load up on the Vitamin C foods listed below and if you have an infection then it’s always good to top up with a Vitamin C supplement. A higher dose taken over a few days can dramatically reduce the duration of a cold.
Top Foods: citrus fruits, berries, goji berries, kiwis, tomatoes, apricots, peppers, leafy greens and sweet potatoes.
If not via foods, then Camu Camu is an excellent form of Vitamin C. My family and I are all taking this daily at the moment. You may also come across Liposomal Vitamin C, this form contains the normal vitamin C but it is coated in what is referred to as a ‘phospholid layer’ allowing the vitamin c to be absorbed more efficiently into the bloodstream.
Vitamin D - the Sunshine Vitamin
Difficult to get given the climate in Ireland and also hard to get via foods (salmon, egg yolks and some mushrooms). There is ample research showing the extension of Vitamin D past bones to its ability to enhance our immune systems. This is back to white blood cells again - current research tells us that T cells (a special type of white blood cell) which help destroy the ‘foreign invaders ‘ (bacterial or viral) need Vitamin D as part of this process. An insufficient amount of Vitamin D therefore leaves the T cells in hibernation and not out in the body patrolling against disease.
‘Scientists have found that vitamin D is crucial to activating our immune defenses and that without sufficient intake of the vitamin - the killer cells of the immune system -- T cells -- will not be able to react to and fight off serious infections in the body. The research team found that T cells first search for vitamin D in order to activate and if they cannot find enough of it will not complete the activation process.’
This is one essential supplement to take at this time - my personal preference is for an oral spray as it bypasses the gastric acid in the stomach and goes direct into the bloodstream. One Nutrition D# Max, an Irish brand is the one I use, it is an excellent oral spray.
Oil of Oregano
Not just the lovely herb for adding to your dishes - it has strong antibacterial and anti-viral properties. It is a great source of anti-oxidants so another aid to your internal warriors This has been used for respiratory illness for decades. For dosage and methods of use follow the instructions on the pack as different sources vary.
Well known for its ability to boost the immune system and its ability to fight infection. Echinacea can help our bodies defences and helps stimulate those essential white blood cells (warriors) to control bacterial and viral infections.
Note: If you have an underlying auto immune disease you should check with your GP before taking echinacea as it may over stimulate the immune response.
Elderberry & Beta Glucans
A powerful combination and hard to get through diet alone, so this is a supplement worth looking at. Beta Glucans are like the warrior’s shield - a protective mechanism for the body, stimulating the immune response and enhancing the body’s Natural Killer Cells. Elderberries (Sambucus nigra berries) packed with Vitamin C, fibre and anti-oxidants are anti-viral, helping fight free radicals and inflammation. They two in combination work extremely well. Currently my boys are taking Sambucol daily as a preventative and immune boost, this is available in most chemists, health stores and Supervalu.
Foods containing beta glucans: mushrooms, seaweed, oats.
As most of you know I am a lover of essential oils and at the moment we are steaming nice combinations in the morning and in the evening. Right now I have Rosemary on it's own as it's great for memory and concentration. The boys are loving this addition to their new day - checking all the smells and then choosing which ones they like. Essential oils can transform your mood, brighten your day, change the atmosphere in a room and each contain different properties that make them all legends in their own right. Hop over to my lovely friend Fiona for her tips and advice on using oils at home.
Sip on green tea during the day - another antioxidant and can help strengthen your immune system. Peppermint tea or fresh mint tea is also another good addition at this time.
Loads up on red onions - quercetin is not a very well-known flavonoid (phytonutrient/plant chemical) but it is another powerful antioxidant.
Foods: grapes, kale, cherries, red onions and red wine.
Keep Safe, Keep Handwashing, Keep Social Distancing, Keep nourishing those Wellness Warriors in your body and Keep Smiling.
Please note the advice given here will not prevent you from getting Covid19. If you do get it or want to enhance your immune system then the tips outlined here are a good place to start.
How far we have come in recent years in creating an equal society for women - and yet we have a great distance to go. This chapter is still being written and we are all part of the change that will help this generation of women and those coming behind us. Growing up I always saw women the same as men, both my parents worked equally hard, both were inspiring in so many ways and always valued what us ‘4 girls’ could add to the equation. I took equality as a given. Naive.
It was only when I entered the wider world did I start to see the differences that exist and certainly great variations across countries. Growing up as I did, however, gave me an inner belief and confidence in what we as women can achieve and I believe that confidence helps me every day. The same sadly cannot be said for many women and we need to work not just for ourselves but for all women to ensure we change the inequality that still exists.
My Mum left school at the age of 13 to start working - she did not have a choice. She was extremely bright and always told us how she loved school - what a hard path it was for her back then. As the eldest girl she had to work to help her family and as she would say ‘keep bread on the table’. My mum often told us about the scarcity and lack she grew up with - this was after WWII and Ireland was still in the throes of hardship. She worked hard as did all her family. This did not just start with my Mum and her siblings - this started with the generations of women before her. I was fortunate to grow up with both sets of grandparents and my beloved ‘grannies’ were very strong women who held there families together through various upheavals that life throws along the way. Generations of strong women…they exist in every family. They played their part in raising strong women and encouraging their grandchildren. I can even say one granny pushed us 'girls' harder!
For me gender equality starts in the home, as that's where children learn about the wider world as I did when I was growing up. If my boys can reflect on life, practise daily kindness and treat all people equal as I was raised too then I will consider it a job well done.
How does it look in my house ?
I think it's fair to say it's equal - we all (the boys included) put the bins out :-), we all cook, we all do our own washing, Tom & I both work hard at jobs we are both passionate about, we share drops and collects with the kids, all the daily life 'stuff'...the boys see us as equal, for me that's so important. It will set them up for life.
Whether it is maintaining a house on a weekly basis, running a business, working full time - this all comes with the juggle of home life and keeping a balance. This all takes strength and we should give ourselves kudos for what we achieve everyday. We are amazing beings, we are strong beyond our awareness and we are so adaptable. Think about the journey of perimenopause, all the changes that happen along the way and we adapt, we change, we bolster ourselves to move through all these chapters.
Gender equality is an essential ingredient to the future - a world where both men and women are equal will be a wholesome, balanced and happier place. Equality needs to reach to governments, media, workplaces, sport, healthcare, homes, science…..everywhere. We can each play our part in creating this change.
Thanks to all the amazing, supportive women that I am proud to have in my life - to my Grannies who are now gone but I learnt so much from, to my Mum, my sisters, aunts, cousins, my beautiful friends, my DBR family, my fellow menopause advocates and all you wellness warrior followers & supporters out there who have joined me on this crazy journey and become such a special part of my life. I am blessed to have made so many new girlfriends in the last few years and reunited with old friends on this journey. To you all I wish abundance and happiness in your life.
#EachforEqual. The below is the universal symbol for this years International Women's Day.
This is a list of recommended practitioners that have been sent to me either by clients, social media followers or doctors. These are not personal recommendations with the exception of Dr. Brenda Moran, as I do not yet know the other practitioners.
Any additional names please add to the Comments below and I will update.
Acupuncturist - Katheen Mc Auliffe, North Cork
GP - General Practioner with Menopause experience:
Killarney - Dr Brenda Moran is working 1-2 days a week in Ross Medical. Brenda advises women who are not registered with the practice when they are booking an appointment to say it's a menopause consult so the receptionists will allocate 30mins.
Tralee - Dr. Angela O'Donoghue
Tralee - Dr Mary Mc Caffrey, Scotia Clinic
Castlegregory - Dr. Clodagh kenny
Kinesiologist - Joan Flynn Tarbert, 068 36378
Reflexology - Caroline Mahony, Killorglin
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.
Bringing you the latest research and health tips to help you navigate perimenopause and beyond