Hormone Imbalance in Menopause

If you’re reading this you are probably well aware that perimenopause – the years leading up to a woman’s last menstrual period – and menopause can be a challenging stage in a woman’s life. Hormone imbalance in perimenopause and menopause (which we will refer to interchangeably in this article) is responsible for some 34 recognised symptoms, which range from the common and cliché hot flushes, brain fog and night sweats, through anxiety, insomnia and vanishing libido, to the downright bizarre: tinnitus, burning tongue, random new allergies and itchy legs to name but a few! As it we didn’t have enough to worry about, perimenopause also happens to be the most “at-risk” time for weight gain. Suddenly, what you have always eaten, and the way you have always exercised, just isn’t working for you in your 40s. So what is hormone imbalance in perimenopause and menopause and, more importantly, what can we do about it?

Why we put on Weight in Menopause

It’s very rare I see a perimenopausal or menopausal woman who isn’t struggling with her weight. The decrease in oestrogen levels, a result of declining ovarian function, is a key player here. Alongside hormone imbalances in perimenopause, factors such as ageing, reduced physical activity, Western diet, and emotional eating due to psychological stress (typical picture: moody teens + ageing parents + stress at work) all contribute to increased body fat and waist circumference. Sadly, a larger waist circumference is more than just an aesthetic issue, being a key risk factor for cardiovascular and metabolic diseases in menopausal women. Measuring waist inches rather than weight or BMI can therefore provide a more accurate assessment of health.

The foundation of a healthy metabolism lies in gut health and hormone balance. Addressing the following common hormonal imbalances in menopause by adopting strategic lifestyle modifications under the guidance of a Registered Nutritional Therapist can help manage risks and alleviate menopausal symptoms effectively.

Insulin Resistance

Fluctuations in oestrogen and progesterone can cause blood sugar dysregulation, leading to insulin resistance. This means our bodies are less good at handling sugar (glucose) than they were, often resulting in higher average blood sugar levels compared to a decade ago. Incorporating enough protein into your diet is a powerful solution. Consuming 25g or more of protein at breakfast can stabilise blood sugar levels, reduce insulin, and curb cravings. Protein is also vital for muscle building, and more muscle means more energy burned at rest. Fibre is another key player in managing blood sugar levels.

Oestrogen Dominance and fibre

Whilst oestrogen levels are in overall decline during this period, the first stage of perimenopause is often a time of oestrogen dominance. This is because oestrogen doesn’t decline in a clean, linear way, but rather in a very erratic fashion. There will be big exaggerated peaks and dips, with the overall trajectory being down. Meanwhile, progesterone – which serves to counterbalance oestrogen – is often lacking. We need to ovulate in order to produce progesterone, and in perimenopause cycles tend to be erratic and frequently anovulatory. Ergo, no/low progesterone and relatively more oestrogen. Excess testosterone can also be converted into oestrogen, too.

Oestrogen dominance can contribute to insulin resistance (see above) and can manifest as breast tenderness, weight gain around the hips and thighs, and much worse PMS. Increasing fibre intake is essential for managing oestrogen dominance. Initially, aim for 30g of fibre daily, gradually building up to 50g, from a mix of soluble and insoluble food sources. Fibre supports the oestrobolome, a unique set of gut bacteria which recycle and eliminate the breakdown products of old oestrogen. Psyllium, chia seeds and flaxseeds are a fantastic addition to your daily diet (just be sure to increase your fluid intake or they can worsen constipation). Cruciferous veggies like brocolli, cauli and kale are another must: aim for 5-7 servings per week, along with half an avocado and a tablespoon of extra virgin olive oil daily. These strategies can help support liver detoxification and effective oestrogen metabolism.

Environmental Chemicals

Our bodies have a limited capacity to eliminate toxins. Over time, especially with added stress and genetic factors, our liver may struggle, and environmental chemicals known as xenoestrogens can contribute to oestrogen dominance and other hormonal imbalances of perimenopause and menopause. Xenoestrogens are sadly ubiquitous in plastics, pesticides and water systems. Sometimes referred to as oestrogen “mimickers”, they are close enough in molecular structure to oestrogen that they can bind to oestrogen receptors. Reducing exposure to environmental chemicals by eating organically as much as possible, filtering drinking water, avoiding plastics for heating or storing food, and using natural cleaning products and cosmetics can all help.

Thyroid Health

I’ll bet you or someone you know has an under-active thyroid. It’s practically endemic in the West, and massively under diagnosed. One reason for this underdiagnosis is that a GP will typically only measure your TSH level, despite the fact that thyroid antibodies are what point to a diagnosis of Hashimoto’s disease (which is an autoimmune disease and the cause of an under-active thyroid in 90% of affected women in the UK). Our risk for this and other autoimmune diseases skyrockets in menopause.

An under-active thyroid is no joke. The gland is our metabolic regulator and works like an engine: If it’s slow, the whole body system slows down. A main role of the thyroid is stimulating metabolism. And if our metabolism is all good, our weight is kept in check, our muscles stay strong, we have daily bowel movements, our hair grows….you get the picture. If the thyroid slows down, we feel like crap. We’re exhausted. Hair, nails, skin, everything dries up. We’re lethargic and cold and sluggish. Just getting through the day is an effort so libido is non existent. We start forgetting things, can’t concentrate and feel depressed. It’s striking how many of these symptoms mirror those of perimenopause….

The thing about feeling tired all the time, and low, is that it tends to drive overeating of sugars and simple carbohydrates, as well as excessive caffeine consumption. Unfortunately too much sugar and coffee also spike cortisol and insulin levels….a cruel vicious cycle. Fatigue makes it challenging to drum up motivation to exercise, further impacting thyroid function. Addressing constipation is also crucial as it inhibits oestrogen detoxification (discussed above).

Cortisol and Stress Management

Perimenopause is a demanding phase for many women, with career pressures, family responsibilities, and relationship changes converging to reach a climax at a time when our resilience to deal with such pressures is arguably at its lowest. And that’s without throwing into the mix hormone imbalance in menopause! High stress levels can lead to poor sleep, elevated cortisol and feed into a picture of hormone imbalance in menopause. It’s important to actively manage stress, perhaps through therapy or other stress-reducing activities. Some of the strategies I see work time and time again in clinic are breathing practices, daily movement, practicing gratitude, journalling and getting out in nature.

The Impact of Sleep

Hormonal imbalance in menopause can severely impact sleep quality, which in turn affects eating behaviour, fat storage (all around the middle), and muscle mass. Sleep deprivation can increase sugar cravings and lead to poor food choices and excessive caffeine intake, disrupting the HPA axis (our stress response system) and exacerbating cortisol levels.

The first thing I work on with perimenopausal insomniacs is blood sugar balance. Poor blood sugar control, manifesting in night-time blood sugar dips, is the number one reason I see in clients waking up at 2am and being unable to go back to sleep. Hypoglycemia results in a surge of adrenaline which wakes us up, and ensure we stay awake. Poor and disrupted sleep also worsens blood sugar control – another viscous cycle.

To Fast or not to Fast?

Fasting: It seems like everyone is doing it, right?! But just because something can be healthy doesn’t mean it will be healthy for everyone. Perimenopausal women who struggle with blood sugar stability and hormonal imbalances are not the ideal candidates! Skipping meals, exercising without food on board or over-exercising can perpetuate and exacerbate hormone issues. Instead, a structured eating schedule, with protein every 4 hours or so and a 12-14 hour overnight fast, is a reasonable recommendation for most women.

Where to get help for hormone imbalance in menopause

Navigating the challenges of perimenopause requires a multifaceted approach. By addressing the hormonal imbalances of perimenopause and menopause through diet, stress management, and sleep improvement, women in their 30s and 40s can maintain or even up-level their health and well-being during this transitional phase.

To find out more about how we can support you on your perimenopause or menopause journey, book a FREE no obligation Discovery Call today.


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