What is Cardiovascular Disease?

Cardiovascular disease (CVD) is an umbrella term for a variety of different diseases that affect the heart and blood vessels of the body. (1) It commonly includes heart failure, high blood pressure, high cholesterol, coronary heart disease, cardiomyopathy, congenital heart disease, peripheral vascular disease and stroke. (1)

Types of Cardiovascular disease can either be acute such as angina, stroke or heart attack and are mainly contributed by blockages of certain arteries, or it could be progressive caused by stress, excessive alcohol, trauma or chronic hypertension that has not been adequately treated. Smoking and poor dietary and lifestyle habits contributes to the compromised health of the cardiovascular system. (2)

Some signs and symptoms of cardiovascular disease include:

• High blood pressure
• Pain or discomfort in the middle of the chest
• Pain that can been associated with breathlessness and sweating
• Radiating pain in the shoulders
• Pressure or tightness in the chest
• Radiating pain in the neck, jaw and arms
• High pulse rate
• Nausea, dizziness, fatigue and sweating that is associated with chest pain, high pulse rate or high blood pressure (3)

There are known risk factors that correlate to the development of Cardiovascular disease and these include:

• Physical inactivity- Increases blood pressure, cholesterol levels and weight gain. (4)
• Smoking- Smoking damages the lining of the blood cells, can increase fat deposits in the arteries and potentially increases clotting. (4)
• Diet high in saturated fat and sodium- Increases blood pressure, fat deposits in arteries and cholesterol levels (4)
• High alcohol intake- Can damage the heart muscle and increase risk of stroke (4)
• High cholesterol– Can increase fat deposits in arteries increasing the risk of blockages, heart attack and stroke (4)
• Obesity- May lead to an elevation in blood pressure and increase fatty deposits in arteries (4)
• Diabetes- People with diabetes are 2-4 times more likely to develop CVD and this is the leading cause of death in diabetics. (4)
• Family history of Cardiovascular disease- Having a first-degree male relative who has suffered a heart attack prior to the age of 55 or, a first degree female relative who has suffered one before the age of 65, increases your risk of developing heart disease (4)

The Statistics

Unfortunately, Cardiovascular disease is the leading cause of death in Australia. (1) It has been estimated that 1.2 million Australians over the age of 18 have experienced a condition related to the heart or vascular system. (5) Approximately 2.6 million Australians reported having high blood pressure and 430,000 have reported having a heart attack at some point in their life. (1)

The risk of developing CVD increases with age with 1 in 4 of those aged 75 and over having a heart attack or some sort of vascular disease. (5)

The role of hormones in Cardiovascular Health

The main female sex hormone involved in regulating blood pressure is of course, oestrogen. How oestrogen influences blood pressure is still being widely studied, however in both animal and human models oestrogen has been shown to induce vasodilation (dilate blood vessels) by increasing the amount of nitric oxide being produced and as a result, can aid in the prevention of vasoconstriction (narrowing of the arteries) which is correlated with an elevation in blood pressure. (6)

Many longitudinal studies have been conducted and have found a 4-fold increase in blood pressure during the onset of menopause. Because menopause is associated with a natural decline in oestrogen levels, it is this decline that has been in part, associated with elevation in blood pressure during this life stage. Support for this comes from observations that during the menstrual cycle, blood pressure tends to be lower during the luteal phase (when oestrogen levels are at their highest) than during the follicular phase (where oestrogen levels are at their lowest) (6)

We know that natural production of oestrogen has a positive correlation with blood pressure however, conjugated, synthetic oestrogens have been shown the opposite. A study by Wren et al. shows synthetic preparations of oestrogen have been shown to increase blood pressure in women who would have otherwise, had healthy blood pressure. 4 months after ceasing the synthetic preparations, blood pressure normalised. (7)

In a different randomised, controlled, cross over trial, although it only studied 30 menopausal women with mild hypertension, it indicated some promising results. (8) The women used 100mg of transdermal (applied to skin) oestradiol and over 24 hours their blood pressure had reduced, particularly of a morning and evening. These studies need to be conducted over a larger scale to accurately determine how oestrogen truly benefits blood pressure. (8)

Much of the limited research conducted is indicating that transdermal Oestrogen reduced blood pressure, whereas oral treatment of Oestrogen did not alter blood pressure. This is a positive outcome as transdermal Oestrogen is proving to be protective against high blood pressure. (9, 11)

In another study, Oestrogen was found to stimulate certain growth factors and prostaglandins which prove to be protective against cardiovascular disease and high blood pressure. (10,11)

Although larger studies are certainly required, the beneficial role Oestrogen has on the cardiovascular system cannot be discounted. Please speak to our doctors today to determine your suitability for bioidentical hormone therapy.

1. https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio#ris
2. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio#ris
4. https://www.world-heart-federation.org/resources/risk-factors/
5. https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-health-compendium/contents/how-many-australians-have-cardiovascular-disease
6. Dubey R, Oparil S, Imthurn B, Jackson E. Sex hormones and hypertension. Cardio Res 2002;53: 688-708
7. Wren BG, Routledge DA. Blood pressure changes. Oestrogens in climacteric women.Med J Aust 1981;2:528–531.
8. Mercuro G, Zoncu S, Piano D et al. Estradiol- 17B reduces blood pressure and restores the normal amplitude of the circadian blood pressure rhythm in postmenopausal hypertension. Am J Hypertesn 1998;11:909-13
9. Akkad A, Halligan A, Abrams K, al-Azzawi F. Differing responses in blood pressure over 24 hours in normotensive women receiving oral or transdermal oestrogen replacement therapy. Obstet Gynecol. 1997. 89(1): 97-103
10. Zacharieva S et al. Effect of transdermal oestrogen therapy on some vasoactive humoral factors and 24h ambulatory blood pressure in normotensive postmenopausal women. Climacteric. 2002. 5(3): 293-9
11. Cagnacci A, Rovati L, Zanni A, Malmusi S, Facchinetti F, Volpe A. Physiological doses of Estradiol decreased nocturnal blood pressure in normotensive postmenopausal women. Am J Physiol. 1999. 276(4). 1355-60

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Epigenetics refers to changes in gene expression (not the genes themselves).

MTHFR is a gene (part of the genetic code) and a ‘MTHFR variant’ is a mutated gene, or a changed gene.

Genome is the sum total of your DNA (including all genes and non-coding DNA).

Nutrigenetics is the study of the relationship between genes, diet and health outcomes.

It was once a strong belief that your genes are your future. We once thought that if you have the MTHFR gene mutation, then you are going to experience digestive issues, migraines, nerve pain, depression, chronic fatigue, etc. What we are starting to understand now is that the presence of a gene mutation is not a guaranteed life-sentence. What we have come to understand is that our conscious choices in our day-to-day life have a significant impact on our genetic expression.

The presence of a gene mutation should be viewed with interest. This mutation should be seen as either an indicator of why you are feeling this way, or as an indicator for what may develop, or what you are susceptible to.

Enter the ‘genome’. Some people are interested in identifying their genetic material and being aware of their genetic potential. While this can be a good idea, it can create stress and anxiety for what illnesses could potentially eventuate. Being aware of the MTHFR gene mutation, or the BRACA1 gene mutations are examples of tests people are commonly looking at. For some, the knowledge of their genetic potential is a motivator for a healthier lifestyle. For others, it is a cause of anxiety and stress for what may develop at some point in the future. I suggest you consider your personality and decide how the results of a genetic test may impact your lifestyle – will it give you sleepless nights, or maybe give you permission to be unhealthy, alternatively, will it make you a healthier person, or will you simply decide now to make all those healthy choices you have been avoiding, regardless of a test result? Knowledge is power, but in this case is it healthy or likely to create harm?

Is important to know? Or should you simply ‘be healthy’ in your choices regardless?

Enter nutrigenetics; the study of diet on genes, and the health outcomes.

If you have a MTHFR gene mutation, what should you do? – in short, the answer is to eat more green and leafy vegetables, ensure your bowels are working regularly, consider regular detoxification and maintain a ‘healthy’ life balance (an ideal sleep, stress, relaxation balance). What should you do if you want to live a healthy lifestyle and you don’t know if you have the MTHFR mutation – the same as the above. What is the difference? You are aware of your potential doom and gloom and it may make you lose sleep. Alternatively, you are aware of your genetic potential, and it may help you stay on a healthy pathway.

Yes, there are those who are significantly impacted by their MTHFR genetic mutations and these lifestyle changes are simply not enough. Keep it in perspective.

Perhaps one of the most beautiful things about nutrigenetics, is your epigenetic influence – put simply, just because you have the gene, doesn’t mean you have a ticking time-bomb to ill health. Just because your parents are obese with diabetes, doesn’t mean you are going to become obese with diabetes. You can influence how your genes are expressed. Not all your genes, but a noteworthy amount. You are not destined to the ill health your parents experienced. You have a level of control. It comes down to your choices.

Your environment and your choices can turn gene expression on and off. While we don’t know everything about the genome and epigenetics just yet, we do know that the effect of nutrition on genetic expression is modifiable. Diet plays a huge role. Lifestyle does too. See below for some nutrigenetic and lifestyle tips.

• Diet plays a huge role in healthy epigenetic expression and methylation. Simply put, eat your vegetables. Eat them at every meal, and ensure you have green leafy vegetables in the mix. Aim for a rainbow of colours and aim for vegetables to make up the majority of the meals.
• If you’re not getting ‘it’ (everything) from your diet, get it from a supplement. Speak with our Naturopath and Nutritionist team to see what is right for you.
• Ensure adequate sleep. ‘Adequate’ varies from person to person but aim to get at least 6 hours of quality sleep every night.
• Stress less. Easy to say, not always easy to do. Sit down and consider what is important in life. Think logically about how you can prioritise the important things, and work on prioritising these. Prioritise ‘me-time’ and ensure you are getting enough relaxation (daily!). Apps like ‘headspace’ and ‘calm’ may help, playing an instrument, colouring, reading, epsom salt baths and socialising are all great options for relaxation.
• Consider a low glycemic load and anti-inflammatory diet – this style of eating is rich in methyl donors – making it great for DNA. Speak with our Naturopath and Nutritionist team to see what this diet involves and if it is suitable for you.
• Consider intermittent fasting or intermittent ketosis – this may favourably influence epigenetic expression. Speak with our Naturopath and Nutritionist team to see what this dietary change involves and if it is suitable for you.
• Exercise, within your limits, and regularly.

Your genes are part of who you are – they are what connects you to your ancestors. You don’t have a choice in what you get. You can influence how your genes are expressed. Choose wisely.

The post Genetics and Gene Expression; One Doesn’t Equal the Other appeared first on Australian Menopause Centre.

What is Osteoporosis?

Osteoporosis, which literally translates to, porous bone is a disease that develops due to a loss of calcium in your bones. It becomes more prevalent as you get older but can occur at any age, particularly around the time of menopause. It is characterised by a reduction in the strength and density of our bones and results in changes to the structure of our skeleton. The reduction in bone density increases the likelihood of fractures developing as well as unwanted falls, which further increases the risk of bone breakages and fractures. (2)

Although Osteoporosis is a disease that is associated with the aging process, it does not mean that each one of us is going to develop it. It is one of the most preventable and curable diseases, if detected in time. (2)

Any bone can be affected by Osteoporosis however, the most common ones are the hip, spine and wrist. (1)

Osteoporosis is often referred to as the silent disease of people over 50.  Reason being, our bones can deteriorate and become weakened without causing any symptoms until a bone fracture or break occurs.  (2)

Some signs of Osteoporosis may include:

• Reduction in height
• Fracture of bones that occurs spontaneously without any trauma
• Bone pain
• Tooth loss
• Curvature of the spine

There are known risk factors that correlate to the development of Osteoporosis and these include:

• Gender- Women are more likely to develop Osteoporosis when compared to men. This is due to women naturally having less bone mass to start with, and due to a faster deterioration of bone strength as a result of fluctuations in hormone levels that occur throughout life. An example of this is a reduction in Oestrogen during menopause. (1,2)
• Age- The older we are the thinner and more porous our bones become. (1,2)
• Weight- Underweight individuals are more at risk due to potential reduction in nutrient intake (1,2)
• Ethnicity- Research has suggested that Asian and Caucasian, together with African Americans and Hispanics are at higher risk than other populations (1,2)
• Genetics- Those who’s parents have experienced fractures are more likely to have lower bone mass and therefore may be at risk for fracture development themselves (1,2)
• Hormones- An absence of a menstrual period, low hormone levels especially Oestrogen (females) and Testosterone (males) can contribute to Osteoporosis (1,2)
• Calcium and Vitamin D deficiency- Deficiencies in these 2 nutrients increase the risk of Osteoporosis development (1,2)
• Medication- Long term use of corticosteroids and some anticonvulsants can lead to a reduction in bone density (1,2)
• Lifestyle- Inactivity increases the risk of Osteoporosis developing (1,2)

The Statistics:

Alarmingly, recent statistics from the International Osteoporosis Foundation has found that worldwide, 1 in 3 women and 1 in 5 men, over the age of 50 will develop Osteoporotic fractures in their lifetime. Unfortunately, once one fracture develops, it increases the risk of further fractures developing. (1)

An analysis conducted by the Australian Government has found that 4.74 million Australians over the age of 50, a percentage of 66% of that age group, have poor bone health. Of this, 22% have Osteoporosis and 78% have Osteopenia (prelude to Osteoporosis). (3)

It is estimated that by 2022, 6.2 million Australians over the age of 50 will have either Osteoporosis or Osteopenia. This is scary considering it is a 31% increase from the 2012 statistics. (3)

Prevention and Treatment:

Although the statistics are alarming, there are a multitude of strategies that can be implemented to prevent the occurrence and progression of Osteoporosis, and one important strategy is hormone replacement!

If you are reading this article, you may likely be a woman suffering from the dreaded menopause! Your hormones are either fluctuating all over the place or extremely low, contributing to a plethora of symptoms that are potentially reducing your quality of life. We know that Bioidentical hormones can aid with the classic perimenopausal and menopausal symptoms, but can they really help with your bone health? The simple answer is, thankfully, yes!

There have been several studies conducted to determine the specific role of 17-beta Oestradiol and micronized Progesterone on bone health, and the results are positive!

Summation of the research indicates that low dose Oestrogen, even as low as 0.014mg per day, which is much lower than what most patients are prescribed, has been found to increase bone mineral density and decreased certain markers that break down bone. (4) When compared to synthetic equine Oestrogens, 17-beta Oestradiol was just as successful at improving bone density and no differences in effectiveness were found. (5,7)

Further to this, 17-Beta Oestradiol (at a dose of 0.014mg/day) applied to the skin, was compared to Raloxifene 60mg/day (an anti-osteoporosis medication) in treating Osteoporosis over 2 years. This study found that both forms of treatment were virtually comparable in improving bone density and strength in the lumbar spine (2.4% improvement in the Oestrogen group and 3% improvement in Raloxifene group). The Oestrogen was also well tolerated by the study participants. (6)

How do hormones help with bone health?

The role of bone formation and bone turnover is a complex process that can at times, be quite difficult to understand, and many nutrients, cells and hormones are involved.  Simply put, from a hormonal perspective, Oestrogen slows down the process as to which cells, called Osteoclasts, break down the tissue in bone. Progesterone, on the other hand, has been shown to stimulate cells called Osteoblasts which aid in building the tissue that forms bones. So, both hormones have a positive influence on bone density and therefore, osteoporosis prevention. (8,9)

The health of our bones is determined by our dietary and lifestyle habits from childhood through to adolescents and beyond. If you’re over 50 and are concerned about your bone health and future osteoporosis, please speak to one of our doctors to discuss the option of bioidentical hormones.

1. Zoen T, Ozisik L, Basaran N. An Overview and management of Osteoporosis. Eur J Rheumatol. 2017 4(1): 46-56
2. NIH Osteoporosis and Related Bone Diseases National Resource Centre 2018 https://www.bones.nih.gov/sites/bones/files/pdfs/osteopoverview-508.pdf
3. Osteoporosis costing all Australians: A burden of disease analysis- 2012-2022 https://www.osteoporosis.org.au/sites/default/files/files/BofD_Exec_Sum_for_print.pdf
4. Ettinger B et al. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomised clinical trial. Obstet Gynecol. 2004 Sept; 104 (3): 443-51
5. Farr J, Khosla S, Miyabara Y, Miller V, Kearns A. Effects of Oestrogen with micronized progesterone cortical and trabecular bone mass and microstructure in recently postmenopausal women. J Clin Endocrin and Metabolism. Jan 2013; 98(2): E249-57
6. Schaefers M, Muysers C, Alexandersen P, Christiansen C. Effect of microdose transdermal 17beta-estradiol compared with raloxifene in the prevention of bone loss in healthy postmenopausal women: a 2 year, randomised double blind trial. Menopause. 2009 May-June; 16(3): 559-65
7. Von Mach-Szcypinski J, Stanosz S, Kosciuszkiewicz J, Safranow K. New aspects of postmenopausal osteoporosis treatment with micronized estradiol and progesterone. Ginekol Pol. 2016; 87(11): 739-44
8. Seifert-Klauss V, Prior J. Progesterone and bone: actions promoting bone health in women. J Osteoporos. 2010 Oct 31; 2010.
9. Prior J. Progesterone for prevention and treatment of osteoporosis in women. Climacteric. 2018. 21 (4). 366-74

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Let’s get the obvious out of the way; sex hormones change. It’s part in parcel with menopause. Your sex hormones tend to go up and down and a little crazy to start with (perimenopause), then they settle down, and reduce significantly as the ovaries retire (menopause). When you have a strong level of oestrogen (think of PMS) you can get fluid retention or sweet cravings, leading to weight gain. On the flip side, when you have too little oestrogen (think of menopause) you lose your oestrogen protection against weight gain.

Interestingly, oestrogen has been identified as playing a significant and positive role in the regulation of appetite, energy expenditure, body weight and fat distribution[1]. Yet when most people are people are faced with the decision to start oestrogen, they become concerned about weight gain.

Yet if we really start to think about it – menopause, lack of sex hormones, weight gain – it starts to make sense that oestrogen is involved somehow in keeping weight under control.

And what do you know, the research backs this up. Oestrogens and their receptors have been shown to regulate various aspects of glucose and lipid metabolism[2]. Oestrogen works in the brain by increasing glucose transport into the cells and by aiding ATP (energy) production. It also works in the central nervous system by regulating food intake, energy expenditure, and body fat distribution[3]. If we stop, pause and think about that, we can agree that those actions are complex, important and numerous, and we have only scraped the surface of looking at what oestrogen can do (and yes, too much of a good thing is bad).

Without this oestrogen action, our appetite and satiety levels, as well as our energy levels, as well as our response to certain foods, all change. This is where I have found a lot of people are caught out.

I am often told ‘I haven’t changed my diet, and I am now gaining weight’. Even though you may not have changed your diet for the last 5, 10, 15 years, your body changes the way it responds to certain foods. You may find that the diet you were stable on, now makes you gain weight. Big bummer.

To explain why this occurs, we must recognise that there is an inverse correlation between oestrogen levels and fasting insulin in menopausal women. This means that the lower your oestrogen levels, the higher the fasting insulin – this higher level can lead to an insulin resistance diagnosis and a myriad of metabolic issues from there on. Whether or not this change is directly linked to oestrogen or linked via oestrogen’s role in fat distribution is debatable[4]. Regardless, low oestrogen has been linked to high insulin, and when oestrogen is re-introduced, a reduction of insulin has been noted[5]. (Interesting – reread that sentence!). Unfortunately, this relationship negatively changes the way your body responds to certain foods; namely sugars and carbohydrates (meaning they are not so forgiving anymore!).

The middle-age-spread, menopausal waist or abdominal fat gain is also widely debated in menopausal women. Many suggest this change simply comes with age, others show it as the result of the hormonal changes that come with menopause[6]. Again, oestrogen is the star suspect. Interestingly, and again, if we sit and think about it, at puberty (when sex hormones like oestrogen become key players) your fat distribution and body shape changes – your hips widen, your thighs increase, and your breasts develop. When menopause occurs and your sex hormones (namely oestrogen again) significantly reduce, we lose the shapely waist, hips and thighs curve and gain back that almost prepubescent up and down figure (losing your waistline), and just generally being a little more ‘plump’ or ‘apple’ shaped.

If you haven’t noticed it yet, oestrogen is pretty important in keeping your weight under control. Of course, outside factors like diet, exercise and free-will can overrule your oestrogen effect, but it is still quite impressive and vast to consider the effects oestrogen has over the body. One last function of oestrogen that I want to highlight is fat deposits. Oestrogen is heavily involved in choosing where fat cells are deposited in the body[7]. A lack of oestrogen rearranges fat, leading to the middle-aged spread, or abdominal fat. Unfortunately, this type of fat is significantly unhealthy and can lead to metabolic syndrome, cardiovascular issues, Alzheimer’s, inflammation, obesity and sadly too many other unhealthy outcomes[8]^,[9].

This is partly because fat, especially abdominal fat, functions as an active gland (just like the thyroid and the ovaries function as active glands).

Once your fat cells are present and if you have an increased amount of fat cells, particularly around your abdomen, it’s not so easy to shake it off. Unfortunately, you have few things working against you.

Fat cells secrete multiple hormone-like substances including leptin, resistin and adiponectin. These substances play a large role in appetite and energy levels, and thus they can influence your weight struggles. To simplify, leptin is considered positive for weight control as it reduces appetite, but unfortunately in a study of 634 postmenopausal women[10], it was found that low oestrogen (menopause) is associated with low leptin levels – reducing the hormone-like level of appetite control. Resistin, another hormone-like substance produced in fat cells, is still relatively new and its function hasn’t really been agreed upon. However, it is found to be linked to insulin resistance and increased inflammation. And finally, adiponectin, the other hormone-like substance produced in fat cells has thankfully been found to improve insulin resistance. Unfortunately, adiponectin reduces with menopause[11].

If leptin, resistin and adiponectin are new words to you, you are not alone. Weight loss after menopause is hard. In this instance, preventative measures are best (if you don’t have the abdominal fat cells to begin with, you don’t have the increased barrier to losing weight).

I am sorry to keep going, but there is more.

Another way menopause affects the waistline is indirectly through poor sleep. Hot flushes, night sweats, anxiety and insomnia are classical symptoms of menopause and all of these impact sleep. These symptoms not only create a barrier for weight loss, but they actually encourage weight gain. A study looking at the effects of just one bad nights sleep (and by ‘bad’, I mean only 33% less sleep than normal) found a significant increase in hunger and cravings which resulted in the consumption of larger meals and more sweets[12]. Several other studies have found similar results with the general consensus being that there is an increased risk of obesity in short sleepers[13]. This risk seems to, in part, come from the development of insulin resistance and reduced glucose tolerance (when sleep is limited to 5.5hrs only)[14]. Additional factors include an increase in afternoon and early evening cortisol levels, a decrease in leptin levels and an increase in ghrelin levels[15]^,[16].

Interestingly, melatonin (the hormone that helps you sleep, and may be lacking in those with sleep issues) can contribute to weight loss[17].

Other factors to consider include the thyroid, metabolism, inflammation, cortisol, and of course your microbiome (gut bugs). Weight gain is complex, and weight gain in menopause is even more so complex. (We will cover these factors in another article – this one is getting long!).

But don’t worry, it’s not all doom and gloom. Here are some ways you can help yourself.

• Exercise. Too many studies are suggesting that menopausal weight gain is because women are becoming sedentary with age. If you can exercise, do it. If you have injuries, speak directly to an exercise physiologist or to your doctor to get a referral to an exercise physiologist so that you can learn how to exercise with the injury. This needs to become a priority. The weight that often comes with menopause is difficult to lose and easy to become unmanageable.
  • Also, exercise helps improve insulin sensitivity, decrease leptin and increase ghrelin[18] – all the important factors that menopause negatively affects.
• Limit or eliminate sugars and refined carbohydrates[19]. These are the foods that require insulin function and if we remember, menopause is a time of insulin vulnerability, leading to increased risk of insulin resistance, weight gain and diabetes. Sugar includes your table sugar and sweet items (chocolate, lollies, golden syrup, honey, etc.) and refined carbohydrates includes bread, pasta, pastry, crackers and biscuits.
• Aim for protein at every meal¹⁹. Protein helps with your appetite signals (which can become significantly distorted in menopause). Protein includes meat, tofu, eggs, seafood etc.
• Load up on vegetables. Each meal should be predominantly vegetables. This means that you are getting your nutrients, fibre and bulk, leaving you satisfied, full and ideally healthy. Aim for a rainbow of colours at every meal, and a variety of vegetables throughout the week.
• Bio-identical hormones – namely oestrogen and progesterone. Speak with the medical team at the Australian Menopause Centre to see if bio-identical hormones can help you.
• Be mindful. Mindful eating can help you become aware of internal, rather than external cues to eat. This can be a significantly helpful approach to binge eating or emotional eating.
• Write down your goals. Be accountable, monitor your changes. Weight loss only works if you want to work it.
• Be positive. The power of positive thinking is real.
• Seek help if you are feeling overwhelmed, vulnerable or out of control. Nutritional support, medical support, and mental support is available from the Australian Menopause Centre. Speak with the team to get started.

[1] Roepke, T. A. (2009). “Oestrogen modulates hypothalamic control of energy homeostasis through multiple mechanisms.” J Neuroendocrinol 21(2): 141-150.

[2] Coyoy, A., et al. (2016). “Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause.” Horm Metab Res 48(8): 489-496.

[3] Coyoy, A., et al. (2016). “Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause.” Horm Metab Res 48(8): 489-496.

[4] Marchand, G. B., et al. (2018). “Increased body fat mass explains the positive association between circulating estradiol and insulin resistance in postmenopausal women.” Am J Physiol Endocrinol Metab 314(5): E448-e456.

[5] Munoz, J., et al. (2002). “Fat distribution and insulin sensitivity in postmenopausal women: influence of hormone replacement.” Obes Res 10(6): 424-431.

[6] Ambikairajah, A., et al. (2019). “Fat mass changes during menopause: a metaanalysis.” Am J Obstet Gynecol 221(5): 393-409.e350.

[7] Frank, A. P., et al. (2019). “Determinants of body fat distribution in humans may provide insight about obesity-related health risks.” J Lipid Res 60(10): 1710-1719.

[8] Razmjou, S., et al. (2018). “Body composition, cardiometabolic risk factors, physical activity, and inflammatory markers in premenopausal women after a 10-year follow-up: a MONET study.” Menopause 25(1): 89-97.

[9] Park, J. K., et al. (2013). “Body fat distribution after menopause and cardiovascular disease risk factors: Korean National Health and Nutrition Examination Survey 2010.” J Womens Health (Larchmt) 22(7): 587-594.

[10] Karim, R., et al. (2015). “Association of endogenous sex hormones with adipokines and ghrelin in postmenopausal women.” J Clin Endocrinol Metab 100(2): 508-515.

[11] Sieminska, L., et al. (2006). “The relation of serum adiponectin and leptin levels to metabolic syndrome in women before and after the menopause.” Endokrynol Pol 57(1): 15-22.

[12] Yang, C. L., et al. (2019). “Increased Hunger, Food Cravings, Food Reward, and Portion Size Selection after Sleep Curtailment in Women Without Obesity.” Nutrients 11(3).

[13] Cappuccio, F. P., et al. (2008). “Meta-analysis of short sleep duration and obesity in children and adults.” Sleep 31(5): 619-626.

[14] Nedeltcheva, A. V., et al. (2009). “Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance.” J Clin Endocrinol Metab 94(9): 3242-3250.

[15] Copinschi, G. (2005). “Metabolic and endocrine effects of sleep deprivation.” Essent Psychopharmacol 6(6): 341-347.

[16] Morselli, L., et al. (2010). “Role of sleep duration in the regulation of glucose metabolism and appetite.” Best Pract Res Clin Endocrinol Metab 24(5): 687-702.

[17] Walecka-Kapica, E., et al. (2014). “The effect of melatonin supplementation on the quality of sleep and weight status in postmenopausal women.” Prz Menopauzalny 13(6): 334-338.

[18] Kang, S. J., et al. (2018). “Effects of 12-week circuit exercise program on obesity index, appetite regulating hormones, and insulin resistance in middle-aged obese females.” J Phys Ther Sci 30(1): 169-173.

[19] Ford, C., et al. (2017). “Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study.” Br J Nutr 117(8): 1189-1197.

The post Menopause Affects Your Waistline. appeared first on Australian Menopause Centre.

Itchy skin can quite easily drive you bonkers. You try to remind yourself not to scratch, convince yourself you can dig your fingernails in a little to relieve the itch, try some ice cubes or saliva to relieve the itch, but then forget completely and scratch continually, only to make the itch itchier (was that possible?!), your skin red, and eventually break the skin and cause yourself to bleed.

Then repeat that again, and again, and again. Because the itch isn’t relieved, it’s still there!

Bonkers.

Itchy, dry, flaky skin can start as you enter menopause; and guess what, oestrogen is the main culprit here.

Oestrogen is often considered the youthful, glowing hormone that makes your face young, your skin full, plump and moisturised, and many other beautiful feminising things. But do you know how it does all these wonderful things? Oestrogen can increase skin collagen content, supporting and increasing skin thickness[1]. It plays a great role in skin moisture and has a positive effect on elastic fibres. It also positively influences fatty tissue deposits, particularly near the face, neck, arms and hands, causing a plumpness that disappears when menopause sets in (and your fat cells redistribute).

If we consider these actions, we can start to understand how the decline in oestrogen during menopause becomes the main culprit in the accelerated aging of the skin. It starts to become apparent that oestrogen, for all its negative associations, has a large positive influence over our skin, our youth, and essentially our barrier and border, stopping our insides from falling out.

But what about that itchy skin that we just can’t relieve?

You guessed it; the dryness, that comes from the lack of oestrogen, can cause an irritation that can be experienced with the urge to itch.

Occasionally the itchy sensation can be likened to feeling as if there are insects crawling under the skin. This is called formication, and this is something we often hear about at the Australian Menopause Centre. This often can’t be relieved by scratching and has a lot to do with your oestrogen levels.

Unfortunately, when the ovaries retire, and the oestrogen production within the body significantly reduces, your skin can dramatically change. It can almost feel like your skin changes overnight, and that might not be too far from the truth.

Interestingly, those who are considered ‘oestrogen dominant’ are often thought of as ‘looking great for their age’ (finally a positive to being oestrogen dominant!).

However, eventually, the ovaries do retire.

For some, oily skin and ‘adult acne’ can develop, as the ‘anti acne’ effect that oestrogen has over the skin glands reduces. This allows testosterone to run rampant, unopposed by oestrogen. This can result in the skin glands creating a thicker oily secretion, changing your skin to an oily and acne prone skin type.

Unfortunately, facial hair can also run rampant due to this oestrogen-testosterone imbalance.

If you have not considered it already, it’s time to consider how you protect your skin from the sun (especially the face if ageing is a concern). Protein construction, particularly that of collagen and elastin (important skin proteins), are somewhat controlled by oestrogen. This means that when your oestrogen levels drop, you lose the construction and also the repair of collagen and elastin fibres. This lack of repair is particularly pronounced if the skin is exposed to UV rays. If we can remember the old government ad stating, ‘tanning is skin cells in trauma’, then we can easily understand that UV rays are particularly destructive to collagen. During a time when our oestrogen levels are diminished, which means our repair mechanism is diminished, we can start to understand how we can look so aged once menopause kicks in.

To add to the importance of being sun smart, we should consider ageing spots. These brown ‘ageing spots’ appear on the face, hands, neck, arms and chest of many menopausal women. Once again oestrogen is playing a regulating effect, but this time on melanin production, keeping its production under control. When we lose the oestrogen regulating effect, and when the skin is exposed to UV sun rays, melanin synthesis increases. The increases in melanin is evident in the appearance of brown spots, commonly referred to as ‘ageing spots’.

And finally, we should delve a little deeper into the dryness factor. Dryness is the most common skin concern of all the menopausal women we speak with (and we have spoken to thousands over the years). Oestrogen (once again) has partial control over the growth and maintenance of blood capillaries within the skin layers. A reduction in blood capillaries means a reduction in blood flow and reach, resulting in less nutrients and oxygen to support and nourish skin health. This impacts the thickness of the skin and reduces the cell turnover rate, leading to poor, thin skin, often accompanied by a dampened skin barrier function and an increase in water loss.

Therefore, oestrogen impacts the dryness of the skin by reducing blood flow to the area, reducing repair to skin cells, reducing skin thickness, reducing the cell turnover rate (making older skin stay present for longer), increasing susceptibility to UV damage and by reducing skin barrier function (leading to increased water loss).

Unfortunately, this impact is body wide (not just the face). Meaning vaginal dryness is almost equally as common as dry skin, and again it is a significant complaint that many women have reported to us. Vaginal dryness should not be ignored.

Understandably, skin sensitivities start to appear in menopause and many women have had to turn to the ‘sensitive’ laundry powders, skin creams and sunscreens.

To support your skin and reduce the impact menopause has over your skin health, I recommend the following:

• Sunscreen

If you’re not using sunscreen, why not? Go and have a good look at the health food shop or pharmacy and find a sunscreen you are comfortable with and start regularly applying it. I prefer ‘invisible zinc’ and I apply this when I know I will be outside for periods of time.

• Water

Stay hydrated! Really work hard on getting your 2+L of water daily. If you lose fluids from sweating (via exercise, hot flushes, night sweats, etc.), vomiting or diarrhoea, you need to replace those fluids, on top of the 2L daily.

• Moisturise

Moisturise your whole body regularly. Find a cream that is suitable for your skin type and use it regularly, particularly after a shower (within a few minutes of drying off).

• Stop smoking

Cigarette smoking can accelerate the dermal aging process within the skin by further reducing blood flow, accelerating or enhancing the dry skin and causing discolouration.

• Reassess your soap

Regular soap may have become too harsh or drying for your skin.  Try replacing your soap with a mild cleanser or a sensitive option.

• If you are still concerned, see a specialist.

For aging concerns, consider speaking with the Australian Menopause Centre. If suitable, the team can consider a compounded anti-ageing cream, or an individualised blend and boost option – both uniquely great options.

[1] Shah, M. G. and H. I. Maibach (2001). “Estrogen and skin. An overview.” Am J Clin Dermatol 2(3): 143-150.

The post How Does Menopause Affect Your Skin? appeared first on Australian Menopause Centre.

Let’s look at some ways to reduce your chances of anxiety and go through some ways to increase your defenses.

Lifestyle:

• Reduce caffeine
  • Caffeine is a stimulant and unfortunately too much stimulation can lead to an overwhelming sensation of anxiety. A 2009 study showed the vulnerability of those with panic disorder and generalized social anxiety disorder to caffeine. Panic attacks were seen in 60% of those with panic disorder and 16% of those with anxiety disorder, after consuming 480mg caffeine[1]. An additional study found anxiety increased in both a singular high caffeine intake (200mg), and a small but frequent caffeine intake (4x 65mg over 5hrs)[2]. Test how caffeine affects your anxiety. Give it the flick for over a week and reassess your mental health.
• Quality sleep
  • Sleep disorders can cause anxiety and anxiety can cause sleep disorders. Sleep is needed to help your brain function properly, and where possible, it is best to set yourself up for success. Go to bed at a decent time, allowing yourself 7-9hrs before your alarm goes off, minimize stress or stimulation 1hr before sleep, minimize caffeine, practice mindfulness. Do what works for you to get a good night’s sleep, every night. Make it a priority.
• Exercise
  • In 2017 a group of researchers looked at all the evidence investigating how exercise affects those with anxiety[3]. After careful examination they concluded that exercise significantly decreased anxiety symptoms. A different team in 2018 dug deeper and found that it was high intensity exercise regimes that are more effective than low intensity regimes[4]. There are so many benefits to exercise that regular high intensity exercise should be near the top of the priority list.
• Reduce stress
  • If you can’t reduce the stress, change the way you approach, or view, the stress. The best way to beat the stress is to identify what creates stress for you, learn some relaxation techniques, cultivate some resilience.

Diet

• Eat real food
  • Being in a heightened state of anxiety can be draining on the body. Eat real foods. The foods that look like they have come out of the ground or off the ground – vegetables, nuts, eggs, meats. A packet of chips didn’t look like that when it came out of the ground, neither did the chocolate bar or the hot dog. Your food is your fuel, choose your fuel wisely.
• Watch your sugar
  • Don’t let sugar, or even caffeine, depict your ups and downs. A sweet lolly has the power to give you a boost of energy, but ‘what goes up must come down’, and unfortunately it generally goes down as fast as you went up. An erratic blood sugar level can impact your anxiety.
• Don’t forget to eat
  • Sometimes eating can be forgotten or delayed. Try not to let this happen. As mentioned previously, being in an anxious state is quite draining on the body and you need the fuel to sustain your function. Set alarms if you need to, make appointments in your calendar to eat, have your food handy, do what you need to make sure you are fueling your body. A hungry body is a vulnerable body.

Mental

Use these 9 strategies to manage anxiety from beyondblue.org.au

1. Slow breathing
   • Deliberately try to slow your breathing. Count to three as you breathe in, count to three as you breathe out. Breathe deeply so that if you were to put your hand on your belly button, your breathing would move that hand up and down.
2. Progressive muscle relaxation
   • Relax those muscles that are often tense when anxious. Find a quiet location, close your eyes and work on slowly tensing and relaxing each muscle group. From your toes to your head try to hold each muscle group for three seconds before relaxing.
3. Stay in the present moment
   • Anxiety can make your thoughts jump forward into a terrible future that hasn’t happened yet. Try to bring yourself back to where you are now and enjoy the present. The future hasn’t happened and there are an endless number of possibilities for each and every situation.
4. Take small acts of bravery
   • You can do it. Avoiding the situations that make you anxious is a good short-term strategy, but in the long term this may make you more anxious. Try approaching something that makes you anxious, even in a small way. The way through anxiety is by learning that what you fear isn’t likely to happen, and if it does, you’ll be able to cope with it.
5. Challenge your self-talk
   • How you think impacts how you feel. Try to think of different interpretations for the situation and try to look at the facts for and against your thoughts being true. The power of positive thinking is thoroughly undervalued.
6. Plan worry time
   • This may sound a bit different but try to set aside 10 minutes each evening to write down your worries. This can take the worry from your mind and stop your worries from taking over mentally.
7. Get to know your anxiety
   • Consider making a diary of when your anxiety is at its best and when it is at its worse. Your menstrual cycle can impact your self-confidence and finding your pattern can mean that you can manage your week or day to work best for you.
8. Learn from others
   • Talking with others who are also experiencing anxiety can help you feel less alone and may help you find some beneficial management tactics. Counselling or professional help may also be significantly beneficial.
9. Be kind to yourself
   • You are not your anxiety. You are not weak. You are not inferior. You have a mental health condition (just like so many others). It’s called anxiety.

[1] Nardi, A. E., et al. (2009). “Panic disorder and social anxiety disorder subtypes in a caffeine challenge test.” Psychiatry Res 169(2): 149-153.

[2] Brice, C. F. and A. P. Smith (2002). “Effects of caffeine on mood and performance: a study of realistic consumption.” Psychopharmacology (Berl) 164(2): 188-192.

[3] Stubbs, B., et al. (2017). “An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis.” Psychiatry Res 249: 102-108.

[4] Aylett, E., et al. (2018). “Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis.” BMC Health Serv Res 18(1): 559.

The post Need Help to Re-Gain Control Over Your Anxiety? appeared first on Australian Menopause Centre.

Mental health can be quite confronting. It can make you feel all kinds of things ranging from hopeless, to weak, to vulnerable and fragile. Sometimes knowing what is going on, understanding why it is happening, how common it is, and being aware of how you can help yourself, can be a huge relief and just what you need to keep you feeling somewhat in control.

It’s back to the old adage, ‘knowledge is power’.

Before we get into the nitty gritty of the ‘hows’, we can simply liken perimenopause and menopause, to puberty. It’s a crazy time for a lot of reasons, and there are lot of ‘behind the scenes’ things occurring that can cause the fireworks and rollercoasters. This can be the simple and quick explanation for how you feel and how you’ve been acting. The in-depth reason involves the complicated sex hormones.

Perimenopause marks the time leading up to menopause. It often starts in the mid to late forties, and continues until your last period has passed, and the ovaries have finally retired. During this time the ovaries start to become unreliable in their function, unpredictable in their malfunction Sometimes they overcompensate for their performance. Oestrogen and progesterone are the key hormones involved in the ups and downs of perimenopause. Both are quite powerful.

Oestrogen typically fluctuates in a lovely up and down manner throughout the month. In a complex and thoroughly impressive mechanism, your brain keeps tight control over your oestrogen production and controls its fluctuations.

Progesterone is only present in the body once ovulation has occurred. If ovulation doesn’t occur, no progesterone is produced for that menstrual cycle. Once again, it is a complex and impressive mechanism that needs to happen for ovulation to occur. Generally, ovulation occurs every cycle and the lack of pregnancy results in the menstrual bleed.

Unfortunately, perimenopause is the time when ovulation is hit-or-miss, and the communication between the brain and the ovaries starts to break down, interrupting the oestrogen control the brain once had.

This is where it starts to get unpredictable.

When your body produces oestrogen in its lovely fluctuations, but you don’t ovulate and don’t produce any progesterone, you end up in an oestrogen dominant state (your normal oestrogen levels are dominating over your non-existing progesterone levels). This can result in oestrogen, a stimulating hormone, over-stimulating the body, across the board, leaving you in a heightened stimulated state. This may express itself as the overactive anxiety state.

This lack of ovulation also leaves you in a progesterone deficiency state. Progesterone is a calming, soothing, relaxing hormone, and when it fails to show up (due to a lack of ovulation), you lose out on the calming, soothing and relaxing effects that you are used to having. Without this, it is understandably quite easy to become overwhelmed, agitated and anxious. To top this off, this change in mood often occurs ‘out of the nowhere’ (which can make you even more unsure or anxious).

The other common state of hormonal change you often pass through is oestrogen deficiency. This occurs as you get closer to menopause and the ovaries get closer and closer to retiring completely. A lack of those lovely monthly oestrogen fluctuations can significantly impact the protective or balancing effect oestrogen has, particularly on the brain chemical serotonin. Serotonin is often referred to as your happy hormone and it plays a large role in mood balancing. Oestrogen supports or increases your serotonin levels, helping you keep your cool. Without oestrogen, your serotonin levels can drop, and your mood control can struggle. Anxiety can occur.

Serotonin also plays a role in your sleep quality. Unfortunately, but not at all unexpectantly, a lack of sleep can impact your stress, worry and anxiety levels.

Night sweats can interrupt your sleep, impacting your anxiety levels.

Hot flushes, or the embarrassment that can come with hot flushes, can impact your anxiety levels.

Lack of concentration, memory concerns and weight gain can impact your anxiety levels.

Concerns about ageing can impact the picture, and we notice quite a lot of life challenges occurring at this time (kids, elderly parents, sicknesses, marriage, work… life), significantly impacting your stress levels, the feeling of being overwhelmed, and the possibility of anxiety.

On a nerdier note, oestrogen is involved in neuronal synapse activity, is both neuroprotective and neurotrophic on tissues within the brain and calms the fear response. This is the hormone that starts to slow down with menopause, requiring the body to readjust.

Of course there may be other reasons for your anxiety (there are many possibilities), however sex hormones, perimenopause and menopause are key suspects, especially if it has just started or exacerbated in your mid to late forties.

I hope it’s no longer surprising that anxiety may sneak into your life during perimenopause and menopause. It’s quite common and you are not alone. You don’t simply have to ‘put up with it’. Speak with the team at the Australian Menopause Centre if you would like some support.

Thankfully, when the menopausal influence calms down, the anxiety often calms down too. However, this can take some time (years). Let us know if you would like to talk.

The post Why is Anxiety So Common in Perimenopause and Menopause? appeared first on Australian Menopause Centre.

Everyone gets angry.

It’s a normal, regular emotion. It’s how you choose to react with the emotion that is the defining and important part.

But what if your anger is really out of the ordinary? What if you are generally a placid, happy, approachable person who is now experiencing episodes of rage? What if you are no longer in control, or no longer recognise yourself?

Unfortunately, this is quite common.

I’ve said it a thousand times, and I’ll say it again; menopause is a time of change.

And it changes your emotions – just like depression, tears and anxiety can be exacerbated through perimenopause and menopause, anger can be too. There are a few different ways your sex hormones can affect your tolerance level, or fuse, but the why isn’t too important, it’s the understanding and knowledge that is important. You are not alone. This is not who you are. This too shall pass.

In the mean-time, recognising your changes and taking some swift actions to reduce, control or do damage-control can be beneficial.

Menopause induced anger can feel quite different to your typical anger or frustration. You can go from zero to one-hundred in seconds and then drop back down just as fast. Your patience may suffer and your friends and family may feel like they are stepping on egg shells when they are around you, but that doesn’t mean you have to isolate yourself. Recognising your approaching outburst, remembering that it may be out of proportion or unjustifiable, and removing yourself from the situation can be powerful. If you can manage to stop, think and react proportionally, you may be able to defuse any outbursts before the explosion.

Don’t misunderstand me, I don’t want you to bottle up your emotions, I want you to gain back control.

During this perimenopause/menopausal hormonal turmoil, lots of things will change – it’s the nature of menopause; change. The beauty of the human mind is that we can decide how we respond to change. We can choose to embrace it, or we can choose to fight it. Sometimes, recognising the power of choice (and the power of the mind) this is all that’s needed to get that control back.

Next time you find yourself overcome with the urge to rage try the below actions:

• Accept your anger

When you acknowledge the feeling, you are no longer controlled by the feeling. Sometimes we just need to be angry. Allowing the emotion to be voiced and felt, can be the release that lets you move on.

• Learn your triggers

There are some habits (caffeine, fasting, etc.), situations or people that may trigger your angry side. Being aware of your triggers can either prompt you to avoid that trigger, or give you time to consciously keep your cool by increasing your tolerance levels.

• Take a step back

When you are in the midst of a heated moment, practice taking a step back to consider your emotions and your situation – is your reaction justified? Is the anger (and all the energy that it requires) worthy of the situation?

• Find an outlet

Find an outlet to work through your emotions. Whether its team sport, boxing, gardening, loud music or yelling, do what works for you.

• Let it go

What is done is done, and it can’t be undone. We can’t change the past, but you can change how you feel about the past. Don’t let the guilt eat you up. Let it go. Move forward.

• Educate your loved ones

A little education or warning can go a long way. It may be best to warn your close family and friends about any unjustified or unexpected mood swings. Explaining that you may be a little more fragile or reactive can go a long way to keeping those relationships strong.

• Know when to seek help

There is always help. Speak to your GP for counselling support or contact the Australian Menopause Centre for hormonal support.

Try not to burn any bridges in your journey through perimenopause/menopause. The hormonal changes are temporary, the ‘normal you’ will return – she may be wiser, and she may be stronger, but the you, who is in regular control of her emotions, will return.

The post Owning Your Emotions, Even Anger. appeared first on Australian Menopause Centre.

It’s no longer viewed as a sign of weakness or embarrassment. Or at least in theory it isn’t. When you’re the one crying, especially in public, it can be a turmoil of emotions, unfortunately including weakness and embarrassment. It’s a tough battle to embrace, but like I said earlier, it can be oh so very therapeutic.

We all know crying is a natural response humans have to a range of emotions, including sadness, grief, joy and frustration (yes, only humans shed emotional tears). It’s not unusual to cry, and apparently, we cry a lot more than people assume – women cry an average of 3.5 times a month, and men cry on average 1.9 times a month.

However, menopause makes things different (menopause makes everything different!).

Menopause (also perimenopause) can mean that you start crying for no known reason. It can mean that your threshold for sad ads, difficult situations and easy decisions is terrible, and you may find yourself crying so much more than what you are used to. Unfortunately, it’s normal in menopause and perimenopause. I once had a patient tell me she started to cry because she looked out the window and saw a bird land. Not only was this a out of character for her, but it concerned her. Yes, it is unusual. Yes, it’s a little different. Yes, I believe it can help to know that you are not alone, and to know that this too shall pass.

Let’s delve into the world of hormones.

Menopause marks the time that your ovaries retire. When they retire, they are essentially shutting down the ‘oestrogen making factory’ and cancelling the production of progesterone (it’s not quite that extreme, but it’s almost that extreme). Without the hormones that your body has been used to working with, a few things start to change. Hot flushes and night sweats are some of the most talked about menopause changes, but your moods and your brain function are also quite noticeable and concerning parts of that change.

Oestrogen deficiency is thought to be the instigator of tears, cognitive decline, depression and almost everything bad in menopause (or at least it feels that way). Too much oestrogen can have a negative effect too (anger and irritability), but unless you are crying because you feel guilty about the anger outburst, it is likely menopause tears are tears of oestrogen deficiency.

There are a few factors at play. One of the factors is serotonin[1]. Serotonin is a chemical that sends signals between nerve cells. It is believed to regulate mood and social behaviour (hence the involvement in tears), as well as regulate appetite, digestion, sleep, memory and sexual desire and function.

Earlier this year, a group of researchers examined the scientific literature surrounding the link between serotonin and oestrogen[2]. After examining the literature, the team hypothesised that oestrogen plays a role in regulating the serotonergic system, providing a protective effect towards serotonin linked diseases. Another team who examined the research on this link have also consistently found that oestrogen increases serotonin availability by altering markers and decreasing breakdown[3].

During menopause, and the decline of oestrogen that comes with it, you are left without the protective or regulating effect that oestrogen has over serotonin. This lack of benefit can leave you vulnerable to erratic changes in mood and social behaviour (plus the rest). Thus, this can result in the tears and the reduced threshold to tears that I mentioned earlier. Serotonin is a key factor.

Another factor involved in the tears in menopause involves something called MAO-A.

MAO-A (monoamine oxidase A) is an enzyme that is involved in removing certain brain chemicals from action, including serotonin and dopamine. It is a key regulator for healthy brain function and is heavily involved in mood, feelings and behaviour. A 2014 study[4] has examined the changes in perimenopause and discovered a relationship between oestrogen and MAO-A. The team was able to identify a 34% increase in MAO-A during perimenopause, suggesting it plays a significant role in the removing of serotonin, and the tears and moods seen during this time. This increase in MAO-A improved (decreased) in menopause, but it was still higher than those in their reproductive years. The switching off of serotonin (or the removal of serotonin) that MAO-A does, heavily impacts the fragile balance of happiness, mood, anxiety and depression. This research team concluded that the strong oestrogen decline was implicated in elevating MAO-A levels. This means that it’s not just the hot flushes or night sweats that can influence your moods, but the hormones and hormonal changes themselves directly impact your brain function.

Summing it up, not only does the decrease in oestrogen mean that you lose your protective effect over serotonin, but it accelerates the break-down, or removal of serotonin. It’s a double whammy – no wonder the tears are fragile.

Don’t fret. Your hormones change, and your body eventually catches up to this change.

Menopause generally marks the time for consistency regarding your sex hormones – yes, they are consistently low, but that consistency is key.

Purely and simply, hormones are messengers that need to connect with a hormone receptor to create a response. Generally speaking, when your ovaries start to malfunction, then retire (perimenopause, then menopause) it takes a little longer for your receptors to respond to the changes, and then down-regulate, or turn off themselves. Eventually, your hormone receptors equal your hormone levels and a harmonious (and comfortable) balance arrives. Until that time, symptoms are present.

My advice for now, be gentle with yourself.

If you find yourself feeling a little vulnerable, teary or emotional, take some time out. Breathe through it, take a seat, feel the emotions (use the tears as a therapy). Once you’re better, move on and don’t fret about the tears. Definitely don’t hold grudges.

If you’re overwhelmed, consider support from the team at the Australian Menopause Centre. The transition time can be challenging, but once you are through and the receptors match the hormones, smooth sailing entails and the next adventure begins.

[1] Lokuge, S., et al. (2011). “Depression in women: windows of vulnerability and new insights into the link between estrogen and serotonin.” J Clin Psychiatry 72(11): e1563-1569.

[2] Hudon Thibeault, A. A., et al. (2019). “Serotonin-estrogen interactions: What can we learn from pregnancy?” Biochimie 161: 88-108.

[3] Lokuge, S., et al. (2011). “Depression in women: windows of vulnerability and new insights into the link between estrogen and serotonin.” J Clin Psychiatry 72(11): e1563-1569.

[4] Rekkas, P. V., et al. (2014). “Greater monoamine oxidase a binding in perimenopausal age as measured with carbon 11-labeled harmine positron emission tomography.” JAMA Psychiatry 71(8): 873-879.

The post Why Am I Crying!? appeared first on Australian Menopause Centre.

Your libido is your overall sexual drive or desire for sexual activity. There is nothing that states you must desire sexual activity 3 – 5 – 10 times a week. There is no medical minimum or limitation on libido. It is completely up to you.

Of course, if you have a partner, take them into consideration. But even they don’t decide if you have a high or low libido.

It’s your decision.

Great, now that’s off my chest, how is your libido? Have you taken a moment to check in and assess to see you are happy with your libido? If you have noticed something has changed, you’re probably not alone. Perimenopause and menopause are prime times for libido changes. And not just for the obvious hormonal changes.

As you go through perimenopause your oestrogen levels tend to dominate and your progesterone levels are very ‘hit and miss’. This can be felt through symptoms like overheating, mood swings, pain, insomnia and fatigue. Unfortunately, your libido also takes a swing. Most women in perimenopause are likely too tired, too hot or too bloated to consider intercourse, let alone initiate it.

As we hit menopause your oestrogen starts to flatline and symptoms like hot flushes, anxiety, vaginal dryness, weight gain and depression emerge, and again indirectly affect your sexual desire. Often this is the time that intercourse becomes uncomfortable due to dryness or your confidence takes a hit due to weight gain or anxiety.

Yes, the menopause journey can be a rough gig, similar to how the puberty journey can be a rough ride too. But you made it through puberty, right? You can make it through menopause.

Let’s just make a few things clear, so that you know how to manoeuvre and use these changes to your benefit.

See below for the most common reasons your libido takes a hit during the menopause journey. Assessing these factors is essential to naturally boosting your libido.

Oestrogen drop:

Oestrogen is either a love it or hate it hormone. It makes us feel young, feminine and lubricated, however it can also play a large role in period pain, breast engorgement and hip, buttocks and thigh weight gain. Whatever your thoughts on oestrogen, just know that it is the key hormone involved in vaginal lubrication. Vaginal dryness can lead to sexual pain, which can lead to anxiety or negative thoughts on intercourse, which in effect can predictably lead to a reduced desire and a reduced libido. Is vaginal dryness affecting your libido?

Testosterone drop:

A 2014 study has found testosterone to significantly improve desire, excitation, lubrication, orgasm and satisfaction of sexual function in menopausal women. Testosterone is naturally produced in the ovaries at varying levels through your whole life. Unfortunately, as menopause progresses, the ovaries retire from functioning and your testosterone levels drop. This may be a large contributing factor for menopausal low libido.

Insomnia:

Are you too tired to even care about intercourse? That’s okay. If that is the case, it’s a relatively easy fix – get some more sleep. Check what it is that is interrupting your sleep. Ensure that you are going to bed with roughly 7-9 hours before your alarm goes off. Check that your sleeping environment is perfect for you (temperature, light, noise). Check that you are relaxing efficiently before bed, allowing you to get to sleep relatively quickly. Double check you are not overdoing caffeine or sugar too close to bed. If you have done this, and you are still not getting enough sleep, speak with a health professional and ask for help.

Stress:

Two factors are involved in how stress can affect your libido – psychological (distraction) and hormonal (cortisol). Cortisol is the main hormone involved in the stress response. If you think about how smart the human body is, it’s understandable that when our body is stressed it spends more energy and diverts more hormonal stimulus into surviving that stress, rather than procreating. It’s unfortunate (especially when you take into consideration the stress relieving benefit of intercourse), but it makes sense. Building on this, the psychological and time-consuming distraction that thinking about the stress creates dampens mood, focus and enjoyment. Don’t under-estimate the dampener stress can put on your sex drive.

Feeling undesirable:

Unfortunately, menopause can lead to weight gain, wrinkles and sagging. Fortunately, ‘sexy’ is open to interpretation. Your mental decision about how sexy you are, significantly impacts how sexy you feel, your confidence, your comfort and ultimately your sexual enjoyment. Have a think about what wrinkles, sagging and ageing mean to you. Try to place a positive spin on the ageing process and embrace your beauty. Or take positive steps to regain the body you felt most sexy in.

Vaginal dryness:

If you have vaginal dryness you may find sexual intercourse painful or distracting. ‘Painful’ and ‘distracting’ are not pleasurable. This can result in a disinterest or fear of intercourse, significantly impacting your desire or willingness to partake in intercourse again. Vaginal dryness is not an indicator of sexual response. It is an indicator that your oestrogen levels have dropped (as they do with menopause) and your vaginal walls are no longer creating the lubrication needed for a healthy environment. Using a lubricant or speaking with a health professional can significantly and quickly improve your dryness.

Medication:

Some medications can do a great job at what ever they were prescribed for, but unfortunately, they can negatively affect your libido. A common example of this is antidepressants, specifically SSRI antidepressants, which are commonly prescribed through menopause. Other examples include blood pressure lowering medications and the oral contraceptive pill. If you are on medication and you are concerned it may be affecting your libido, speak with your GP to see what your alternative options are. Do not stop medication without consulting your GP.

Depression:

Depression is a symptom of menopause that many women experience. Not only is it coupled with low energy and low motivation, but it also involves a chemical soup of neurotransmitters that are lacking in the ingredients for sexual desire and interest. Depression can be sneaky and be upon us before we realise it. Unfortunately, it is very common in menopause and should not be brushed aside. Take a moment and assess to see if depression may be present in your picture. Seek support, feel better.

Relationship changes/breakdown:

Has your libido gone walkabout because you no longer have any interest in your partner? Is your relationship toxic, lonely, boring or repulsive? It might be time to have a very honest conversation and work on moving forward or moving away from each other. It’s a tough time, but menopause is a time of change and often your relationship gets involved in this fluent transition time. Has your relationship evolved with you? A change in your relationship may be the reason for your lowered libido.

Loss of sexual responsiveness/pleasure:

If intercourse isn’t what it used to be, speak up. Speak with your partner and explore new positions, temptations and foreplay. Speak with your health practitioner if pain, numbness or another issue concerns you. Sometimes hormonal imbalances, sensitivity creams or a change in scenery (not your partner, or maybe your partner) can be all that’s needed to put the spring back into your step.

As we all know, women don’t have an on or off switch. As it can take a combination of the right touch, play and words to get you in the mood, it can also take a combination of changes to keep you out of the mood. It’s often not as simple as one issue causing the problem, but more a mixture of two, three or more of the above. Have a think, speak out and spice it up.

References:

Fernandes, T., et al. (2014). “Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial.” J Sex Med 11(5): 1262-1270.

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