Sleeping well

This is a great place to start. One of the most important building blocks to living a healthy and productive life is getting a good night’s sleep, ever y night. Unfortunately, for many perimenopausal or menopausal women this is an elusive, ‘if only…’ aspiration.

A lack of sleep – for example, 4-5 hours a night instead of 7-8 hours – can have a negative effect on how your brain functions and exacerbates brain fog and memory difficulties. It can also lower your immunity and increase your risk of developing heart disease and cancer. There is no system in your body or aspect of wellness that gets away unscathed by a lack of sleep.

Sleep is not like your bank account – if you accumulate a debt (after a few nights of poor sleep) you cannot make up for it by paying in credit and having lots of sleep over the weekend, or a nap in the afternoon, for example. This binge-purge style is common to many, but research shows those who follow this pattern are twice as likely to report poorer health in the future.

Because good sleep is absolutely essential to your health, it is worth doing all you can to maximise those precious hours in bed. Research shows the two most effective changes you can make are:

A) Keep your bedroom cool – it is much easier to get to sleep and stay asleep if you are on the cool side of comfortable rather than warm. A room temperature of around 18°C is recommended as ideal for a good night’s sleep. You may find avoiding hot drinks before bed and having a fan in the room helps with any hot flushes or night sweats.

B) Regularity is key – a consistent routine is like an anchor to your sleeping patterns. Go to bed at the same time every night and wake up and get up at the same time every morning – yes, even at the weekends if you are serious about establishing better sleep! A consistent routine improves not only the quantity of sleep but the quality too, leading to a real difference in how your body will function and how you feel during the day. Other things to avoid to improve your sleep are alcohol, caffeine or any drugs, such as marijuana. While alcohol or marijuana may help you get off to sleep, they are sedatives, so they only give you an artificial kind of sleep which does not have the same physiological benefits as ‘natural’ sleep. They also block your dream sleep, or REM sleep, which is essential for emotional and mental health.

Managing low mood, anxiety and stress

The perimenopause and menopause can bring a host of changes to how you feel about yourself, your mood, emotions, and levels of motivation. You may not have been someone that ever struggled with feeling anxious but now find you’re worrying over things for the first time. It’s really common to experience anxiety, low mood, mood swings, and a lack of interest or drive in doing things you usually enjoy. While this is predominantly caused by a reduction in hormones (and therefore hormone replacement/HRT can be very effective at relieving many of these feelings), there are some other things that can help too.

For low mood, mood swings and a lack of motivation:

The perimenopause and menopause can bring a host of changes to how you feel about yourself, your mood, emotions, and levels of motivation. You may not have been someone that ever struggled with feeling anxious but now find you’re worrying over things for the first time. It’s really common to experience anxiety, low mood, mood swings, and a lack of interest or drive in doing things you usually enjoy. While this is predominantly caused by a reduction in hormones (and therefore hormone replacement/HRT can be very effective at relieving many of these feelings), there are some other things that can help too.

1. Sleep well – did we mention this already?!

2. Eat right – take a look at our diet section

3. Cut out – smoking and excessive alcohol drinking

4. Get out – make time for regular exercise and leisure time

5. Check in – meditation has been found to improve symptoms associated with low mood by lowering cortisol – the stress hormone. This allows your body to produce more of the happy hormones such as serotonin and dopamine. This might only be a 5 or 10-minute, daily period of mindfulness, or checking in with yourself, slowing down, breathing more deeply and being aware of your emotions and your surroundings. There are some great apps for mindfulness and meditation.

6. Meet up – seeing friends or family may be the last thing you feel like doing on some days, but moments of social connections are really important for your mental health and overall wellbeing. Bonding with other people actually helps you release more mood boosting hormones.

7. Get support – if you’re regularly struggling with feeling low and don’t feel like doing any of the things you normally enjoy, see someone about it and talk through your options – this might be a health professional or a counsellor for talking therapy. Make it a priority to get the help you need to start feeling like yourself again.

For worries, anxiety and stress:

1. Challenge your thoughts – negative thoughts and worries can often take control of the way you think and feel. When you find yourself having these thoughts, challenge them, question if they’re really true and think of practical actions around the worry that would help you feel more in control.

2. Slow down and breathe – deep breathing has a positive impact on many emotional and psychological symptoms. Breathe in to a count of 4, and out to a count of 4. Even just 2 or 3 minutes of doing this will help you feel much calmer and it’s a great ‘go to’ technique for those times of overwhelm.

3. Keep a note – you may not have written a diary since you were a teenager but writing down some of your thoughts can really help them be less bothersome, especially at night. It helps to look back and acknowledge how worries don’t usually come to pass and see the progress you’ve made at overcoming negative thinking.

4. Take a break – walking away from a situation can help clear your mind and make you feel calmer about what you’re facing.

If you experience panic attacks here are some helpful hints at dealing with these, specifically:

1. Recognise what’s happening – this can help reduce the fear and severity of it.

2. Focus on your breathing – breathe in for 4 and out for 4 and keep focussed on just doing this.

3. Find your focus – if it’s hard to focus on breathing find something small and trivial in your surroundings to focus on to distract yourself as you wait for the panic to subside.

4. Relax your muscles – think through and relax every muscle of your body, starting with your fingers and hands, up to your face and jaw and down to your feet and toes.

5. Picture your happy place and imagine every detail of it, this will distract you while you slow your breathing down.

Prioritising exercise and leisure time

It is estimated that 40% of adult women in the UK don’t get enough exercise, putting them at risk of a raft of health problems including type 2 diabetes, hear t disease and cancer. This figure is probably higher for menopausal women and it is completely understandable as energy, motivation and mood can be at an all- time low during this time. However, the benefits of regular exercise that raises your heart rate and moves and impacts on your joints are too important to ignore.

Benefits of exercise

1. It improves your bone health – bones get stronger as you use them and give them work to do. Aim for a combination of weight-bearing exercise with impact, and muscle strengthening exercise (see our ‘Lifestyle for healthy bones’ booklet for more information).

2. It maintains muscle mass – you lose muscle mass as you get older and regular exercise can slow this down, lowering your risk of falls and fractures.

3. It helps heart health – going through the menopause puts you at greater risk of diseases of the heart and blood vessels if you do not take HRT. Regular exercise helps to maintain healthy cholesterol and reduce the risk of high blood pressure and heart disease.

4. It helps your mood – as discussed, regular exercise can really help how you’re feeling, lift your mood, help you de-stress and give you more energy and motivation.

5. It helps you stay a healthy weight – falling levels of estrogen can lead to greater fat distribution around your middle (which in turn raises risks of heart disease, diabetes and cancer) and some menopausal women find their weight creeps up – perhaps because they’re doing less exercise due to their achy joints, or they’re drinking more alcohol to help unwind or get off to sleep. It helps you stay a healthy weight – falling levels of estrogen can lead to greater fat distribution around your middle (which in turn raises risks of heart disease, diabetes and cancer) and some menopausal women find their weight creeps up – perhaps because they’re doing less exercise due to their achy joints, or they’re drinking more alcohol to help unwind or get off to sleep.

Leisure time

As well as having regular exercise for hear t and bone health, spending time doing things you enjoy will have a beneficial effect on your symptoms and how you’re feeling. Whether that is going for a long walk with a friend or spending some much-needed time by yourself enjoying a hobby – without demands being made on you. These activities are really important for your wellbeing and relaxation. You are more likely to stick to activities you enjoy, and we often exercise more when it is a social activity and we do it with a friend.

Eating Well

Benefits of a well-balanced diet

Eating a well-balanced diet has a multitude of benefits for your menopause and future health. The right foods can help combat fatigue and give your energy levels the boost they need. Without estrogen, your bones need extra nourishment from your diet to stay strong. And to maximise your health in the future it is important to maintain a healthy weight – which may feel harder to achieve than it used to.

Mediterranean diet principles

A great place to start looking for a menopause friendly diet is one that follows Mediterranean diet principles; this is high in vegetables, nuts, beans, cereals, fish (or other sources of omega 3 oils) and unsaturated fats (like olive oil). It is a diet that is low in processed foods, meat and dairy foods, and low in salt and sugar.

Low GI carbs for mood balance

Try to avoid white refined carbohydrates such as in white bread, white rice and pizza, as this causes a rapid release of blood glucose – which can exacerbate mood swings. Changing to low GI (glycaemic index) carbohydrates such as wholegrain bread, brown rice, pulses, beans or sweet potatoes and plenty of low GI vegetables such as salad or greens will help maintain blood sugar levels. You might also find smaller meals more regularly helps keep mood swings in check.

Importance of calcium and vitamin D

Ensure your diet contains plenty of calcium and Vitamin D; this is not only .essential for your bone health, but it will help stabilise your emotions and moods too.

Gut-friendly foods

Many women suffer from bloating, cramps and other IBS-like symptoms during the perimenopause and menopause. Research is revealing more and more about the importance of a healthy gut and its influence on hormone health and our emotional wellbeing. Eating a diet rich in fibre encourages the growth of ‘friendly’ bacteria which will aid energy levels, immunity, and weight maintenance. Healthy bacteria also have a role in production of serotonin which can improve your mood.

The main foods good for gut health are prebiotic and probiotic foods. Prebiotics stimulate the growth of good bacteria in the gut. Examples of these are garlic, onions, asparagus, chicory, ginger, cabbage, beetroot, bananas, blueberries, and apples.

Probiotic foods contain live bacteria and yeasts which are believed to help restore the natural balance of bacteria in the gut. Examples of probiotic foods are kefir, live yoghurt, kombucha, sauerkraut, kimchi, natto and live apple cider vinegar.

Supplements containing probiotic bacteria can be beneficial, such as lactobacillus acidophilus which is a bacteria normally found in the gut and has an important role in your immune responses. It can also help IBS type symptoms such as bloating or diarrhoea, it aids some allergies, and it may even help lower cholesterol levels.

Cutting down on alcohol and smoking

When discussing improving habits for a better menopause it would be remiss not to mention the impact alcohol and smoking has, not only on your menopausal symptoms but also on your future health.

As you age, your body becomes more sensitive to alcohol because it holds less water to dilute it. Alcohol may help you unwind or forget about your worries for a moment, but it has a negative effect on your mood and mental health in the long run.

There is a fine line between a ‘moderate’ amount of alcohol that is not associated with increased health risks and an excessive amount that has many potential risks. Research shows anything more than one small glass of wine per day (or one beer or single shot of spirit) can be identified as ‘excessive’.

Drinking more than this amount increases your risk of many types of cancer, heart disease, liver disease, osteoporosis (bone-weakening disease) obesity and depression. Many menopausal women find that alcohol increases the number or severity of hot flushes or headaches, and it negatively affects the quality of your sleep, as discussed.

Likewise, smoking is associated with similar risks for your future health; you are more likely to develop heart disease, cancer, and osteoporosis if you smoke. The risks of these diseases increase anyway for all women as they age, but if you smoke the risk is much higher. Some studies have shown hot flushes are more frequent or severe in smokers than non-smokers, and smoking may even bring on an early menopause.

Take a look at all aspects of your life and make some positive changes to the ones you feel are most important to you and your wellbeing. It might be worth first trying to improve your sleep, energy levels and motivation for example, and then you will feel ready to tackle habits such as smoking or your weekly alcohol intake. Using a focussed, realistic approach that addresses one or two things at a time will be more successful than a scatter-gun attempt at improving everything in a single burst.

Work and relationships

Aspects of your sleep, emotional wellbeing, exercise and diet have been addressed to provide information on how you can optimise your life choices for a smoother menopause. Two other significant areas in your life that can be hugely impacted by your menopause are your work and your relationships. These aspects also need special care and attention at this time and there is much that can be done to minimise this impact.

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