Navigating Menopause: Understanding Your Treatment Options
For many women, menopause is a significant life transition that can bring both challenges and relief. As oestrogen, testosterone and progesterone levels decline, symptoms such as mood changes, vasomotor symptoms, night sweats, musculoskeletal symptoms, fatigue and brain fog can emerge, affecting daily life and overall well-being.
Life can often become overwhelming.
Fortunately, there are various treatment options available to manage perimenopause and menopause effectively.
Let’s explore these options through the real-life journey of Helena, one of my patients, a 46-year-old woman navigating this transition.
Helena’s Story: Struggling to Find Balance
Helena had always been active and full of energy, but in her 40s, she began experiencing a wave of unexplained symptoms. She was waking up at night, struggling to concentrate at work, and feeling increasingly anxious for no apparent reason. Initially, she thought stress was to blame, due to her hectic lifestyle juggling family and work, but as her symptoms worsened, she sought our help.
We completed a comprehensive assessment of her symptoms and checked her hormone levels confirming she was in perimenopause.
We discussed her lifestyle, work-life balance, nutrition, supplements she was currently taking and medical treatment options. Here is a summary of options we discussed. Our treatment plans often involve medical treatment options alongside lifestyle goals to provide a holistic approach to overall well-being. We closely worked with Helena to improve her symptom control with tailored body-identical HRT which carried a very low risk to her health and worked with her to implement lifestyle changes to improve her quality of life, resulting with her feeling like her old self again, energised, engaged and able to manage her work-life commitments with enthusiasm.
Menopause treatment options: lifestyle, medical, non-hormonal, nutrition
Exercise: A Key Component for Menopause Health
Regular physical activity plays a crucial role in managing menopause symptoms and promoting overall well-being. Exercise helps improve mood by releasing endorphins, reducing stress, and combating anxiety and depression. It also aids in weight management, which can become more challenging due to hormonal changes. Strength training and weight-bearing exercises enhance muscular strength and bone density, reducing the risk of osteoporosis. Additionally, cardiovascular activities such as walking, swimming, and cycling support heart health, which is particularly important as oestrogen levels decline. Incorporating a mix of aerobic exercise, resistance training, and flexibility exercises can help women navigate menopause with increased energy and resilience.
Recommendations from the osteoporosis foundation for preventing osteoporosis are adding weight bearing exercise 3x weekly, this can be in number of forms from walking, yoga to strength training with weights.
Nutrition: A Vital Role in Menopause Management
A well-balanced diet is essential in managing menopause symptoms, improving energy levels, and supporting overall health. Consuming a diet rich in lean proteins, healthy fats, and fibre helps regulate weight and maintain muscle mass. Calcium and vitamin D are crucial for bone health, reducing the risk of osteoporosis. Foods high in phytoestrogens, such as soy, flaxseeds, and legumes, may help balance hormones naturally. Staying hydrated and reducing processed foods, caffeine, and alcohol can also alleviate symptoms like bloating, mood swings and vasomotor symptoms and improving energy levels.. Incorporating a variety of nutrient-dense foods ensures optimal well-being during this transition.
Improving Sleep During Menopause
Sleep disturbances are common during menopause, often due to night sweats, anxiety, or hormonal fluctuations. To improve sleep quality, establishing a consistent bedtime routine, maintaining a cool and dark sleeping environment, and avoiding caffeine and heavy meals before bed can be beneficial. If night waking is problematic, relaxation techniques such as deep breathing, meditation, or gentle stretching may help ease the return to sleep. Magnesium supplementation can often be helpful. Additionally, limiting screen time before bed and engaging in regular physical activity during the day can contribute to more restful sleep. If sleep disturbances persist, we look at potential treatment options, such as cognitive behavioural therapy for insomnia (CBT-I) or adjusting HRT, may be necessary. Sleep disturbance is common when hormone levels decline as they help to regulate our sleep architecture and enable us to transition into deep restorative sleep and keeping us asleep through the night. HRT does help to improve sleep and this may need adjustments to fully manage sleep disturbance.
Weight Management in Menopause
Weight gain is a common concern during menopause, driven by a combination of hormonal changes, aging, and lifestyle factors. Declining oestrogen levels can lead to increased fat storage, particularly around the abdomen, while a slower metabolism makes it harder to maintain a healthy weight. Additionally, loss of muscle mass, poor sleep, and increased stress can contribute to weight gain. Strategies for effective weight management include maintaining a nutrient-dense diet rich in lean protein, fibre, and healthy fats to promote satiety and metabolic health. Regular exercise, including both resistance training and aerobic activities, helps preserve muscle mass and improve energy expenditure. Time-restricted eating, such as intermittent fasting, may aid in weight control by improving insulin sensitivity and reducing overall calorie intake. For women struggling with significant weight gain, GLP-1 receptor agonist medications, such as Mounjaro or Wegovy, may be an option to help regulate appetite and improve metabolic function, though they should be considered in consultation with a healthcare provider.
Correcting Nutrient Deficiencies
Nutrient deficiencies can worsen menopause symptoms, leading to fatigue, weakened bones, and cognitive decline. We often recommend blood tests to diagnose nutritional deficiencies that may be contributing to symptoms. Ensuring adequate intake of key nutrients is essential for overall well-being. Iron deficiency, especially in women experiencing heavy periods during perimenopause, can contribute to fatigue, restless legs and dizziness. Vitamin D deficiency is common and can impact bone health, increasing the risk of osteoporosis and lowing mood. B vitamins, particularly B12, support energy production and cognitive function. A well-balanced diet rich in leafy greens, lean meats, dairy, eggs, nuts, and fortified foods can help correct deficiencies. In some cases, targeted supplementation may be necessary to maintain optimal health during menopause.
Supplements for Menopause Symptom Relief
Certain supplements may help alleviate menopause symptoms and support overall well-being. Magnesium can improve sleep quality, reduce anxiety, and help with muscle relaxation. Ashwagandha, an adaptogenic herb, has been shown to reduce stress and support hormonal balance. Omega-3 fatty acids contribute to heart and brain health while also helping to manage mood swings. Vitamin D and calcium are essential for maintaining bone density, reducing the risk of osteoporosis. Additionally, B vitamins can help combat fatigue and support cognitive function. While supplements can be beneficial, it is always advisable to consult with us to determine the most appropriate options based on individual health needs. Supplementation toxicity is on the rise as people use supplements unnecessarily or at high doses.
Complementary Therapies: Supporting Overall Well-being
we explored complementary therapies to support Helena's treatment plan. Acupuncture helped her sleep better, and she incorporated herbal teas and relaxation techniques to ease stress. While these therapies do not replace medical treatments, they can complement other strategies for symptom management.
Hormone Replacement Therapy (HRT): A Gold Standard Approach for perimenopause treatment
After thorough discussions, we recommended body-identical HRT, a treatment that provides oestrogen, progesterone and possibly testosterone in forms identical to those naturally produced by the body. She started on transdermal oestrogen (applied as a gel) and micronised progesterone. Within a few weeks, her night sweats decreased, and her sleep improved.
Her blood tests showed that her testosterone level was low, we discussed the symptoms of low testosterone including low libido, poor energy, lack of motivation, poor brain focus and memory and lowering of mood. After we had optimised her oestradiol dose we added in female testosterone replacement.
HRT remains the most effective treatment for menopausal symptoms, improving bone health and reducing the risk of heart disease. However, it must be individualised based on personal and family medical history.
Non-Hormonal Treatments: Alternatives for Those Who Can’t or Prefer Not to Use HRT
While HRT worked well for Helena, one of my other patient's, Annie, had recently been treated for breast cancer and couldn’t take hormones. Instead, For Annie we turned to non-hormonal options such as cognitive behavioural therapy (CBT) for anxiety and a newer medication, Fexolinetant, which helps to reduce temperature dysregulation and prevent night sweats and hot flushes, effectively treating these symptoms had additional benefits for Annie of reducing sleep disturbance, and subsequently improved cognition and energy levels.
Finding the Right Approach - your menopause health
Every woman’s menopause journey is unique. Helena’s experience highlights the importance of working with a specialist who considers all treatment options and views health holistically. Whether it’s HRT, non-hormonal medications, or lifestyle adjustments, the right approach is the one that aligns with individual needs and medical history.
If you’re experiencing menopause symptoms, consider seeking guidance from our menopause specialist who follows evidence-based recommendations to help you navigate this phase of life with confidence and clarity.
Are you looking for expert guidance on your menopause journey? Get in touch with our menopause specialists today to discuss your options.