MENOPAUSE MIDDLE
From the three causes to why going on diet is a bad move, how to beat weight gain in menopause like Lisa Snowdon
THE hot flush, arguably the most recognisable symptom, is the tip of the menopausal iceberg, experts say.
There are at least 48 symptoms, encompassing physical and mental changes, according to GenM.
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They start in perimenopause – where hormones decline but periods occur – and can last years after your final period.
Dr Sarah Ball, GP and specialist at Health in Menopause, told Sun Health: “On average symptoms last somewhere between seven and eight years.
“About a third of women will have symptoms beyond age 60, ten per cent will have symptoms forever.”
Just before World Menopause Day Susan Griffin and Vanessa Chalmers take an in-depth look at the complicated issue.
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AGE AND STAGES
THE age at which a woman starts to notice symptoms varies.
In 90 per cent of cases, the signs begin to creep in from the early to mid-40s.
Dr Ball explains: “Your symptoms tend to come and go because your ovaries are only working some of the time.
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“You might think you had imagined it, and then you feel rotten again for another few days.
“Gradually, the days you experience symptoms become more frequent, and the good days less so.
“Progesterone, a calming hormone which helps to control periods, actually drops first.
“That’s why often the first symptoms in perimenopause are poor sleep, anxiety and problematic periods.”
Soon afterward, oestrogen levels start to fluctuate “like a rollercoaster”.
Dr Ball says: “That’s when we start to get the larger range of symptoms like the hot sweats and flushes, joint pains or the genital urinary problems.”
A year after your last period, a woman is deemed to have reached menopause – and it’s a sign that the ovaries have fully stopped functioning.
Dr Ball says: “Once you get to menopause, both of those hormones are low forever, so they’ll stay low unless you choose to replace them with treatment.”
STILL TABOO
MENOPAUSE has been in the spotlight, thanks to the likes of Davina McCall, Lisa Snowdon and Carol Vorderman speaking out.
For years, hot flushes and night sweats were the only symptoms women talked about.
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But, Dr Ball points out, there are more common signs that go unmentioned.
She says: “It’s because women haven’t made the connection.
“It’s usually the psychological issues — low moods, anxiety the rage, the loss of confidence.
“Then there are symptoms almost nobody dare mention, as they relate to things like vaginal dryness, poor sex drive, incontinence or cystitis.”
Menopause fundamentally changes how a woman’s body works in the second half of their life.
Dr Ball says: “Generally after menopause, we make more cholesterol, our blood pressure goes up, we don’t process sugar as well and our bone density reduces.”
‘MENO MIDDLE’
ONE common symptom is the “meno middle”, extra weight you pile on around your tum.
It affects more than half of women, according to a survey for The Sun’s Fabulous Menopause Matters campaign.
Supporter of the campaign, Lisa Snowdon said she put on three stone “out of nowhere”.
In her book, Just Getting Started: Lessons In Life, Love and Menopause, she said: “Feeling bigger affected my confidence massively.”
Lisa fought to lose around two stone with a change in exercise and diet, but says she has largely “come to terms” with the fact she won’t shift it all.
It might sound superficial to worry about gaining weight, but the “meno middle” poses potential health risks, too.
Dr Ball says: “Weight gain is associated with a greater risk of various types of disease.
“For example, being overweight is a well-recognised risk factor for breast cancer.
“It places strain on our musculoskeletal system and can have a negative impact on issues such as incontinence.
“It can also have psychological impacts.”
WHY IT HAPPENS
THE causes of the “meno middle” are a combination of hormonal, lifestyle and metabolic factors.
Dr Ball says: “When oestrogen declines our body responds with a survival instinct mechanism to try to increase oestrogen in a way that doesn’t involve the ovaries.
“So it increases production of fat cells, as these cells produce a weaker, less healthy type of oestrogen.”
Fat begins to build up around the belly, not the hips and thighs.
Dr Ball adds: “We also lose bone density and muscle, which leads to a reduced basal metabolic rate.
“This means that even if we continue to eat the same, and exercise as before, we are likely to gain weight.”
Sound familiar? Dr Ball continues: “Changes in the gut microbiome can affect weight gain, as can disturbed sleep leading to daytime tiredness and the urge to reach for a sugary snack.
“Women who lead sedentary lifestyles, consume high sugar and processed foods, or have chronic stress might be more prone [to weight gain].”
It might feel overwhelming, but Dr Ball says understanding where menopausal weight gain comes from allows us to tackle it better.
DITCH THE DIET
RESTRICTING yourself or going on a diet is the worst thing you could do, warns menopause nutritionist Charlotte Hunter.
She says: “Just like overdoing it at the gym, low-calorie diets can add more stress to an already overburdened system.
“It may also not effectively address hormonal changes and metabolism during menopause.”
Charlotte suggests moving to a Mediterranean diet — low in alcohol and sugar, full of lean proteins, healthy fats, and seven to ten portions of vegetables per day.
A balanced meal — which helps nourish the body and its fluctuating hormones — has protein, complex carbohydrates and fats.
Charlotte says: “Snacking isn’t necessary if you have well-rounded meals.”
Lisa says she watches what she eats but makes sure she isn’t restrictive. She finds intermittent fasting worked for her, adding: “There are days when I am stricter with myself, and there are days when I say yes to that dessert.”
WALK THIS WAY
WALKING is one of the simplest ways to battle the bulge without putting stress on your body while elevating your mood.
Lisa said she “walked for miles” to shift the pounds – but any extra steps in your daily life will be beneficial.
Dr Suzanne Bartlett Hackenmiller, chief medical advisor at AllTrails, says: “It can increase your heart rate and activate endorphins for a mind and body boost.
“This contributes to increased energy, relaxation, and improved hormonal balance, which can ease the transition period of menopause.”
Studies show that within the first five minutes of being outside, you will experience improvements in mood.
Add strength and aerobic exercise by incorporating hills into your route.
To feel safer and more comfortable, seek out walking groups and resources.
SALIVA SAVIOUR
NINE in ten women didn’t know changes to taste and smell could be symptoms of menopause, a survey found.
It’s a result of oestrogen, a natural lubricant in the body, dropping.
This can contribute to weight gain.
Menopause nutritionist Emma Bardwell says: “Saliva plays a key role in breaking food down into chemicals that our taste buds then translate as flavours.
“Lack of saliva can lead to dry mucous membranes, which affect what we taste (or don’t taste).
“It’s why women often crave sweeter, saltier, spicier foods that have more of a kick.”
Use herbs and spices in cooking. Emma says acidic flavours, such as lemon juice or balsamic vinegar, help stimulate saliva production.
PICK IT UP
WEIGHT training is the first tip Aroosha Nekonam, certified personal trainer at Ultimate Performance, gives clients in menopause.
She says: “Training with weights increases muscle mass and improves everything from cognitive function to insulin sensitivity.”
The hormone insulin regulates blood sugar, which rises whenever we eat. Dr Ball says: “Women are more prone to ‘insulin resistance’ around and after menopause which leads to more fat storage.
“There is an increased risk of cardiovascular diseases and diabetes due to insulin resistance.”
Aroosha says weight training three times a week is sufficient to stimulate muscle growth.
A good place to start is a programme that works your full body, with a split of upper and lower body moves.
She says: “Prioritise compound exercises, which are exercises that work multiple muscle groups at the same time, such as squats, deadlifts, lunges, incline bench presses and weighted split squats.”
Instead of low weights with lots of repetitions, aim to progress to heavy weights over time with five reps or more.
Lisa said she varies her workouts as much as possible, including lifting weights.
YOUR MIND MATTERS
IT is just as crucial to consider the toll menopause takes on mental health, which ties into how you care for your body.
Emma McElhinney, founder of Team Eat Move Win, says: “In your 40s and 50s, it’s common to feel like ‘nothing works’.
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“Looking in the mirror and not recognising the reflection can prompt an identity shift leaving you thinking, ‘Who even am I?’”
Emma says women can feel guilty about prioritising themselves, yet doing so can reduce stress.
She advises being open-minded to changing past beliefs, like, “I just need to eat less and move more”.
Instead, think about what it is that you want to achieve — do you want to feel healthier, happier, more in control?
Then ask yourself what’s in the way, whether it be overtime at work, drinking too much alcohol or taking on all the housework.
DON’T SUFFER IN SILENCE
THERE’s no threshold for how “bad” a woman’s symptoms need to be before she seeks help.
Dr Ball is clear – ignoring symptoms may lead to some getting worse, especially those that affect the bladder and vagina.
There are a number of treatment options, and doctors should work with patients on a case-by-case basis to find the most suitable, she adds.
Hormone replacement therapy, which literally replaces lost hormones, can help prevent the worsening of symptoms.
Dr Ball explains: “If you introduce it to a body that is still healthy, it can help keep it that way. It’s a bit like a preservative.
“If you wait until the problems have already become established, it’s a bit harder to reverse them.”
It’s not a “miracle” cure, and must be used in conjunction with a healthy lifestyle.
She says: “If you eat McDonald’s, smoke and drink alcohol, HRT isn’t going to achieve much.
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“A healthy lifestyle will almost certainly make symptoms more bearable.”
That means a balanced diet, more exercise and plenty of sleep, she adds.
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