By Dr Anita Sturnham, GP
An internationally renowned doctor specialising in dermatology and anti-ageing medicine
By the time a woman enters perimenopause, it can be difficult to determine which signs are the result of common midlife events such as children going through school exams or leaving home, ageing parents with health issues, bereavement, relationship breakdown, career changes etc, or the result of declining hormone levels. Here is a summary of common signs women may experience in the perimenopause and menopausal years.
Up to 50% of perimenopausal women will suffer from sudden hot flashes. Untreated this tends to settle a year or so after menopause but in 10-15% of women, this can persist well into the postmenopausal period. The reasons for the hot flashes are multifactorial. Declining oestrogen impacts an area of our brain called the hypothalamus. This is our temperature control centre. Fluctuating hormone levels confuse the hypothalamus so that it thinks the body is overheating when it is not. This triggers a process called vasodilation, which causes the flushing. Many women get relief from hot flashes after being prescribed a contraceptive pill in perimenopause and some doctors may recommend hormone replacement therapy, particularly in women as they approach their 50’s or enter the post menopausal period.
Over 50% of perimenopausal women experience sleep problems. There are many reasons why sleep can become disturbed. Hot flashes most certainly exacerbate the issue but there are also hormonal triggers at play. Progesterone is an important hormone when it comes to sleep. It switches on GABA receptors in the brain, which can help to calm nerve cell hyperactivity and this promotes a calm state, which is more conducive to sleep. As Progesterone is produced when we ovulate, the perimenopausal period sees less frequent ovulation and post menopause this stops completely, resulting in progesterone deficiency.
As Oestrogen declines, the production of Melatonin, a hormone that is made by the pineal gland in the brain and helps control your sleep patterns also declines. The Hypothalamic Pituitary Axis (HPA) is a communication system that sends signals from the brain to the adrenal glands. It controls many hormone signals including the production of cortisol, which should be high in the morning to give us energy and drive and lower in the evening / night, allowing us to switch off and sleep. Many women in perimenopause and early post menopause experience elevated night-time cortisol levels, which also adds to the sleep disturbance.
Magnesium contributes to a reduction in tiredness and fatigue
We need Oestrogen to make healthy collagen, the important structural protein that supports skin elasticity. Oestrogen is also needed for skin hydration as it helps to make ceramides, the lipids that are responsible for helping our skin to retain moisture. As hormone levels decline, skin is prone to thinning (atrophy) and dryness all over the body and this can become an issue in the vaginal region. Urogenital tissues are extremely sensitive to oestrogen so as levels drop the dryness can lead to itching and irritation. Thin, sensitive skin and lack of lubrication can also be a source of pain during intercourse, contributing to a decline in sexual desire at this stage of life. The urinary tract also contains oestrogen receptors in the urethra and bladder, and as oestrogen declines many women start to get urinary tract infections and may also experience incontinence.
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Part 2 to follow