Dr Amanda Buadi
With so much in the popular media about the menopause recently, this article seeks to explore how using a Fertility Awareness Based Method can help!
WHAT IS MENOPAUSE?
Menopause is said to be established when more than 12 months have passed since a woman’s last period. The average age for menopause in the UK is 51 years although 1 in 100 women go through the menopause before age 40 and this is known as premature menopause. There are many euphemisms for the menopause – The Change or The Change of Life and The Big M to name a few, and these are very apt as menopause does signal a change from regular cycles and consistent hormones to the complete cessation of cycles. For many women, the time leading up to menopause (peri-menopause) can last up to 10 years and can be very challenging for a number of reasons. It is during this time that the woman can experience a high degree of unpredictability in her hormones and therefore also in her cycles.
WHAT IS ACTUALLY HAPPENING DURING PERIMENOPAUSE/MENOPAUSE?
A woman is born with all the eggs she will ever have. These exist as immature follicles within her ovaries. When puberty starts, Follicle Stimulating Hormone (FSH) stimulates these follicles to grow and these follicles in turn produce oestrogen which helps the lining of the womb to grow. One follicle is selected to become the main follicle and this ruptures at ovulation. The sac that contained the now ruptured follicle folds in on itself and becomes what is called a corpus luteum. This corpus luteum produces progesterone which helps stabilise the lining of the uterus. Over the course of a woman’s reproductive lifetime the follicles become less and less sensitive to the effects of FSH which leads to fewer growing follicles and less oestrogen production. The body will try and overcome this by producing higher and higher levels of FSH to get the follicles to grow, but this eventually proves futile. Fewer growing follicles leads to less circulating oestrogen and less fre- quent ovulation. This then leads to lower levels of progesterone. The lack of progesterone and less frequent ovulation leads to irregular cycles. This continues until the follicle reserve becomes insuf- ficient such that ovulation finally stops and cycles cease.
SYMPTOMS ASSOCIATED WITH PERI- MENOPAUSE/MENOPAUSE
The lack of circulating oestrogen and progesterone leads to a myriad of symptoms. Below are some common effects.
UROGENITAL
Lack of oestrogen can cause thinning and drying of the lining of the vagina which can make inter- course painful and can lead to vaginal bleeding. It can also lead to lack of libido. Low oestrogen levels can also cause weakening of the urethral muscles which can lead to urinary incontinence and increased frequency and urgency of urination.
BONE
Oestrogen is responsible for bone building so when oestrogen levels fall, bones can become thinner and fractures more common.
CARDIOVASCULAR
Oestrogen provides protection for women against heart and blood vessel disease by keeping levels of LDL cholesterol low and by making the blood vessels themselves flexible. LDL cholesterol is responsible for the fatty build up in blood vessels. Lower levels of oestrogen lead to an increase in LDL cholesterol and a stiffening of blood vessels which increases the risk of blood vessel disease –
i.e. heart attacks and strokes.
LOW PROGESTERONE
The effects of this are thought to be responsible for the mood fluctuations, sleep disturbance, loss of concentration (brain fog), lower self-esteem, breast tenderness, weight gain, fatigue, irregular cycles and spotting in the perimenopausal period. Seventy-five percent of women have vasomotor symptoms e.g. hot flushes and night sweats. While it is not entirely clear what causes these, it is thought at least in part to be due to changes in the thermoregulatory centre located in the brain – a narrowing of the temperature range outside which the body adjusts its internal temperature, hence greater fluctuations in body temperature. High circulating levels of FSH and LH due to low fol- licle reserve are also thought to contribute to these temperature changes.
HOW FERTILITY AWARENESS CAN HELP
Women who start tracking their cycles early in their reproductive lives using a fertility awareness- based method will already have mastered looking for the biomarkers which are signs of cycle health as well as cycle dysfunction. This eases the transi- tion into the perimenopausal stage as they are used to their own cycle patterns and can start to notice any changes as they happen. Cycle length variation, excessive oestrogen causing more cervi- cal mucus than usual, signs consistent with low levels of progesterone such as spotting, PMS symptoms and tail end brown bleeding as well as any other abnormal bleeding can be easily observed. Any abnormal bleeding would need to be checked out by their GP. In addition, since ovulation has not completely stopped in the perimenopausal phase, conception is still possible, so charting cycles helps to keep track of those fertile windows.
MANAGEMENT
Although neither peri-menopause nor menopause are illnesses, many women find the symptoms difficult to manage and seek treatment at this time. Managing symptoms requires a holistic approach.
HORMONE REPLACEMENT
NaproTechnology uses natural oestrogen and progesterone supplements which are bio-identical to a woman’s hormones to help these symptoms. For women who are still having menstrual cycles, these supplements are given in cooperation with the cycle. She tracks her cycles using a Fertility Awareness Based Method so that the replacement hormone is taken at the appropriate time. Women in established menopause can also benefit from bio-identical hormone replacement.
LIFESTYLE MEASURES
Good quality sleep and exercise can help with general wellbeing as well as with low mood and anxiety. Counselling or cognitive behavioural therapy can also be very effective if needed. Vitamin D and calcium supplements can help maintain bone strength. Exercise can also help prevent the bone density loss seen in osteoporosis. Caffeine, alcohol and spicy foods are known to exacerbate hot flushes so these should be kept to a minimum. For general wellbeing and to keep stress levels low, spending time doing relaxing activities – like time with family and friends and enjoyable hobbies should be increased where possible during this time.
For more information, please contact the Diocesan Marriage and Family Life Team at
mandfl@portsmouthdiocese.org.uk.
