October 14th 2018
Liz Earle: "We need to separate fact from fiction on HRT"
June 18th 2018 / 0 comment
Georgia Glynn Smith for Liz Earle Wellbeing
The wellness expert busts key menopause myths and explains why she opted for Hormone Replacement Therapy. Plus, the key lifestyle changes that make all the difference
Like most women, I had no real concept of what the menopause would be like until I started to consider my own personal journey and I found it baffling that there was so little information available to me and the millions of others who were at a similar stage of life. Advice was muddled, contradictory and very often failed to explain what was happening which was what prompted me to write The Good Menopause Guide.
Why the perimenopause is stealthy….
I think it’s fair to say that the perimenopause (the years of hormonal fluctuation leading up to the menopause) can sneak up on most of us in our forties and take us by surprise – we may feel fabulous and in the peak of good health, only to become aware of niggling troublesome changes, which when pieced together like a jigsaw puzzle suddenly make sense!
Many of us find ourselves in the sandwich generation, running busy lives, raising teenage children and looking out for elderly parents while also working. We may not realise amidst all this juggling that we are in the midst of the perimenopause.
Female friends in their forties are amazed and surprised when I say that their sleeplessness, tiredness and low mood are most likely caused by shifting hormones. Particular symptoms to look out for, as well as the physical ones, include loss of confidence, anxiety and feeling tearful at the slightest upset. Strange outbursts of unexpected anger and rage can also be due to declining oestrogen levels.
There are simply dozens of symptoms associated with the perimenopause and menopause and some of the lesser known ones include hearing loss, sore mouth, yeast infections, incontinence, intolerance to alcohol/caffeine, tinnitus, dizziness, brain fog and palpitations.
The average age of the menopause is 51, with the perimenopause usually starting from around the age of 45 onwards. In some cultures, and communities, such as among Pakistani women, the average age is even earlier.
As for the ‘end’ of the menopause, every woman’s experience is as individual as a thumbprint – it may last a few months for some and up to ten years for others, and all of these time spans are considered completely normal in medical terms.
Why I opted for HRT…
For me, pretty much my only symptom of menopause was sleep disturbance and that was the one that sent me booking the doctor’s appointment. As a busy working mother of five, I can handle most of what life throws at me – but only if I get a good night’s sleep! When that started to go, I sought professional help.
As far as I’m concerned, HRT is simply topping up what our body naturally lacks as we age, as our oestrogen levels naturally decline. For me, I now have much better sleep and increased energy levels, so I can do more! The long-term health and wellbeing benefits (in terms of reduced risk of coronary heart disease, osteoporosis and even Alzheimer’s protection) outweigh the risks for the vast majority of us.
Why we’re confused about HRT
Since its arrival on the scene, HRT has divided doctors and confused menopausal women. I think it’s so important to separate fact from fiction on HRT and make women aware of what they really need to know and we’ve included a big feature on HRT in the summer edition of Liz Earle Wellbeing to help provide further clarity here.
Key facts include: HRT is a daily treatment with no cumulative effect (the day we stop taking it, our body reverts to its natural hormone level at that time and there are no ongoing benefits), there is no link between oestrogen-only HRT and an increased risk of breast cancer and taking HRT does not increase the risk of cardiovascular disease if you start taking it before the age of 60 (it actually protects against heart attacks and strokes).
We have oestrogen-receptors in our brain, so taking HRT improves mood, anxiety and depression (as well as potentially Alzheimer’s too) and should be considered as a frontline treatment before anti-depressants for mid-life women seeking help.
Previous health scares linked to an increased risk in breast cancer have now been discredited. The authors of the negative news study published 12 years ago have even publicly apologised for the misinformation (You can read menopause specialist Dr Louise Newson's analysis of this here).
That’s not to say all women can take HRT or all are suited to it. It’s important that you discuss your own personal needs with your GP or specialist doctor, which will take into account your personal health history, underlying conditions and lifestyle.
The power of a menopause diet plan
Food has such tremendous power to help and heal our changing bodies and what we choose to eat is one of the most important wellbeing factors we can control in life. My top tips and special ingredients for the perimenopause and menopause, as outlined on the Liz Earle Wellbeing website and in The Good Menopause Guide, include phyto-oestrogens, which provide oestrogen-like compounds that occur naturally in the plant kingdom.
Phyto-oestrogens can help ease many menopausal symptoms. Soya milk and soya flour, linseeds, tofu, Japanese tempeh and miso, pumpkin seeds, sesame seeds, sunflower seeds, celery and green beans all contain useful phytoestrogens and are good ingredients to work into your diet if you’re not taking HRT. It’s also important to ensure adequate iron levels (for energy), magnesium (for sleep and stress), calcium and Vitamin D for bone density and iodine for a slowing metabolism.
Why start the day with apple and cinnamon chia pots (full of magnesium and calcium), lunch on a warm green bean salad with spring onions and avocado (full of Omega 3s and prebiotics), curb your afternoon sugar cravings with a slice of my famous menopause cake, and end the day with a baked sweet potato burger made with kidney beans and chickpeas.
Other natural remedies for menopause
There’s increasing evidence from across the world that small simple additions to our everyday routines can really help with the many varied symptoms of the perimenopause and menopause. For example, a recent study of more than 3,500 women living in Latin American cities showed that women who do little or no exercise experience more severe menopause symptoms compared with those who are more active.
Leading personal trainer Michael Garry, who I spoke to as part of my research on the menopause, says there are three simple stretches we should all do every single day as we get older to protect back, leg and hip mobility. These stretches include a particular focus on hamstrings, quads and calves.
What we should tell our daughters
I’ve long highlighted to my two daughters the importance of eating a well-balanced diet and doing weight-bearing exercise, to avoid ending up with crumbling bones later in life, but I’ve reiterated this message to them further to my recent research. From our late twenties onwards, we can’t build any more calcium into our bones, so it’s a matter of bone maintenance – preserving what we have already got through diet and exercise. This is severely tested during the first five years of the menopause when nearly 10 per cent of our bone mass is lost. Weight-bearing exercises (any upright movement so pressure flows through the spine, pelvis and legs) also play a key role in strengthening bones and keeping them strong.
Menopause as a positive life stage
Nowadays the vast majority of us will live for 30 to 40 years after the menopause So, my advice is to see this time of life as a good moment to take stock and begin to appreciate who we have become and what we may still achieve and do – or even change! Personally, I feel there is much more for me to achieve and do – and the next step for me is for my Liz Earle Wellbeing magazine to go global!
We need greater openness about the menopause at work
We need to give ourselves as women far more credit for simply keeping it together and when we can’t to put up our hand and ask for help - both at work and with friends and family. If the stigma of mental health issues can be overcome to make top billing across the media, government and the public then so should the menopause - it happens to all women fortunate enough to live long enough!
A brilliant example of how the workplace might adapt comes from GP and menopause medical expert Dr Louise Newson who I have interviewed a number of times for my Wellness with Liz Earle podcast. She offers workshops to the older female police workforce across several countries and devises strategies for and raises awareness of how the menopause might affect them.