In the week where we turn our attention towards raising Mental health awareness, it felt fitting to write about how changes during menopause can have a significant impact on women’s mental well being.
Anxiety is the key theme for Mental Health Week 2023, which is pertinent as it's one of the top symptoms women cite when talking about their menopause journey. In fact, a 2022 study of 2000 women aged between 40 and 60 found that 50% suffered from anxiety. Additionally, 53% experienced low mood and depression and 33% reported feelings of worthlessness. [1].
For some it may be a general feeling of anxiety or unease, whilst others talk about feeling totally overwhelmed by things which previously would have been manageable. This may lead to panic attacks for some women, resulting from cortisol and adrenaline being triggered in response to the brain signalling a threat.
There is a clear link between the physiological changes happening during perimenopause/ menopause and how we feel. Evidence suggests that when our reproductive hormones (especially oestrogen and progesterone) are imbalanced for long periods across the menopause transition, mood can be directly affected.
Some interesting facts to explain some of the reasons behind this:
Oestrogen/ oestrogen levels play a key role in the synthesis and regulation of serotonin, dopamine, noradrenaline. These are neurotransmitters in the brain which directly affect our mood. [2]
Evidence suggests that oestrogen is also linked to our stress hormone cortisol. So when oestrogen declines, it may lead to increased cortisol leaving us more stressed and anxious. [3]
Progesterone- our “peaceful” hormone- affects levels of GABA. GABA is another neurotransmitter, and is known for its calming effect and importance in controlling feelings of anxiety and stress, as well as supporting sleep. [4]
Alongside these physiological changes, the psychological impact of hot flushes, sleep issues, brain fog and other symptoms can further impact mood. Also not forgetting that women of (peri)menopausal age are often juggling a whole host of responsibilities- including work, family and caring for ageing parents. It can be a significant physical and emotional burden to carry.
Such factors may mediate ongoing feelings of stress and anxiety, even after the initial “stress” triggers of hormonal changes have settled. Therefore, identifying this and understanding how we can support our nervous system as well as our hormones can be incredibly powerful during this time.
Adopting a holistic approach to menopause and mental health can be beneficial here to not only help with hormone balance, but also encourage a level of calm again. And when I talk about holistic, this doesn’t need to be instead of taking HRT. It can be an integrated approach, helping optimise the effects of hormone therapy.
Below are some nutrition and lifestyle strategies and tips which may help reduce feelings of anxiety and instill calm. I should flag, it’s not about trying to do everything at once, as that may lead to even more overwhelm. It’s about choosing a couple of things at a time to focus on which are realistic for your life and trying to make them workable.
1) Balance your blood sugars
My primary goal when working with clients is often to help them balance their blood sugar levels. When our blood sugar levels drop, our bodies respond by releasing our “fight-or-flight hormone” adrenaline and our “stress hormone” cortisol to raise levels again. You may have experienced this feeling when you're busy all day and skip a meal, causing you to feel irritable, anxious, and your heart racing. Eating regular meals and including a source of protein and healthy fat with each meal (and snack) is an effective way to avoid these blood sugar dips. For example, adding eggs and avocado to toast for breakfast or having nuts alongside an apple for a snack can be effective. “Healthy” omega 3 fats have the additional benefit of helping brain function. So adding things like oily fish, olive oil, nuts and seeds can also help improve cognitive wellbeing, memory and learning.
When we are exhausted and don’t feel our best, we often crave “the good stuff”, such as caffeine, sugar-filled foods, alcohol and refined carbohydrates (e.g. white bread, pasta). However, just be mindful that whilst this drives a quick energy release it is followed by a swift blood sugar dip. Striving to maintain steady blood sugar levels can improve not only your mood but also your energy levels.
2) Nourish your gut
Have you heard about the gut-brain axis? It refers to the communication processes between the gut and brain, which are connected by a number of nerves, including the vagus nerve. Our gut health has a significant impact on our mental health because the digestive tract is sensitive to emotions such as anxiety, depression, and happiness. This is why you may encounter butterflies in your stomach, or feel nausea before a big event. If our gut health isn’t great it can conversely impact our mental health. [5]
So how can we foster good gut health? Our gut is made up of trillions of bacteria, fungi and other microbes. These gut microbiota love whole foods and variety, so a good start is to include lots of different types of plants in your diet. Evidence shows significant benefits to our gut microbiome if we eat 30 different plants each week [6]. This could include fruit and vegetables, nuts, seeds, grains, spices and legumes.
Eating a rainbow of fruit and vegetables also nourishes our gut with fibre and phytochemicals, with antioxidant and anti-inflammatory properties. Additionally, brightly coloured fruit and vegetables (especially greens) are high in B and C vitamins which can become deficient when we are stressed, but are key for our adrenal glands. Additionally fermented foods such as kimchi, kefir, sauerkraut and miso can contain living microbes which further improves gut diversity.
3) Boost your happy hormones
Hormones such as Dopamine, Serotonin, Oxytocin and Endorphins are chemical messengers which work within the body to help promote positivity, feelings of happiness and keep feelings of anxiety and stress at bay. There are a number of ways we can boost this naturally.
For example, 95% of serotonin – our happy hormone- is produced in the gut, so taking the steps above can be hugely beneficial. Also including tryptophan-rich foods, e.g. eggs, cherries, turkey, oats as these are an important precursor for serotonin production.
Magnesium also stimulates serotonin production (and melatonin to aid sleep). It becomes depleted in times of stress, so foods such as leafy greens (e.g. spinach, rocket), wholegrains, avocados and even dark chocolate are good additions to meal times. Some women find they benefit from taking a magnesium supplement to boost levels.
It's not just about food though. Whilst we often want to hide away when feeling stressed or down, evidence shows that human connection can be an important tool in feeling calmer and happier by boosting oxytocin [7]. Additionally getting out in nature, or just doing something enjoyable like dancing or listening to a favourite track. So scheduling in a call with a friend when things seem overwhelming, or taking a taking a walk in the park during lunch break can seem like small steps but bring significant benefits.
And don't forget about the power of movement. Exercise can boost our feel-good endorphins as well as act as a stress reliever by reducing cortisol and adrenaline. Doing laps of the pool, lifting weights to music or going on a run can also be meditative, helping switch concentration to the task at hand instead of the day’s worries. There are also a number of other benefits during menopause such as with bone health, as mentioned in my previous blog.
4) Create pockets of calm
It can be difficult to switch out of "fight-or-flight" mode, which mediates feelings of stress, as soon as we wake up and carry on the day at 100 mph. Creating pockets of calm can help encourage the body towards "rest-and-digest" mode. It doesn't need to mean taking a long yoga class; taking just 5 minutes at the start of the day to listen to a meditation (e.g. Calm app) or doing a simple breathwork exercise can set the scene for the rest of your day. Or taking a few minutes out of a stressful day to step back, breathe (e.g. box breathing) and calm the vagus nerve.
I’d love to hear to hear your thoughts and how you get on with these tips. If you're interested in exploring any of the themes above or finding out more about how you can support your health through nutrition and lifestyle then please book a free 30-minute consultation with me. I’d love to help action plan with you on ways to help you feel calmer, happier and more in control of your emotions during your menopause journey.
Should you find however that you are really finding yourself struggling with consistent low mood, anxiety and mental health issues, then please do reach out to your primary healthcare provider for options on further support. Or drop me a line and I can help with suggestions on where you may find the right level of support. Please don’t suffer in silence as the right support is out there for you.
References:
[1] OnePoll. “Essity – UK’s Largest Menopause Study”, OnePoll, 14 October 2022. https://pr.onepoll.com/2022/10/14/essity-menopause-study/
[2] Barth, C. Villringer, A. Sacher, J. (2015). ‘Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods’, Front Neurosci, 20(9),37.
[3] Rubinow, DR et al.(2016). ‘Naturally occurring changes in estradiol concentrations in the menopause transition predict morning cortisol and negative mood in perimenopausal depression’. Clin Psychol Sci 2016 (4),pp.919–935.
[4] Gilfarb RA. Leuner, B. (2016). ‘GABA System Modifications During Periods of Hormonal Flux Across the Female Lifespan’, Front Behav Neurosci. Jun16(16), 802530.
[5] Clapp, M. Aurora, N. Herrera, L. et al. (2017). ‘Gut microbiota's effect on mental health: The gut-brain axis’, Clin Pract., 15;7(4):987.
[6] Leeming, E.R. Johnson, A.J. Spector, T.D. et al. (2019). ‘Effect of Diet on the Gut Microbiota: Rethinking Intervention Duration’, Nutrients, 11(12),2862.
[7] Uvnäs-Moberg, K. Handlin, L. Petersson, M. (2015). ‘Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation’, Front Psychol, 12(5), 1529.
Really helpful tips. Thank you!