By: Jillian Sarno Teta
Menopause can be one of the most disruptive and bewildering times in a woman’s life. Although the focus of much discussion regarding menopause tends to center around the lady hormones estrogen and progesterone, it would serve us well to extend our conversation to exactly what these hormones do, and what implications changes to them have throughout the body.
With understanding of the myriad changes that occur, it becomes possible to tailor our lifestyle to offset many of the uncomfortable symptoms that accompany menopause, like hot flashes, belly fat, brain fog, emotional changes and digestive distress.
1. Estrogen and insulin
Estrogen is an important female hormone not just for reproductive health and function, but for the impacts it has on another hormone, insulin. Insulin takes sugar out of the blood and puts it into the cells to be burned for energy. Estrogen helps keep you sensitive to insulin.
When estrogen declines, sensitivity to insulin declines, too. This means you become more resistant to insulin by the very action of going through menopause. Your body will not bring as much sugar into the cells, turning it aside and sending it to fat storage instead. This is one mechanism for weight gain and belly fat associated with menopause. Through no fault of your own, you are biochemically and physiologically less equipped to handle the amount of carbohydrates you could before.
As such, women in perimenopause and menopause need to find their new carbohydrate tipping point. You would be well served to adjust carbohydrate consumption in volume or timing (or both), and to emphasize fiber and adequate protein. This will help improve insulin sensitivity.
2. Progesterone and cortisol
Cortisol is a rather infamous hormone, connected with stress response. Cortisol is not inherently bad or good, but in menopause it becomes a big player.
Progesterone helps you buffer the negative effects of cortisol. It opposes cortisol’s action and can act as a shield between the stressed-out feelings cortisol can induce and your nervous system.
Progesterone also helps keep your waistline trim, along with estrogen. Cortisol, if left unopposed by progesterone, will strip muscle in the arms and legs and deposit fat in the middle. This, combined with increased insulin resistance, is a perfect one-two punch to gain belly fat.
Not only are women more prone to gain belly fat under this hormonal environment, they also become more sensitive to the effects from stress. They feel it worse. It sticks around longer; they can’t recover from it as well. You may notice things that never bothered you before, and that you are getting forgetful.
To help oppose cortisol, soothe the nervous system and reverse the loss of your waistline, transitioning your movement and exercise routine becomes important. Swap medium intensity/medium duration exercise – which promote an exaggerated cortisol response – for a combination of long, slow movements like walking and a combination of resistance training and sprint or interval style training. Shorter, more intense workouts will release hormones like testosterone, human growth hormone (HGH) and IL-10, which blunt the action of cortisol.
3. Testosterone, the progesterone helper
Women have testosterone too! In perimenopasue, the body will oft recruit testosterone to help with some of progesterone’s duties – like keeping the waist trim. Testosterone can also sharpen the mind and keep your mood up. In post-menopause, testosterone too begins to fall.
Lifting weights and incorporating resistance training helps increase testosterone naturally, where it can help take inches off the waistline and give a mental boost. Resistance training is critical for women, not simply for these hormonal benefits, but also to increase bone density and help balance insulin. Pushing heavy weights around really makes your muscles soak up some sugar, and thus, increase insulin sensitivity.
4. Autonomic nervous system
Your autonomic nervous system (ANS) has two branches – the sympathetic/ “fight or flight” and parasympathetic/ “rest and digest”. Together, they are responsible for bodily functions that are outside of your conscious control – heart rate, breathing rate, blood pressure, dilation and constriction of the arteries and small vessels, digestion and more.
In menopause, with the help of unchecked cortisol, your ANS becomes more irritated and more dominant toward “fight or flight”. In turn, you are less equipped to deal with this more heavily stressed nervous system.
As such, it must become your job to carve time out for self-care and de-stressing sessions. Addressing sleep concerns, going for long walks in the woods, taking baths, pampering yourself, structuring time with loved ones and engaging in activities/hobbies that fulfill you are non-negotiable steps to take to minimize a frazzled nervous system.
5. Enteric nervous system
The enteric nervous system (ENS) is the proper name for your Second Brain – the network of nerves that is in your digestive tract and monitors and manages all aspects of digestion.
With your autonomic nervous system in sympathetic overdrive, your Second Brain feels these effects exquisitely. Increased gas and bloating, constipation, diarrhea, heartburn, appetite changes, feeling full faster, belching, indigestion, queasiness and worsening symptoms of IBS (irritable bowel syndrome) are extremely common in menopause.
Thirty percent of women have IBS symptoms, which means thirty percent of menopausal women have IBS symptoms, too.
With your Second Brain under the influence of your ANS, motility problems easily show up. This means not just problems pooping, but more reflux and cramping too. You may not produce as much digestive enzymes, leading to belching, gas and bloating.
Helping soothe your ANS will also help soothe your Second Brain and gut. Be sure to sit when you eat and chew your food really well. You may want to consider a digestive enzyme with your meals, particularly if you have increased bloating, gas and belching and if you are seeing undigested food in the stool.
This topic warrants its own section, it is so common. Common does not mean normal, however. With rates of constipation so high, and so much money spent on laxatives and digestive aids, it may feel like no big deal.
However, constipation is a major barrier to fat loss. Constipation reduces the ability for you to metabolize and appropriately detoxify many hormones, including estrogen. Thus, constipation will worsen many hormone-related symptoms, including those of menopause. Severe constipation (fewer than one bowel movement per week or less) increases the risk of cardiovascular disease in women. Did you hear me?
Most cases of constipation are functional in nature, meaning they are due to the general state and environment of many aspects of the gastrointestinal system and the body at large, and not just a case of too little fiber.
Sometimes, fiber actually makes constipation worse! Adequate protein, water and fat are also keys for bowel regularity; as are micronutrients like minerals and electrolytes. Movement, in the form of walking and exercise sessions, also helps to keep things regular.
Magnesium glycinate is a safe, gentle constipation helper that has other beneficial side effects like: helping with sleep, blood sugar balance and loosening tight muscles. Taking 300-400mg before bed can help you sleep and set you up for a bowel movement in the morning.
7. Gut bugs
Even your healthy beneficial bacteria, that reside in your gut, feel the effects of menopause! Estrogen and progesterone are sources of fuel for your bacteria. As they begin to decline, you can also have a decline (temporary or permanent) in your healthy gut flora. In fact, this happens each month before menses, which is part of the reason why bowel changes are common in the premenstrual time.
If your good gut guys decline in variety or numbers, this is a problem. One, it leaves your gut open to other, perhaps unsavory characters moving in and setting up shop. A less diverse microbiome is more vulnerable to frank infection, and will create more gastrointestinal symptoms, including motility and regularity issues.
An imbalance in the healthy flora – whether it is a low number of good guys, infection, or a higher number of bacteria that can be bad for you depending on context – is called dysbiosis. Dysbiosis is common in menopause and a cornerstone of IBS.
Bacteria are very responsive to their local environment, so in a constipate state, the bacteria that thrive in a slow transit locale will thrive and crowd out other guys. This will reinforce constipation.
You want your gut flora robust with high numbers of good guys, and a wide variety of strains. These guys provide innumerable functions for your body. Up to twenty percent of thyroid hormone is converted to the active form by action of the gut flora.
Directly and indirectly, your gut flora plays a big role in how you feel. To help your gut flora be as diverse and strong as possible, you want to eat a wide variety of vegetables and fruits, green tea and fermented foods and drinks. Fermented foods like kombucha and sauerkraut provide supplemental beneficial bacteria to your microbiome. Women with IBS or other digestive concerns should strongly consider a probiotic in addition to these other suggestions.
When we take a broad vision of the consequences of menopause in all of the body’s systems, as an integrated whole, we begin to see patterns that emerge and guide us in action as to what to actually DO to help offset the less-than-desirable symptoms that result.