Taming Your Hormones: The Expert’s Guide To Menopause
After selling 150,000 copies of her 2014 book, Period Repair Manual, Christchurch-based naturopathic doctor Lara Briden has turned her focus to menopause. Hormone Repair Manual is an relatable guide to perimenopause and menopause. It includes sections on what to expect as you enter perimenopause, vignettes in which women share their experiences, questions to ask your doctor, advice on hormone therapies, and the diet and lifestyle changes that can help. Tonic talked with Lara to find out more.
Our society doesn’t talk a lot about menopause. Why is that?
We don’t want to hear about it. It signals ageing female bodies, which is something we’re made to feel ashamed of, [as if] we are no longer competent and trustworthy. When I started treating menopausal women 20 years ago, menopause was stigmatised. In my book I tell the story of a doctor I know, Sonia, in her late 40s and at the peak of her career. She was having coffee with colleagues and mentioned how she was sweaty because she was having a hot flush. The men in the group said in unison, “Too much information”, laughed awkwardly and changed the subject, while the younger women stayed silent. This made Sonia feel a flash of shame. She was with a group of friendly colleagues but at that moment she learnt that, for them, her experience of a hot flush was off-putting. The British Medical Association surveyed 2000 female doctors and discovered that although many experienced symptoms of menopause, few were willing to discuss it for fear [of] being laughed at or ridiculed.
Is that stigma changing?
Yes, I feel like I am part of the revolution we’ve seen around talking openly about periods over the past five years and now I think we’re headed for a revolution around menopause, as well. As Gen X hits menopause and as Millennials hit perimenopause, it's the first time it’s been talked about openly. I feel something big is shifting around it and that the Millennials are just going to jump on it! There’s a lot more awareness of menopause now and the stigma is finally being talked about – which is how you destigmatise it. It’s no longer a secret women’s business.
We are also hearing a lot about perimenopause as distinct to menopause. What is the difference?
There has been a conflation of the two – perimenopause and menopause. Perimenopause means the two to 12 years leading up to the final period and it’s a time [when you may have] three times more oestrogen [than usual in your system]. Menopause is the rest of your life, which starts after the final period, and is a time of much lower oestrogen. Perimenopause and menopause are very different periods but they get conflated. I saw this confusion in the treatments, and that’s why I wrote this book.
““Twenty years ago most of my patients had had hysterectomies – it was so common to have your uterus out. I wanted to make a bumper sticker: ‘Keep Your Uterus’.””
Are the treatments different, too?
[Sometimes] women are offered more oestrogen [during perimenopause] when they are already experiencing an increase in it, which doesn’t make sense to me or work clinically. We hear perimenopause described as a time of hormonal chaos, which gives the impression that we don’t quite know what’s going on. Actually, what’s going on is not that mysterious. For many women, progesterone is dropping and becoming low while oestrogen is fluctuating or it’s increasing, and that’s what accounts for a number of perimenopausal symptoms.
Once you understand it from that angle and perceive the process as a sequence of describable events, it will help you find the right treatment. There needs to be ways to assist with oestrogen metabolism – clearing it from the body – as well as, potentially, coming in with progesterone treatment. But it’s not established as a treatment within the medical community. They don’t see it as valid treatment.
It's hard to believe that not so long ago, hysterectomies were used to treat perimenopause.
Yes, 20 years ago, most of my patients had had hysterectomies – it was so common to have your uterus out. I wanted to make a bumper sticker: “Keep Your Uterus”. Having a hysterectomy was [intended as a treatment] for the crazy heavy periods of perimenopause. It’s less common now but then, eight out of 10 women had their uterus removed; now it’s about one in five.
Women need uteruses – they are not just for making babies. All the organs are in there together, joined – you need it for the structure of the pelvis. I like to think more women can hang on to their uterus because of [newer] strategies, such as hormonal IUDs, which didn’t exist in the ’90s as a period lightening strategy. Not that every woman gets the crazy heavy periods, but one in three go through those final few years with a really intense flow. My colleague [Canadian endocrinology professor] Jerilynn Pryor calls it the “grand finale of the ovaries” – all the fireworks of oestrogen and no progesterone to counteract it.
What’s the No. 1 symptom that your patients seek help for?
Sleep. The brain undergoes massive rewiring during perimenopause and the first few years of menopause, and that recalibration is the origin of symptoms like sleep disturbance and hot flushes. During your reproductive years your brain becomes quite used to progesterone and oestrogen. Progesterone is the hormone that calms the brain and promotes sleep while oestrogen helps brain cells use glucose for energy. Moving to the lower oestrogen state of menopause can result in a drop of up to 25 per cent in the energy and activity of the brain. It’s basically a temporary “energy crisis” while your brain adjusts and recalibrates. If you still have problems sleeping by the time you hit 60, that is not related to this remodelling of the brain and you should see a medical practitioner if you are worried about it.
What do you find most interesting about menopause?
I’m very intrigued by the evolutionary perspective on menopause – I could have written a whole book about it. Menopause is not an accident of living too long. A lot of evidence points to the fact that our ancestors evolved a longer lifespan because post-reproductive women are so valuable to the group. This phase in life has been around for a long time and has meaning.
Hormone Repair Manual by Lara Briden is published by Pan Macmillan, $34.99. Lara Briden blogs at larabriden.com
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