“We are far from where we need to be” - Dr Zoe Hodson on menopause awareness

This Menopause Awareness Month, Dr Zoe Hodson talks menopause, eating disorder recovery, and reaching out for support

Menopause Awareness Month is often a bittersweet event for those of us who work in this field. There can be a crescendo of activity ranging from social media posts, workplace and community events to releases and updates from the global Menopause Societies. It is easy to start to think that awareness is increasing and to be tempted to sit back and consider the job done. However, we are far from where we need to be, which is a world where every person going through menopause is able to access evidence-based treatment and support.

For those struggling with - or in recovery from - an eating disorder, approaching menopause can also bring extra complications or challenges. We are seeing a lot of people where neurodivergence is unmasked during perimenopause, and some research indicates a crossover between neurodivergence and the likelihood of developing an eating disorder.

While research is scant and is mostly not UK-based, binge eating disorder and orthorexia appear to be the most commonly developed during menopause, potentially linking to other mental health struggles and higher rates of body dissatisfaction during this time.

Those struggling with enduring eating disorders may also experience further adverse health affects during menopause; restricted eating is known to have a potential adverse effect on bone density. However, there are steps you can take if you have a history of eating disorders. I would suggest discussion with a healthcare professional to see whether a DEXA bone density scan should be considered. It’s also worth noting that HRT is protective of bone density and cardiovascular disease.

What is menopause and why should we all know about it?

Menopause is just one day. It is a ‘retrospective’ diagnosis and is the day a year after periods have been absent for 12 months following normal cycling. The period before this where cycles are starting to change is called ‘perimenopause’ and the time after this ‘post-menopause’.

This pertains to normal physiological menopause and the average age for this in the U.K. is 51. Around 1 in 10 will become menopausal between the ages of 40-45, approximately 3 in 100 below the age of 40, 1 in 1000 below the age of 30 and 1 in 10000 below the age of 20. There are also many who experience removal of the ovaries due to surgery (surgical menopause) or suppression of ovarian function due to medications including chemotherapy.

Just read those numbers again. That is a LOT of people who will become menopausal below the age of 45 yet we hear time and time again that ‘you are too young, you can’t be menopausal’. Studies have also indicated that many who are menopausal due to surgery and medical treatments were not given adequate or any information about menopause.

What can we do to help?

Many people find trying to follow a nutrition plan that avoids sugar highs and lows can help with symptoms. A Mediterranean style nutrition plan includes plenty of protein, mixing up the types of vegetables and fruits that we eat as well as adding healthy fats and plenty of fibre.

There is increasing awareness about the way that our gut bugs (microbiome) can impact on everything from mood to hormonal pathways and this type of nutrition supports a healthy mix of organisms. However, this of course may be much more difficult for some than others, and especially those recovering from an eating disorder. It’s important to seek extra support if you are struggling, either by reaching out to Beat’s Helpline or chatting to your GP.

Sleep quality can have a big impact on wellbeing and many of us reach perimenopause with dreadful sleep hygiene. Things that can start to help are eliminating screen time in the evenings, avoiding stimulants such as caffeine and nicotine and also having a good look at alcohol intake.

Exercise can also have a part to play in both symptom control and future health protection, though for those struggling with an eating disorder it is important to seek personalised advice, particularly if you have a history of over exercising. If you’re able, even going for a very short walk outside can have huge benefits: being out in green space is known to also help to decrease stress.

On the flip side, rest can also be crucial. Menopause can be a tough time for the body both physically and psychologically, even more so for those struggling with an eating disorder. Many find that they need more quiet time, and for those who are able, activities that support the vagal nerve system such as grounding, mindfulness, yoga and cold water exposure can really help

Psychological support can be really helpful. We know that those who have experienced previous adverse events or susceptibility to hormonal fluctuations may find perimenopause harder. Having a structured time to explore difficult issues that may resurface can help and in many areas you may be able to self-refer for these. Contact your GP Practice for more details.

Perimenopause and menopause can be tough, there is no doubt about it, but can also be incredibly rewarding. Many people that I work with or speak to comment that they have learned to let go of past destructive behaviours, they have learned to really tune in to their physical and psychological needs and they have learned to prioritise themselves and their health. This can take time and a lot of ‘unlearning’. If it feels overwhelming we often start with ‘the littles’. This involves noting 3 little changes each day that have been completed for self care. It can be anything from taking time in the morning to stand outside and do some slow, calming breathing to a hand massage with a scented oil.

It is also worth observing how interactions with others make you feel. Are you the one who says ‘yes’ to everything to the detriment of your health and wellbeing. Could you start to say ‘no’? This may be a time to start to make your own rules... and in the words of the wonderful Karen Arthur to say, ‘I am here. I am enough’.

Zoe's further reading recommendations:

www.menopausesupport.co.uk

https://www.healthywholeme.com/menopause/

https://theros.org.uk/

https://www.menopausematters.co.uk/

https://menopausesupport.co.uk/?page_id=17128