Menopause Q&A: Our expert Dr Khan answers your questions

hormone expert dr khan
You asked, and the wonderful Dr Khan answered your most popular hormonal questions.
This is the first in a two-part question and answer series. Watch out for the second instalment, coming soon. We’d like to thank Dr Khan for offering her expertise, support and knowledge.
I watch what I eat and exercise, so why am I still putting on weight?

Weight levels, especially over the age of 40, are multi-factorial and is not only a combination of how we move and what we eat, but stress and insulin also plays a big part as well. Other things to look out for is sleep, which is really important because sleep disruption can cause issues. So it’s not just what you’re eating, it’s also when we eat. Eating after 7pm can cause you to deposit weight around the waistline. Things you can do to help include doing some kind of activities such as core strengthening, such Pilates, or yoga for destressing, breath-work is really important for destressing as well. A lot of us might not feel stress, but unfortunately with our modern lifestyles, just going to grab groceries or doing daily errands, can cause us to feel stress psychologically, which has physiological response in releasing the cortisol hormone for woman. The response is the same as we had in caveman days and we haven’t really evolved from that. A single thought of worry or rushing can cause us to experience the same hormonal fluctuations, which will cause us to gain weight, believe it or not

Do we require testosterone and other hormones later in life?

Testosterone declines are produced by the ovaries so around the menopause it will decline. However, I do see women as early as in their 40s who can have low levels and result in low libido, low sexual drive, other symptoms such as low energy, fatigue, changes in cognitive ability, brain functions such as confidence, decision-making, focus; they can all be impacted as well. I normally start women on testosterone once I’ve established and corrected the underlying hormone imbalances and especially replace oestrogen because in the absence of oestrogen, testosterone is not as effective. I’ve done a post on low libido which covers testosterone replacement therapy, but certainly women can take it for as long as they need.

How can I kick start my metabolism?

Metabolism essentially is movement, food, sleep and stress management, and I think we can all focus on eating and moving but not many of us sleep well and not many of us are managing our stress. So I normally say no blue-light after 9pm, so no screens. You need to do something pro-active and stress reducing, so it could be a warm magnesium bath, it could be breath-work, it could be journaling, it could be connecting to something where you invest time in your body, such as not eating after 7pm is best, cutting out excessive alcohol, excessive caffeine, so just limiting to one cup in a day, alcohol to maybe two nights a week and keep moving. Even if you do an hour of exercise a day. It’s important if you’re sedentary the whole day that you keep some form of movement going. I think the biggest suppressor of metabolism is under-eating and over-exercising.

What are the signs of perimenopause?

Well, the first sign will be irregularity in your cycles and the earliest sign comes when you’re getting really heavy periods they might go on for five to seven days, you’re flooding through your pads, you’re finding you’re becoming a bit anaemic, losing iron and those are the signs that you obviously going through hormonal changes, followed by changes in your moods. So you might notice irritability, mood and anxiety and these get enhanced just before your period a week before so PMS like symptoms. If you’re getting tender breasts, bloating and you’re getting heavy periods and headaches and mood changes, we know that you are going through the early changes off the menopause and after that you’ll start getting the declining oestrogen so you will get things like a bit of hot flushes, vagina dryness, sleep disturbance, restless legs and the list goes on.

Why am I so angry all the time? It’s heart-breaking

It’s a combination of hormone imbalance with a lack of progesterone and/or oestrogen, then you also might have too much stress. It is also to do with the food we eat, and lack of movement. Connections are really important. This can be a time when we feel quite isolated and when we don’t sleep properly, and when we are in a rotten mood we will find we start to withdraw and not necessarily see people. I generally recommend psychological support as well. It’s a time for self-reflection, time for healing, time for speaking to psychologists who will help give you the tools to work on your mindset and change perceptions. A lot of women I see have either come through a divorce, or lost someone that they’ve loved; like a parent or sibling, or a close friend. All of these things can make us feel quite negative, so these are normal emotional reactions. We also tend to carry a lot of resentment and anger towards the people around us if they’ve hurt us, but in the long term that’s only going to harm us. It’s about working on forgiveness and letting go, and that takes a lot of strength and courage.

Are headaches and nausea part of menopause or perimenopause?

Yes they are. Headaches can be very frequent with fluctuations in the cycle.

I find they get worse just before your period and during menstruation. This is due to the decline in oestrogen. A lot of women come to me in their 40s with premenstrual migraines. There are lots of things you can do for that. It’s all about maintaining balanced hormones, and some may benefit from additional oestrogen to maintain that. There are also natural and herbal things you can use but they don’t really last. If you’re getting this in your early 40s, we need to look at the underlying cause of it.

How long does menopause last?

How long is a piece of string really? I’ve seen it in women in their mid-60s who are still getting hot flushes and sleep disturbance after 15 years, while I have also seen women in their mid 50s with no symptoms at all. Each women is unique.

Is itchy skin a sign of menopause?

It’s very common to get the sensation of insects crawling and that tends to be due to the decline of oestrogen, so unfortunately it is definitely a sign of menopause.