What are the most common symptoms of menopause? And which can hormone therapy treat?
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Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.
Adding to the uncertainty, a recent series in the Lancet medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.
So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.
Remind me, what exactly is menopause?
Menopause, simply put, is complete loss of female fertility.
Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).
Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.
Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).
What are the most common symptoms of menopause?
Our study of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:
- hot flushes and night sweats (known as vasomotor symptoms)
- disturbed sleep
- musculoskeletal pain
- decreased sexual function or desire
- vaginal dryness and irritation
- mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.
However, none of these symptoms are menopause-specific, meaning they could have other causes.
In our study of Australian women, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.
But the severity of these symptoms varies greatly. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.
So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are similarly affected.
Maridav/Shutterstock
Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.
The most robust guidelines do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of menopausal hormonal changes.
The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. Some studies suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) have not been shown to change.
Who might benefit from hormone therapy?
The Lancet papers suggest menopause hormone therapy alleviates hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).
In contrast, the highest quality clinical guidelines consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.
Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).
Monkey Business Images/Shutterstock
However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.
Despite musculoskeletal pain being the most common menopausal symptom in some populations, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.
Some guidelines, such as an Australian endorsed guideline, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.
What are the risks?
The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.
Oestrogen-only menopause hormone therapy is consistently considered to cause little or no change in breast cancer risk.
Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer, although any risk appears to vary according to the type of therapy used, the dose and duration of use.
Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels prescribed at standard doses
What if I don’t want hormone therapy?
If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.
In Australia, most of these options are “off-label”, although the new medication fezolinetant has just been approved in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).
Unfortunately, most over-the-counter treatments promoted for menopause are either ineffective or unproven. However, cognitive behaviour therapy and hypnosis may provide symptom relief.
The Australasian Menopause Society has useful menopause fact sheets and a find-a-doctor page. The Practitioner Toolkit for Managing Menopause is also freely available.
Susan Davis, Chair of Women’s Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Vitamin C (Drinkable) vs Vitamin C (Chewable) – Which is Healthier?
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Our Verdict
When comparing vitamin C (drinkable) to vitamin C (chewable), we picked the drinkable.
Why?
First let’s look at what’s more or less the same in each:
- The usable vitamin C content is comparable
- The bioavailability is comparable
- The additives to hold it together are comparable
So what’s the difference?
With the drinkable, you also drink a glass of water
If you’d like to read more about how to get the most out of the vitamins you take, you can do so here:
Are You Wasting Your Vitamins? Maybe, But You Don’t Have To
If you’d like to get some of the drinkable vitamin C, here’s an example product on Amazon
Enjoy!
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Overcome Front-Of-Hip Pain
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Dr. Alyssa Kuhn, physiotherapist, demonstrates how:
One, two, three…
One kind of pain affects a lot of related things: hip pain has an impact on everything that’s connected to the pelvis, which is basically the rest of the body, but especially the spine itself. For this reason, it’s critical to keep it in as good condition as possible.
Two primary causes of hip stiffness and pain:
- Anterior pelvic tilt due to posture, weight distribution, or pain. This tightens the front muscles and weakens the back muscles.
- Prolonged sitting, which tightens the hip muscles due to inactivity.
Three exercises are recommended by Dr. Kuhn to relieve pain and stiffness:
- Bridge exercise:
- Lie on a firm surface with your knees bent.
- Push through your feet, engage your hamstrings, and flatten your lower back.
- Hold for 3–5 seconds, relax, and repeat (10–20 reps).
- Wall exercise with arms:
- Stand with your lower back against the wall, feet a step away.
- Tilt your hips backwards, keeping your lower back in contact with the wall.
- Alternate lifting one arm at a time while maintaining back contact with the wall (10–20 reps).
- Wall exercise with legs:
- Same stance as the previous exercise but wider now.
- Lift one heel at a time while keeping your hips stable and your back against the wall.
- Practice for 30–60 seconds, maintaining good form.
As ever, consistency is key for long-term relief. Dr. Kuhn recommends doing these regularly, especially before any expected periods of prolonged sitting (e.g. at desk, or driving, etc). And of course, do try to reduce, or at least break up, those sitting marathons if you can.
For more on all of this plus visual demonstrations, enjoy:
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Take care!
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Kombucha vs Kimchi – Which is Healthier
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Our Verdict
When comparing kombucha to kimchi, we picked the kombucha.
Why?
While both are very respectable gut-healthy fermented products,
• the kombucha contains fermented tea, a little apple cider vinegar, and a little fiber
• the kimchi contains (after the vegetables) 810 mg sodium in that little tin, and despite the vegetables, no fiber.You may reasonably be surprised that they managed to take something that is made of mostly vegetables and ended up with no fiber without juicing it, but they did. Fermented vegetables are great for the healthy bacteria benefits (and are tasty too!), but the osmotic pressure due to the salt destroys the cell walls and thus the fiber.
Thus, we chose the kombucha that does the same job without delivering all that salt.
However! If you are comparing kombucha and kimchi out in the wilds of your local supermarket, do still check individual labels. It’s not uncommon, for example, for stores to sell pre-made kombucha that’s loaded with sugar.
About sugar and kombucha…
Sugar is required to make kombucha, to feed the yeast and helpful bacteria. However, there should be none of that sugar left (or only the tiniest trace amount) in the final product, because the yeast (and friends) consumed and metabolized it.
What some store brands do, however, is add in sugar afterwards, as they believe it improves the taste. This writer cannot imagine how, but that is their rationale in any case. Needless to say, it is not a healthy addition, and specifically, it’s bad for your gut, which (healthwise) is the whole point of drinking kombucha in the first place.
Want some? Here is an example product on Amazon, but feel free to shop around as there are many flavors available!
Read more about gut health: Gut Health 101
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The Metabolism Reset Diet – by Alan Christianson
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The liver is an incredible organ that does a very important job, but what’s not generally talked about is how we can help it… Beyond the obvious “try to not poison it too much with alcohol, tobacco, etc”. But what can we do that’s actually positive for it?
That’s what Alan Christianson offers in this book.
Now, usually when someone speaks of a “four week cleanse” as this book advertises on its front cover, it’s a lot of bunk. The liver cleanses itself, and the liver and kidneys between them (along with some other organs and processes) detoxify your body for you. No amount of celery juice will do that. However, this book does better than that:
What it’s about, is not really about trying to do a “detox” at all, so much as supporting your liver function by:
- Giving your liver what it needs to regenerate (mostly: protein)
- Not over-taxing your liver while it does so
The liver is a self-regenerating organ (the mythological story of Prometheus aside, here in real life it can regenerate up to 80% of itself, given the opportunity), so whatever the current state of your liver, it’s probably not too late to fix it.
Maybe you’ve been drinking a little too much, or maybe you’ve been taking some meds that have hobbled it a bit (some medications strain the liver rather), or maybe your diet hasn’t been great. Christianson invites you to draw a line under that, and move forwards:
The book gives an overview of the science involved, and explains about the liver’s role in metabolism (hence the promised weight loss benefits) and our dietary habits’ impact on liver function. This is about what we eat, and also about when we eat it, and how and when our body metabolizes that.
Christianson also provides meal ideas and recipes. If we’re honest (and we always are), the science/principles part of the book are worth a lot more than the meal-plan part of the book, though.
In short: a great book for understanding how the liver works and how we can help it do its job effectively.
Click here to check out “The Metabolism Reset Diet” on Amazon today!
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Teen Daily Delivery Requested
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It’s Q&A Day at 10almonds!
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In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
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I thoroughly enjoy your daily delivery. I’d love to see one for teens too!
That’s great to hear! The average age of our subscribers is generally rather older, but it’s good to know there’s an interest in topics for younger people. We’ll bear that in mind, and see what we can do to cater to that without alienating our older readers!
That said: it’s never too soon to be learning about stuff that affects us when we’re older—there are lifestyle factors at 20 that affect Alzheimer’s risk at 60, for example (e.g. drinking—excessive drinking at 20* is correlated to higher Alzheimer’s risk at 60).
*This one may be less of an issue for our US readers, since the US doesn’t have nearly as much of a culture of drinking under 21 as some places. Compare for example with general European practices of drinking moderately from the mid-teens, or the (happily, diminishing—but historically notable) British practice of drinking heavily from the mid-teens.
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Microplastics are in our brains. How worried should I be?
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Plastic is in our clothes, cars, mobile phones, water bottles and food containers. But recent research adds to growing concerns about the impact of tiny plastic fragments on our health.
A study from the United States has, for the first time, found microplastics in human brains. The study, which has yet to be independently verified by other scientists, has been described in the media as scary, shocking and alarming.
But what exactly are microplastics? What do they mean for our health? Should we be concerned?
Daniel Megias/Shutterstock What are microplastics? Can you see them?
We often consider plastic items to be indestructible. But plastic breaks down into smaller particles. Definitions vary but generally microplastics are smaller than five millimetres.
This makes some too small to be seen with the naked eye. So, many of the images the media uses to illustrate articles about microplastics are misleading, as some show much larger, clearly visible pieces.
Microplastics have been reported in many sources of drinking water and everyday food items. This means we are constantly exposed to them in our diet.
Such widespread, chronic (long-term) exposure makes this a serious concern for human health. While research investigating the potential risk microplastics pose to our health is limited, it is growing.
How about this latest study?
The study looked at concentrations of microplastics in 51 samples from men and women set aside from routine autopsies in Albuquerque, New Mexico. Samples were from the liver, kidney and brain.
These tiny particles are difficult to study due to their size, even with a high-powered microscope. So rather than trying to see them, researchers are beginning to use complex instruments that identify the chemical composition of microplastics in a sample. This is the technique used in this study.
The researchers were surprised to find up to 30 times more microplastics in brain samples than in the liver and kidney.
They hypothesised this could be due to high blood flow to the brain (carrying plastic particles with it). Alternatively, the liver and kidneys might be better suited to dealing with external toxins and particles. We also know the brain does not undergo the same amount of cellular renewal as other organs in the body, which could make the plastics linger here.
The researchers also found the amount of plastics in brain samples increased by about 50% between 2016 and 2024. This may reflect the rise in environmental plastic pollution and increased human exposure.
The microplastics found in this study were mostly composed of polyethylene. This is the most commonly produced plastic in the world and is used for many everyday products, such as bottle caps and plastic bags.
This is the first time microplastics have been found in human brains, which is important. However, this study is a “pre-print”, so other independent microplastics researchers haven’t yet reviewed or validated the study.
The most common plastic found was polyethylene, which is used to make plastic bags and bottle caps. Maciej Bledowski/Shutterstock How do microplastics end up in the brain?
Microplastics typically enter the body through contaminated food and water. This can disrupt the gut microbiome (the community of microbes in your gut) and cause inflammation. This leads to effects in the whole body via the immune system and the complex, two-way communication system between the gut and the brain. This so-called gut-brain axis is implicated in many aspects of health and disease.
We can also breathe in airborne microplastics. Once these particles are in the gut or lungs, they can move into the bloodstream and then travel around the body into various organs.
Studies have found microplastics in human faeces, joints, livers, reproductive organs, blood, vessels and hearts.
Microplastics also migrate to the brains of wild fish. In mouse studies, ingested microplastics are absorbed from the gut into the blood and can enter the brain, becoming lodged in other organs along the way.
To get into brain tissue, microplastics must cross the blood-brain-barrier, an intricate layer of cells that is supposed to keep things in the blood from entering the brain.
Although concerning, this is not surprising, as microplastics must cross similar cell barriers to enter the urine, testes and placenta, where they have already been found in humans.
Is this a health concern?
We don’t yet know the effects of microplastics in the human brain. Some laboratory experiments suggest microplastics increase brain inflammation and cell damage, alter gene expression and change brain structure.
Aside from the effects of the microplastic particles themselves, microplastics might also pose risks if they carry environmental toxins or bacteria into and around the body.
Various plastic chemicals could also leach out of the microplastics into the body. These include the famous hormone-disrupting chemicals known as BPAs.
But microplastics and their effects are difficult to study. In addition to their small size, there are so many different types of plastics in the environment. More than 13,000 different chemicals have been identified in plastic products, with more being developed every year.
Microplastics are also weathered by the environment and digestive processes, and this is hard to reproduce in the lab.
A goal of our research is to understand how these factors change the way microplastics behave in the body. We plan to investigate if improving the integrity of the gut barrier through diet or probiotics can prevent the uptake of microplastics from the gut into the bloodstream. This may effectively stop the particles from circulating around the body and lodging into organs.
How do I minimise my exposure?
Microplastics are widespread in the environment, and it’s difficult to avoid exposure. We are just beginning to understand how microplastics can affect our health.
Until we have more scientific evidence, the best thing we can do is reduce our exposure to plastics where we can and produce less plastic waste, so less ends up in the environment.
An easy place to start is to avoid foods and drinks packaged in single-use plastic or reheated in plastic containers. We can also minimise exposure to synthetic fibres in our home and clothing.
Sarah Hellewell, Senior Research Fellow, The Perron Institute for Neurological and Translational Science, and Research Fellow, Faculty of Health Sciences, Curtin University; Anastazja Gorecki, Teaching & Research Scholar, School of Health Sciences, University of Notre Dame Australia, and Charlotte Sofield, PhD Candidate, studying microplastics and gut/brain health, University of Notre Dame Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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