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.

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).

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.

We all want to eat healthily, especially as we reset our health goals at the start of a new year. But sometimes these plans are sabotaged by powerful cravings for sweet, salty or carb-heavy foods.

So why do you crave these foods when you’re trying to improve your diet or lose weight? And what can you do about it?

There are many reasons for craving specific foods, but let’s focus on four common ones:

1. Blood sugar crashes

Sugar is a key energy source for all animals, and its taste is one of the most basic sensory experiences. Even without specific sweet taste receptors on the tongue, a strong preference for sugar can develop, indicating a mechanism beyond taste alone.

Neurons responding to sugar are activated when sugar is delivered to the gut. This can increase appetite and make you want to consume more. Giving into cravings also drives an appetite for more sugar.

In the long term, research suggests a high-sugar diet can affect mood, digestion and inflammation in the gut.

While there’s a lot of variation between individuals, regularly eating sugary and high-carb foods can lead to rapid spikes and crashes in blood sugar levels. When your blood sugar drops, your body can respond by craving quick sources of energy, often in the form of sugar and carbs because these deliver the fastest, most easily accessible form of energy.

2. Drops in dopamine and serotonin

Certain neurotransmitters, such as dopamine, are involved in the reward and pleasure centres of the brain. Eating sugary and carb-rich foods can trigger the release of dopamine, creating a pleasurable experience and reinforcing the craving.

Serotonin, the feel-good hormone, suppresses appetite. Natural changes in serotonin can influence daily fluctuations in mood, energy levels and attention. It’s also associated with eating more carb-rich snacks in the afternoon.

Low carb diets may reduce serotonin and lower mood. However, a recent systematic review suggests little association between these diets and risk for anxiety and depression.

Compared to men, women tend to crave more carb rich foods. Feeling irritable, tired, depressed or experiencing carb cravings are part of premenstrual symptoms and could be linked to reduced serotonin levels.

3. Loss of fluids and drops in blood sugar and salt

Sometimes our bodies crave the things they’re missing, such as hydration or even salt. A low-carb diet, for example, depletes insulin levels, decreasing sodium and water retention.

Very low-carb diets, like ketogenic diets, induce “ketosis”, a metabolic state where the body switches to using fat as its primary energy source, moving away from the usual dependence on carbohydrates.

Ketosis is often associated with increased urine production, further contributing to potential fluid loss, electrolyte imbalances and salt cravings.

4. High levels of stress or emotional turmoil

Stress, boredom and emotional turmoil can lead to cravings for comfort foods. This is because stress-related hormones can impact our appetite, satiety (feeling full) and food preferences.

The stress hormone cortisol, in particular, can drive cravings for sweet comfort foods.

A 2001 study of 59 premenopausal women subjected to stress revealed that the stress led to higher calorie consumption.

A more recent study found chronic stress, when paired with high-calorie diet, increases food intake and a preference for sweet foods. This shows the importance of a healthy diet during stress to prevent weight gain.

What can you do about cravings?

Here are four tips to curb cravings:

1) don’t cut out whole food groups. Aim for a well-balanced diet and make sure you include:

• sufficient protein in your meals to help you feel full and reduce the urge to snack on sugary and carb-rich foods. Older adults should aim for 20–40g protein per meal with a particular focus on breakfast and lunch and an overall daily protein intake of at least 0.8g per kg of body weight for muscle health
• fibre-rich foods, such as vegetables and whole grains. These make you feel full and stabilise your blood sugar levels. Examples include broccoli, quinoa, brown rice, oats, beans, lentils and bran cereals. Substitute refined carbs high in sugar like processed snack bars, soft drink or baked goods for more complex ones like whole grain bread or wholewheat muffins, or nut and seed bars or energy bites made with chia seeds and oats

2) manage your stress levels. Practise stress-reduction techniques like meditation, deep breathing, or yoga to manage emotional triggers for cravings. Practising mindful eating, by eating slowly and tuning into bodily sensations, can also reduce daily calorie intake and curb cravings and stress-driven eating

3) get enough sleep. Aim for seven to eight hours of quality sleep per night, with a minimum of seven hours. Lack of sleep can disrupt hormones that regulate hunger and cravings

4) control your portions. If you decide to indulge in a treat, control your portion size to avoid overindulging.

Overcoming cravings for sugar, salt and carbs when trying to eat healthily or lose weight is undoubtedly a formidable challenge. Remember, it’s a journey, and setbacks may occur. Be patient with yourself – your success is not defined by occasional cravings but by your ability to manage and overcome them.

Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.