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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Chatter – by Dr. Ethan Kross
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This book is about much more than just one’s internal monologue. It does tackle that, but also the many non-verbal rabbit-holes that our brains can easily disappear into.
The author is an experimental psychologist, and brings his professional knowledge and experience to bear on this problem—citing many studies, including his own studies from his own lab, in which he undertook to answer precisely the implicit questions of “How can I…” in terms of tackling these matters, from root anxiety (for example) to end-state executive dysfunction (for example).
The writing style isn’t dense science though, and is very approachable for all.
The greatest value in this book lies in its prescriptive element, that is to say, its advice, especially in the category of evidence-based things we can do to improve matters for ourselves; beyond generic things like “mindfulness-based stress reduction” to much more specific things like “observe yourself in the 3rd person for a moment” and “take a break to imagine looking back on this later” and “interrupt yourself with a brief manual task”. With these sorts of interventions and more, we can shift the voice in our head from critic to coach.
Bottom line: if you would like your brain to let you get on with the things you actually want to do instead of constantly sidetracking you, this is the book for you.
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Fast Like A Girl – by Dr. Mindy Pelz
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A lot of information out there when it comes to intermittent fasting is very much centered on men in the 25–35 years age range. What about the rest of us?
Our physiological needs are not the same, and it’d be foolhardy to ignore that. But what things do still stand the same, and what things would benefit from a different approach in our cases?
Dr. Pelz has our back with this book packed with information based on the best science currently out there. She gives a general overview of fasting with full consideration to the fact that we the reader may well be female or over a certain age or both. In addition, the book offers:
- Metabolic switching (the “missing key to weight loss”)
- Building a fasting lifestyle (that works with your actual life, not just on paper)
- How to time fasting according to your menstrual cycle (if you don’t have a cycle, she has you covered too)
- How to break a fast—properly (and many other hacks/tips/tricks to make fasting so much easier)
Bottom line: if you want to do intermittent fasting and want to work with rather than against your body, then this book is a fine option.
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Best morning routine?
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You’ve Got Questions? We’ve Got Answers!
Q: Best morning routine?
A: The best morning routine is whatever makes you feel most ready to take on your day!
This one’s going to vary a lot—one person’s morning run could be another person’s morning coffee and newspaper, for example.
In a nutshell, though, ask yourself these questions:
- How long does it take me to fully wake up in the morning, and what helps or hinders that?
- When I get out of bed, what do I really need before I can take on my day?
- If I could have the perfect morning, what would it look like?
- What can evening me do, to look after morning me’s best interests? (Semi-prepare breakfast ready? Lay out clothes ready? Running shoes? To-Do list?)
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Ricezempic: is there any evidence this TikTok trend will help you lose weight?
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If you spend any time looking at diet and lifestyle content on social media, you may well have encountered a variety of weight loss “hacks”.
One of the more recent trends is a home-made drink called ricezempic, made by soaking uncooked rice and then straining it to drink the leftover starchy water. Sounds delicious, right?
Its proponents claim it leads to weight loss by making you feel fuller for longer and suppressing your appetite, working in a similar way to the sought-after drug Ozempic – hence the name.
So does this drink actually mimic the weight loss effects of Ozempic? Spoiler alert – probably not. But let’s look at what the evidence tells us.
New Africa/Shutterstock How do you make ricezempic?
While the recipe can vary slightly depending on who you ask, the most common steps to make ricezempic are:
- soak half a cup of white rice (unrinsed) in one cup of warm or hot water up to overnight
- drain the rice mixture into a fresh glass using a strainer
- discard the rice (but keep the starchy water)
- add the juice of half a lime or lemon to the starchy water and drink.
TikTokers advise that best results will happen if you drink this concoction once a day, first thing in the morning, before eating.
The idea is that the longer you consume ricezempic for, the more weight you’ll lose. Some claim introducing the drink into your diet can lead to a weight loss of up to 27 kilograms in two months.
Resistant starch
Those touting ricezempic argue it leads to weight loss because of the resistant starch rice contains. Resistant starch is a type of dietary fibre (also classified as a prebiotic). There’s no strong evidence it makes you feel fuller for longer, but it does have proven health benefits.
Studies have shown consuming resistant starch may help regulate blood sugar, aid weight loss and improve gut health.
Research has also shown eating resistant starch reduces the risk of obesity, diabetes, heart disease and other chronic diseases.
Ricezempic is made by soaking rice in water. Kristi Blokhin/Shutterstock Resistant starch is found in many foods. These include beans, lentils, wholegrains (oats, barley, and rice – particularly brown rice), bananas (especially when they’re under-ripe or green), potatoes, and nuts and seeds (particularly chia seeds, flaxseeds and almonds).
Half a cup of uncooked white rice (as per the ricezempic recipe) contains around 0.6 grams of resistant starch. For optimal health benefits, a daily intake of 15–20 grams of resistant starch is recommended. Although there is no concrete evidence on the amount of resistant starch that leaches from rice into water, it’s likely to be significantly less than 0.6 grams as the whole rice grain is not being consumed.
Ricezempic vs Ozempic
Ozempic was originally developed to help people with diabetes manage their blood sugar levels but is now commonly used for weight loss.
Ozempic, along with similar medications such as Wegovy and Trulicity, is a glucagon-like peptide-1 (GLP-1) receptor agonist. These drugs mimic the GLP-1 hormone the body naturally produces. By doing so, they slow down the digestive process, which helps people feel fuller for longer, and curbs their appetite.
While the resistant starch in rice could induce some similar benefits to Ozempic (such as feeling full and therefore reducing energy intake), no scientific studies have trialled ricezempic using the recipes promoted on social media.
Ozempic has a long half-life, remaining active in the body for about seven days. In contrast, consuming one cup of rice provides a feeling of fullness for only a few hours. And simply soaking rice in water and drinking the starchy water will not provide the same level of satiety as eating the rice itself.
Other ways to get resistant starch in your diet
There are several ways to consume more resistant starch while also gaining additional nutrients and vitamins compared to what you get from ricezempic.
1. Cooked and cooled rice
Letting cooked rice cool over time increases its resistant starch content. Reheating the rice does not significantly reduce the amount of resistant starch that forms during cooling. Brown rice is preferable to white rice due to its higher fibre content and additional micronutrients such as phosphorus and magnesium.
2. More legumes
These are high in resistant starch and have been shown to promote weight management when eaten regularly. Why not try a recipe that has pinto beans, chickpeas, black beans or peas for dinner tonight?
3. Cooked and cooled potatoes
Cooking potatoes and allowing them to cool for at least a few hours increases their resistant starch content. Fully cooled potatoes are a rich source of resistant starch and also provide essential nutrients like potassium and vitamin C. Making a potato salad as a side dish is a great way to get these benefits.
In a nutshell
Although many people on social media have reported benefits, there’s no scientific evidence drinking rice water or “ricezempic” is effective for weight loss. You probably won’t see any significant changes in your weight by drinking ricezempic and making no other adjustments to your diet or lifestyle.
While the drink may provide a small amount of resistant starch residue from the rice, and some hydration from the water, consuming foods that contain resistant starch in their full form would offer significantly more nutritional benefits.
More broadly, be wary of the weight loss hacks you see on social media. Achieving lasting weight loss boils down to gradually adopting healthy eating habits and regular exercise, ensuring these changes become lifelong habits.
Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University and Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Turns out the viral ‘Sleepy Girl Mocktail’ is backed by science. Should you try it?
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Many of us wish we could get a better night’s sleep. Wouldn’t it be great if it was as easy as a mocktail before bed?
That’s what the latest viral trend might have us believe. The “Sleepy Girl Mocktail” is a mix of tart cherry juice, powdered magnesium supplement and soda water. TikTok videos featuring the concoction have garnered hundreds of thousands of views. But, what does the science say? Do these ingredients actually help us sleep?
Tart cherry juice
There is research to show including tart cherry juice in your diet improves overall sleep. Clinical trials show tart cherry juice increases sleep quality and quantity, as well as a lessening insomnia symptoms (compared to a placebo). This could be due to the presence of melatonin, a sleep-promoting hormone, in cherries.
Tart cherry varieties such as Jerte Valley or Montmorency have the highest concentration of melatonin (approximately 0.135 micrograms of melatonin per 100g of cherry juice). Over the counter melatonin supplements can range from 0.5 milligram to over 100 milligrams, with research suggesting those beginning to take melatonin start with a dose of 0.5–2 milligrams to see an improvement in sleep.
Melatonin naturally occurs in our bodies. Our body clock promotes the release of melatonin in the evening to help us sleep, specifically in the two hours before our natural bedtime.
If we want to increase our melatonin intake with external sources, such as cherries, then we should be timing our intake with our natural increase in melatonin. Supplementing melatonin too close to bed will mean we may not get the sleep-promoting benefits in time to get off to sleep easily. Taking melatonin too late may even harm our long-term sleep health by sending the message to our body clock to delay the release of melatonin until later in the evening.
Magnesium – but how much?
Magnesium also works to promote melatonin, and magnesium supplements have been shown to improve sleep outcomes.
However, results vary depending on the amount of magnesium people take. And we don’t yet have the answers on the best dose of magnesium for sleep benefits.
We do know magnesium plays a vital role in energy production and bone development, making it an important daily nutrient for our diets. Foods rich in magnesium include wheat cereal or bread, almonds, cashews, pumpkin seeds, spinach, artichokes, green beans, soy milk and dark chocolate.
Bubbly water
Soda water serves as the base of the drink, rather than a pathway to better sleep. And bubbly water may make the mix more palatable. It is important to keep in mind that drinking fluids close to bedtime can be disruptive to our sleep as it might lead to waking during the night to urinate.
Healthy sleep recommendations include avoiding water intake in the two hours before bed. Having carbonated beverages too close to bed can also trigger digestive symptoms such as bloating, gassiness and reflux during the night.
Bottoms up?
Overall, there is evidence to support trying out the Sleepy Girl Mocktail to see if it improves sleep, however there are some key things to remember:
timing: to get the benefits of this drink, avoid having it too close to bed. Aim to have it two hours before your usual bedtime and avoid fluids after this time
consistency: no drink is going to be an immediate cure for poor sleep. However, this recipe could help promote sleep if used strategically (at the right time) and consistently as part of a balanced diet. It may also introduce a calming evening routine that helps your brain relax and signals it’s time for bed
- maximum magnesium: be mindful of the amount of magnesium you are consuming. While there are many health benefits to magnesium, the recommended daily maximum amounts are 420mg for adult males and 320mg for adult females. Exceeding the maximum can lead to low blood pressure, respiratory distress, stomach problems, muscle weakness and mood problems
sugar: in some of the TikTok recipes sugar (as flavoured sodas, syrups or lollies) is added to the drink. While this may help hide the taste of the tart cherry juice, the consumption of sugar too close to bed may make it more difficult to get to sleep. And sugar in the evening raises blood sugar levels at a time when our body is not primed to be processing sugar. Long term, this can increase our risk of diabetes
sleep environment: follow good sleep hygiene practices including keeping a consistent bedtime and wake time, a wind-down routine before bed, avoiding electronic device use like phones or laptops in bed, and avoiding bright light in the evening. Bright light works to suppress our melatonin levels in the evening and make us more alert.
What about other drinks?
Other common evening beverages include herbal tisanes or teas, hot chocolate, or warm milk.
Milk can be especially beneficial for sleep, as it contains the amino acid tryptophan, which can promote melatonin production. Again, it is important to also consider the timing of these drinks and to avoid any caffeine in tea and too much chocolate too close to bedtime, as this can make us more alert rather than sleepy.
Getting enough sleep is crucial to our health and wellbeing. If you have tried multiple strategies to improve your sleep and things are not getting better, it may be time to seek professional advice, such as from a GP.
Charlotte Gupta, Postdoctoral research fellow, CQUniversity Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Welcoming the Unwelcome – by Pema Chödrön
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There’s a lot in life that we don’t get to choose. Some things we have zero control over, like the weather. Others, we can only influence, like our health. Still yet others might give us an illusion of control, only to snatch it away, like a financial reversal or a bereavement.
How, then, to suffer those “slings and arrows of outrageous fortune” and come through the other side with an even mind and a whole heart?
Author Pema Chödrön has a guidebook for us.
Quick note: this book does not require the reader to have any particular religious faith to enjoy its benefits, but the author is a nun. As such, the way she describes things is generally within the frame of her religion. So that’s a thing to be aware of in case it might bother you. That said…
The largest part of her approach is one that psychology might describe as rational emotive behavioral therapy.
As such, we are encouraged to indeed “meet with triumph and disaster, and treat those two imposters just the same”, and more importantly, she lays out the tools for us to do so.
Does this mean not caring? No! Quite the opposite. It is expected, and even encouraged, that we might care very much. But: this book looks at how to care and remain compassionate, to others and to ourselves.
For Chödrön, welcoming the unwelcome is about de-toothing hardship by accepting it as a part of the complex tapestry of life, rather than something to be endured.
Bottom line: this book can greatly increase the reader’s ability to “go placidly amid the noise and haste” and bring peace to an often hectic world—starting with our own.
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