As part of our Lunch & Learn series of webinars, here’s endocrinologist Dr Nicky Keay to explain more about how our hormones work and how they affect us during menopause.
Henpicked: Welcome to the webinar. First of all, can you explain to us what an endocrinologist is?
Dr Nicky Keay: Endocrinology means study of hormones. For me, it was the most interesting area to specialise in. They’re very challenging and complex. You can’t see or feel them, yet they’re circulating in your bloodstream and essential to your health.
The most complex, and therefore the most interesting to me, are female hormones. They are fascinating, but it can be tough to unravel what’s going on with them sometimes.
Henpicked: A big subject at the moment is Covid-19. There have been some suggestions that oestrogen can provide us with a certain amount of protection. Is this true?
Dr Nicky Keay: With any discussion around Covid-19 we have to say this is a very new virus and we’re learning more every day. We can’t make absolute statements but indications are that oestrogen is protective in some way we don’t fully understand.
It does appear from looking at statistics that men seem to be more affected and have more severe symptoms. This has led to a suggestion that oestrogen may be somehow playing a protective role and enabling our immune systems to function better.
Henpicked: What does this mean for menopausal women? Is there anything they need to do?
Dr Nicky Keay: There are lots of ways to keep our immune system healthy. Keep active, eat healthy, fresh produce, and get plenty of sleep. This really important for rebooting all of our hormones. In fact, we should be doing these things anyway to keep our immune system in top notch. Women shouldn’t look to taking HRT as a miracle to prevent them from getting Covid-19, it’s better to think of this time as what you need to do to be at your best.
Vitamin D is also important as it can be difficult for us to get the right amount, especially in the winter months – personally I take it all year round. It’s so good for the immune system and also bone health. Public Health recommends we all take Vitamin D every day.
Henpicked: Can you tell us more about female hormones?
Dr Nicky Keay: First we need to start with what controls your hormones. They are released from various glands, including our ovaries. The boss of all hormones, which I’ve heard described as the ‘conductor of the orchestra’, is the pituitary gland in the brain. This secretes control hormones. In women these are FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These act in turn on the ovary and produce oestrogen, progesterone and testosterone. These then go on to have effects in tissues throughout the body.
So when we’re talking about female hormones we have to remember there are control ones, too. These are essential for our system to work in its beautifully synchronised fashion, from when you start your periods until you reach menopause. The body is amazing, with a beautiful regulation between control from the pituitary gland and response of the ovaries. That goes through that lovely cyclical pattern of hormone release many of us have experienced.
When you come to menopause – on average age 51 – the ovaries become uncooperative and stop obeying the control hormones. They don’t secrete the hormones you’ve been used to having in circulation.
In that context, it’s not surprising that when menopause occurs it does affect how you feel physically and mentally. Hormones have been with you all these years and are now in decline. This can affect the whole body, creating symptoms and affecting long-term health including bone and cardiovascular health. No wonder you feel different.
Henpicked: With that in mind, we don’t just need to manage symptoms but consider our longer-term health, don’t we?
Dr Nicky Keay: Yes, it can be literally be a bit of a shock to the system in all respects. The interesting thing is that because of increased life expectancy of women, up to a third of your life may be spent in post menopause. Tudor age women, for example, would often die in childbirth and rarely get to menopause.
It’s important to say, this is normal physiology, not some disease or condition. It’s the way women have evolved. Our ovaries have been working very hard all our lives and have just had enough. Evolution says it would be difficult to give birth to a child and look after it if you’re over 50. So we shouldn’t talk about it being a ‘condition’. It’s just a case of accepting it and being aware it’s normal. This is not to minimise it.
We have to look for different strategies to find what’s going to suit you to live your life to the fullest in your slightly altered state hormone wise.
Henpicked: Is it true that resistance training is good for long-term bone health?
Dr Nicky Keay: As we get older we should all be doing more resistance training. It’s very important for bone health and body composition to maintain muscle strength and mass. If you don’t much like going to the gym, there are other things you can do. For me it’s ballet. Even hopping a few times a day can help bone health.
Resistance doesn’t mean you have to be lifting heavy weights. You can use a filled water bottle or resistance bands. It’s important to do exercise you enjoy. Even a walk round the block is a starting point. Try to mix it up so you’re not doing exactly the same thing. Go for a mix of cardio – walking, jogging, swimming, cycling – but get some type of resistance too, as this will help with your bone health. You could also try Pilates or yoga.
Really, it’s best to find something you actually like doing.
Henpicked: NICE guidelines for diagnosing menopause say women presenting with menopausal symptoms age 45 and over who are otherwise healthy don’t need a blood test. Is it a good idea to keep track of your symptoms, for anything which may not be menopause related?
Dr Nicky Keay: Yes, under those circumstances diagnosis is clinical. But the advantage of blood test is you can check up on other things, like vitamin D and iron levels, and thyroid function. The place for a blood test is to check there’s nothing else going on. If it comes back as definitive menopause then that’s helpful too.
Keeping a personal log of what symptoms you’re getting and when they’re happening is a really good idea. In our current situation with Covid-19 many of us are under more stress. Then our friend the conductor pituitary gland dampens everything down. So you need to take into account what’s going on in your life in general, too. The person that knows your body best is you.
A blood test is informative and helpful but has to be placed in clinical context for an individual. All this can help you feel empowered. You’re putting together your symptoms with any external happenings, and any blood tests can understand the full picture.
Henpicked: This isn’t on the NHS though you can take a private test can’t you?
Dr Nicky Keay: Yes, and there are developments under way to help women create a personal profile, to reduce the number of blood tests they take. Hormones are essential but they are personal. Even within a normal range, you might be higher or lower, so it’s a matter of timing and balance.
Henpicked: If oestrogen gives some women some protection will phyto-oestrogens have a similar effect?
Dr Nicky Keay: Theoretically. But it’s all still only hypothesis. It’s more important to look at other factors we’ve discussed.
Henpicked: Is there a natural way to increase testosterone?
Dr Nicky Keay: Yes, our friend resistance training. We normally associate that with men, but the same applies to a certain extent to women. It’s also great for bone health.
Henpicked: What else might be driving the way women feel if it’s not perimenopause?
Dr Nicky Keay: This is where a log can help to see what symptoms they’re experiencing. I would run a blood test, check they are exercising and eating a varied diet, and understand what else is going on in their lives. Thyroid would be a top thing to check, as well as blood counts to check for iron and B12 levels – especially important in vegetarians – and vitamin D.