Dr Naomi Potter’s Guide to Menopause
There’s no doubt that menopause can be tough, but support is out there. We asked Dr Naomi Potter, menopause specialist and co-author of the book Menopausing, for her expertise on navigating your body and mind through this transformative time.
“The menopause is when your ovaries essentially stop working – officially, that’s 12 months after your last period. Perimenopause is the time before that, where you have more turbulent hormonal activity. Perimenopause can last for months, years, or sometimes even a decade.”
“It can be difficult to pinpoint exactly which symptoms are down to perimenopause – this is because they can change all the time, and because you’ve got oestrogen receptors throughout your entire body. The symptoms that everybody associates with the perimenopause and menopause are hot flushes, night sweats and periods changing and stopping, but there are so many more. You can have symptoms from the top of your head to the tips of your toes, from hair loss and eye dryness to palpitations and muscle pain – and that’s what makes it so difficult to diagnose. It really can affect any organ at any time.” Other common effects include: • Mood swings, anxiety and low self-esteem • Brain fog • Difficulty sleeping • Headaches or migraines • Skin changes • Reduced sex drive or discomfort during sex
“There’s often a lot going on when you’re perimenopausal. You may have children, older parents to look after, or a demanding career. It can be hard to work out what’s hormonal and what’s life. If you feel like you’re not coping with everyday challenges like you once did, that’s a hint it could be perimenopause.” Your GP should be your first port of call.
“Lifestyle is really important. There are a number of adjustments you can make… • Cutting down on caffeine is a big one: it’s a really powerful stimulant and probably the most anxiety-inducing. • Exercise is phenomenal! • A balanced diet that’s rich in unrefined foods and low in sugar. • Smoking: it’s terrible. You have to stop.”
“There are a lot of common misconceptions about the menopause and the perimenopause. “I'm too young“ is probably the biggest one - we frequently see women younger than 40 experiencing perimenopause symptoms. Probably the biggest concern among my patients is, “Am I ever going to feel like 'me' again?“ The answer is, invariably, yes – you are. Have faith that things will get better. Ultimately, it’s about what’s right for you.”
What to read next
An evidence-based article outlining how estrogen decline contributes to joint pain, muscle loss, and osteoporosis in menopause.
A peer-reviewed study using PET imaging to reveal how estrogen receptor density evolves in menopausal brains—highlighting menopause as a neurological transition.
Every year, about 1.3 million American women enter menopause—the stage of life when
your estrogen levels diminish and your periods stop completely. It’s a natural part
of aging and nothing to fear.
That said, the symptoms of menopause—including hot flushes, low sex drive, trouble
sleeping, weight gain, UTIs and vaginal dryness, brain fog, heart palpitations, muscle
and joint aches, and mood changes—can be miserable and debilitating. You also lose the
health benefits of estrogen itself, like heart and brain protection, says Avrum Z.
Bluming, MD, a hematologist and medical oncologist who has spent decades investigating
the benefits of estrogen. Women can avoid many of these problems with one treatment:
hormone replacement therapy, or HRT. Alternatively called MHT, for menopausal hormone
therapy, HRT refers to the combination of estrogen and progesterone given to women who
still have their uterus; estrogen alone is given to women who have had a hysterectomy.
Unfortunately, HRT remains controversial, due mostly to the results of the decades-old
Women’s Health Initiative, the largest study done on the health of postmenopausal women
in the United States. In 2002, findings from the WHI were released suggesting that women
on HRT had greater risks of heart disease, stroke, dementia, and, scariest of all, breast
cancer; as a result, millions of women of menopausal age either quit or avoided it at all
costs. Subsequent studies have walked back these claims, but many women remain gun-shy
about taking estrogen. The fallout has been enormous: Among menopausal women in the
United States, just under 5 percent are currently on HRT, and it’s been estimated that
between 2002 and 2012, over 90,000 American women died prematurely, mainly from heart
disease, as a result of avoiding HRT.