The Menopause as a Creative Transition: A Conversation with Dr Elizabeth Thompson

Dr Elizabeth Thompson is CEO and Holistic Doctor at the National Centre for Integrative Medicine (NCIM) and has dedicated her career to empowering both patients and healthcare professionals within a more holistic model of healthcare. We sat down with her to talk about a specialist area of interest for her clinically and personally! the Menopause.

Why do you think we as a society are so bad about talking about the Menopause?

This is something that I’ve been considering myself recently. I was talking with a guy friend about my hot flushes and he literally walked away! I was surprised and thought: this is interesting, he’s embarrassed for me to talk about the Menopause.

It may be because the Menopause is considered to be a ‘loss’ which is something we’re not good at talking about. The conversation is focused on a loss of oestrogen and progesterone, a loss of fertility and sexuality, instead of potential positives like greater freedom and gaining more stable mental health without the highs and lows of the menstrual cycle.

It may also be because the Menopause heralds later life in a culture where youth is valued, making it difficult for women to feel comfortable to talk of the Menopause openly. The workplace can be a tricky place and the women that I’ve spoken to in my clinics are embarrassed to simply explain to a colleague at work that they are experiencing a hot flush but to mention urinary frequency would be mortifying!

Much of my clinical practice has been helping women who are experiencing an induced Menopause in and around breast cancer treatments, when the Menopause can come on suddenly and symptoms can be more severe and where HRT is not an option. This contrasts with a more gradual onset as part of a ‘natural’ Menopause where the body can make slower adjustments often taking about 4 years to complete the transition to be postmenopausal. It’s important to remember that in either case, it is a transition that can be supported. It doesn’t last forever, but during that time there can be difficult symptoms, including hot flushes, sleep disturbance, mood disturbance, joint pain, vaginal dryness and bladder disturbance. This can be frightening for women who might not be expecting these changes and I have sometimes had to give the clear message ‘No! You are not going mad!’. Yes, it is a journey that takes you out of yourself, but it can be creative – it’s still you, just the potential for a new you.

You’ve talked about quite a few symptoms associated with the Menopause – why are these not well understood?

The most well-known problem symptom is the hot flush, but even this isn’t well understood. As oestrogen levels fall, increasing levels of Follicle Stimulating Hormone (FSH) gets released from the pituitary gland, and with no response from the ovaries, more gets released and it impacts other regions nearby, including the part that regulates our body temperature, causing a hot flush. The FSH is shouting louder and louder to the ovaries to release a follicle but there aren’t any left and eventually FSH gives up and that’s when hormone levels can quieten. Some women get anxious during hot flushes and can feel very panicky – but the more anxious you feel, the more intense the hot flush becomes. This is where mindfulness practice is very helpful, to support that feeling of calm and to encourage the hot flush to pass without escalating.

We also need to understand the Menopause much better so that women can understand what’s happening. For example, I have also noticed women complaining of increased joint and ligament pain sometimes with acute inflammation such as frozen shoulder or achilles tendinitis. Something here is triggering pain in support structures around joints, so there’s still a lot more to understand. This is where I have found homeopathy to be very useful with homeopathic remedies like Ruta Graveolens for inflamed ligaments and tendons or giving homeopathic FSH to assist the body to rebalance and not get stuck with high levels of circulating FSH. Massage can be great to work on these painful areas and encourage the body back into wholeness.

Why do we gain weight during the Menopause?

Weight gain can be a problem in the Menopause. We know that through our lives, our metabolic rate can slow down a bit, and when this happens one of the things that’s important is to eat less. That’s not easy: we get into habits and we are used to eating a certain amount. But what’s unique about the Menopause is that you have a variety of changes in the body each of which might cause some women to gain weight such as mood swings and cravings. Also, due to tiredness, sleep disturbance, and joint pain, we can find ourselves moving less and doing less exercise. I have personally found Helen’s book ‘How to Retrain Your Appetite’ very useful, both for myself and as a clinician. The idea of appetite retraining, connecting to our bodies and making small changes that make a big difference, is very powerful. As we age we can also lose muscle bulk and muscle burns more calories so I recommend muscle strengthening exercises such as Pilates, Tai Chi or Yoga.

How does this weight gain during the Menopause affect a person’s wellbeing?

The problem is that you’re experiencing change, your body is changing on the inside, you’re noticing more wrinkles around the eyes, your neck may be changing shape – if you then gain weight, it can impact a woman’s self-esteem which may not have been great anyway.

It’s important to value and enjoy this different phase of life so I also recommend re-orientating our thinking away from some of our negative expectations of ageing such as when you are older you feel tired and don’t want sex – and asking is this true for me and what do I want from my life- activating creativity is another vibrant life force? Some women experience more sexual desire liberated from the concern of getting pregnant. Focusing on the plus points, we have lived life, seen things change, experienced lots of relationships and friendships, hopefully we are wiser. Often but not always there is less responsibility, more free time, more time with friends, more time with hobbies that can bring additional meaning into our lives, such as creative writing, art, and music.

What can women do in a healthy way to combat this weight gain?

Mindful eating is really important: whatever we eat, we need to really enjoy it. I use some of the techniques that Helen talks about, such as eating when you are hungry and stopping when you are full and having a mindful approach to be led by a natural appetite.

I would also encourage women to reduce their carbohydrate intake. Carbs are there to fuel us up, but unless we are running marathons, we don’t need them as much as we think. Focus on slow release carbs such as brown rice or granary bread, avoiding fast release carbs such as white bread, sugar, and white pasta. Refined sugars and coffee can trigger a flush as they drive the adrenaline response, and alcohol and spicy food dilate blood vessels so you may choose to avoid or cut down some of these things.

But it’s not all about restrictions! As you move away from white food, sugars, and pastas, move towards rainbow colour foods. When you look at your plate, you should see different colours, lots of plants, fish with omega 3 and 6, and chia seeds for magnesium. Consider eating Miso, a naturally occurring plant based oestrogen to bring balance to the body. We know that in the Far East where women have regular Miso soup, they experience fewer hot flushes on a daily basis.

So it’s not all doom and gloom then?

Absolutely not! There are plenty of things that women can do to make the Menopause a less difficult time and we don’t always have to use HRT to get through. Your diet and exercise can be tweaked to make you feel better, and I also recommend a diverse range of lifestyle and holistic approaches – homeopathy, acupuncture, connecting with green spaces, and mindfulness. I believe in a full ‘prescription’ of approaches to support you and that’s what I enjoy about being a Holistic Doctor.

We need women who have gone through this transition to speak up and share their journeys – both highs and lows. Helen’s book has helped me enormously in the fight not to gain weight, and I’m still hopeful to lose a bit to feel lighter and more energetic! Remember that everything is reversible in the body until our mid-eighties. If we have this in our mind, we can recreate, reshape, and reform, giving us lots of reasons to be cheerful!