Why is stress affecting women's menopause symptoms?
The concept of the Stress Adaptation Response was first conceptualised in the 1950s by Psychologist, Dr Hans Selye.
Since his early research and descriptions of the ‘General Adaptation Syndrome’ (G.A.S.), this syndrome has been seen as a three-stage process of (1) alarm reaction, (2) adaptation stage, followed by chronic stress and (3) the exhaustion stage.
But whilst these stages are well known, researchers now better understand that there is so much more going on in terms of the physiological and emotional responses to stress, as well as the effect on the HPA-Thyroid Axis in women.
The HPA-Thyroid Axis refers to the powerful bio-chemical connections that exist between the hypothalamus, pituitary, adrenal and thyroid glands. These glands and the role of this axis are also linked to the ovaries.
The glands are key regulatory centres in the body. Their respective hormones are influenced by numerous genetic, environmental and developmental factors – both past and present. As such, many of these hormones get out of balance as we move through life.
For example, imbalances of the HPA-Thyroid-Ovarian Axis are easily triggered by grief, fear, anxiety, excitement, sleep disorders, blood glucose dysregulation, inflammation, low nutrient absorption and of course, by the changing hormonal profile as we move through menopause into post-menopause.
Changes to ovarian function during menopause influence the balance of the HPA-Axis and it’s normal regulation.
This normal regulation and balance of our hormones is known as ‘homeostasis’. This is the state whereby the organs and hormones as well as the bio-chemistry of the body are continually changing and adjusting to sources of stress (stressors) in order to maintain balance within the body.
But homeostasis also differs from ‘Allostasis’ and Allostasis differs from Allostatic Load.
As a Practitioner or a Health Coach working with midlife women, it’s important that you understand the difference.
Allostasis is the process of achieving stability through physiological or behavioural change. It’s a bit like homeostasis, however homeostasis is the term given to a fixed state of balance of the body.
Allostasis however, means that our body is constantly adapting in a proactive way to anticipated demands, rather than just reacting to them. Heart rate, hormones, blood pressure and temperature are parameters that are adjusting to the stressors that we encounter every day – this is allostasis.
Allostatic load and allostatic overload are points on a continuum.
In women, allostatic load represents the body not coping with Allostasis. Stressors and perceived stressors accumulate, (including the stress of menopause hormonal changes, especially not sleeping), until suddenly, women experience symptoms of chronic stress and changing immune health.
These main symptoms are:
- Anxiety
- Depression
- Cognitive difficulties and mood swings
- Insomnia
- Fatigue (which becomes chronic)
Physically, allostatic load manifests as:
- Higher blood pressure
- Higher resting heart rate and respiratory rate
- Higher levels of cortisol throughout the day
- Inflammation
- High C-reactive Protein (CrP) – an inflammatory marker
- Metabolic concerns, including pre-diabetes and overweight and obesity status
- Chronic pain.
The process of Allostasis through to Allostatic Overload may take years … and then, with menopause hormonal and neural changes, midlife becomes the perfect storm for women hitting rock bottom with their stress levels.
There are many events which alter homeostasis, and for women feeling stressed, these events may be physical, chemical and emotional/ personal – even work related for women like Wendy, a Paramedic, in the image below.
Diminishing Returns
Over 20 years ago, I used to give numerous talks to workplaces on stress, fatigue and wellbeing. I used to show attendees the graph below.
It depicts how athletes, when training, undergo an increased workload to stimulate positive performance changes, and then afterward the gruelling training sessions, they focus on their recovery. Work and recovery – this is how athletes improve performance.
If athletes don’t get the balance right, then it may be that they are over-training. As such, there is a period of ‘diminishing returns’ – a known phenomenon in sports science, whereby health changes occur. This is especially so in female athletes – when their HPA-Thyroid Axis gets out of balance … as does their hormone balance.
'Load' versus 'Unload'
As I explained to the Health Professionals on my CPD course recently, the concept of ‘too much daily load’ and ‘not enough unload’ is the same for women in peri-menopause and menopause.
Many women these days are feeling busy, time-poor and physically and emotionally stressed. Their body and their hormones are under ‘load’ and as such, if they aren’t recovering well, or sleeping, or resting, or eating the right nutrients, or they are doing too much heavy-volume exercise, then the HPA-Thyroid-Ovarian Axis is working harder to try to restore balance.
But here’s what happens when we are stressed and the HPA-Thyroid Axis is out of balance – women typically go into ‘coping mode’ and fail to attain Allostasis. Their cortisol levels rise and remain high, day after day.
For some women, this means they eat more, or eat less. Perhaps they exercise more, or experience changing moods, from melancholy to anger or they begin to feel anxious. Sometimes, they experience physical symptoms, such as sore joints and aching muscles.
Often, they feel hot and experience poor sleep and night sweats. For many, their caffeine, alcohol, tobacco or sugar consumption increases too – you can see in the diagram that over 20 years ago, I called these ‘C.A.T.S.’. Yes, it was the same back then as it is now.
When various sources of stress build up, menopause symptoms become worse. This increase in stress-sources is known as ‘Allostatic Load’ and for midlife women, there are a variety of sources of stress. I wonder how many you or your clients can list!
As sources of stress accumulate, the effect on the body may lead to burn-out and exhaustion.
Performance and motivation starts to decline. Suddenly, there is ‘diminished returns’, i.e. changing immune health (frequent colds and flus), changing thyroid function (feelings of heightened anxiety, hot or cold feelings and low energy) and changing pituitary function (poor sleep patterns).
I wonder if all this sounds familiar?
Cortisol Chaos and Calming Progesterone
The more stressed women feel, the higher is their production of a chronic stress hormone called cortisol.
Chronic stress hormone, Cortisol, is a pesky hormone when it comes to menopause symptoms and weight gain.
As one of our stress hormones produced by the adrenal glands, balancing cortisol production as the day goes on is important. It has far-reaching effects around the body — including in muscles and bones, heart and blood vessels, lungs, hormone-producing glands, liver, gut and the brain.
Some cortisol production is good, but too much over a long time starts to impact our health.
For example, high levels of cortisol can lead to weight gain. Cortisol has an intricate relationship with the hormone insulin, which controls blood sugar levels. High or low cortisol can cause hypo-glycemia (low blood sugar), hyper-glycemia (high blood sugar) or both.
When cortisol levels increase, the body’s cells can become resistant to insulin, the hormone that regulates blood sugar levels. This may lead to an increase in blood sugar, weight gain and potentially Type 2 Diabetes as women head into post-menopause when periods have ended for a year or more.
High levels of cortisol may also disrupt the other hormone-producing glands, such as the pituitary gland which produces melatonin, our thyroid gland which helps to regulate temperature, blood pressure and metabolism. When cortisol levels are chronically high, then this can also disrupt the balance between oesterogen and progesterone.
With this disruption, women can also lose the protective role of calming progesterone. If your clients are feeling bloated, tired, wired, angry, frustrated and experiencing sore breasts or hair loss, then you will know what I mean about low progesterone.
If you or your clients have been experiencing an increased heart rate and blood pressure, insomnia, anger, mood swings, frustration, memory lapses and/or hot flushes and night sweats, then, as women on the MyMT™ programmes discover, it’s time to manage the production of cortisol.
When cortisol is out of balance and it stays high throughout the day and night, then menopause symptoms may become worse. As the Seattle Midlife Women’s Health Study (2009) suggests,
“Rising cortisol levels have been associated with poor health, including lower bone density in older women, minor cognitive complaints, and could be hypothesized to be related to perceptions of poor health overall.” (p. 2).
When I went into peri-menopause, the time of our lives when our ovaries gradually stop producing oestrogen and our progesterone declines as well, I had no idea that not sleeping all night as well as the type of exercise I was doing, was connected to my night sweats, hot flushes and mounting feelings of daily stress, anxiety, brain-fog and fatigue.
Like thousands of women going through menopause, I felt emotionally and physically exhausted but boxed-on – as we tend to do when there is so much to be done.
Emotional and physical stress are accumulative – and it’s not just the ‘here and now’ stress. I’m also talking about the decades-long build-up of oxidative or physical stress that manifests as inflammation and metabolic chaos in the body too.
For your clients with sore muscles and joints, and/or fibromyalgia, or for those with changing gut health, weight gain, insomnia and temperature dysregulation, then these are all signs of Allostatic Load, not just ‘menopause’.
Identify the Sources of your Client's Stress
What are the sources of stress impacting your clients? Are they over-exercising? Do they sleep all night? Do they feel that they are time-poor, juggling both workplace and family demands? Perhaps they are caring for elderly parents as numerous women on my programmes are doing too?
To support your clients to manage their symptoms in menopause and to improve their health as they age, you need to address their accumulated sources of stress. I can’t reinforce this enough. And there’s another reason for this.
Oxidative or cellular stress and high levels of cortisol production are becoming well recognised as a cause of age-related diseases due to chronic inflammation.
Chronic inflammation arrives in the gut, liver, heart and kidneys as well as muscles and joints as we age. And yes, the brain doesn’t escape the effects of damaged and inflamed cells and tissues either.
In a new study about the brain and stress, the authors state,
‘Allostatic load represents the ‘wear and tear’ of chronic stress on the brain and body and … women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities and health behaviours, that influence associations between allostatic load and their mental health.’ (Kerr, Kheloui, et el., 2020, p.1).
Help Client's Build Resilience to Stress with MyMT™ Education
As many of the Practitioners and Coaches discover on the Certified Lifestyle Science and Menopause Practitioner Course, cealth and wellbeing in later life is not just about maintaining physical and mental health, but also about creating an environment that enables women to live their life to the full.
Understanding how to support women to take a holistic and integrated view of their symptoms and align this to their daily stress, is an important role that you play – whether they choose to go on HRT with their medical Practitioner’s support or not.
With the world going into a huge age shift, the United Nations announced in 2020, that they were naming 2020 to 2030, the Decade of Healthy Ageing.
Women’s ageing starts during the menopause transition.
With results from international studies indicating that improvements in the general health status of the older female generation may moderate the demand and need for health services as this cohort ages (Cornwall & Davey, 2004; WHO, 2015, 2023), the greatest challenge in public health promotion, especially for menopausal and post-menopausal women, according to DiPietro, (2012), may well be that “now more than ever, it is time to move science into action” (p. 4).
That’s the purpose of the MyMT™ Certified Education Courses. Join us when you can.
References:
Childs, E., & de Wit, H. (2014). Regular exercise is associated with emotional resilience to acute stress in healthy adults. Frontiers in Physiology, vol. 5 161. 1, doi:10.3389/fphys.2014.00161
Davis, S., Castelo-Branco, C. et.al. (2012). Understanding weight gain at menopause. Climacteric, 15: 419–429.
diPietro, L. (2012). Physical activity and public health: The challenges ahead. Journal of Physical Activity and Health, 9, 3-4.
Kerr, P., Kheloui, S. et al. (2020). Allostatic load and women’s brain health: A systematic review. Frontiers in neuroendocrinology, Vol 59, 100858.
Pfaltz MC, Schnyder U. Allostatic Load and Allostatic Overload: Preventive and Clinical Implications. Psychother Psychosom. 2023;92(5):279-282. doi: 10.1159/000534340. Epub 2023 Nov 6. PMID: 37931612.
Sievert LL, Jaff N, Woods NF. Stress and midlife women’s health. Womens Midlife Health. 2018 Mar 16;4:4. doi: 10.1186/s40695-018-0034-1. PMID: 30766714
Stewart, A.L., Kathawalla, UK., Wolfe, A.G. et al. (2018). Women’s heart health at mid-life: what is the role of psychosocial stress?. Womens Midlife Health 4, 11. https://doi.org/10.1186/s40695-018-0041-2
Volarić N, Šojat D, Volarić M, Včev I, Keškić T and Majnarić LT (2024) The gender and age perspectives of allostatic load. Front. Med. 11:1502940. doi: 10.3389/fmed.2024.1502940
Woods, N. F., Mitchell, E. S., & Smith-Dijulio, K. (2009). Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause (New York, N.Y.), 16(4), 708–718. https://doi.org/10.1097/gme.0b013e318198d6b2
World Health Organisation, (2015). World report on ageing and health. Geneva, Switzerland: World Health Organisation.
