“I’m responsible for the emotional well-being of 12,000 UK National Health Service staff and I’ve never been busier” mentioned Consultant Clinical Psychologist to the NHS in South Wales, Dr Clare Wright, when she emailed me during the worst of the UK’s pandemic. In response to the Coronavirus pandemic, she spent her time visiting the Emergency Departments, Intensive Treatment Units, and hospital wards across 3 District General Hospitals and 3 community hospitals where COVID 19 positive patients were being cared for, providing emotional support to staff on the frontline and guidance to their line managers on how to support their wellbeing and intervene if staff are struggling.
But it was Clare’s wellbeing I was concerned about too – especially as she was transitioning through menopause. It’s a time in our lives, when the effects of stress – both emotional and physical – manifest as insomnia, worsening hot flushes, increased anxiety and heart palpitations as well as metabolic changes in the gut, which in turn affects weight gain, including for Claire. Hence, I was heartened with her reply to me – “Being on MyMT though really helps, as it gives me a sense of control over one area of my life, when the rest of it is chaos, stress and a lot of heartbreak.”
Our chronic stress hormone, Cortisol, is a pesky hormone.
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 your muscles and bones, heart and blood vessels, lungs, hormone-producing glands, liver, gut and your brain. And that’s the problem for women transitioning through menopause. With declining levels of oestrogen affecting our heart, nervous system, blood vessels and our breathing, we may start to experience an elevated response to stressful events in our life changes.
This valuable hormone has lots of functions — both positive and negative. It helps to control how you respond to stress, how your body fights infections, it has an effect on your blood sugar levels, and it helps to regulate blood pressure. But when we feel chronically stressed, then cortisol levels remain high thoughouot the day, ad they shouldn’t.
As such, high levels of cortisol may disrupt the other hormone-producing glands, such as our pituitary gland which produces melatonin, our thyroid gland which helps to regulate temperature and metabolism and when cortisol levels are high, then this can also disrupt the balance between oesterogen and progesterone. Wit this disruption, we can also lose the protective role of calming progesterone. If you are feeling bloated, tired, wired, angry, frustrated and experiencing sore breasts or loss of hair too, then you will know what I mean about low progesterone.
High cortisol also affects your weight. Cortisol has an intricate relationship with the hormone insulin, which controls our blood sugar. High or low cortisol can cause hypo-glycemia (low blood sugar), hyper-glycemia (high blood sugar) or both.
When cortisol levels increase, the cells of our body can become resistant to insulin. In turn, 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.
The Seattle Midlife Women’s Health Study (2009) offers wonderful insight into the role of higher cortisol levels overnight and why this is related to our heightened feelings of stress throughout the day. Cortisol levels rise among some women during the late stage of the menopausal transition, especially at night. This is the time when cortisol levels should be low. Higher overnight cortisol levels during the menopause transition were significantly and positively associated with adrenaline (epinephrine) and nor-adrenaline (norepinephrine) levels. These are your other stress hormones and they exert an influence all around your body.
If you’ve been experiencing an increased heart rate, anger, frustration, memory lapses and/or hot flushes and night sweats, then, as women on the MyMT™ programmes discover, it’s time to manage your production of cortisol. When cortisol is out of balance and it stays high throughout the day and night, then your 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. Like so many other women heading into post-menopause, the weight just crept up and up, despite exercise and dieting.
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 our body too. If your muscles are sore, if you have fibromyalgia, if your gut health has changed, if you have put on weight, and if you are feeling hot and bothered all the time, and you aren’t sleeping, then yes, these are all signs that your body is ‘stressed’.
Identifying the Sources of your Stress is Important
The balancing act between oestrogen and progesterone over the 8 to 10 years (yes!) that we move through menopause is important. It’s why many of you are put on progesterone as hormonal therapy during this stage of life. But here’s the thing – often your various sources of stress are overlooked. All these sources of stress accumulate. Then this increased allostatic load of cortisol ‘steals’ progesterone. That’s why, although you might go on HRT to manage your symptoms, other sources of stress in your life need to be managed as well.
High volumes of exercise or being sedentary are both sources of stress to you, as well as lack of sleep, poor diet, workplace and family stress and of course, any underlying health issues also stress your body at a time when your hormonal environment is changing.
To manage symptoms in menopause and to improve your health as you age, you need to address these sources of stress too. 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.
Oxidative stress is a term that refers to chronic inflammation building-up deep inside our cells and tissues. This chronic inflammation arrives in our 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).
Build your Resilience to Managing Stress Levels in Menopause with Aerobic Exercise
Health and wellbeing in later life is not just about maintaining physical and mental health, but also about creating an environment that enables us to live our life to the full. With the world going into a huge age shift, this is why the United Nations announced in 2020, that they were naming 2020 to 2030, the Decade of Healthy Ageing. And ageing starts in mid-life.
For women this means our menopause transition and whist exercise matters as we age, the question is ‘how much?’ and ‘how hard?’ Thanks to the studies that have emerged from the American Heart Association, we now know that there is a dose-response effect with exercise and cardiovascular disease prevention.
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. Fortunately, these guidelines now look at both men and women differently. This is important. We aren’t men and nor do we age the same way that males do. Observational studies have reported decreased numbers of Coronary Heart Disease (CHD) events in subjects who perform regular aerobic activity.
There is a dose-response relationship between CHD and aerobic physical activity, and even 1 hour of walking per week is associated with lower risk, but the ideal is 150 minutes of aerobic exercise as your starting point for improving heart health. Aerobic exercise helps your circulation and helps to dilate your blood vessels. All necessary factors in reducing blood pressure as our other preventative measures such as reducing your cholesterol levels, losing weight if you are overweight (especially reducing belly fat and getting your waist circumference under 84 cm) and of course, stopping smoking and eating a diet evidenced for cardiac health as I have for you in the MyMT™ programmes.
It’s never too late to turn around your health as you age. For those in post-menopause (over 52 years) then please also check your junk mailbox if you have missed my JULY post-menopause weight loss programme offer to you. Women are already underway now. 12 weeks with me, might just change how you are feeling and most importantly, set you up for your healthy ageing years ahead.
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.
Kerr, P., Kheloui, S. et al. (2020). Allostatic load and women’s brain health: A systematic review. Frontiers in neuroendocrinology, Vol 59, 100858,
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
Tanaka H. (2019). Antiaging Effects of Aerobic Exercise on Systemic Arteries. Hypertensio, AHA doi: 10.1161/HYPERTENSIONAHA.119.13179.
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