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August 2023

Introduction to Menopause. 

Source – Reflexions; March 2022 – Written by Sally Earlam

Reflexions is the AoR members quarterly magazine letting you discover the latest reflexology insights. Written by Reflexologists, for reflexologists.
In our March 2022 Edition we offered members an insight into menopause, the importance of relaxation for easing symptoms and some fascinating facts about how menopause is experienced in different cultures. Here we share with you one article from this popular magazine.  Want more? Join today and access this whole edition of Reflexions as well as a library of previous editions of this highly sought after magazine.

Menopause is not an illness but a natural process that all women will go through and yet it is a time that is often feared by women in western cultures. However, with education, wellbeing can be significantly improved and menopause should be viewed as being part of positive healthy ageing. This is so important as women may spend a third to a half of their life post menopause and it can actually be an opportunity for transformation and growth – a time to decide who they want to be for the rest of their lives and to plan how they can achieve this.

As reflexologists we can be there to provide our hands on touch therapy, be a listening ear, to suggest possible lifestyle changes if the client would like to know more, direct them to useful resources and to offer some hope that they can feel better. There is compelling evidence that lifestyle has a huge impact on menopausal symptoms and this will be discussed later in the magazine.

Attitudes to menopause are certainly changing as even in the Victorian times women were frequently institutionalised as Victorians viewed menopause as a mental illness named Menopause Induced Hysteria. I am pleased to say that today it is a subject starting to be more freely discussed by celebrities and we are seeing workplaces developing menopause policies to help support menopausal women to stay in work in light of the Government publication on menopause.

Perimenopause and Menopause

Perimenopause generally starts in the 40’s and on average lasts for 4 years but can range from 1-12 years. Menopause starts when there has been no period for 12 consecutive months. The average age of menopause in the UK is 51.
Natural perimenopause begins when the remaining number of oocytes (eggs) are low. Hormones begin to fluctuate due to the declining ovarian function and the ovarian follicles are not always able to mature and release an egg.

Hormones start to become erratic with progesterone being the first hormone to decline which can cause periods to become irregular and with extended heavy menstrual flow. Oestrogen levels will then begin to fall, but this can leave times where there is oestrogen dominance (relatively higher levels of oestrogen over progesterone) and this is one of the biggest contributors to unpleasant menopausal symptoms.

Typical symptoms of oestrogen dominance include bloating, insomnia, fatigue, anxiety, feeling oversensitive, headaches, low libido, cravings for sweet foods, poor memory, etc.

Oestrogen also rises when there is a high calorie diet with little exercise and being overweight, as fat cells can produce oestrone. This is one of the three types of oestrogen that is still produced in small quantities by the ovaries, adrenals and in adipose tissue (fat cells) in menopause.

During perimenopause, 8 out of 10 women in the UK will experience some symptoms and the most common are hot flushes and night sweats which can severely affect quality of life. The majority of symptoms typically last for 4 years but for 10% of women they can last for 12 years. When it comes
to menopause, this is more about an increased risk of a number of long-term conditions such as osteoporosis, heart disease, high blood pressure,
high cholesterol, diabetes, stroke etc, hence the need for lifestyle education.

We typically think about oestrogen and progesterone as our reproductive hormones however we have oestrogen receptors around the whole body. These are proteins that are found within cells across the body and they receive oestrogen from the bloodstream, which acts as a message for a particular activity. They are found in many areas of the body including reproductive organs, breast tissue, bones, joints, ligaments, tendons, skin, cardiovascular system, thyroid, central nervous system and gastrointestinal tract. So it then comes as no surprise that, as oestrogen levels fall, the symptoms are so far reaching.
Symptoms can include hot flushes, night sweats, palpitations, irritability, mood swings, insomnia, irregular periods, low libido, dry vagina, fatigue, anxiety, depression, poor concentration, poor memory, incontinence, itchy skin, achy joints, achy muscles, headaches, migraines, bloating, allergies, weight gain, hair loss, facial hair, dizziness, gum disease, bad breath, weak nails, tinnitus, etc. Longer term, blood vessels and lymphatics become less elastic, cholesterol levels can increase, there can be changes to the liver including inflammation and fatty liver, higher cortisol levels and increased inflammatory markers that can contribute to many chronic conditions. So this does not make very positive reading for women in the UK but if we look across different cultures we can see some very different pictures of how menopause is experienced.

Firstly there are differences in the way menopausal women are viewed. In the East they are viewed as wise women or matriarchs whilst in the west it is seen as a time of loss of fertility and children and I remember the feeling of being an invisible woman and frequently being ignored.

In East Asia they view it as a rite of passage and regard it with respect, maturity and wisdom and they don’t demonise it.

Secondly there are differences in physical symptoms. In agrarian non-industrialised cultures menopause is generally an uneventful time with women reporting no symptoms whereas we have seen that in western, industrialised countries, such as the UK, it can be a very trying time.

In China, farmers had less symptoms than professional Chinese women and Hadzu hunter-gatherers report virtually no symptoms.

These differences are thought to be due to lifestyle differences that will be discussed later on, but also due to the stresses involved in modern Industrialised living.

A Note About Stress and the Importance of Relaxation

A study has shown that chronically elevated cortisol increases the likelihood of severe menopausal symptoms so prioritising relaxation is key. In the research section we have seen that reflexology has been shown to be beneficial in reducing symptoms but as well as encouraging clients to have regular reflexology we should also suggest that clients make time every day for some form of relaxation such as meditation, mindful walk, yoga, etc.

If we look at the pathway of how hormones are produced in the body our oestrogens, progesterone and testosterone are primarily produced in the ovaries and adrenals. Production of these hormones requires cholesterol, pregnenolone and dehydroepiandrosterone (the latter 2 are produced in the adrenal gland). However if cortisol is required by the body the adrenals will rob the cholesterol, pregnenolone and DHEA to produce the stress hormone potentially leaving no base ingredients for the sex hormone production. So lowering stress can have a profound effect on symptoms.
As a final note, remember the endocrine system works together to achieve homeostasis so I recommend a little extra care and attention on all endocrine reflexes – setting your focus and intention for healing.

  • www.gov.uk/government/publications/menopause-transition-effects-on-womens-economic-participation
  • www.nice.org.uk/guidance/ng23/chapter/Context
  • Melissa K. Melby, Margaret Lock, Patricia Kaufert, Culture and symptom reporting at menopause, Human
  • Reproduction Update, Volume 11, Issue 5, September/October 2005, Pages 495–512,
  • Cagnacci A, Cannoletta M, Caretto S, Zanin R, Xholli A, Volpe A. Increased cortisol level: a possible link between climacteric symptoms and cardiovascular risk factors. Menopause. 2011 Mar;18(3):273-8. doi: 10.1097/gme.0b013e3181f31947. PMID: 21037488.