Me-no-pause

Resumé

By Dorothy Parker

Razors pain you;

Rivers are damp;

Acids stain you;

And drugs cause cramp.

Guns aren’t lawful;

Nooses give;

Gas smells awful;

You might as well live.

That is how menopause often makes me feel. I know there are women for whom it's not a big deal. I'm glad for them while also wanting to punch them when words like "empowerment" reach my ears.

For me - and many other women - it's a different story. HRT has helped, but it's not a panacea, nor is it appropriate for everyone. Controlling blood sugar levels has become more of a challenge than ever and I don't recognise my body any more.

Menopause has arrived like a wrecking ball on my mood and energy levels. It's a jarring, metabolic shift like travelling on a motorway at 70 mph and suddenly jamming into reverse without warning. While losing control of your inner thermostat. And your ability to focus. And misplacing the joy you felt just an hour ago. And being consumed by an urge to bludgeon intelligent people behaving stupidly.

Obviously, I need something to blame. It's estrogen. Its job in my life so far has been to keep periods regular and apparently it's also got a role in mood regulation (could do better). In addition, estrogen has soemthing (no, I'm not amending that. It's forward only today) to do with insulin sensitivity, fat distribution (I seem to be attracting it from all continents), the regulation of appetite and controlling inflammation.

That's quite the job description, estrogen. Ghosting me without a fight is not an option. Except it's stacked the odds in its favour.

The loops I am fighting harder than ever to break are: weight gain makes it more difficult to manage blood sugar levels and high blood sugar levels make it harder to lose weight; low energy levels make it very hard to drag myself to the gym and sometimes dragging myself to the gym leaves me floored for the rest of the day; and eviscerating people is a criminal offence and not eviscerating them makes me even angrier.

You see my problem.

Right. So. Let's get to blaming estrogen and understanding what's happening. Menopause is when estrogen leaves the building. Among the many disasters in its wake are:

• Increased insulin resistance: it's harder than ever to control blood sugar levels

• Increased visceral fat: you know, the nasty stuff that collects around the organs in our belly. That fat is metabolically active. That means it secretes hormones and other molecules that can increase the risk of developing a range of illnesses. Some visceral fat is, though, important to cushion our organs

• Sleepless nights: increased anxiety, night sweats and wakefulness at around 2:43 am at least four nights a week. In addition to all the other challenges it piles on you, poor sleep affects glucose metabolism - and not in a good way. Poor sleep also increases levels of the hunger hormone ghrelin and reduces levels of the satiety hormone leptin. So, for the first time in my life, I am waking up regularly exhausted and craving carbohydrate. This is not normal for me

• Mood dysregulation and mental fog: stupid things worry me. I mean really stupid. I have developed a voice in my head that comments on just how stupid the worries are. And I don't have the energy to shut either of them up. Add this to fluctuating hormones and less predictable blood sugar regulation and you get mood swings from hell. As to mind fog... where was I?

• Muscle wasting: this is an age and stage at which our muscles waste away. We have to use and nourish them to maintain a mass that helps us not only maintain a healthy range of motion without injury, but also burns the glucose a diabetic cannot metabolise as efficiently

In terms of managing blood sugar levels, I've had to re-think a lot of what I used to take for granted:

• Waking energy levels: I now don't think of my day in terms of how much time I have to do things. I have to approach it in terms of how much energy I start the day with. If it's a teaspoon, I.m very careful about who gets it and why

• Thinking of my plate as art: colours make me happy. Simplicity gives me energy. So I eat colourful food that is as close as possible to its simplest form: raw, fresh or lightly cooked, with the occasional stew. I start with greens and prebiotics (to slow digestion of what comes next and lower sugar spiking, feed gut bacteris), add lean protein (to increase satiety and support maintenance of muscle mass), add some low glycaemic index carbohydrate (pulses, quinoa), some colourful fruit and veg (tomatoes, raw beetroot, carrots), sprinkle some nuts (sprouted when possible, to lower carbohydrate content and increase nutrition levels) and seeds on top then drizzle with olive oil. If you make it a habit, it's a very quick routine - and pretty, which helps

• Timing when I eat: insulin sensitivity in the body is higher in the morning, so I eat more in the first half of the day. Cortisol levels are also higher in the morning, though, and cortisol increases blood sugar levels. So I don't eat fruit or honey in the morning, on the whole. I try to stop eating by 6pm and avoid work evening meals like the plague (when possible). This means taking food to work, which in turn means planning ahead and carrying more stuff to and from work... don't get me started

• Building muscle: resistance training has become non-negotiable, so I can maintain enough muscle mass to metabolise glucose. Non-negotiable though it is, I also don't always have the energy to do more than collapse and simply resist ingesting food that will make me feel worse. So I do that instead, when I can't move

• Befriending my vagus nerve: see my blog post 'What happens in Vagus...' for furthers and betters

• Prioritising sleep: even though it is often disturbed, sleep has become as important in my life as breathing

• Letting myself feel angry: I went through a period of getting angry about feeling angry. Which triggers cortisol. Which triggers higher sugars. Which then winds me up again. Instead, I've decided that it's ok to feel pissed off about this wrecking ball. I stop there. No platitudes or zen master aphorisms. It's ok to feel pissed off. End of

Finally, I've learned a little about hormone clearance. It's part of my campaign of letting go. I didn't realise that once a hormone has done its job in our bodies, we still have to metabolise, de-activate and eliminate it. Like some rogue agent.

I guess it's obvious: the job of a hormone, once produced, is to travel to its target tissue and deliver a message to the cells in that tissue, to inform essential functions like growth, metabolism, mood regulation and the waking/ sleeping cycle. After it delivers its message, the hormone is broken down into different metabolites which have to be cleared out of our bodies.

Inefficient hormone clearance can cause build-up or retention of the metabolised components in forms that do not do us any good. In menopausal diabetics, hormone clearance is especially important, because:

• Retaining estrogen metabolites increases the risk of oxidative stress, which is linked to a range of serious illness

• Insulin is a hormone. If it is not effectively cleared from the body (for example, because of liver dysfunction or chronic inflammation), then it can aggravate type 2 diabetes

• Inefficient clearing of cortisol can increase belly fat and leave you feeling hung over

Hormone clearance is, therefore, an important part of coping with menopause changes when you're diabetic. Here are some ways of improving hormone clearance - though always check with your doctor what's best for your health profile:

• Eat cruciferous vegetables: this helps estrogen metabolism through liver support

• Increase fibre: to help clear the gut (I drink psyllium husk)

• Drink enough water: to suppor kidney health. I aim for 2 - 2.5 litres a day

• Take care of your liver: limit processed foods, add turmeric, milk thistle or dandelion root to your diet (if appropriate) and reduce alcohol

• Bowel health: feed your gut biome with prebiotics and address constipation, so the gut empties regularly and comfortably

• Prioritise sleep: this is when the body's detox systems come alive

• Learn how to hack your vagus nerve: high levels of cortisol hinder the clearance of estrogen and insulin. Switching your nervous state from sympathetic (on alert) to parasyumpathetic (at rest) by stimulating the vagus nerve is an easy shorcut to lowering stress, especially when your energy levels are low and just the mention of "mindfulness" is likely to make you reach for a machete

Letting go. I guess that's what this phase of life is all about: I'm not quite who I used to be, though I also am; I don't feel the same way to myself any more; I am parenting someone on the cusp of adulthood; and suddelny (not correcting that either, incidentally), I'm using semi-colons all the time.

And now, I'm going to publish this without re-reading it.

Because it's all about letting go.

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