Menopausal Symptoms Getting You Down? 5 Things You Need to Address Before Taking HRT

Menopause does not have to be a time of unpleasant symptoms. Here are things that you can do to prevent needing HRT.

I am not against my patients taking hormone replacement therapy (HRT), far from it. I have seen the dramatic improvements women get when they replace hormones, in terms of mood, energy, sleep and well-being. For some women, flashes and mood disturbances can be debilitating and so HRT can be a welcome relief.

But there is a darker side to HRT and with the cancer risks that are associated, it should never be taken long-term.  Generally, if you address the underlying issues leading to hormone dysregulation, then most women will never need to take the risk of taking HRT.

We have known for a long time that HRT carries a substantially high risk of triggering hormonal cancers and cardiovascular problems such as blood clots. Research on over 500 000 women have shown that the risk of developing breast cancer becomes significant after only one year of use and remains even 10 years after discontinuing medication. So, the more you can do naturally to navigate this hormonal transition, the better in the long run.

If you are suffering from any of the symptoms listed below, you do not need to just put up with it:

  • Night sweats
  • Flushes
  • Mood changes such as irritability
  • Low libido
  • Skin changes
  • Insomnia
  • Migraines
  • Brain fog

Many women sail through this transition without too many issues while others have unpleasant or even crippling symptoms. Having any of the above symptoms, however, indicate that there is a general imbalance in the body.  Here is what you can do regain hormonal balance:

1. Maintain gut health

You may be surprised to find that the health of the gut plays a significant role in hormone balance.  Here is what we know about the gut-hormone connection:
Research has shown that of the many pathways affected by hormones, the production and reabsorption of sex hormones is profoundly impacted by antibiotics. Antibiotics are known to disrupt our gut ecology.

A recent study found that after a course of antibiotics, more than 27 different hormone metabolites were altered. This is hugely significant and shows a direct correlation between the microbes that inhabit us and our hormonal control. It would make sense then to look at the health of the gut, and in practice I find that there is a significant correlation.

Many of the symptoms that women experience in menopause is as a result in a drop in hormone levels. Researchers have found that individuals with the highest hormone levels have a more diverse gut microbiome, thereby strengthening the finding that antibiotic use can disrupt hormonal balance.

How does it all connect? We still don’t fully understand the connection between the gut and hormones. The complexity of the interactions between our gut microbes and hormones is still being unravelled. One thing that we do know for certain is that when we rebalance the gut microbiome, hormonal symptoms improve.

One clue may lie in what scientists call the estrobolome. The estrobolome are certain bacterial populations that are capable of metabolising estrogen. These gut microbes produce an enzyme called beta-glucuronidase, that can increase levels of free estrogen in circulating blood. When the gut microbiome is healthy and balanced, the estrobolome can regulate the right level of estrogen within the body, but when imbalanced – gut dysbiosis can drive the production of estrogen in either direction, disrupting the normal flow and leading to estrogen-related imbalance.

Metabolic endotoxemia is a term for the translocation of bacteria from the gut into circulation. This has been shown to alter progesterone production, leading to a multitude of hormonal issues.

What can you do to maintain gut health?

Firstly, avoid antibiotics when possible.   Antibiotics can be life-saving when needed but they are often over-prescribed and the impact of taking antibiotics can last up to 2 years. If it is necessary to take them, make sure that you take a high-quality broad-spectrum probiotic alongside your prescription.

Every meal that you eat is food not just for yourself, but for the millions of microbes that inhabit your gut. Keeping the microbes healthy, will ensure that keep the estrobolome healthy. To do this, the diet needs to be rich in fibre, phytonutrients and nutrients and be void of sugar and processed foods.

Fermented foods can be good for feeding the gut but only if you do not suffer from a condition called Small Intestinal Bowel Overgrowth (SIBO).

If you have any gut symptoms, I strongly suggest getting comprehensive gut testing that looks at the entire microbiome, rather than just guessing what the problem may be. That way you can develop a targetted strategy for gut repair.

2. Stress

We all recognise that stress can have a damaging effect on health, but when it comes to hormones the impact is dramatic. We refer to the hormonal effects of stress as the “cortisol steal” and it is often the culprit for many of the extremely uncomfortable symptoms listed above.  

Defining stress can be challenging and many of my patients do not initially recognise that they are stressed when we first open the topic.  Not until we do laboratory or heart rate variability (HRV) testing, do they realise that the impact of our modern day lives on the body.

When we face stress, our adrenal glands produce hormones that help us rise to the challenge. This is called the “fight or flight” response. Once the situation passes, the body should move back to the “rest and repair” phase.  Our modern lives often mean that we are spending more time in the fight or flight with little time for the body to repair and bounce back.

Many of my patients report that menopausal symptoms worsen during periods of stress.  Additionally, we know that the gut microbiome is also directly affected by stress, thereby indirectly affecting the estrobolome.

Chronic stress is not only the greatest cause of premature ageing and cardiovascular disease, it also inhibits hormonal function, leading to a variety of unpleasant symptoms. In turn, the symptoms drive up more stress, so it is a negative feedback loop.

I find HRV one of the most powerful ways of building resilience to stress.

Suggestions to reduce immediate stress:

* Daily walks in nature can be helpful to reduce stress
* Listen to music or dance to burn off some of the stress hormones
* Breathe deeply and centre yourself
* Spend time with supportive friends or family

Long-term suggestions for reducing stress:

* Learn breathing techniques such as Heartmath
* Build a network of supportive friends and family
* Learn mindfulness techniques

Certain herbal remedies and supplements can be extremely helpful in managing stress and emotions, but it is advisable to speak to your Functional Medicine practitioner or a qualified herbalist to make sure you get the right support for your situation.

3. Blood sugar regulation:

Another surprising connection is the role of blood sugar regulation and our sex hormones. There is a strong association between diabetic patients and estrogen deficiency with testosterone excess, leading to further complications such as cardiovascular and kidney disease.

This connection is not so surprising to women who have suffered from hypoglycaemia.  The symptoms women experience in an episode of hypoglycaemia has a striking similarity to some of the hormonal issues faced in menopause.

Rising insulin levels are often the cause of hormone pathways that are blocked. In response to high blood sugar levels, insulin levels often creep up insidiously, causing great harm over time.  By the time we see raised glucose levels, insulin levels have often already been raised for over a decade.

If you already have a diagnosis of diabetes, you will need supervised medical support to help regulate hormones. However, in terms of prevention, reducing insulin levels is very achievable and can make a huge difference to hormone balance.

I believe that all women (and men) over the age of 40 should have their insulin levels regularly screened.

4. Friendships

As if menopause isn’t difficult enough, a new study has found that complicated friendships can make symptoms worse.
Researchers from the University of Arizona analysed data from 11,000 women in which they discovered a link between those who were experiencing a stressful time in their social life and increased menopausal symptoms.

And it wasn’t all a matter of perception. Women who had stressful friendships also had a reduced bone density!
We still don’t know exactly how stress impacts on our physical health, but there are measurable changes in health as a result of our emotions.   Friendships are extremely beneficial to health when they are supportive and healthy. They help us weather the storms of life. When friendships are toxic, however, they can do great harm to health.

It may be time to consider letting go of unhealthy friendships and nurturing those that nourish and replenish you.

5. Sleep:

Poor sleep quality and sleep disturbance are lesser-known changes during this phase of life, but they can be extremely debilitating. Disturbed sleep leads to a dysregulation of hormones, which in turn disrupts sleep further.  

For some women it is hot flashes at night that trigger wakefulness, for others it can be anxiety or as a result of raised cortisol.
Bizarrely, this is also a time where women tend to develop sleep apnoea as a result of loss of hormones. In fact, postmenopausal women are three times more likely to have sleep apnoea than younger women who have not gone through the change.
Sleep apnoea can lead to a variety of health concerns and needs to be recognised early.  Home night-time oxygen monitors are a good place to start if you suspect that you may have sleep apnoea.
Even mild sleep deprivation has been shown to increase the hormone cortisol, thereby throwing off hormonal balance. So, regulating sleep patterns is essential for hormonal balance.

Avoid being over-stimulated at bedtime:

  • Avoid caffeine if you can't fall asleep, especially after noon.
  • Avoid all alcohol if you have any sleep issues, especially from late afternoon on. Alcohol is sedating but has a paradoxical effect of causing awakenings during the night.
  • Turn off electronic devices which emit blue light, such as the TV, computers, smart phones, and tablets at least 2 hours prior to going to sleep as they inhibit melatonin production. If you must use these devices, consider using a blue light filtering app such as Flux or Twilight. Alternatively, you can use amber colored glasses to block the blue light.
  • Allow your mind to relax and unwind at least an hour before bedtime. If this is challenging to you, try journaling, relaxation breathing, progressive relaxation, guided imagery, listening to soft music, taking a relaxation bath, with lavender essential oils and Epsom salts is desired. Try going to sleep to the sounds of the ocean or similar pleasant sounds.
  • Aim for 30-60 minutes of exercise daily to help support sleep, but don’t do it too close to bedtime if you know you’re prone to being over-stimulated by it.

Train the brain to feel sleepy & awake at regular times:

  • Try to view the sunset and dim the house lights after dark, always being mindful of safety. Keep your bedroom very dark and cool. Remove electronics from the bedside and use natural products for your bedding and pillows.
  • Keep a sleep routine-go to sleep and arise at the same times each day, including weekends. Retire between 10 and 11 PM for the healthiest melatonin production and restorative sleep.
  • If you have to get up during night to use the bathroom use a nightlight or as little light as possible.
  • Avoid napping as it interferes with the natural Circadian Rhythm. If extremely tired, limit nap time to 30 minutes or less.
  • Get at least 30 minutes of exposure to sunlight per day with no sunglasses. Get some bright light exposure soon after awakening and get some natural light exposure during the mid-portion of the day.

Develop a strong mental association between your bedroom & sleep:

  • The bedroom should be an oasis of tranquility. Do not use it as an office or recreation room-avoid reading, working, or watching TV in your bed!
  • Get into bed only when you are sleepy. If you are unable to fall asleep, get up and go into another dimly lit room and read a paper book or magazine or listen to soft music. Do not use a computer, watch TV, or use your smart phone.

An evening ritual helps prepare your body/mind for sleep:

  • Do the same thing every night, as you are training your body/mind to unwind from the day. Having a ritual that involves several steps triggers the brain that it’s time for bed. For example, taking a bath, brushing your teeth, and then doing some deep breathing while lying in bed.
  • Count your blessings is a great way to end the day.
  • Relax with a cup of tea an hour before bed. Some herbal sedating and relaxing teas include Passion flower, lemon balm, valerian, hops, and chamomile.
  • Progressive relaxation, gentle stretching, or yoga may also help you unwind and release from the day.

If you already have good sleep hygiene but still struggle with sleep, it may be worth getting professional help.


One thing that many women in my practice benefit from duringmenopause, is acupuncture. This ancient treatment practice has proven to be greatlybeneficial for some of the menopausal symptoms such as flashes, insomnia andanxiety. The thing that I love about acupuncture is that there are no side effects,and that the treatment is completely safe. Why would you not trial something that is completely safe before embarkingon a more risky treatment?

In Conclusion:

There is no reason to put up with unnecessary menopausal symptoms.  Working with a Functional Medicine practitioner can be extremely helpful in getting to the root cause of your symptoms. I am a great believer in thorough testing to help identify the exact causes of dysfunction, so that you can very specifically target treatment rather than attempting a once size fits all approach which sometimes works but often fails.

We have helped thousands of women in our clinic reclaim their lives. If you are serious about investing in your health and well-being, get in contact for an appointment with us today.
Antunes LC, Han J, Ferreira RB, Loli? P, Borchers CH, Finlay BB. Effect of antibiotic treatment on the intestinal metabolome. Antimicrob Agents Chemother. 2011 Apr;55(4):1494-503. doi: 10.1128/AAC.01664-10. Epub 2011 Jan 31. PMID: 21282433; PMCID: PMC3067180.
Shin JH, Park YH, Sim M, Kim SA, Joung H, Shin DM. Serum level of sex steroid hormone is associated with diversity and profiles of human gut microbiome. Res Microbiol. 2019 Jun-Aug;170(4-5):192-201. doi: 10.1016/j.resmic.2019.03.003. Epub 2019 Mar 30. PMID: 30940469.
 Kwa M, Plottel CS, Blaser MJ, Adams S. The Intestinal Microbiome and Estrogen Receptor-Positive Female Breast Cancer. J Natl Cancer Inst. 2016;108.
 Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45-5
Bruns CM, Kemnitz JW. Sex hormones, insulin sensitivity, and diabetes mellitus. ILAR J. 2004;45(2):160-9. doi: 10.1093/ilar.45.2.160. PMID: 15111735.