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Taking HRT but not feeling better?

HRT is a game changer for most women when they reach menopause and find that all of a sudden they can’t function. Where they used to be the life and soul of the party, they are now much more at home curled up on the sofa watching Netflix. Memory lapses leave them scratching their head trying to remember where they parked the car or why they are standing in the middle of the kitchen.


However, for some women taking HRT can make them feel worse. Now the thing with HRT is that it comes in lots of different formulations and doses and it may take a few attempts to get the correct dosing and combination of hormones. So if you fall into this camp do not be afraid to go back to your GP and ask them to tweak your HRT prescription. However, if you have done this and are still not feeling any better it may be time to look beyond HRT. After all, the terrain you are putting HRT into will determine how effective it is.


Hormones are communication molecules that form part of a complex communication network between the different functional systems in the body. There are three other hormones that need to be taken into consideration when women hit perimenopause – cortisol, insulin and thyroid hormone. These hormones all heavily influence your menopause experience.


Cortisol is the stress hormone and is the top dog when it comes to your hormones. It takes priority over everything else as it controls the fight or flight response. This response is essential to our survival and prepares the body to either fight a predator or run from danger by increasing glucose in the bloodstream for energy, increasing blood pressure, heart rate and  clotting factors in the blood as well as increasing breathing rate. In an effort to save energy for survival it also shuts down non-critical functions such as the immune system, reproduction and digestion.


We only have one stress response and this response is the same whether the trigger is a life-threatening danger or the day to day stressors such as work, financial worries, family concerns, bereavement. However, the fight or flight response is designed to respond to a danger that passes but these stressors we face today mean that the stress response remains continually switched on. All of the sugar that is mobilised but not used, gets turned into fat. The immune system becomes suppressed which leads to increased inflammation and accelerated aging. Sex hormones production is inhibited and ovulation may stop. This is by design – you don’t want to be bringing a baby into a ‘dangerous’ world. However, this means that chronic stress can exacerbate your menopause symptoms by influencing oestrogen and progesterone production.


Insulin is our fat storage hormone. Insulin is the main hormone responsible for keeping your blood sugar levels at an optimal level (typically fasting blood glucose levels are the equivalent of 1 teaspoon of sugar or approximately 5g). This is an incredibly important job as deviations too far from the optimal range can be dangerous. Insulin is released by the pancreas in response to increases in blood sugar levels. Blood sugar levels rise predominantly after eating carbohydrates and insulins role is to help your cells open their doors and allow glucose to enter the cell where it can either be used to produce energy or stored as fat. Any excess glucose is stored as fat. The more insulin you produce, the more fat you tend to store. The responsiveness of insulin to changes in blood sugar levels is known as insulin sensitivity and this decreases with declining oestrogen levels. After menopause, when oestrogen levels are low, women are much less responsive to insulin, i.e. they become more insulin resistant. Insulin resistance encourages fat storage around the middle and as glucose is unable to enter the cells, the ability to produce energy is decreased. This leads to fatigue, brain fog, poor memory and low mood.


Finally we come to thyroid hormone which is the master metabolic regulator. It sets the basal metabolic rate, i.e. how much energy each cell produces. When thyroid hormone is not working optimally, everything slows down. Digestion becomes more sluggish, you feel the cold more, you gain weight and you may suffer from brain fog, poor memory and low mood.


Cortisol, insulin and thyroid hormone not only impact each other but they also impact sex hormone production. High insulin can not only reduce thyroid function but can also increase testosterone levels whilst decreasing oestrogen (this is typically the picture in hormone conditions such as PCOS). Cortisol can reduce thyroid hormone and when thyroid hormone is low, sex hormone output maybe reduced. Optimising the function of these three hormones can have a huge impact on your menopause symptoms – without the need for HRT.


So if HRT isn’t an option for you or if you have tried HRT and it didn’t make things better, it may be time for a new approach.


If you would like to find out more about how a personalised bespoke health plan could help you, please book a complimentary midlife review now. After all, if nothing changes, nothing changes!


Michaela x

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