Hormonal Changes in perimenopause
In your perimenopause, you’ll start to notice changes in your body, mind and emotions as your hormones start to fluctuate and your menstrual cycle becomes irregular. Your body is winding down from its reproductive role, reducing the amount of oestrogen produced in your ovaries and shifting oestrogen production to other parts of your body. Hot flushes are one symptom of this change.
If you are used to experiencing a monthly bleed in your menstrual cycle, it can feel destabilising to miss a period. The rise and fall of oestrogen and progesterone in our monthly cycle normally gives us hormone related highs and lows in energy and emotions.
Even if your contraception is continuous, you are likely to still experience subtle shifts in your mind and body each month.
Every menstrual cycle is different with some women experiencing more bloating, tiredness, pimples, and others feeling more Premenstrual Syndrome irritability. So each woman’s experience of perimenopause will be different.
However, all women will start to feel internal shifts, physical and emotional changes that are out of her control and unpredictable. It can feel as if your body is no longer your own. One woman described this feeling to me, saying, ‘My body hates me.’ Another woman said ‘I don’t recognise myself anymore – it feels alien.’
Symptoms such as hot flushes can seem to occur without warning, night sweats, muscle and joint pain arise overnight, bloating, weight gain, stomach cramps, headaches, sore breasts, vaginal dryness, hair loss, dry or itchy skin, brain fog, short term memory loss, and of course longer, heavier menstruation, or no periods for months. These symptoms don’t happen all at once and don’t happen to everyone.
Learning to ‘befriend your body’ and listening to what it needs is essential at this stage of perimenopause. We need to nurture ourselves with nourishing foods, pampering ourselves with comfort, giving ourselves time and space to rest and relax.
Treating yourself with kindness and compassion is key. Many of us have an inner critic – the voice in our head that , for complex social and psychological reasons, tells us we are not good enough, not worthy of care and love. In women, that inner critic is often directed at our physical appearance and whether our bodies meet a social stereotype of beauty, health or sexual attractiveness. We may have listened to that voice for many years, so that it becomes habitual.
The perimenopause is a good place to start changing the tone and message of that inner voice – turn the inner critic into our best friend. What would we say to a friend who was experiencing these symptoms?
The Menopause Yoga class for ‘Befriending Your Body’ focuses on ways to alleviate hot flushes because this is one of the main symptoms that women say are most disruptive to their daily lives. Research in clinical trials has found that simple breathing techniques, meditations and yoga stretches can help women reduce the frequency and intensity of these symptoms. Changing the emotional response to hot flushes can help too. Nutrition, vitamins and mineral supplements also reduce the occurrence of hot flushes. Befriending your hot flushes instead of fearing them is a good place to start. First we need to understand what they are and why we have them?
Hot Flushes vs vs Night Sweats?
Hot flushes affect three in four women. A hot flush is often a feeling of intense heat that comes suddenly and spreads throughout your face, neck, chest and body. Some women experience it as a wave of heat that floods over your head.
During a hot flush you may experience:
- Redness in your face
- Heart palpitations
- Cold shivers
Hot flushes can last anything from a few seconds or a few minutes to an hour. They may occur just a few times a month when your oestrogen levels are lowest, or frequently throughout the day. This symptom usually starts in your perimenopause and lasts for four-five years, but some women experience them long into their post menopause.
There are various theories about the causes of hot flushes, but one theory is that the falling levels of oestrogen affect another hormone called noradrenaline (norepinephrine), which helps to regulate body temperature. These hormones affect the hypothalamus is the brain which becomes more sensitive to temperature changes.
Yes the temperature gauge can swing both ways.
For the same reason, hot drinks and hot showers can also trigger hot flushes, and so can being crammed into a crowded, airless bus or train.
Thoughts can also trigger hot flushes. If you feel angry, insulted, frustrated or stressed, your body tenses into a ‘fight or flight’ response, which causes your heart to race and an injection of adrenaline and cortisol. This triggers internal heat and a hot flush. Heated emotions really can cause hot flushes.
Stimulants such as coffee, alcohol, sugar and spicy foods can cause hot flushes because these are vasodilator substances that increase your heart rate and the flow of your blood. Many women don’t experience hot flushes in the daytime, they come out at night. These are night sweats.
The Night sweats:
Night sweats can also be triggered by changes in temperature that naturally occur at different stages of your sleep cycle. Many women find that they wake up 1-3 times in the night in a hot sweat that soaks their bedclothes.
Avoiding stimulants such as nicotine, caffeine, alcohol, sugar, spicy foods, especially in the evening, can reduce the nights sweats, and it is advisable to eat your main meal earlier so that you don’t go to bed with a stomach of undigested food. Setting a regular time for bed, sleeping with an open window for ventilation, ditching the heavy duvet in favour of layers of bedding made of natural fibres can help you regulate your temperature at night. Urinary and bladder problems are common in the menopause, caused by low oestrogen that weakens the pelvic floor muscles. By staying hydrated throughout the day instead of drinking water too close to bedtime, you can avoid the urge to go to the bathroom in the middle of the night.
Anxious dreams can also cause night sweats, which then wake you up and disturb your sleep pattern. Learning to calm your mind, release anxious thoughts by writing a journal before bedtime, and switching off digital devices at least one hour before bedtime can improve your sleep routine. Taking a magnesium citrate tablet about one hour before bed can relax your muscles so that you drift off more easily, and other natural remedies such as valerian and hops can help you stay asleep.
Need support with improving your sleep?
Lisa Sanfilippo is a MFML teacher and the founder of Sleep recovery. If sleep issues are your problem try her sleep recovery course.
How can yoga help reduce hot flushes?
Yoga poses that create space for heat to release, cooling breathing techniques and meditation that calms the mind can significantly reduce the frequency and intensity of hot flushes. We practice gentle yoga poses that stretch, open and release through the areas where we normally feel sweaty. Working into muscle tension in the hips, breathing more deeply into the chest, and allowing heat to escape around the arms all help you to cool.
We are also seeking to relax the body because tension generates heat. Remember, our thoughts create emotions that are manifested in our bodies. Heated emotions can trigger or exacerbate hot flushes, so calming your mind can help cool and reduce the sensation of physical heat.
Once you’ve practiced these simple techniques and put them into practice, it can feel empowering as you no longer feel out of control of your body. Managing your symptoms in this calm and compassionate way can build confidence, new habits and behaviours as we start to befriend our bodies.
5 Tools to help with reducing hot flushes
Breathing techniques to help with hot flushes:
The Menopause Yoga class begins with a breathing technique called the Hot Flush Wave. Lying on your back with your knees bent and feet on the floor, rest your hands on your belly button and allow the abdomen to soften so that you can take deeper longer breaths. As you inhale, allow the belly to gently rise into the palms of your hands and exhale out of the mouth, making a soothing sighing sound that calms the mind and releases heat.
Now, rest one hand on your ribs and one hand on your belly button. Deepen the inhalation with three-part breath. Allow your belly to rise, then feel the ribs expand out to the sides, and fill the lungs all the way up to the chest. Exhale slowly out of your mouth releasing heat and stress. The soft sighing sound helps to calm your mind.
Repeat this for 8-10 rounds of breath, slowing down your exhalation, which calms your nervous system.
Imagine this wave of breath was the wave of a hot flush that rises in your belly and into the chest. You can visualise the hot flush as a colour, or a heat or a light. Instead of panicking and tensing the body, instead allow the heat to flow over and pass through you. Repeat 8-10 rounds of breath.
Positive affirmations and mantras to help with hot flushes:
Here is an affirmation you can try saying to yourself as you practice the hot flush wave.
‘This is a hot flush,
it will not last,
I let it flow through me,
It will pass.’
Now try some other breathing techniques. As you inhale, purse your lips and suck the air gently in as if you were sipping a drink through a straw. Pause at the top of your breath, close your mouth and slowly breath out through your nose. This is Straw Breath.
When you pause at the top of the inhalation, try swallowing the air before you breathe out. The swallowing action activates the vagus nerve which can have a relaxing effect. Practice the Hot Flush Breath every day so that when you come to have a hot flush, it will feel automatic. This style of breathing is also calming for an anxious mind. Two benefits in one!
In the Menopause Yoga class there are other breathing techniques you can try sitting down. These are cooling breath practices, also known as Sitali (curled tongue) and Sitkari (smiling with bared teeth).
Yoga poses for hot flushes
The yoga poses in this class all involve hip and thigh stretches and opening across the chest and armpits. These poses create a wider surface area for releasing heat and can help you to emotionally relax and release.
In Indian Ayurveda, hot flushes are viewed as an excess of heat (pitta) and in yin yoga they are linked to a kidney imbalance that causes an excess of fire causing dehydration and increased thirst. In these eastern health systems, women are encouraged to surrender to the process of change, let go and release, and rest.
The final restorative yoga practice is a reclined cobbler’s pose lying back on a bolster with lots of props to support your body so that you can stay in this wonderful heat releasing position and enjoy a sense of opening and cooling.
The perimenopause can be an unsettling time of change as our body undergoes significant hormonal changes. We need to give ourselves a meno-PAUSE – time out to rest, release and let go of the thought patterns that drive us to live out of balance with our bodies. Pushing, forcing through perimenopause will not help you. Reducing stress, nurturing ourselves and giving time to rest, or simply sit quietly in nature will feel healing.
Meditation & Self Reflection
After a Savasana practice, we end in a comfortable seated position for a meditation. I invite you to befriend your body with kindness and compassion. Listen to your inner voice and ask what your body needs to feel nurtured and nourished? Can you respond to this voice by honouring this inner wisdom?
If any thoughts arose at this time, write them down in your journal, or draw a picture. Capturing these moments of clarity will deepen your connection with yourself and help guide you on your menopause journey.
Read more about eliminating hot flushes, Eliminate Hot Flushes by Barbara Warren, and 5 Tips to Reduce Hot Flashes. Also read more about ways yoga can help and different classes and courses you can do to support you through menopause, ‘Yoga for Menopause‘.