Managing the effect of Hormonal Changes in your forties

Management of Hormonal Related Breast Pain and Symptoms of hormonal changes 35-50yrs of age

healthy foods and exercise

We’ve all heard the phrase “going through the change” but what does it actually mean – and can you treat the symptoms of menopause without taking hormones? Here, I explain how making simple changes to your diet and lifestyle can dramatically decrease the need for HRT. For patients 35-50 years of age who are experiencing new pains, tenderness, premenstrual symptoms (palpitations, poor sleep, fatigue, night sweats, poor concentration etc), there are often simple measures and a few simple tests that make big differences


The menopause marks the end of menstruation. During this time a woman’s body prepares to switch off its reproductive system and stop producing eggs. This means she will no longer be able to have a period or have children naturally. The average age is 51 (in the UK) but some women experience it in their 30s or 40s. During this time a woman’s body prepares to switch off its reproductive system and stop producing eggs. This means she will no longer be able to have a period or have children naturally.


The years leading up to menopause are called peri-menopause and can be a source of worry and frustration. As hormone levels change, many women experience hot flushes, night sweats, mood swings and insomnia – just to name a few. These symptoms for some come in a burst as their ovarian function falls away in their late 40’s but for some women, variable and disabling hormonal symptoms can start much younger from 35 yrs of age onwards.

Some women find these symptoms can lead to awkwardness. For example, having hot flushes in the middle of meetings in front of their work colleagues. Others have mood swings so severe that it can put strain on their relationships. People often assume that it is related to working hard or raising young children but it is a time of great pressure for parents. The combination of work/life balance pressures (which typically come to a head at 40), make it easy to ignore subtle symptoms that creep up. many parents are reaching their work and career peak (getting that top job, partnership at the law firm, becoming a senior member of the company) and also have young children often under 5. The insidious depletion of the body’s natural mineral resources (vitamin D, Thyroxine, Vitamin B12, C, Magnesium) can lead to vague and non specific symptoms that are often put down to just being busy. People compensate for these physiological stresses with alcohol, late nights, poor diet and stress. If you combine this with the common hormonal changes that start to appear from 35 years of age onwards it can lead to feeling really run down and fatigued.


We get taught at medical school that symptoms such as hot flushes and night sweats are a result of falling oestrogen levels. However, every menopausal woman will have falling oestrogen levels but not every woman will have menopausal symptoms. Why? Because there are many other factors that play a part – most importantly, nutrition and lifestyle.

The actual process of menopause is unavoidable – and so are the hormonal changes that can cause menopausal symptoms. However, it’s not just your hormone levels in isolation that dictate how unpleasant the symptoms are or even if you get them at all. Making positive changes to your lifestyle – eating better, moving better, sleeping better as well as knowing how to react in stressful situations – will all make your body better able to keep these symptoms under control.


It is often possible to successfully treat menopausal symptoms without using hormones. Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause by replacing some of the hormones that are decreasing in the peri-menopause. Before reaching for HRT or B-Blockers for palpitations, antidepressants for low moods and other drugs it is worth looking at the root cause of problems rather than simply suppressing symptoms.

The first thing to understand is that hormones are messengers of communication. That is their job – to help communicate between different parts of the body. What’s key, however, is that they are all linked. If one set of hormones goes up, the other hormones in your body will change as they try and compensate for the fluctuating hormone. No hormone works in isolation. It is like a complex symphony where everything affects everything else.

If your stress hormones – like cortisol – are raised, this will have an impact on many of your other hormones. If you are on a blood sugar roller coaster all day because of your high sugar diet, your insulin levels will be fluctuating and this can lead to subsequent changes in your cortisol and adrenaline levels. They’re all linked.

Often I find when women make some simple (although often, not easy) changes to their diet and lifestyle, they can rapidly start to improve their hormonal symptoms.

These are some of the key areas to work on to improve hormonal balance:

Stabilising your blood sugar

If you eat a diet that doesn’t spike your blood sugar, your insulin levels stay stable. If your insulin levels rise too high, they start off a hormonal cascade that can exacerbate menopausal symptoms

De-stressing and relaxation

Modern life is stressful, no doubt about it. Women often juggle looking after small children, working in high pressure jobs and often caring for elderly parents as well. Most women I see with menopausal symptoms have a degree of background stress in their lives. It can often be impractical to remove the sources of those stresses but it is possible to change the way you react to them. Having 10-15 minutes per day of “me” time can be hugely beneficial. Try 10 minutes of meditation (there are loads of helpful apps on the market, such as headspace or try to switch off all electronic devices one hour before bed and take a relaxing hot bath instead.

Moving more

Don’t fear, I’m not talking about a vigorous gym workout. Just putting more movement into your everyday life can help. Simply by giving an overweight patient of mine a pedometer and asking her to reach 10,000 steps per day was a hugely powerful motivating factor and dramatically changed her physical activity levels.

A good night’s sleep

Not sleeping makes menopausal symptoms worse. The problem is that the hormonal changes during peri-menopause can actually make you not sleep, so it can be a vicious cycle. Often, while you’re putting the above lifestyle changes into practice (these can take a few weeks to kick in), I find it helpful to give some of my patients a magnesium supplement to help them sleep. Magnesium can be thought of as a “relaxation” mineral.



Make changes to your diet to balance blood sugar and insulin

Increase the “good fats” in your diet, these include almonds, cashews, avocado, coconut oil, flaxseed to name a few. Try and avoid eating late and make breakfast count. Take a snack for that late morning break – examples might be crackers and hummus, handful of almonds, apricots, cashews. The cookery authors I would recommend would be

  • Madeline Shaw (Get the Glow, Ready Steady Glow)
  • Ella Woodward (Deliciously Ella)
  • Hemsley Hemsley (The Art of Eating Well)
  • Jamie Oliver (Superfood Family Classics)
  • Joe Wicks (Lean in 15)
  • Amelia Freer (Eat, Nourish, Glow and Cook, Nourish, Glow, also coming out 2017 Nourish and Glow, the 10-day plan)

Increasing exercise requires a higher protein diet, try and reduce the amounts of refined sugar in your diet as well (agave nectar, coconut sugar and maple syrup instead of granulated sugar). Lean turkey, chicken, biltong (dried lean beef) are good animal protein sources but people forget that lentil and nuts are good protein sources and you can always pack in protein in the form of rice protein and hemp protein powders (e.g Pulsin from Holland and Barrett).

As I am not a Dietician or Naturopath you could take more specific advice particularly if you are intolerant to some foods. Going dairy free for a while, gluten free for a while etc. have all shown benefits in subsets of patients e.g. for acne, psoriasis, eczema, so try something different and see if it help. If you are concerned that some of your symptoms are not menopause or hormone related then a baseline set of blood tests to cover your blood count to exclude anaemia, Thyroid Function, Vitamin B12, and D and some trace elements (Magnesium, Zinc etc.) can be useful as Thyroid and vitamin D deficiencies are common, worth excluding and are simply treated.


Some people find a Nutri-bullet or Cold Press Juicer (Retro are a good make) is a good and easy way of getting in the raw nutrients fast and easy. Take a look at Jason Vale (Funky Fresh Juice Book) the “juicemaster’. Post exercise these juices can be a great of getting in vitamins, nitrites (beetroot – great for opening up blood vessels and increasing exercise performance). Increasingly there are “retreats” which offer week long breaks combining yoga and juicing (e.g Juicy Mountain in Turkey). Some people find a week away, focus on simple day to day life with yoga and healthy eating can kickstart these changes. Steam not boil, grill don’t fry your food.

Have a look at the list below and see if sprinkling a few of these on your porridge would be possible:

  • Spirulina – packed full of calcium, iron, magnesium and Vitamin A
  • Chia Seeds – high fibre, calcium, zinc, magnesium, high protein and omega 3 FA (I find these a power seed – adds energy to your day)
  • Wheatgrass – Vitamin C, B12, Zinc, E, high protein
  • Cacao – Gluten free, high fibre, high protein, good source of iron, potassium, zinc and copper

(Naturya are a good online supplier)

MOVE MORE and MORE often

Get a pedometer and try to walk 10,000 steps every day

Try and take 2 sessions of 15-20 minutes of vigorous exercise per week ideally resistance based or with weights to maintain muscular density and core strength. This could be with kettlebells or hand weights (Try Joe Wicks – “lean in 15” You tube videos)

Make exercise achievable and enjoyable. Interval training can be much more achievable as it breaks down the exercise into parcels of activity with rest in between. It’s quite daunting and actually stressful to be “training” for that first 5K even and it might put you off from moving more and pushing yourself in everyday activities. Get off the train early and powerwalk the last stop home. Take 15 minutes in the park before you face the chaos of home life at 6pm.

The buzz word is “HIIT” training and in principle this means exercising at threshold (close to your max Heart Rate) continuously and moving quickly between short exercises (skipping, box jumps, lunges, squats are common examples). This ranges from a few simple sets of exercises repeated over a 15 minute workout), to the more extreme workouts (Insanity DVD set – Shaun T) many of which do not require gym membership but a few accessories at home. A Swiss ball, 2 sizes of kettle bells (e.g. 6 and 12kg) and a jump rope can provide a wide range of exercise options for you.


Post exercise – Epson Bath Salts are a good source of magnesium and relaxing, get the bedtime routine right, avoid caffeine after 3pm and mobile devices late at night

  • Make a commitment to 10 minutes meditation daily
  • Try acupuncture to help reduce hot flushes
  • Work on your reaction to stressful situations to help reduce cortisol levels (stress hormone levels)
  • Ask your doctor or pharmacist for information about personalised food supplements, such as Magnesium to help you sleep and relax


Supplements to consider (trial for 8 week before considering whether they work or not)

Mild to moderate breast pain

  • Evening Primrose oil 1G/day

or Starflower oil 1G/day

  • Vitamin D 1000 iu/day

More severe breast pain

  • Add Vit B6
  • Sage
  • Topical Anti-inflammatory gel at free edge of pectoral muscle (small disc of gel let it soak in), daily for a week