Menopause & Peri-Menopause

Menopause is a complex hormonal transition that affects physical health, emotional wellbeing, cognitive function, sexual health and long-term disease risk. With the right care, women can navigate this stage confidently and improve their quality of life for years to come.

Dr Rebecca Mackenzie-Proctor provides evidence-based, personalised menopause and perimenopause management with a strong focus on hormonal expertise, whole-person wellbeing, and proactive prevention of long-term consequences such as osteoporosis, heart disease and metabolic dysfunction.

Understanding the Menopause Transition

What is Perimenopause?

Perimenopause refers to the years leading up to menopause when hormonal patterns become erratic. Typical changes include:

• Change in menstrual cycle - shorter or prolonged.. 

• Heavy or unpredictable bleeding

• New-onset PMS-like emotional sensitivity

• Sleep disturbance

• Hot flushes & night sweats (may be intermittent)

• Mood volatility (“emotional whiplash”)

• Increasing anxiety

• Breast tenderness

• Migraines or worsening headaches

Hormone levels are fluctuating, not consistently low. This makes perimenopause physiologically unique and requires tailored treatment.

What is Menopause?

Menopause is defined as 12 months without a period, marking the end of ovarian egg release and significant reduction in oestrogen and progesterone production.

Common symptoms:

• Persistent hot flushes

• Night sweats

• Difficulty sleeping

• Vaginal dryness and painful sex

• Recurrent UTIs

• Brain fog and memory changes

• Low libido

• Fatigue and joint pains

• Weight redistribution (central adiposity)

Why These Symptoms Occur

Oestrogen Decline

Affects:

• Thermoregulation → hot flushes

• Vaginal and bladder tissues → dryness, UTIs

• Skin collagen → dryness, wrinkles, reduced elasticity

• Bone turnover → rapid bone loss

• Lipid profile → increased LDL, reduced HDL

• Brain function → cognition, mood regulation

Progesterone Decline

Contributes to:

• Sleep difficulty

• Increased anxiety

• PMS-like irritability

• Heavier, irregular bleeding (late perimenopause)

Androgen Changes

• Gradual testosterone decline

• Reduction in libido

• Reduced muscle mass and strength

• Lower energy and vitality

Comprehensive Menopause Assessment

Dr Mackenzie-Proctor provides a detailed evaluation that includes:

Symptom Review

• Vasomotor symptoms (hot flushes, sweats)

• Mood changes

• Sleep quality

• Cognitive changes

• Urogenital symptoms

• Sexual function

• Bleeding pattern

• Weight, energy and metabolic profile
  

Medical History & Risk Assessment

• Cardiovascular risk

• Thrombosis history

• Breast cancer risk

• Migraine profile

• Bone health history (fractures, family history)
  

Diagnostic Tests (when appropriate)

• Fasting lipids

• Fasting glucose or OGTT

• Thyroid function

• Vitamin D

• Bone mineral density (DEXA)

• Pelvic ultrasound for abnormal bleeding
  

Blood tests are not routinely needed to diagnose menopause but may guide tailored management.

Personalised Hormone Therapy (HRT)

HRT is the most effective treatment for hot flushes, night sweats, vaginal dryness, mood symptoms, sleep disturbance and early bone density loss.

Types of HRT

1. Oestrogen Therapy

• Patches (steady delivery, lowest clot risk)

• Gels (flexible dosing)

• Tablets (use based on individual risk profile)
  

Progesterone Therapy

If a woman has a uterus, progesterone is required for endometrial protection:

• Oral micronised progesterone (also helpful for sleep)

• Synthetic progesterone (for specific indications)

• Mirena IUD (excellent for heavy bleeding + endometrial protection)
  

Testosterone

Used selectively for:

• Low libido

• Low energy

• Poor sexual satisfaction

• Reduced muscle strength

Prescribed based on symptoms and blood levels.

Vaginal (Local) Oestrogen

Low-dose local oestrogen treats:

• Vaginal dryness

• Painful sex

• Recurrent UTIs

• Bladder urgency

• Reduced pelvic floor health

Safe for most women and can be used long-term.

Benefits of HRT

• 75-90% reduction in vasomotor symptoms

• Protects bone density

• Helps prevent osteoporosis

• Improves sleep quality

• Supports mood and cognitive function

• Enhances vaginal and urinary health

• Reduces risk of type 2 diabetes

• Possible cardioprotective effect when started early (within 10 years of menopause)*

*Evidence supports the "timing hypothesis" where starting HRT early confers the most benefit and lowest risk.

Non-Hormonal Treatments

For women who cannot or choose not to use HRT:

• SSRIs/SNRIs (venlafaxine, paroxetine)

• Gabapentin

• Clonidine

• Cognitive behavioural therapy

• Mind–body therapies (mindfulness, yoga, acupuncture)

• Lifestyle modifications (exercise, sleep, nutrition)

• Complementary supplements (evidence-supported options discussed individually)

• Diet and nutritional support

Sexual Health & Genitourinary Syndrome of Menopause (GSM)

Symptoms include:

• Vaginal dryness

• Recurrent UTIs

• Painful intercourse

• Reduced natural lubrication

• Burning, itching

• Reduced sexual satisfaction

Management options:

• Vaginal oestrogen

• Vaginal moisturisers and lubricants

• Pelvic floor physiotherapy

• Testosterone for sexual function (when indicated)

• Holistic care for libido and relationship wellbeing

GSM is progressive without treatment, and early intervention improves long-term comfort and sexual wellbeing.

Mental Health, Mood & Cognitive Function

Perimenopause and menopause are associated with:

• Increased anxiety

• Mood swings

• Irritability

• Low mood

• Difficulty concentrating

• Brain fog

Contributing factors include hormonal fluctuations, sleep disruption, and life-stage stressors.

Management may include:

• HRT (very effective in perimenopause)

• SSRIs/SNRIs when appropriate

• Sleep optimisation

• Exercise and nutrition for mental clarity

• Psychological support

• Iron/B12/thyroid assessment where relevant

Sleep & Circadian Rhythm Support

Oestrogen and progesterone influence sleep architecture. Support may include:

• Progesterone at night

• Sleep hygiene strategies

• CBT-I

• Magnesium and melatonin (where appropriate)

• Treatment of night sweats/hot flushes

Weight, Body Composition & Metabolism

Menopause is associated with:

• Increased central adiposity

• Reduced muscle mass

• Insulin resistance

• Slower metabolic rate

Management includes:

• Resistance training (key evidence-based strategy)

• High-quality protein intake

• Mediterranean-style diet

• Targeted metabolic screening

• Addressing sleep and stress (critical for appetite regulation)

• HRT can help prevent central fat accumulation

Bone Health & Osteoporosis Prevention

The first 5 years after menopause can result in up to 10% bone loss.

Assessment and prevention include:

• DEXA scan

• Calcium and vitamin D optimisation

• Weight-bearing + resistance exercise

• HRT (strongest preventive strategy in early menopause)

• Bisphosphonates or denosumab where indicated

Heart Health & Cardiovascular Prevention

Oestrogen decline increases risk of:

• High cholesterol

• Hypertension

• Atherosclerosis

• Type 2 diabetes

Care includes:

• Lipid screening

• Blood pressure monitoring

• Lifestyle optimisation

• Consideration of HRT if within the “cardioprotective window”

Perimenopause vs Menopause - Treatment Philosophy

Perimenopause

Hormonal stabilisation is the focus.
Treatment often uses:

• Combined hormonal therapy

• Progesterone for sleep/mood

• Mirena for bleeding control

Menopause

Hormonal replacement and symptom control are central.
Treatment focuses on:

• Oestrogen + progesterone (if uterus present)

• Vaginal health

• Bone, heart and metabolic protection

When to Seek Urgent Care

• Heavy bleeding causing dizziness or weakness

• Postmenopausal bleeding

• Chest pain

• Severe mood changes or suicidal thoughts

Nutrition Support in Peri & Menopause

Nutrition plays a central role in managing symptoms, supporting metabolic health, protecting bone density, stabilising mood and promoting long-term wellbeing during the menopause transition. As both a fertility specialist and qualified dietitian, Dr Rebecca Mackenzie-Proctor integrates personalised nutrition guidance into menopause care to optimise hormonal balance and overall health.

Why Nutrition Matters During Menopause

Hormonal shifts impact multiple systems that respond directly to dietary choices:

• Declining oestrogen → changes cholesterol, insulin sensitivity, bone turnover, and body fat distribution

• Lower progesterone → fluid retention, sleep disturbance, inflammation

• Reduced muscle mass → lowered metabolism and fatigue

• Changes in gut microbiome → bloating, food sensitivities, metabolic changes

Evidence shows that targeted nutritional patterns can improve vasomotor symptoms, maintain healthy weight, stabilise mood and protect long-term cardiovascular and bone health.

Nutrition for Midlife Hormonal Health

Mediterranean-Style Eating Pattern (Gold-Standard Evidence)

A diet high in:

• Colourful vegetables and fruits

• Extra virgin olive oil

• Fatty fish (salmon, sardines, trout)

• Whole grains

• Nuts and legumes

• Herbs and spices

• Moderate dairy

Benefits:

• Reduced vasomotor symptoms

• Improved cardiovascular health

• Better lipid profile

• Anti-inflammatory effect

• Support for gut microbiome

• Weight maintenance

Supporting Metabolic & Insulin Health

After menopause, insulin sensitivity decreases.

Effective strategies include:

• Adequate protein (1.2-1.5 g/kg/day)

• Regular resistance training

• Low-glycaemic index carbohydrates

• Fibre-rich foods (25–30 g/day)

• Balanced meals with protein + fat + complex carbs

Helps reduce:

• Abdominal fat gain

• Post-meal blood sugar spikes

• Energy crashes

• Sugar cravings

Protein for Muscle, Metabolism & Weight

Muscle mass declines by ~1% per year after menopause without intervention.

Recommendations:

• Protein at each meal (20-30 g)

• Lean meats, fish, eggs

• Greek yoghurt, cottage cheese

• Lentils, legumes, tofu

• Whey or plant protein (if needed)

Protein + strength training is the most effective strategy for maintaining metabolic rate.

Anti-Inflammatory Nutrients

Hormonal changes increase inflammatory pathways that contribute to:

• Joint pain

• Fatigue

• Brain fog

• PMS-like symptoms

Focus on:

• Omega-3 rich foods: fish, walnuts, chia/flaxseeds

• Olive oil as primary fat

• Brightly coloured plants (polyphenols)

• Spices: turmeric, ginger, cinnamon

Bone Health Nutrition

Accelerated bone loss occurs in the first 5 years post-menopause. Aim for:

• Calcium: 1,000-1,300 mg/day (milk, yoghurt, cheese, sardines, almonds, tofu with calcium)

• Vitamin D: 800–1,000 IU/day (sun exposure + supplementation when needed)

• Magnesium: 300–350 mg/day (nuts, seeds, legumes, whole grains)

• Vitamin K2: fermented foods, eggs, hard cheeses

HRT also plays a major role in bone preservation.

Mood & Cognitive Nutrition

Nutritional support for emotional wellbeing includes:

• Omega-3 fatty acids (EPA-rich)

• Folate-rich foods (greens, legumes, whole grains)

• B-vitamins, especially B6 & B12

• Regular complex carbohydrate intake for serotonin stability

• Reduction of excessive caffeine and alcohol

Stable blood sugar = more stable mood.

Gut Health & Menopause

Oestrogen decline changes gut microbiome composition. Supportive strategies:

• Fibre-rich foods

• Fermented foods (kefir, yoghurt, kimchi, sauerkraut)

• Prebiotic foods (onions, garlic, oats, asparagus)
  Hydration and regular movement

Healthy gut → better immunity, mood regulation and hormone metabolism.

Alcohol & Menopause

Alcohol may worsen:

• Hot flushes

• Night sweats

• Sleep disruption

• Weight gain

• Anxiety

• Breast cancer risk

Guidance often focuses on reduction rather than abstinence, with mindful strategies provided individually.

Evidence-Based Supplements

Note: Individualised Use Only

1. Magnesium Glycinate - For sleep, anxiety, muscle tension.

2. Omega-3 (EPA/DHA) - Improves mood, inflammation, cardiovascular health.

3. Vitamin D - Essential for bone, mood, immune health.

4. Calcium - Bone support when dietary intake is insufficient.

5. B6/B12 & Folate - Mood regulation and energy.

6. Phytoestrogens (soy, red clover) - Evidence varies; may reduce mild vasomotor symptoms.

Supplement use is always personalised and medically guided.

Practical Menopause Nutrition Framework

Dr Mackenzie-Proctor commonly uses a simple, effective framework:

• Protein + Plants + Healthy Fats at Every Meal - Balances blood sugar & supports metabolism.

• 30 Plants per Week - Diverse fibres feed the microbiome.

• Mediterranean Foundations - Evidence-supported for midlife health.

• Reduce Alcohol & Ultra-Processed Foods - Improves energy, sleep and cardiac health.

• Hydration + Electrolyte Balance - Supports cognition, energy and hormone metabolism.

Nutrition & Your Personalised Care Plan

Dr Mackenzie-Proctor incorporates nutrition into menopause care to support:

• Weight stability

• Mood & cognitive function

• Energy levels

• Metabolic health

• Joint health

• Bone density

• Sleep quality

• Cardiovascular health

• Symptom reduction

This integrated approach recognises that menopause management is most effective when hormonal therapy, lifestyle support, and medical guidance work together.