Intro and Outro: Hello and welcome to the Microbiome Medics Podcast.

I'm Dr.

Siobhan McCormack.

Intro and Outro: And I'm Dr.

Sheena Fraser, and we're your co-hosts.

We are both GPs and lifestyle Intro and Outro: medics with a shared passion for microbiome science.

Intro and Outro: We'll be translating the evidence and packaging it into actionable, Intro and Outro: bite-sized chunks so that you could harness the power of the microbiome to improve Intro and Outro: your own health and that of your patients.

Sheena: Hello and welcome to a Mike Biomedics podcast today.

Sheena: I'm Dr Sheena Fraser and I'm joined by Dr Olga Morton.

Sheena: Olga is a lifestyle medic just like me and she's also a GP with over 15 years of experience.

Sheena: At the moment, her special interest is the menopause.

And that's what we're Sheena: going to be talking about today, the menopause and the gut microbiome.

Sheena: So Olga has been specializing in the menopause and running an online program Sheena: for women who'd like to embrace menopause with effective lifestyle change.

Sheena: So you're not so interested in the drug approach, Olga?

Sheena: Well, my approach is lifestyle changes Sheena: first and yes of course HRT has Sheena: been a life changing solution for a lot Sheena: of women but then there are women who either are Sheena: not safe to have it or they have tried it and maybe it had sorted it had fixed Sheena: some of their symptoms but it hasn't sorted out everything and then and they Sheena: feel lost because they have nothing else left for them really or offered to Sheena: them and then there are women who choose not to have it.

Sheena: And I think we should respect that.

And at the same time, we should also support them.

Sheena: And I think, again, looking at the evidence, lifestyle changes could be very Sheena: effective in treatment of a lot of the menopause symptoms.

Sheena: Yeah, I agree.

And, you know, as GPs, we see patients all the time who are having menopausal symptoms.

Sheena: You know, a lot of them quite early on, but also, you know, at various times in their life.

Sheena: Some people, of course, get really horrific symptoms.

Other people have fairly Sheena: mild symptoms.

And so we're dealing with the whole spectrum.

Sheena: And, you know, not everybody wants a drug approach, as you say, but some people do.

Sheena: And, you know, it's important to consider all the options.

Sheena: So we're going to be focusing on the menopause.

And I don't want to jump too Sheena: far ahead and talk about the treatment options at the moment but I want to talk Sheena: about what the menopause is first of all and just to give people an idea of Sheena: you know what is actually happening in their bodies when they are going through this, Sheena: time frame so so what sort of age should people be going through the menopause Olga?

Sheena: Well, I think it really varies.

So first of all, menopause is not an illness.

Sheena: It's not a disease, in my view.

I think it is a physiological transition and Sheena: it involves a neurochemical change so that our brain changes, Sheena: but also the hormonal changes are super important through that transition in midlife.

Sheena: And I think if you look at the statistics, I think the changes could start, Sheena: The symptoms could start as early as early 40s, 45, and they can go on for quite a few years.

Sheena: So, you know, we're talking 45 and 55 kind of age bracket, but then everybody's different.

Sheena: And what I see as well, and I'm sure you agree with me, for some women, Sheena: they start a lot earlier, even before the hormonal changes are, Sheena: for example, detectable within the blood test.

Sheena: And in the NHS, mostly we check for the FSH, which is the follicular stimulating hormone.

Sheena: Um, but, um, for some women, um, the symptoms could be very, very mild as well.

Sheena: So they, and the changes could also start a lot later.

Sheena: And then again, where is that end?

The menopause itself is defined as that one Sheena: day of your lifetime when you can look back and say, well, I have not had my Sheena: period for 12 months straight.

Sheena: And after that, that's your basically postmenopausal.

Sheena: And quite often women ask me, well, when am I expected then to see the end of Sheena: the end of that?

And I think everybody is very, very different.

Sheena: And I think that's why, again, it opens a whole discussion about when HRT should be stopped.

Sheena: And I think the current consensus is women should be able to take it as long as they need to.

Sheena: But then again, where is that?

How long is that piece of string?

Sheena: Again, it's difficult, isn't it?

Sheena: And so, you know, when you're talking about the age that people start their Sheena: menopause, And what's really interesting is just how long that time frame of Sheena: being sort of in the middle, that perimenopause, how long that can last.

Sheena: Because, you know, you might say, well, your periods are slowing down.

Sheena: They may be not coming quite as often.

Sheena: And you think, okay, great, they're going to stop eventually.

Sheena: But then, you know, I've known patients who would not have a period for 11 months and then get one.

Sheena: And then another year later, they'll get another one.

And, you know, Sheena: so it seems to drag on for some people.

And of course, you know, Sheena: some people have those menopausal symptoms from the very start of the perimenopause Sheena: time and that will drag on.

Sheena: So, you know, they are completely different.

Sheena: Every single patient, I would say, has a very different experience when it comes Sheena: to menopause.

So why is that?

Sheena: I think some of it is down to genetics because, you know, quite often early menopause.

Sheena: And again, if we talk about early menopause, again, I think the current guidelines Sheena: define early menopause happening before the age of 40.

Sheena: So premature ovarian insufficiency or early menopause could unfortunately hit Sheena: some women in their 20s and 30s.

And so I think the reasons for that are very complex.

Sheena: Genetics may play some role, but also lifestyle changes, environmental factors.

Sheena: There's so much, I think, involved in that.

Sheena: But even with the symptoms, I think looking at lifestyle changes and even with, Sheena: you know, simply like looking at a person's women's diet, that can also affect their symptoms.

Sheena: And again, the more processed the diet is, Sheena: there was an interesting study done in 2021 by Sheena: Neil Barnard when they looked at women and literally switched them over from Sheena: what we call that standard American diet of processed foods and pizza and sausage Sheena: rolls and yogurts and donuts and changed them over to more plant-based whole foods, Sheena: not necessarily even vegetarian diet, but diet which had less processed food.

Sheena: And even just that, within three months, led to the reduction of symptoms of Sheena: hot flushes and night sweats.

Sheena: Alcohol, again, is huge because we know that alcohol does affect our internal thermostat, so to say.

Sheena: So it tells your body how hot, how cold it is.

Sheena: And when the thermostat goes, I would call it wonky, with the reduction or the Sheena: decline of estrogen, You throw in alcohol into that mix and it's just going Sheena: to make the hot flushes and night sweats a lot worse.

Sheena: And I don't think a lot of women are quite ready to face that, Sheena: but then an open discussion.

Sheena: And just even making women aware of it can reduce their symptoms.

Sheena: And I've spoken to a lot of women who would say, yes, I mean, Sheena: just even reducing alcohol intake.

Sheena: And let's face it, I mean, I think in the UK, we would consider maybe three Sheena: drinks a week is not a big deal.

Sheena: But that could be, again, a life-changing situation for some women who would reduce it.

Sheena: And suddenly the hot flashes, the vasomotor symptoms improve quite a bit.

Yeah, interesting.

Sheena: Because, of course, you know, we do have a habit of sort of comparing ourselves to others.

Sheena: And then when we get different symptoms to other people, we sort of think, Sheena: well, you know, that's just genetics.

That's just the way we are.

We're different.

Sheena: And not consider that we all have different lifestyles and that those lifestyles Sheena: may be playing a significant role in, you know, what we're experiencing in terms of our health.

Sheena: So, yes, I mean, you and I are both lifestyle medics.

So we understand this Sheena: stuff, but really we need to work out exactly what it is about these lifestyle factors.

Sheena: Is changing the dynamics.

So as you say, with the alcohol, it's easy to see Sheena: how the alcohol may be altering your sympathetic response and your stress hormones Sheena: and your vasomotor symptoms.

Sheena: And so the alcohol may be playing a direct role in enhancing that.

But what about the diet?

Sheena: You know you mentioned the American diet causing you Sheena: know worse symptoms and I've read Sheena: papers on this as well showing that Sheena: you know we think that the symptoms are exaggerated Sheena: in people that have a more processed diet so what Sheena: is it about the processed diet do you think that is Sheena: causing the symptoms to be worse in these people Sheena: because a lot of people can't quite see the correlation between Sheena: hormones and hormonal changes Sheena: in the body and what we eat yeah Sheena: well i think it's more of a what is it Sheena: that is in the processed food it's not that it's more of a what is lacking in Sheena: that processed food and i think if you look at the three p's the what is lacking Sheena: in the processed food is the polyphenols prebiotics and your probiotics and Sheena: again we are talking about microbiome here.

Sheena: And I think it's going to eventually, this conversation I'm going to lead to Sheena: discussing that microbiome.

Sheena: But those are the things that are going to feed your gut microbiome.

Sheena: Well, polyphenols are also antioxidants.

Sheena: Prebiotics, probiotics is going to feed your microbiome.

And that is basically Sheena: part of your microbiome.

Sheena: I would also emphasize the phytoestrogens, which have been getting, Sheena: unfortunately, a bad reputation.

Sheena: A couple of maybe years ago, there was a paper saying that, you know, Sheena: phytoestrogens should not be given to women, especially like with breast cancer.

Sheena: Do you want to explain what phytoestrogens are?

Phytoestrogens, yes.

Sheena: Phytoestrogens are estrogens which are basically naturally found in nature in plants.

Sheena: So phyto is plant, estrogen is the name of the hormone.

Sheena: And if you think about it, Nature is so clever, it has already given us something Sheena: that will help us to replace or replenish our oestrogen reserves.

Sheena: And traditionally, I think, when we think of phytoestrogens, Sheena: we think of soybeans and tofu, soya products, basically.

Sheena: But then there's also, I think there's eight of them, Sheena: if you divide into small groups, but the most common ones are the ones that Sheena: are found in soy products, Sheena: but also lignans that are found in linseeds and all sorts of seeds, Sheena: but also in colorful fruits and vegetables, Sheena: which is a staple diet again for the Mediterranean diet.

Sheena: And so they again are giving us the nature's oestrogens that are found in fruits Sheena: and seeds in particular.

Sheena: And so, and I think that is what's going to be missing in the processed diet.

Sheena: Okay.

You will not get it from the donuts and the biscuits and, Sheena: you know, the processed pizzas, takeaways and fast foods, unfortunately.

Sheena: So you've got your phytoestrogens and we should start with those.

Sheena: And interestingly, I was reading about soy isoflavones, and I came across something Sheena: that I had not realized before about soy isoflavones.

Sheena: So these are the phytoestrogens in the soy that we expect to give us all those Sheena: lovely health benefits that are supposed to help with the symptoms of menopause Sheena: by replacing the estrogen that we're losing with a plant version of it.

Sheena: Now, I didn't realize that if you suffer from obesity, you may not absorb and Sheena: be able to metabolize those soy isoflavones.

Sheena: Now, that was news to me because I thought everybody would get the same benefit from it.

Sheena: But again, it turns out that our ability to metabolize certain plants and things Sheena: will depend on our gut microbiome.

And that will depend on, you know, Sheena: what we've been feeding it.

Sheena: And, you know, it may be that that can be turned around because, Sheena: of course, we can manipulate the gut microbiome and feed it other foods that Sheena: can change that microbiome composition and perhaps change some of the microbes Sheena: there and almost prepare it for digesting isoflavones.

Sheena: But I didn't realize that some people in society, despite eating a load of soy Sheena: with the best of intention, may not be getting the benefits because they may not be able to absorb it.

Sheena: Yes.

That's incredible, isn't it?

Yes.

So, so...

Sheena: When we're looking at the benefits, you've talked about the phytoestrogens and Sheena: obviously they're really, really useful.

Sheena: How effective are they for menopausal symptoms?

Sheena: Do you think that they are equivalent to HRT?

Sheena: Are they going to do as good a job or are we talking about just sort of minor incremental changes?

Sheena: Well, I think there's been quite a few studies, but anecdotally, Sheena: if you also read about women in far East Asia, Japan, Sheena: Vietnam and China, where soy food is pretty much of a staple food and soy product.

Sheena: And women in Japan in particular do not report many menopausal symptoms, Sheena: many hot flushes.

In fact, hot flashes, they don't exist.

Sheena: That word doesn't exist in their vocabulary.

Sheena: I think the most common symptom they were citing was shoulder stiffness.

Sheena: So it begs the question then, what's happening there?

Sheena: Okay, we also know that on average, the BMI, the body mass index, Sheena: the weight is in a slimmer women in those countries.

Sheena: They probably consume much more green tea, which is again an antioxidant, Sheena: which probably will help with the symptoms.

Sheena: So there have been a few indications that they might be effective.

Sheena: Probably not as effective as HRT, I would say.

Sheena: But then combined with other lifestyle changes, Sheena: combined with looking at microbiome and supporting it better with food, Sheena: I think that could be an option and it could be one of the tools that could Sheena: be used in midlife and perimenopause.

Sheena: Yeah, excellent.

And so...

Sheena: On that Western diet, so it's missing these phytoestrogens that people may be Sheena: getting if they've got that lovely varied diet with lots of colors in them.

Sheena: But you also mentioned it's missing the prebiotics and the probiotics.

Sheena: And probably our listeners here are quite used to hearing us ranting on about Sheena: the importance of fiber in the diet.

Sheena: And of course, prebiotics are your fibers.

so how does that improve the gut Sheena: microbiome from a hormonal perspective?

Sheena: So I think we should probably at this stage then mention the estrobilone so Sheena: if your listeners are familiar now with the gut microbiome which is the collection Sheena: of the trillion of microorganisms with the benefit to the host the estrobilone, estrogen, Sheena: basically Basically, it's that subsection of those bacteria that are helping Sheena: to utilize your existing estrogen.

Sheena: So they are helping to regulate hormones in particular.

And so the healthier Sheena: your estrobolone, the more you're going to get out of your own estrogen.

Sheena: Or I would even say if you're on HRT, you probably will get much more out of Sheena: your HRT if you've got microbiome is healthy.

Sheena: Because what this estrobolone, this subsection of bacteria do.

Sheena: They help recirculate your existing estrogen because what happens is estrogen goes through the liver, Sheena: the liver attaches a little kind of, you know, an additional molecule to the Sheena: conjugate and then you're supposed to then kind of get rid of it.

Sheena: You literally either peed out, you know, your body kind of gets rid of it.

Sheena: Whereas those bacteria catch that literally and then they de-untangle it again Sheena: and send the estrogen back into circulation through the liver, i.e.

Sheena: Recycling it, so that you will get much more out of your hormones.

Sheena: And that's why the healthier your estrobolone, which means the more prebiotics Sheena: you have in your food to feed those bacteria, Sheena: the more you're going to get out of your hormones and that will obviously support Sheena: your body better so you'll get less symptoms and you will go through that midlife Sheena: having a less bumpy ride.

Sheena: Interesting.

So my understanding of the estrabilone is that the estrabilone is neither good nor bad.

Sheena: It is beneficial to us if it is metabolizing sufficient quantities of estrogen Sheena: back into the circulation for Sheena: us to utilize to prevent symptoms like menopausal symptoms or, you know, Sheena: issues with our hormones in general.

But, Sheena: If that estrabilome is unbalanced, if you have too many of these bacteria that Sheena: are able to convert the oestrogens back into the circulation, or too few, Sheena: you can end up with either too much oestrogen or not enough oestrogen.

Sheena: And that will depend on the health of the gut microbiome.

Sheena: So an unbalanced gut microbiome could give us very unbalanced hormone levels.

Sheena: And this is what a lot of researchers are now considering, you know, Sheena: whether the estrabilome is playing a role in a lot of our hormonal conditions Sheena: like polycystic ovarian syndrome.

Sheena: You know, endometriosis, premenstrual tension.

Sheena: And these post-menopausal symptoms or perimenopausal symptoms.

Sheena: What happens if we make too much of the oestrogens ourselves?

Sheena: Yes, I think you're hinting towards this condition called oestrogen dominance.

Yes.

Sheena: Because I wonder, because if we've got that capability to rebuild oestrogen.

Sheena: Then of course you know we could be susceptible for Sheena: example in the menopause to estrogen sensitive cancers Sheena: yes you know is this a good thing that we're able to rebuild estrogen all the Sheena: time or is it because you know microbiome science is never clear cuts from what Sheena: i have learned about it is this a good thing or is it a bad thing and is it Sheena: something that we have the ability to change when Sheena: we need to yeah so i think um from Sheena: what i understand there are there's estrogen and there's estrogen so Sheena: there's different types of estrogen the one Sheena: that we are after is the one that is good for us Sheena: this is estrogen is estradiol estrone and i can't remember the third one so Sheena: it's the one that it i think the one that is the good the one that's good for Sheena: us that will help our symptoms is not the one that's being kind of recirculated Sheena: because i was thinking about you know, Sheena: when I was reading about this, we don't want too much of it.

Sheena: But it's the one that is the beneficial to us is being sent back to circulation Sheena: and that will help our symptoms rather than makes us more predisposed to cancers.

Sheena: Yeah, yeah, yeah.

I know that's really interesting.

And we haven't really talked Sheena: much about estrogen so far.

Sheena: So when it comes to the menopause, you know, estrogen is the big main factor.

Sheena: Yes, I mean, it's been talked about, I think, the most.

I think everybody who Sheena: thinks menopause immediately thinks estrogen.

Sheena: Yes, it is important, but I think the more I read about it, I think progesterone Sheena: probably deserves more of an attention, at least at the beginning of the menopause.

Sheena: We don't tend to talk about it as much.

Sheena: But if you think about hormone decline, so your estrogen, let's say, Sheena: If you're watching us, it starts declining from somewhere from here on the graph, Sheena: whereas progesterone, the actual value is a lot higher than estrogen.

Sheena: It starts declining from a lot higher mark.

And so you might not notice the Sheena: hot flashes and night sweats straight away, but you might notice sleep issues, Sheena: irrational anxiety, irrational fears.

Sheena: That's all progesterone going down.

Oh, okay.

The progesterone goes down.

Sheena: Progesterone is the calm hormone.

It makes us feel safe.

It makes us feel happy.

Sheena: That also helps our sleep.

And so when progesterone goes down, it brings down GABA.

Sheena: GABA is an important neuromodulator, which again makes us calm and happy.

Sheena: And so quite often women will say, well, my periods are still regular.

Sheena: I don't really have the hot flashes, but my sleep is funny and it's weird and Sheena: I'm very irritable.

and I've got this irrational anxiety, I can't shift.

Sheena: It's the progesterone that actually, I think, needs a lot of attention at that stage.

Sheena: Whereas I think most of the HRT and menopause conversation is focused around Sheena: oestrogen, which is important, IV.

Sheena: That's the one that gives you the symptoms of hot flushes and night sweats, dryness down below.

Sheena: Those are typical oestrogen deficiency symptoms.

Sheena: But yes, both of them are important, I think.

Sometimes, in my opinion, Sheena: progesterone doesn't get the attention it deserves.

Sheena: Yeah, it sounds like it.

And on the progesterone side, how does the progesterone Sheena: then affect?

Do you know how it affects the gut microbiome if it's dropping?

Sheena: Does it have any effect?

It's interesting.

I actually haven't come.

Sheena: Did you come across anything?

Well, I didn't come across anything on progesterone.

Sheena: I only came across the stuff on oestrogen and the lack of oestrogen.

Sheena: So yeah, maybe we're needing a bit of research into that area just to see what Sheena: the impact of the lowering of progestogen is doing there.

Sheena: And of course, you and I have been reading about the impact of the menopause, Sheena: the perimenopause and the menopause on the gut microbiome and what's actually happening there.

Sheena: And, you know, I think it's important to discuss the importance of estrogen Sheena: in terms of its effect on the gut microbiome.

Sheena: Because, again, you know, I was quite surprised at what an important role it Sheena: seems to play in maintaining a healthy gut microbiome.

Sheena: So, Olga, tell us a little bit more about that.

Sheena: So the relationship between hormones and estrogen in particular is twofold.

Sheena: First of all, with estrogen going down in perimenopause, it does affect our Sheena: microbiome diversity, and not in a good way.

Sheena: I guess the diversity goes down, and through that, it kind of has this negative Sheena: effect on our hormones and our state of health in general.

Sheena: But then on the other hand, as we discussed, the gut microbiome in itself has Sheena: this protective effect.

Sheena: And the healthier it is, the more we're going to get out of our hormones, Sheena: including our estrogen.

So it's a very interesting relationship.

Sheena: And then if you then look at the changes with estrogen decline on our microbiome Sheena: in general, not just the gut.

Sheena: I mean, I was really amazed to know, to learn that it affects our mouth, Sheena: our oral mucosa, it affects our vaginal mucosa, obviously.

Sheena: And that, again, is super, super important, I think, for us to be aware of because vaginal changes, Sheena: in menopause, women tend to not to bring it up, unfortunately.

Sheena: They would just rather quietly suffer through it.

Sheena: And I always encourage women to talk about it because there are solutions and we don't have to suffer.

Sheena: And so, and again, being aware that, right, so with the declining estrogen, Sheena: it's going to affect my, you know, Sheena: as a woman, it's going to affect your vaginal flora through the lack of estrogen Sheena: in the first place, but then also the microbiome.

Sheena: And so it's such a complex effect of the defying hormone, doesn't it?

Sheena: It is.

So you're going to see the effects, as you say, vaginally.

Sheena: We were also chatting earlier about orally and and Sheena: you know again what's very interesting is the Sheena: how similar the mucosa is Sheena: in the vagina and in the mouth and so Sheena: the the estrogen effects on that Sheena: are very similar so um because Sheena: i had never really correlated dry mouth with the Sheena: menopause before but but it is actually Sheena: um you know a sign of estrogen deficiency deficiency Sheena: um so dryness in the vagina um Sheena: a change in the flora in Sheena: the vagina and you know my understanding is Sheena: that you know in adult life and we we did a an interesting vaginal podcast um Sheena: and and what's interesting is we tend to have a more narrow spectrum of of bacteria Sheena: in the vagina in our adult life um and we tend to sort of go for you know, Sheena: a couple of main lactobacilli in the vagina.

But, Sheena: Post-menopausally, the diversity increases.

So it's kind of opposite to what's Sheena: happening in the gut, where the diversity is reducing and we're losing some diversity of species.

Sheena: And we're losing some of the really beneficial ones in the gut, Sheena: like the bifidobacteria and the lactobacilli, which we often find in our fermented foods.

Sheena: And in the vagina, you're getting a whole load of other bacteria in there.

Sheena: Yes, including anaerobes as well.

Sheena: But probably because the hormonal changes within the vagina are altering that ecosystem, Sheena: changing the pH and allowing it to become more favorable for some of those anal Sheena: bacteria that are sitting around.

Sheena: And the dryness changes the habitat entirely, doesn't it?

Sheena: So that the pH will probably go a little bit higher and allow more overgrowth of bacteria.

Sheena: So that's problematic.

I was also interested in the fact that estrogen is antibacterial.

Sheena: So estrogen actually helps us to fight infections.

Sheena: So it's quite an important thing for Sheena: us women throughout our adult life to to help protect us from infections by Sheena: protecting our gut mic biome and things so it helps to reduce the virulence Sheena: of bacteria so their their ability to cause infections by hindering the way they talk to each other.

Sheena: Which is really interesting.

So when we lose that, when the oestrogen levels Sheena: drop, our predisposition to catching infections will go up.

Sheena: Yes, like frequent UDIs, again, for some women, they don't realize this could Sheena: be the first sign sometimes of perimenopausal changes.

Sheena: And interestingly, I mean, we used to think offering women topical HRT, Sheena: vagina HRT as a pest or a gel, Sheena: is simply going to increase the moisture in that area and help with dryness Sheena: and through that reduce the risk of UTIs or urinary tract infections.

Sheena: But now we know that actually is also going to Sheena: potentially support that more of Sheena: an acidic pH which we are losing through holding on to those lactobacilli rather Sheena: than allowing the more anaerobes like Gardnerella and all the bacterial vaginosis Sheena: pathogens to proliferate or to grow there.

Sheena: So that's obviously got the topical, it's just got the dual effects with that.

Sheena: Yeah, so HRT is obviously quite good at helping Sheena: that because obviously your systemic or your Sheena: topical HRT providing estrogen Sheena: back is helping us to prevent infections Sheena: because it's you know it's giving us back the estrogen whether that Sheena: be topically in the vagina or or systemically and Sheena: so so HRT can be really really useful and obviously it's well proven to be very Sheena: effective for for female symptoms and but what about what about diet on this Sheena: front because you know lactobacilli for example that we want more of.

Sheena: We're losing it from the gut.

Sheena: We're losing it from the vagina.

Sheena: So, you know, my understanding is that our fermented foods are packed with lactobacilli.

Yes.

Sheena: How are fermented foods for menopausal women?

Sheena: Yes.

I mean, they are going to support the microbiome.

They're going to support your estrobilum.

Sheena: So absolutely, whether it's going to be fermented dairy products, Sheena: whether it's going to be your sauerkraut, your kimchi, your kombucha, misal.

Sheena: I mean, And there's so many options.

Sheena: And if you are dairy intolerant, there's so many non-dairy options as well.

Sheena: I just mentioned the sauerkraut, the miso, the kimchi, and kombucha.

Sheena: And again, because there was a question, do we then need a supplement?

Sheena: If we know that the microbiome diversity is going down, I think the supplements Sheena: probably might have some place in it.

Sheena: I think the research is still not quite there yet.

Sheena: But again rather than going for the supplement route, why not start with your plate and start, Sheena: you know, replacing or supporting the healthy gut microbiome with naturally Sheena: occurring fermented foods and also feeding those bacteria then with the naturally Sheena: occurring prebiotics.

Vibers.

Sheena: Vibers in your diet.

Yeah.

So, so the Estrebolome, Sheena: you know, we still need to know a little bit more about it, but it seems to Sheena: be that a good balanced gut microbiome is, is the thing to have, Sheena: to keep our, our hormones really healthy.

Sheena: Absolutely um so so yeah Sheena: i mean all it all makes a lot of sense doesn't it Sheena: that you know whilst all this natural hormonal Sheena: depletion is happening in our body if we Sheena: are topping up with fibers we're topping up with fermented foods we're adding Sheena: more back there we're going to we're going to mitigate those changes in the Sheena: gut microbiome and we're going to mitigate the changes in the oral microbiome Sheena: and also the vaginal microbiome through those dietary changes.

Sheena: And then that's going to sort of almost slow down that menopausal impact and reduce the symptoms.

Sheena: And, you know, it is very interesting that certain societies like the Asian Sheena: societies, you know, was it Japanese that don't have a name for the menopause?

Yes, yes.

Sheena: Because, you know, not that they are, I don't think they're just ignoring women Sheena: at that stage in life.

don't think so.

Sheena: But I think they are actually interested.

They do have a name for menopause.

Sheena: They don't have a name for hot flushes.

Yeah.

Sheena: Okay.

All right.

So it doesn't seem to be a big issue there.

Sheena: Well, that's right.

So that's really interesting.

Sheena: And I do wonder if, you know, if more women were adopting these dietary changes, Sheena: whether we would see quite as much in terms of the symptoms that we're seeing Sheena: in our patients with this.

Sheena: So, yeah, the microbiome and its importance in this is really, really important.

Sheena: In terms of premature, we've touched on premature menopause.

Sheena: And obviously, you know, you and I both know that some people can't help but Sheena: have a premature menopause because they may have their ovaries removed for some reason.

Sheena: You know, so they may have a surgical menopause or perhaps they have to go for Sheena: an early menopause for a hormonally driven cancer or, you know, some reason like that.

Sheena: But in terms of, you know, what else could be going on there?

Sheena: I know that there's potentially a genetic predisposition, but you and I both know that epigenetic, Sheena: which is really how the lifestyle affects our genes and our gene expression is really important.

Sheena: And so to say that something is wholly genetic, I'm not quite sure we can be Sheena: as sure as that now when, you know, people's lifestyle is playing a role.

Sheena: Do you think then that this adoption of the, you know, the Western diet is playing Sheena: a big role in the premature menopause.

Sheena: I think it certainly might.

And I think we see in general a lot of hormone imbalances and conditions, Sheena: even like not just with premature menopause.

We see a lot of PCOS.

Sheena: We see a lot of endometriosis.

Sheena: We see a lot of even young girls.

Sheena: I mean, PCOS, we used to, you know, typically it would be linked to obesity.

Sheena: However, now we see young slim girls with PCOS picture, unfortunately.

Sheena: And I don't think the population genome cannot change so quickly as a whole.

Sheena: So there has to be something environmentally, not just dietary, Sheena: I think, as a factor to contribute towards this.

Sheena: And I don't think it's just this one thing that we can pinpoint.

Sheena: And same thing even with early menarche and girls.

Sheena: Again, this again has to do with food.

The food is highly processed.

Sheena: Again, we are overfed but malnourished, which unfortunately leads to precoctuous puberty.

Sheena: And again, that on the whole is not a good thing, I think, for our society or Sheena: the population as a whole.

Sheena: So, yeah, and unfortunately, I don't have the straightforward answer to that.

Sheena: But there's certainly going to be, as with all epigenetic changes, Sheena: something that's above the gene that's going to press that button, Sheena: something's going to regulate that.

Sheena: So we spend a lot of time talking about diet.

But obviously there are other Sheena: things that can impact upon our microbiome.

Sheena: And there's other things that can impact upon our hormones.

Sheena: I was thinking about plastics.

Sheena: Have you any idea about plastics and our hormones?

Sheena: And do you think that that could be playing any role in them?

Sheena: So in my program, and I do it online with women who, it's menopausal with lifestyle, Sheena: but we do cover essentially five steps or five pillars.

And one of them is reducing your toxic load.

Sheena: And we talk a lot about that.

So, and I don't mean by reducing your toxic load, Sheena: I don't mean any expensive detox protocols or programmed lotions and potions.

Sheena: It's the simple things you can implement in life.

But...

Sheena: Plastics, unfortunately, along with other forever chemicals that are found in Sheena: your cleaning products, in your personal care products, even.

Sheena: Unfortunately act as xenoestrogens, and xenos is a Greek word, Sheena: it means foreign, so they act like oestrogens, they mimic oestrogens, Sheena: they can bind the oestrogen receptor, Sheena: but unlike the actual oestrogen, they lead to an unwanted effect once they bind to that receptor.

Sheena: And so we see a lot of this, unfortunately, in the environment.

Sheena: So we've had about 86,000 chemicals released into the atmosphere since 1970s Sheena: and 80s with the rise of pesticides and herbicides and lots of other chemicals Sheena: used in the industry in general.

Sheena: And they can be hormone-stimulating as well.

Absolutely, they could be hormone-stimulating, Sheena: which is not a good thing.

Sheena: And again, there's potentially some scope for further research, Sheena: again, for not just premature menopause, but also for, again.

Sheena: Endometriosis, PCOS, and so many other hormone-linked conditions where we do Sheena: see an imbalance in what's happening.

Sheena: And so by reducing your toxic load, by reducing your plastic exposure, Sheena: and I always say to my women, whatever, even if you do nothing else, Sheena: please do not microwave anything in plastic containers.

Sheena: And so that's what we do.

We get rid of the plastic, first of all.

Sheena: Then we literally, we train our toxic cleanse.

Sheena: We will see where else we could maybe improve that.

Because it's not about avoiding Sheena: everything.

We can not do that.

It's not about creating fear in you when you Sheena: step outside your door and thinking, what else am I exposed to?

Sheena: It's about really taking control over what you can change in your life because Sheena: your liver is working all the time.

It is detoxing it for you, thankfully.

Sheena: And again, this is super important to keep your liver happy.

Sheena: So if your liver is already potentially struggling with trying to get rid of Sheena: all these toxins in the environment, then you're throwing extra excess alcohol to that.

Sheena: Other things that are kind of almost self-inflicted, the liver will have less Sheena: and less room for a wiggle, if you like, trying to cleanse it and to clean your body.

Sheena: And by reducing that exposure, you will be improving your symptoms.

Sheena: And then also think of how else can you naturally detox.

Sheena: And that's going to be through sweating, through, Sheena: Exercise is going to be through, again, keeping your liver happy.

Sheena: Your liver likes greens, bitter greens, dandelion, rocket salad.

Sheena: So that's going to keep your liver happy.

Sheena: Through...

Yeah, bitters.

Your bitters.

Anything bitter is really good for your liver, isn't it?

Sheena: Yes.

So it doesn't have to be expensive.

You don't have to go through expensive protocols.

Sheena: If you have access to a sauna, again, sweating, at least once a week, Sheena: It's going to be the best way to get rid of the toxins.

Sheena: But then equally, again, sweaty exercise.

Sheena: So that's the way of reducing your toxins.

And so on and so on.

Sheena: So there's three main routes to get rid of toxins, as far as I'm aware.

Sheena: You can either poo them out, pee them out, or sweat them out.

Yes.

Sheena: So if you're going to be pooing them out effectively, you need to have a decent, Sheena: fast gut transit time.

Yes.

Sheena: So you want to make sure that you're not constipated, that your Sheena: bowels are moving nice and frequently to pee Sheena: them out more effectively you need good kidney function and you Sheena: want to be passing lots of urine so you want a good fluid intake and passing Sheena: lots of urine and then to sweat them out as you say sauna exercise make sure Sheena: you're getting hot and sweaty every day and that you will be able to detox a Sheena: little bit better and yet the BPA, Sheena: plastics really interest me Sheena: because I suppose I didn't really think about this until a few years ago.

Sheena: And at that point, I think I remember listening to a podcast and somebody talking Sheena: about the estrogenic effects of plastics.

Sheena: And I thought, my goodness, there's plastics everywhere.

Yes.

Sheena: And so then I started thinking, well, if I'm going to reduce my load of plastics, where do I start?

Sheena: So, you know, looked around the house.

Sheena: Thought, well, where am I coming into contact with plastics?

Sheena: And of course, it's everywhere.

Sheena: It's everywhere.

So of course, I got rid of the obvious ones, like the Tupperware.

Sheena: As you say, I used to microwave my soup in my plastic Tupperware container.

Sheena: And I used to put my sandwiches and things into Tupperware containers and use Sheena: them in the freezer as well.

Sheena: And plastic bags and plastic and cling Sheena: film um you know I've got rid Sheena: of cling film now I do use plastic bags still Sheena: occasionally but not as much um and Sheena: I tend to you know I've swapped out my Tupperware Sheena: for stainless steel Tupperware now and silicon Tupperware um and water bottles Sheena: now you know I've got kids they they've got to take a water bottle to school Sheena: with them every day and they will be sucking on these wolfed bottles and these plastic lids.

Sheena: And, you know, it really sort of brought it home to me.

Gosh, Sheena: you know, my children must be taking in a decent quantity of plastics, Sheena: chewing on these things and, of course, even baby toys, chewing away on plastics constantly.

Sheena: But we are surrounded.

Even, isn't one of the worst BPAs the lining of coffee Sheena: cups that you get in coffee shops?

Sheena: Yes, yes.

And also, if you're going to be getting that takeaway coffee, Sheena: that black lid, heated along with the hot coffee, is going to be leaching on Sheena: that plastic.

It's going to be leaching.

Sheena: And that's BPA, isn't it?

Because BPA is the one that you, it will say BPA-free Sheena: on most of your water bottles and things because BPA is a real hormone inducer.

Sheena: So they have gotten rid of BPA from a lot of products that we're using now, Sheena: a lot of Tupperware and things like that.

But BPA still exists in those coffee cups.

Sheena: Absolutely, but it's also been replaced by other plastics.

Sheena: I mean, even if it says BPA-free, because everybody knows about the BPA, Sheena: but we don't tend to know about all the other stuff that is technically, Sheena: we think it's okay, but it's not okay.

Sheena: The plastic bottles at the bottom of it, if you look at it, they've got a little triangle.

It's tiny.

Sheena: It's got a number in it.

And so the higher that number, the worse it is.

Okay.

Sheena: So even if you're eye on, you know, it says BPA-free, it's like one of those Sheena: common big companies that make them.

Sheena: If you actually look at it, I did it with my kids' water bottles and it said Sheena: a number of seven.

It's still pretty high.

Sheena: Yeah.

So, I mean, I know stainless steel is heavier, but we just swapped, Sheena: you know, to stainless steel.

Sheena: Again, it's mitigate what you can, reduce the exposure where you can.

Sheena: Same with your personal care products.

I think we don't realize, Sheena: unfortunately, the perfumes have, again, neuro...

And cosmetics.

Sheena: Yes, they have hormone disruptors in there.

Yeah, yeah, yeah.

And cosmetics.

Sheena: And so there's a Uka app I would recommend to go to use so that it allows you to screen, again, Sheena: the products you buy for toxicity levels and explains to you why the toxicity level is high, Sheena: what's the problem which chemical is in it but also gives Sheena: you the cleaner options yeah that's the yucca isn't it Sheena: how do you spell that well yes it's y-u-k-a y-u-k-a Sheena: y-u-k-a yucca app yes i've used that app it's quite good actually although i Sheena: have to say it's one of those apps that you you go around your house and you Sheena: take pictures of all these yes but then you realize oh my goodness i need to Sheena: get rid of everything and it's Sheena: all a bit too much and so you know There's only so much we can all do.

Sheena: Yes, but what I would say is don't get overwhelmed and start with one thing at the time.

Sheena: You don't have to get rid of your makeup all at once.

It's expensive.

Sheena: But next time you're ready to buy a new piece of makeup or whatever you need Sheena: to buy, do a bit of research.

Sheena: Use that app.

And then remember, you only have to make that swap once because then that's it.

Sheena: You found your alternative, the clean alternative.

Sheena: And then it's really easy from then on.

Yeah, absolutely.

And I was quite heartened to realize that.

Sheena: Dr.

Rangan Chatterjee, listening to him on his podcast, he had a whole load Sheena: of bloods checked to see how he was doing from a sort of very, Sheena: very, you know, broad ranging health perspective.

Sheena: And the one blood test that came up high on him was BPA.

Sheena: And that's not a blood test we can offer in the UK.

Sheena: But of course, he got this in America because he's going over to America all the time.

Sheena: But he found that his BPA levels were high and and that was the one thing that Sheena: he was quite unhealthy with and I thought my goodness if his BPA levels are high ours must be pretty.

Sheena: Much higher than that and so so I guess you know we must all be exposed to this Sheena: all the time And it's another area of hormonally inducing us and changing us.

Sheena: And maybe that's affecting our menopausal symptoms.

Maybe it's not.

Sheena: Maybe it's affecting, you know, the age that we get to the menopause or, Sheena: you know, the age that we go through menarche or the start of our periods and Sheena: various things like this.

Sheena: This isn't proven yet.

We don't know how much these things are influencing these times in our life.

Sheena: But as you say, now that we know that they are inducing hormones and they are Sheena: potentially disrupting the natural hormones that we have in us and they could Sheena: be contributing to these problems, Sheena: then, you know, let's try and mitigate it a little bit and let's try and reduce Sheena: it and see how that goes.

Absolutely, yes.

Okay.

Sheena: So let's talk about, because we should really cover this from a sort of holistic Sheena: lifestyle point of view.

We've talked about diet, talked a bit about toxins there.

Sheena: What else is really important for menopausal women in terms of their lifestyle?

Sheena: In my humble opinion, I think it's our stress levels.

Sheena: And I think it's every woman that I speak to, you know, there's so much going on usually.

Sheena: When we reach midlife, we've got careers, we've got kids to look after, Sheena: and they're teenagers, and teenagers on its own.

It's a whole different, Sheena: you know, a separate conversation.

It's very challenging.

Sheena: We have elderly parents usually, so we become carers.

Sheena: And so we're kind of stuck between the teens and then the elderly parents.

Sheena: And there's a lot of expectations, I think, on women from the society.

Sheena: And I mean, I'm all for healthy feminism, but I think with that, Sheena: we've also acquired a lot of responsibilities.

Sheena: And I think if we then reach the midlife, it's like standing on that cliff edge Sheena: and that one last thing can just push us over.

Sheena: And I think this is when your lifestyle, no matter whether you like it or not, Sheena: your lifestyle will either make you or break you in midlife, through menopause.

Sheena: And so we need to really embrace it and we need to be aware of it.

Sheena: The healthier metabolically, the healthier we are metabolically as we reach Sheena: midlife, the easier our menopause journey is going to be.

Sheena: And I don't think we should be scared of menopause as something.

Sheena: I think a lot of the conversation in the immediate moment is about it's all doom and gloom.

Sheena: There's nothing to look forward to.

It's all going to be horrible.

Sheena: It's going to be all downhill from now.

Sheena: I don't agree with that.

I think we should really embrace it as a next chapter, Sheena: but also look after ourselves.

Sheena: And I think we need to start prioritizing ourselves.

because quite often we Sheena: see that as a luxury, as something that we can't really afford because somebody Sheena: else is always more important.

Sheena: And we might have gone through this through life in our 20s and 30s, Sheena: but I think as we reach midlife, late 40s, 50s, we can't afford to do that anymore.

Sheena: And the stress levels are so high that no amount of HRT is going to fix that.

Sheena: Yes, HRT might help you to some extent.

Sheena: And as I say you know like when you're going Sheena: through that midlife it's not my analogy but I'm going to use Sheena: it is that it's like women climbing a Sheena: Scottish you know Monroe Scottish mountain carrying a really heavy backpack Sheena: and flip-flops and having a hangover you know so your HRT might remove those Sheena: heavy rocks from your backpack but you still got your flip-flops to deal and Sheena: you've still got the hangover.

Sheena: And so I think this is where we need to really start using all the help we can, Sheena: start pushing ourselves first.

Sheena: Because it's not a selfish thing, it's a selfless thing.

Because women have Sheena: always been the central part of society.

Sheena: From the educational point of view, social point of view, financial, et cetera, et cetera.

Sheena: And so I think if we as women are healthy, everybody else around us will be better for it.

Sheena: Yeah, no, I think you're absolutely right.

And, you know, sometimes when, Sheena: you know, people come to me thinking that they're going through the menopause Sheena: because they're feeling so dreadful, they've got loss of energy, Sheena: their memory is going, their sleep's deteriorating everything's Sheena: happening to them and I and I take all their bloods and Sheena: of course they're they don't have the Sheena: hormonal um diagnosis then Sheena: of perimenopause or menopause they might come Sheena: back with entirely normal hormones um but Sheena: they are incredibly stressed and there's Sheena: so much going on in their lives so you Sheena: know even if they're not at the menopause yet Sheena: um as you say there could be some slight drop Sheena: in the progesterone levels that they're starting to experience at Sheena: this stage but or it may be that Sheena: it's just the stress that is causing the brain fog the the tiredness the the Sheena: change in sleep patterns and you know all these other things so so sometimes Sheena: it's hard to distinguish between Sheena: what is menopause and what is actually this time in your life where, Sheena: as you say, you're almost being attacked at all angles from so much going on in your life.

Sheena: So stress, I agree, it's a real biggie for us.

Sheena: And, you know, we're at a stage now where, I mean, I've got teenage kids, Sheena: you've got teenage kids, elderly parents, you know, we're at that stage now.

Sheena: So I'm beginning to empathize now with all my patients in this situation.

Sheena: And I'm, you know, I can see when I overload myself with Sheena: work that my sleep starts to slip and Sheena: you know I've caught myself a few times where Sheena: my work-life balance has has not been good and Sheena: I've and I almost thought I was sort of menopausal and Sheena: it turned out I wasn't but but yeah Sheena: I mean I think that this is really really important for for women of our age Sheena: you know that we yeah so how do how are we gonna manage this again nothing it Sheena: doesn't have to be you know something fancy or luxurious i mean i always say Sheena: to women just even start with 10 minutes of me time.

Sheena: Per day and it doesn't have to be meditation or Sheena: breath or anything um you know journaling obviously Sheena: if it's something that you would like to try absolutely Sheena: go for it even sometimes i think sitting quietly with cup of tea i mean you've Sheena: got a beautiful view here i mean i see you know the fields and it's just even Sheena: looking at the distance um in nature um looking at trees already brings your Sheena: stress levels down without you even being aware of it.

Sheena: And remember, stress is real.

You know, we used to think, oh, Sheena: everybody's a bit stressed.

You know, what's the big deal?

I mean, it's measurable.

Sheena: And the chronic stress is your chronic cortisol release.

Sheena: Cortisol is needed.

We do have a spike of it every single morning.

Sheena: It gets us out of bed.

It gets us motivated.

Sheena: It's the problem is when it's constantly raised and it starts chipping away Sheena: from your other hormones, Because guess what?

Sheena: In postmenopausal stage, not only your ovaries that make the progesterone and Sheena: estrogen sex hormones, your adrenals, which are glands that sit above your kidneys Sheena: that are usually producing cortisol, which is a stress hormone, Sheena: they also take over the production of your...

Sheena: Oestrogen, progesterone, testosterone.

And so if the adrenals are busy chugging Sheena: away and making cortisol because we are so exhausted, there will be no room Sheena: for making your sex hormones.

Sheena: That's why the libido goes down.

Sheena: Because, again, we'd never mention that, but it's big, you know, speaking to women.

Sheena: And again, and I see this across both women and men, I think, Sheena: in midlife.

Because when libido goes down, the first thing we really need to Sheena: think and look at is stress levels.

Sheena: And so, because, you know, think about it.

From the primal days, Sheena: if you're going to be stressed out and chronic stress is like that chronic need to run away from a tiger, Sheena: your body will not think of reproduction or, you know, making sex hormones.

Sheena: That's not your priority.

Sheena: Your priority will be running away from that tiger, producing that cortisol.

Sheena: And so there's a phenomenon called the cortisol steal.

Sheena: So it's not exactly like, you know, it's a chemical reaction where it's, Sheena: you know, cortisol is taking over or stealing something from your body.

Sheena: But what it means is that seesaw phenomenon of the opposite effect of the more Sheena: stress, more cortisol automatically means less sex hormones.

Sheena: And so just even through that mechanism, I hope that is kind of clear enough Sheena: for you to understand and appreciate how important it is to look after ourselves.

Sheena: And start with something small.

Sheena: Start with something that gives you that flow, that sense of peace, Sheena: whether it's one minute, two minutes, and increase it slowly.

Sheena: Find something that you like doing.

I had a lady recently who said, Sheena: well, I don't, you know, quite often, again, you ask women, what is it that Sheena: you do to look after yourself?

Sheena: And unfortunately, very often, I'm just met with a really blank stare.

Sheena: We don't, we've lost that, you know, because we are so used to looking after others.

Sheena: And so, and then suddenly, you know, women will say, oh, I loved gardening, or I loved knitting.

Sheena: I mean, it could be anything, you know.

So go back to doing that.

Sheena: Somebody loved painting or they joined a choir.

And for them at that point, it felt like a luxury.

Sheena: But suddenly they've got back...

Sheena: Tiny piece of themselves that they lost some along the way Sheena: and and that again is so important to Sheena: carry that through because that will Sheena: give you that grounding yeah yeah it's so Sheena: important and and actually even more important than that because you know if Sheena: you start to develop some time for yourself doing things that make you happy Sheena: that make you feel relaxed that that give you a sense of purpose and a sense of self back, Sheena: then, you know, when your children, if you have children, when they leave, Sheena: which is not that far away, Sheena: you know, it's going to help with that emptiness syndrome as well.

Sheena: Because, you know, again, you know, you and I, both GPs, we see it.

Sheena: We see patients coming along and they're lost if they have spent their, you know.

Sheena: Their entire adult life caring for for children and Sheena: looking after their every need and then suddenly when Sheena: they leave you know they don't know what to do and and Sheena: that can be a big source of stress and a big you know Sheena: a big loss of self-confidence um so Sheena: so if you get in earlier you know while your kids are still Sheena: teenagers and they're happy sitting in their bedrooms anyway Sheena: um then you can just you know have some Sheena: time for yourself yes um and and that's good Sheena: for your kids to see as well um so i agree Sheena: with that that's a great tip for people to try um Sheena: okay stress i think there's a Sheena: couple more things we can mention we've touched on sleep do you want to talk Sheena: about how sleep is affecting um your menopause and how your menopause is affecting Sheena: your sleep yeah again it's that you know chicken and egg thing so sleep is a Sheena: funny one because again with estrogen going down you've got your hot flashes, night sweats, Sheena: so your sleep is going to be affected.

Sheena: And then equally with.

Sheena: Having a rubbish sleep, you're going to have more pronounced menopause symptoms.

Sheena: What I would say is, again, prioritize it because you can't get away now with, you know, Sheena: having late social media scrolling and then expecting your body just to get Sheena: up in the morning and just, you know, Sheena: as if nothing happens, back to the grind to 7 in the morning.

Sheena: So I think, again, sleep becomes non-negotiable here, and the non-negotiables Sheena: will be, you know, caffeine, I think for me, if you're somebody who's super sensitive.

Sheena: For some people, the caffeine metabolism, you know, halftime might be six hours.

Sheena: For somebody, it might be 12 hours, which means if you've had your coffee at Sheena: midday, sorry, lunchtime, half of it might still be in your bloodstream.

Sheena: So if you don't have sleep issues, fair enough.

Sheena: But if you are struggling, I think that needs to be addressed.

Sheena: Alcohol, we mentioned already.

Sheena: So stick to the same time when you go to bed.

Sheena: Avoid that social jet lag, meaning avoid, I'm just going to power through this Sheena: week, but then I'm going to catch up on my sleep at the weekend.

Sheena: Unfortunately, the body does not like that.

And then again, we are circadian Sheena: creatures.

We are nature.

And I think living with nature, listening to your body clock.

Sheena: And yes, if you think about it again, the primal women, we lived with, Sheena: you know, we would get up with sunrise, we'd go to bed with sunset.

Sheena: And now we're trying to be clever, you know, like we've got all these white Sheena: lights and devices and gadgets that tell us, hey, it's still daylight because Sheena: they mimic that daylight, the sunlight.

Sheena: And so the body gets confused.

So your melatonin, your sleep hormone, Sheena: it doesn't spike what it should be at 8 o'clock.

Sheena: It will be still low.

Sheena: And that's why we lose that ability to sleep well with, again, Sheena: exposure to blue light late into the night.

There are different devices.

Sheena: I mean, you don't even have to buy the light-blocking glasses.

Sheena: Lots of devices now have the nighttime mode where it switches off that white Sheena: light.

But the best thing is just even keep them out of your bedroom, leave them outside.

Sheena: Try to read instead and i've seen a lot of women who would say Sheena: wow my sleep has improved dramatically and so yeah Sheena: so these are the little things um i Sheena: would mention i didn't talk about micro fasting Sheena: um but it's something that i quite like introducing as well for women when we Sheena: hear fasting i think some people get really scared thinking you know is she Sheena: gonna ask me to starve now but actually it's just this window of meal-free time Sheena: for about 12 hours at least as a minimum overnight.

Sheena: Guess what?

It actually increases your microbiome diversity.

Sheena: So if you think about it, well, not eating, how come there's more bacteria in my gut?

Sheena: But it's the good bacteria that start proliferating when we're giving that space Sheena: of no food coming and the bad bacteria, they go away.

Sheena: So again, it's super beneficial for us.

And a lot of women who've introduced Sheena: that and micro-fasted on a regular basis for 12 hours, which means, Sheena: you know, you eat your dinner at 8 p.m.

or your last meal at 8 p.m.

Sheena: And nothing until the following morning until 8 a.m., very doable.

Sheena: And those women reported an improvement in their sleep, interestingly.

Sheena: Sleep quality was much better.

Sheena: I think the other one is exercise.

I think it's so important.

Sheena: On the sleep side, there's one other thing I want to mention with sleep, Sheena: and that is the important relationship between fiber and sleep.

Sheena: Because I think it's really important to realize that different diets and things Sheena: will affect your sleep in different ways.

Sheena: So a high-fiber diet and having lots of fiber throughout the day will actually, Sheena: again, sets up those very beneficial gut bugs.

Sheena: But it's been shown in studies that people that with a higher fiber diet sleep Sheena: more deeply and sleep, have a better quality of sleep.

Sheena: So again, you know, if we're trying to fix our sleep, then, you know, Sheena: your diet is an important avenue to look down.

Sheena: And if you have, you know, a more unhealthy diet with less fiber, Sheena: then you're more likely to have a lighter sleep, a more disrupted sleep, Sheena: you're more likely to be fragmented, waking up a little bit more often.

Sheena: So that's important as well.

Sheena: And of course, you know, a lot of people aren't just coming to the menopause Sheena: with sleep problems developing then.

Sheena: You know, us women often, what I see is, you know, people develop their sleep Sheena: problems when their children are young.

Sheena: And, you know, and that's a natural phenomenon, I think, because you're on alert.

Sheena: You're waiting for your child to wake up.

And so you naturally sleep much lighter Sheena: and you wake to any slight noise, which is great when they're little.

Sheena: It's really what you want.

You don't want it when they're teenagers.

Sheena: And the thing is, it's really hard to get out of the habit, Sheena: especially if you're like me and you have three kids in Sheena: a row and it's like a long period of your life that Sheena: you're on alert for um so so Sheena: i had to resort to your um i Sheena: was going to suggest that i did the same i've got three kids too Sheena: and i was like i cannot i can't sleep without my Sheena: yeah locking my ears up at night silicon um plugs for my ears are amazing yes Sheena: yeah and and then the light blocking the the blackout blinds yeah yeah you've Sheena: got to have pitch black yes absolutely no i'm like that and you know the The Sheena: Sleep Charity is a great resource, by the way.

Sheena: We can't go through every little last bit of sleep hygiene.

Sheena: But the sleepcharity.org is a brilliant website which will talk you through Sheena: all of the sleep hygiene things that you need to know.

Sheena: And also what I like about them is that they do sleep advice for the over 55s as well.

Sheena: So again, you know, if you're in that age bracket and, you know, Sheena: you have more unique issues around your sleep, you know, that you develop later Sheena: on in life, then, you know, it's pretty helpful.

Sheena: So I would have a wee look at that website.

Sheena: Fabulous.

Okay, you were going to talk about exercise there.

Sheena: Yes, I was going to say that it's one of those things, again, Sheena: it's this non-negotiable things, I think.

Sheena: And reading about microbiome, I was interested to see there was a study.

Sheena: It was done on, I think, mice where they looked at their physical activity.

Sheena: And I think the way they measured it is through the little kind of that hamster wheel, you know, thing.

Sheena: But they looked at the microbiome of those mice and they had an increase in diversity.

Sheena: In response to exercise.

Yes.

How amazing is that?

Sheena: I don't think there's any human studies, unfortunately, but I'm sure there will be something.

Sheena: There have been some human studies and we talked about it in a previous episode.

Sheena: But there was a really interesting study done on rugby players, Sheena: which showed that they had a much more diverse microbiome.

Sheena: And moderate exercise definitely increases diversity of the microbiome.

Sheena: But more endurance exercise, so more extreme exercise, can actually have the Sheena: opposite effect.

Yeah, okay.

Sheena: So, you know, we've got a podcast on exercise and the microbiome, Sheena: so have a wee listen back to that.

But there are some nuances around that.

Sheena: But yes, I would definitely recommend moderate exercise for our postmenopausal women.

Sheena: And what kind of exercise are you recommending for them?

Well, Sheena: I'm a big advocate for muscle strength and, you know, resistance exercise.

Sheena: I'm not saying that don't do cardio, but I think we probably don't need to do Sheena: as much cardio as we did in our 20s and 30s.

Sheena: It's more of, I think we need to be smarter now because the joints are not quite the same.

Sheena: And that's why Sheena: I think muscle resistance strength exercise Sheena: is so so good because again no Sheena: amount of HRT is going to save you from osteoporosis if Sheena: you're not going to put those bones under the strain under Sheena: pressure and so and again Sheena: it doesn't have to be heavy weight sometimes I think Sheena: I mean I see these social media reels sometimes which Sheena: could make you feel really like inadequate like because they Sheena: are showing these women lifting really heavy weights start with your Sheena: own body weight because again you know our bodies Sheena: are very clever and you can't injure yourself with your Sheena: own body weight and that means that you know even just doing Sheena: sit-ups um sorry the squats you know using your Sheena: own body weight that's already enough to start with and then you can increase Sheena: it from there jumping is really good you know especially like again um um i Sheena: quite like um skipping yeah and just even over the summer because we were traveling Sheena: for holiday and I thought, well, I'm not sure how we're going to exercise, Sheena: but having a skipping rope in your suitcase is so easy.

Again.

Sheena: Full disclaimer, not for everybody, if your pelvic floor is not very strong Sheena: and sometimes it's a bit tricky.

Sheena: But again, just a few minutes of that, it can increase your heart rate greatly.

Sheena: But also that jumping movement is going to put that strain on your bone, exactly what you need.

Sheena: Yoga is amazing.

I think, again, if you look at exercise, I see it as like having a varied diet.

Sheena: You know, you need to have a little bit of everything.

Sheena: What I see quite often is either we don't exercise enough or we over-exercise.

Sheena: Because having the other extreme, when we're doing high-intensity training five Sheena: days a week, usually it's done with the aim to lose weight.

But actually the opposite happens.

Sheena: And I think the body goes into that stress mode.

Sheena: And stress, again, in primal times meant five minutes coming.

Sheena: I'm going to have no food.

And so I'm just going to store up on that fat.

Sheena: And the end result is actually weight gain or a stubborn kind of weight around Sheena: you, that spare time and weight gain.

Sheena: And so that's why if there you exercise, maybe the strength training could be Sheena: once or twice a week.

Mm-hmm.

Sheena: Make sure you stretch, make sure you relax and stretch those muscles that you Sheena: worked and maybe a cardio once, twice a week.

Sheena: And I think that's usually a good mixture.

What do you think?

No, I agree.

Sheena: And I think, you know, from the bone perspective, because obviously you're starting Sheena: to lack that estrogen and so you're losing that impact on the bone protection.

Sheena: So we need to maintain good strong bones and good strong muscles and developing Sheena: strong muscles is the best way to strengthen our bones.

Sheena: Um so so yes um i agree Sheena: we need to be doing more resistance exercise um Sheena: weights our body weight exercises like Sheena: you say um we need to load our bones Sheena: and our joints in different directions because you know Sheena: if we only ever do running or if we Sheena: only ever do swimming or we only ever do walking or Sheena: cycling we're only loading those bones and Sheena: in one direction and that's not going Sheena: to prevent osteoporosis so we need to Sheena: think about different activities like you say loading them Sheena: in different directions getting more impact through Sheena: our joints and and that way we're going to help prevent osteoporosis as well Sheena: yes um and and it keeps you happier exercise it really affects your moods yeah Sheena: if you if you do exercise regularly yes and even going back to the pelvic floor Sheena: and From what I've seen again, Sheena: you know, women would say when they started doing even small kind of weight Sheena: lifting and lifting smaller weights, they noticed the improvement in their pelvic floor.

Sheena: And so, and those symptoms had improved as well.

Because let's face it, Sheena: again, with estrogen going down, it's going to be weaker.

We need to be prepared for that.

Sheena: But again, this is where exercise comes in.

Yeah, absolutely.

Sheena: And also, I would say to women, don't be put off if you've got a weak pelvic Sheena: floor.

It's really normal, you know.

Sheena: I've had three kids.

Of course, I've got a weak pelvic floor.

Sheena: But what I would say is...

Sheena: So have an awful lot of women.

I remember a woman telling me once that the whole Sheena: reason why the studio smelt of pee after a hit class is because everybody's got a weak pelvic floor.

Sheena: And that stayed with me.

And I thought, why do I care if I've got a weak pelvic floor?

Sheena: You know, just do it.

Just do the exercise.

Just enjoy it.

Sheena: And never mind about these sort of issues because they're so common.

Sheena: A gynecologist told me that 75% of all people experience incontinence by the Sheena: time they're over the age of 50.

Sheena: And, you know, if 75%, and that's men and women, are experiencing incontinence Sheena: of urine, that's pretty common.

Sheena: So we shouldn't be allowing Sheena: things like that to hold us back we want you know Sheena: we should just be going for it all and Sheena: enjoying it and getting the best out of things and and not allowing that to Sheena: hold us back and yes strengthen your pelvic floor get it as good as you can Sheena: and and get the rest of your body super strong as well and that will empower Sheena: you and build your confidence and and make you better able to charge through the menopause as well.

Sheena: And just, you know, it helps, I think, emotionally and just mentally.

Sheena: You know, some people feel a little bit less of a woman, you know.

Sheena: Less confident when they go through the menopause.

Sheena: And I think exercise is a great antidote for that.

Sheena: Yes, yes.

And that's building a bit of muscle.

Absolutely.

Sheena: Yes.

And find your tribe.

I mean, I am a great fan of group fitness because Sheena: I think, especially if it's group fitness and, you know, women, Sheena: because you feel the camaraderie, you feel the support and it's just so important.

Sheena: And as you said, and so what, you know, if you, if you can do certain exercises Sheena: of, you know, so will others around you.

Sheena: And then that support is super important because then you feel more encouraged to do it.

Sheena: Fabulous.

Okay, I think we've had a great conversation.

I think we've covered Sheena: quite a lot today about the menopause, Sheena: about the impact on the gut microbiome and its role, but also about the lifestyle Sheena: and menopause and how we can use lifestyle to really help us through this difficult time in our lives.

Sheena: And menopause doesn't need to be a disease.

It doesn't need to be a disorder.

Sheena: We need to see it as a time for us to kind of really put ourselves first and, you know, Sheena: try to improve our health for the decades to Sheena: come afterwards and because if we want to be really Sheena: healthy into later life you know if we make these changes Sheena: now then this will really help us along Sheena: with it absolutely yes and it's not just about reducing your menopause Sheena: symptoms i mean you're really reducing your risk of dementia your Sheena: risk of type 2 diabetes your heart disease your stroke Sheena: i mean dementia is now type 3 diabetes it's a Sheena: metabolic condition you're also reducing your risk Sheena: of cancer and so there's so many benefits Sheena: um absolutely gained yeah so so it's Sheena: a good time to take check and think about your general Sheena: health so yeah menopause it's it's Sheena: a great time in your life to rethink things and to Sheena: make those changes um i hope you've enjoyed today's Sheena: podcast thank you so much um olga has been Sheena: really really enjoyable and olga's a good friend of mine so i've just enjoyed Sheena: having you over and so thanks again any any last words or no I think thank you Sheena: for having me and I hope you find this conversation useful and I hope you will Sheena: take something away from it and I hope you embrace menopause thanks thank you bye-bye.

Intro and Outro: Thank you so much for listening to this episode of microbiomedics podcast we Intro and Outro: really hope you enjoy the content and we welcome your feedback we'd love to Intro and Outro: hear any suggestions you might have for microbiome topics that you'd like us to cover.

Intro and Outro: And we also appreciate listeners' questions and we'll endeavour to answer them in the next podcast.