More than a million women will experience perimenopause and menopause each year in the US – a time when the sex hormones including estrogen start to go into freefall triggering a range of physical and emotional changes. Whilst there is not much anyone can do to control this natural hormonal upheaval, new research from Health & Her has pinpointed how lifestyle habits can potentially ignite and exacerbate perimenopausal symptoms.
Why this is an important piece of research is that by understanding what these triggers are, and the reasons why they can set off symptoms, it becomes easier to identify how they might impact on you. In short, the better informed you are, the more in control of your symptoms you should feel.
The Health & Her research was conducted over the course of a year and involved 69,277 UK women. Its findings help us to understand the real-life concerns of those going through this transitional time. Not least the fact that more than 80% of the women identified at least one lifestyle trigger which made their perimenopause/menopause symptoms worse. So, what are the top 10 triggers? What exactly are they doing to your body and what can you do to help minimize their effects?
Trigger #1: Stress at work
Whether working to tight deadlines, having to do a presentation, taking part in a Zoom event, dealing with tricky colleagues, the threat of job cuts and/or a lack of job satisfaction your workplace can be a pretty relentless source of stress and worry. Unsurprisingly, perhaps over half the women (53%) in the Health & Her study identified stress at work as a trigger of their perimenopausal or menopausal symptoms.
Why? Dr Rebeccah Tomlinson M.D., a doctor with a special interest in menopause explains, “Stress is a natural physical and psychological reaction to life. In small doses it is fine but when it revs up especially during work, the body goes into flight or fight mode. Your brain signals the release of the stress hormones cortisol and adrenaline, which prepares your body for action.” Why these symptoms can be aggravated during perimenopause and menopause is because estrogen helps to balance cortisol levels, so when levels of estrogen drop, this can make it harder for you to deal effectively with stress.
What can help? Practical things you can do to help include taking regular exercise (read our top 5 exercises for perimenopause) and getting enough sleep (our experts explain what can help) and whether you are in the office or WFH don’t suffer in silence – be open and honest and ask for support if you feel you have an excessive workload and/or unrealistic targets or deadlines. Julie Dennis, menopause work coach also suggests you prioritize your most important tasks of the day first; don’t feel you have to strive for absolute perfection and if you feel like your brain is fogging up quite literally give yourself a break. As she says, ‘Seriously, five minutes away from your desk can dramatically improve your concentration.’
Trigger #2: A stressful event
These are an unavoidable part of life and research confirms an association between stressful events and worse menopause symptoms The study showed that 47% of women said that stressful events triggered symptoms for their symptoms.
Why? It is not necessarily the event in itself that is the primary trigger here but more how you respond to it. Many of us can spend a huge chunk of time over thinking and catastrophizing, either before and after an event, and these negative thought patterns can raise levels of stress and worry leading to tension headaches, sweating, palpitations, digestive issues, problems sleeping and the temptation to anaesthetize negative feelings with alcohol or overeating.
What can help? Almost any form of exercise (including a brisk walk) helps to reduce stress hormones and stimulate production of feel-good endorphins. Practicing relaxation techniques like yoga & meditation or mindfulness and breathing exercises can also help you to both better manage stress and remain more positive. Many women have also benefitted from cognitive behavioral therapy (CBT) a type of talking therapy which teaches coping strategies including how to change negative thoughts, feelings and behaviors into more positive ones. There is evidence to show that CBT can also help with perimenopause and menopausal worry, low mood and sleep problems. Plus, it has been shown to help reduce the impact of hot flashes and night sweats. Ultimately, we all deal with stress differently, and what helps one woman might not work for another, so it can be a matter of trial and error – and a combination of factors including eating better, getting more sleep and limiting alcohol – that can create a more effective buffer against stressful events and perimenopausal symptoms generally.
Trigger #3: Sugar
It is near impossible to have a diet that is completely sugar free, and there are natural sugars (like fructose in fruit and lactose in milk and dairy products) which are important as part of a balanced diet but generally we almost all exceed the recommended amount of added or ‘free’ sugars we should be having daily. Given that 45% of women in the study logged sugar as a trigger of symptoms, it makes sense to cut down.
Why? It is well-documented that sugary snacks and drinks cause high spikes in blood sugar followed by crashing lows which impact on your energy levels and mood. Blood sugar fluctuations can also affect your concentration and can magnify the effects of brain fog, which are already a symptom of perimenopause/menopause for many. The temptation when you ‘crash’ is to then get another quick energy and mood fix from yet more sugar causing blood sugar levels to zigzag out of control. Evidence also shows that those who eat a diet high in sugar tend to sleep less deeply and are more restless at night due to the stimulating effects of sugar.
What can help? Reduce your intake of obviously sugary foods like cakes, biscuits and chocolate but also be mindful that there are hidden added sugars in savory products like shop-bought pasta sauces, salad dressings, ketchup and relish. Aim to satisfy sweet cravings with more natural and healthy sugars like those in fruit, dried fruits and try substituting cinnamon for table sugar in hot drinks and sprinkled on cereals and porridge (it provides a natural sweetness, is said to help stabilize blood sugar and is virtually calorie-free).
Trigger #4: Caffeine
Having a morning latte, a diet cola as an afternoon pick-me-up or an espresso after a meal might seem innocuous enough but caffeine can crank up symptoms.
Why? Perimenopausal, menopausal or not, sensitivity to caffeine will differ from person to person but the Health & Her study shows us that 44% of women logged caffeine as a trigger for their symptoms. Dr Tomlinson explains that “caffeine accelerates your nervous system, increases alertness and interferes with the absorption of vitamins and minerals. Whilst it might seem like a good pick me up after a bad night’s sleep, caffeine can also have a detrimental effect on sleep, causing insomnia, one of the most common symptoms of perimenopause and menopause.”
What can help? Try to keep a lid on the amount of caffeine you drink (most nutritionists and dietary experts suggest a cut-off point of three to four regular cups a day, but you know your own limits) and/or switch to decaffeinated varieties or drinks that are lower in caffeine (like antioxidant-rich green tea which has many health benefits including helping to improve bone density something affected by falling estrogen levels). If you really can’t live without your caffeine fix, try not to drink anything containing it (including coffee, tea, cola, energy drinks or chocolate) after around 3pm as it is likely to disrupt your sleep. Taking a daily multivitamin and mineral supplement should help with any potential nutrient shortfall linked to your caffeine intake.
Trigger #5: Alcohol
It can be hard to turn down a drink with friends or not to reach for a tipple at wine o’clock, but alcohol has few (if any) health benefits and 4 in 10 women in the Health & Her research identified alcohol as a trigger for their symptoms.
Why? Unfortunately, us women are already at a disadvantage when it comes to drinking as we generally have a harder time metabolizing it than men. Alcohol also causes your blood vessels to dilate and raises your body temperature. When your fluctuating hormones are already disrupting your body’s internal thermostat and causing hot flashes and night sweats, you can see how having alcohol in your body is unlikely to improve things. Alcohol has also been shown to raise levels of the stress hormone cortisol, disrupt your sleep, worsen depression, cause mood swings and increase dehydration (and this comes on top of the dehydrating effects caused by hot flashes and night sweats). If you drink regularly you also more likely to put on weight (and again perimenopause and menopause already makes you more susceptible to weight gain).
What can help? Aim to have at least two or three nights a week when you don’t drink and consider switching to lower or non-alcohol alternatives. Be inspired by events like sober October or ‘sober curious’ sites which can offer helpful advice on how to reduce, or stop, drinking. Think of all the positives of not indulging – no hangovers, saving money, better sleep, better skin, better mood and better perimenopause/menopause – rather than seeing abstaining as something punitive.
Trigger #6: Fatty food
39% of women in the study logged eating fatty foods as a trigger for their symptoms.
Why? Research has shown women who have a diet high in unhealthy fats prior to the menopause have higher estrogen levels than women who don’t but when those estrogen levels begin to drop, and their menopause symptoms kick in, they are more pronounced and problematic. Foods high in trans fats (which raise the levels of ‘bad’ cholesterol and increase your risk of heart disease) are also thought to reduce serotonin (the so-called ‘happy hormone’ responsible for stabilizing mood) in the brain, leading to low mood, depression and memory problems. Added to this, eating more fatty or deep fried foods like fries, chips, doughnuts and pizza can put you at an increased risk of heart disease, and that risk is already amplified by simply being in the perimenopausal or menopausal phase.
What can help? Cut down on unhealthy fats (like the ones found in processed meals, cakes, pastries and biscuits) and eat more healthy ones (like olive oil and those found naturally in avocados, nuts and seeds and oily fish like salmon). Try to include more fruit and vegetables in your diet – research shows menopausal women who ate more fruit and veg had fewer menopausal symptoms than those who ate more fatty foods and sweets. For more expert nutritional advice read Everything you need to know about diet for menopause.
Trigger #7: Hot weather
Whilst hot weather and sunshine can offer a variety of health benefits, unfortunately, 32% of women reported hot weather as a trigger for them.
Why? Fluctuating hormone levels make many women more sensitive to hot weather. This is thought to be due to the action of the hypothalamus – a gland in the brain which helps to regulate our internal temperature – becoming adversely affected by falling estrogen levels. Plus, the heat can make it harder to sleep and if you are already dealing with night sweats this can just compound the problem and make you increasingly dehydrated. Lack of sleep coupled with dehydration can then leave you with brain fog and feeling tired, moody and stressed. This can then set in motion a whole negative cycle of triggers and symptoms.
What can help? For instant relief from the heat (and hot flashes) it can be helpful to carry a cooling spray around with you or invest in a portable neck fan to help regulate your body temperature. Keep well hydrated by drinking plenty of water throughout the day and eating water-rich foods like fruit and vegetables and natural unsweetened yogurt. Investing in clothing and nightwear specially formulated to reduce menopausal sweats can also help keep you cooler.
Trigger #8: Cold weather
The research showed that just under a third of women logged cold weather as a trigger for their symptoms like aching joints, skin changes, dizziness and digestive issues.
Why? Cold wintery weather – and the accompanying shorter days and longer hours of darkness – tend to make us less active as we go into hibernation mode. The less we move the more likely we are to experience joint stiffness and pain plus it can also make our digestion more sluggish (moderate exercise improves gut motility – the flow of food through the gut – which, in turn, reduces constipation). The darker days of winter can also exacerbate low mood and the lack of sunlight means we don’t get the vitamin D we need. Vitamin D is produced naturally in the skin on exposure to UV light (hence it often being called the ‘sunshine vitamin’) and low levels of it have been linked to low mood and depression, joint pain in the over 50s and an increased risk of coming down with respiratory conditions like cold and ‘flu.
What can help? Regular exercise. The health benefits of exercise are well-documented and for perimenopausal and menopausal women include not only a reduction in physical symptoms like hot flashes but also improvements in psychological ones like being better able to manage stress. Even better, do it outdoors in the morning when the light is brighter as this will help to better regulate your circadian rhythm or sleep/wake cycle keeping you more alert during the day and better able to sleep at night.
Trigger #9: Dietary changes
Just over a quarter of women in the study reported that dietary changes as a trigger of symptoms including digestive issues, bloating and skin-related symptoms.
Why? Perimenopausal and menopausal symptoms can impact greatly on our mood and this can impact on our food choices. When you are tired you are less likely to have the energy to make healthier food from scratch and you are also more likely to crave quick-release sugary, carbohydrate and/or fatty ones to give you an instant energy burst. This is not only likely to result in chaotic blood sugar levels but also to you putting on weight and possibly a cycle of yo-yo dieting. Poor food and lifestyle choices can also stand in the way of developing good gut health – something that is fast becoming synonymous with good health generally – by adversely affecting the balance of beneficial gut bugs or microbiome. Achieving a diverse and thriving gut microbiome (dehydration, lack of sleep, alcohol stress can also disrupt it) is something that can benefit not just your digestive health but also how you feel psychologically. 
What can help? Eat as diverse a diet as you can with plenty of plant-based foods like fruit and vegetables, nuts and seeds and pulses and healthy protein like oily fish, eggs and natural yogurt to encourage the beneficial bugs in your gut to thrive. Research shows that those who eat a diverse range of foods are more likely to have higher levels of ‘good’ gut microbes. Taking a live culture supplement can also help to feed these good bugs. Familiarize yourself with which foods are more likely to aggravate symptoms and which ones are likely to improve them by reading Diet tips for a healthy perimenopause and diets and recipes to help balance hormones during menopause. Keeping a symptom diary can also help to pinpoint anything you have eaten that is more likely to provoke your perimenopausal and menopausal symptoms.
Trigger #10: Spicy food
If you are partial to a curry or a zingy chilli it might be time to dial down the spice as a quarter of women surveyed reported that spicy foods triggered symptoms such as stomach problems, palpitations and bladder sensitivity.
Why? It is widely acknowledged that spicy food triggers hot flashes in perimenopausal and menopausal women and we know the active ingredients in things like chilli (capsaicin) and black pepper (piperine) dilate your blood vessels and overly dilated vessels tend to amplify vasomotor symptoms (like severe sweating, hot flashes and night sweats). Chillies and pepper are also known to contain acids that can cause a burning sensation in the wall of the stomach triggering indigestion, bloating and diarrhoea.
What can help? Keeping a symptom diary can initially alert you to what specific spices are triggers for you. When you have identified the likely culprits, you don’t have to resign yourself to a life of bland, beige food – instead add a bit of kick and extra color with spices and flavors that don’t provide as much heat like cumin, turmeric and mild curry powder and see how you respond to those. As a short-term remedy for soothing an upset stomach sip a peppermint or ginger tea. In the longer term, and if you are prone to tummy troubles generally, try and improve your gut health by nurturing, nourishing and balancing your ‘good bugs’ and building a thriving microbiome. Taking a daily live culture supplement should help.
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