I’m delighted to have nutritionist Elisa Ferguson participating in our Q & A series.  Elisa specialises in the life stage which affects all women to varying degrees. Its impact is felt across all aspects of our wellbeing and our bodies, from our bones to our skin and from our energy levels to our sleep. Learning about the perimenopause and menopause can help make it a kinder, smoother transition. Here’s Elisa to tell you how…

Can you tell us a little bit about your pathway to becoming a nutritionist specialising in perimenopause and menopause?

It’s fair to say I took the long way round! After a stressful corporate career in London, I qualified as a yoga teacher in 2008 and set up a yoga studio and therapy centre, managing a group of other yoga teachers and women’s health and hormone specialists. My interest in Nutritional Therapy came from trying to stabilise the erratic hormones that plagued my 20’s and 30’s. A colleague gave me a book about nutrition which, for the first time, offered me a convincing link between what I was eating and how I felt. Learning that food is information and whatever we choose to put in our mouths or eliminate from our diets will have either a positive or negative biochemical bearing on our health was a complete revelation to me. 

I started my training as a Nutritional Therapist in 2013 and from the outset, I knew that women’s health and hormones was an area I wanted to specialise in. Specifically, empowering women to know more about their hormones, what to expect after the age of 40 and what they can do to help themselves. I use an evidence based, functional medicine approach in my practice which is about trying to find the root cause rather than treating symptoms.  By panning out and looking at the bigger picture you can start to connect the dots between symptoms that at face value might seem unrelated. My personal view is that there should be a collaboration between functional medicine and conventional medicine.  Using medication to alleviate symptoms helps a lot of people in the short term. However, addressing the mechanism that is potentially causing the symptoms simultaneously is a very powerful tool.  This is the core of what Registered Nutritional Therapists do.

 What do you think are the biggest physical factors affecting women as their hormone production changes?

Perimenopause is a process leading up to the menopause when a woman’s sex hormone levels (oestrogen and progesterone) begin to fluctuate and decline as well as testosterone causing an array of different symptoms. These symptoms can vary between women as well as their severity, frequency and duration. For some women they can sail through in just a few months, for others they can be severe and can go on for decades. Factors such as genetics, diet, lifestyle and stress can all play a part.

The average age of the menopause – when periods have stopped for a year – is 51, and the perimenopause can last for a number of years. So, symptoms can often start in the early or mid 40s. However, 1 in 100 women will have the menopause before the age of 40 so it could start earlier for some.

 The main physical factors affecting women during this time can be;

Period changes (becoming shorter, longer, heavier or lighter than they have been in the past).

Hair and skin changes: Lower levels of oestrogen can lead to reduced elasticity, fine lines and dryness as oestrogen is an important hormone for building collagen, the protein that protects the structure of the skin.

Hot flushes: This is the most common symptom of all, and the one most often associated with menopause. However it is thought that 25% of women do not experience them. They can be experienced at any time of day lasting for just a moment or several minutes. They can also be accompanied by sweating, dizziness or even heart palpitations.

Night sweats: Night sweats can be disruptive to sleep for women as well as their partners leading to fatigue and low mood.

Fatigue and poor sleep: This can be related to night sweats but women may also start to feel more tired during the day even if their sleep is not affected.

Worsening headaches/migraines: Women who suffer from migraines may find they become more severe and closer together during menopause.

Joint pains: Low levels of oestrogen can cause joint aches and pains as oestrogen is important for providing lubrication in the joints and reducing inflammation.

What skincare do you use to take the best possible care of your skin? Can you tell us a little about your skincare routine?

I’m definitely a Votary Super Seed girl! I love massaging the Super Seed Cleansing Oil into my face and neck, morning and night, and using the warm face cloth to remove the excess. I then use the Lemon and Neroli Toning Serum (NOTE: This product has now been discontinued, shop the Brightening Hyaluronic Serum here) followed by the Super Seed Facial Oil during the day and the Super Seed Nutrient Cream at night. For breakouts or as a revitalising mask, I use the Blemish Rescue Oil.

Which Votary product wouldn’t you be without?

The Super Seed Cleansing Oil. I love breathing it in before massaging it onto my face during my morning shower and giving myself a longer facial massage and letting it soak in during my evening bath.

What routes do you suggest to soften the impact of the menopause?

There are a few things that you can do to lessen the impact of the transition in hormones on your body:

Balance blood sugar levels – One of the simplest ways to feel better is to dramatically reduce or cut out sugar and alcohol. This is key as it can help to balance hormones, sustain energy levels, improve cognitive function and help shed excess weight.

Liver support – Chemical-laden make-up, cleansing and cleaning products can put an extra strain on the liver. We expose the liver to hundreds of hormone-disrupting chemicals, drugs and toxins every day so switching to hormone and liver friendly organic and natural products can really help take off the load.

Reduce stress – External stresses, like work deadlines, financial issues, relationship and family issues as well as internal stresses on your body such as dehydration, nutritional deficiencies, and a sensitive digestive system can raise our stress hormone (cortisol) levels and have a negative impact on overall hormonal health. Avoiding stress is easier said than done, but managing deadlines, having a balanced diet and prioritising self-care such as practicing yoga, meditation, and having essential oil baths and massages can all help.

Activity – Daily light exercise is helpful for your overall health, as well as the side effects of menopause. However, it’s important to avoid over-exercising as this can increase stress on the body and raise cortisol levels.

Sleep – Common side effects of perimenopause and menopause include issues with sleep, so it’s important that you give your body enough time to rest and improve sleep quality through dietary changes, stress management techniques, reducing caffeine intake and turning off devices at least 2 hours before bedtime.

Hormone Replacement Therapy – You may need to take additional hormones (body-identical) in order to address deficiencies as an addition to nutrition and lifestyle interventions. Speaking to a menopause specialist to find out ALL of the options available to you is key so that you can make an informed choice for your own individual circumstances.

How do you think the menopause impacts specifically upon skin?

Declining levels of oestrogen can really affect our skin. Oestrogen stimulates skin-smoothing collagen and oils. The less oil we produce, the harder it is for our skin to lock-in moisture. Skin can become dry and feel itchy. It can also result in less blood flowing to the epidermis (upper layer of your skin) and more water being lost from your skin, which leads to skin becoming less hydrated. Having a good skincare routine is essential to improve your skin’s hydration and can protect the upper layers of your skin by preventing trans-epidermal water loss.

Distressingly, some women can also experience acne and skin pigment changes due to hormonal fluctuations. Menopausal skin is more susceptible to UV damage causing deeper wrinkling and sun damage like age spots and lentigo (small brown spots), so protection from the sun is also essential.

Do you think women are becoming more confident about talking about the menopause and how it affects them?

I think there has been a real shift recently. Menopause has been such a taboo subject for previous generations of women – our mothers and grandmothers didn’t have access to information or support so they just had to ‘get on with it’ and suffer in silence. Thankfully, these days, women are speaking out, asking questions and seeking guidance. There are many celebrities  – like Kim Cattrall, Gillian Anderson, Meg Matthews and Ulrika Jonsson  –  opening up about their own experiences and inspiring other women to seek help. However, there is still some confusing information out there, especially around HRT. The presentation of the full picture rather than just one side of it is so important.  Knowing that there are different options available can make a big difference, from a few simple tweaks to nutrition and lifestyle, to a deeper functional medicine approach, to finding the right type of HRT to support you. Knowledge is power and just knowing that there are options available can be hugely important.

If you had to choose five superfoods as armoury for the menopause, what would they be?

Broccoli is a member of the cruciferous family of vegetables (others include cauliflower, cabbage, sprouts, kale, rocket, watercress and radish) and they are your best friend during perimenopause and menopause. They contain a special compound called DIM which helps your body eliminate excess oestrogen. Oestrogen dominance is common as progesterone levels decline before and during menopause (even when oestrogen is declining too). It can lead to PMS symptoms, fibroids, breast tenderness and an increased risk of cancer.

Flaxseeds are a phytoestrogen, which are natural plant-based compounds that can help to alleviate perimenopausal and menopausal symptoms by supporting self-regulation of oestrogen levels. Non-GM soy products and legumes like lentils and chickpeas are other great options. Oily fish such as wild salmon contain essential fatty acids which are vital to hormone production, absorption of fat–soluble vitamins and stabilizing blood sugar. Healthy fats also keep you fuller for longer so also stop you from snacking. Other options include avocados, nuts, seeds, coconut oil, olive oil and/or grass–fed butter.

Wholegrains contain fibre which helps you get rid of waste, toxins and excess oestrogen. Fibre is essential for keeping your bowels regular and for supporting your gut bacteria too. Other good sources of fibre include vegetables and fruit (with the skin on), oats, beans and seeds.

Go organic where possible – the chemicals used to grow non-organic fruit and vegetables can disrupt your hormones. Organic foods are nutrient-rich and chemical free. Organic meat and dairy come from free range animals that are fed a natural diet, so they are free of hormones and antibiotics that could wreak havoc on your system.

And  – I’m really sorry to say –  but think about cutting back on (or out!) alcohol. It can trigger hot flushes and disrupt your blood sugar balance which can increase fat storage and interrupt your sleep. If you’re going to drink, try to stick to red wine, which contains polyphenols.

What’s your top tip for managing the menopause?

Get informed. Understand your symptoms and what is going on with your hormones. I always advise a functional test as it’s much easier and quicker to get to the root cause of symptoms.

The hormone test I recommend to my clients is a urine test called the DUTCH test which stands for Dried Urine Test for Comprehensive Hormones. Unlike blood tests which give a snapshot in time, this test analyses 4 urine samples taken at a specific point in your cycle. This shows your active hormone levels as well as the metabolites of those hormones over the course of a day. This provides a much bigger picture of how the hormones are actually behaving, and crucially, how they are being detoxified and eliminated. The test also looks at adrenal health, brain neurotransmitters, melatonin and some key B vitamin levels (including B12) – which are really important if you are having any mood issues, anxiety, fatigue or issues with sleep.

You can also take this test if you’re on HRT, to see where your levels are and if you’re on the right HRT and dose for you. Likewise, if you use the Mirena coil you can take the test to see how it might be affecting your natural hormone production and therefore causing any symptoms.

 This test is so useful to know where to focus efforts – which foods to include in your diet to give you specific nutrients, to know what supplements you actually need (rather than what you think you should be taking) and to understand the unique behaviour of hormones in your body as well as the potential risks of further conditions.

Are there any benefits in being post-menopausal? How can you help women feel positive about this life stage?

I think it’s important to remember that menopause is a natural, transitionary stage in a woman’s life. During this time, whilst attempting to manage symptoms, women can be reminded of the importance of self-care, becoming more attuned to what their bodies need and reflecting on what no longer nourishes them.

I love the Ayurvedic and traditional Chinese medicine perspective, which is that this time in a woman’s life is for ‘soul development’. There is a natural shift from being fertile to birthing children to being fertile to birthing new ideas and creativity. A time when we can start to carve something out for ourselves and embrace this next stage of life.

Quickfire questions:

How many avocados do you eat in a week?

Three to four.

Baths or showers?

Baths every time.

Favourite fragrance?

I love Ffern- they are a small company that release different natural, organic fragrances every season.

Best yoga posture?

I love restorative postures like Supta Baddha Konasana over a bolster (with a blanket and lavender eye pillow).

Favourite footwear?

Barefoot (only at home!).

Favourite exercise wear?

The Garudhasana yoga pants from Sweaty Betty.

Best throw-together-supper?

I love comfort food in the winter like casseroles and curries (lentil dhal is my current favourite).

Favourite cocktail?

I don’t really drink cocktails but I do love a glass of red wine.

Last book you read?

Girl, Woman, Other by Bernadine Evaristo.

Best bedwear?

Organic cotton pyjamas.

Elisa, thank you so much for such a brilliantly informative and helpful guide to this period of change. I know our #Votarists will love it.  I’m also so delighted that Votary is one of the allies you choose in your own routine. Thank you very much for sharing with us.

If you’d like to learn more about Elisa and how to work with her in tackling your perimenopausal and menopausal issues, go to www.elisaferguson.co.uk or here on instagram.  In the meantime, let’s all embrace the notion of soul development.

Love, Arabella x

Read more about why Votary skincare works so well with menopausal skin here.

Read more about Votary skincare through every lifestage here.