FAQs

An important long-term effect of reduced oestrogen involves the effects on the skeleton. With age and reduced oestrogen levels, particularly when the menopause occurs early, before the age of 45, there is an increased risk of progressive loss of bone strength leading to bone thinning and fragility (osteoporosis).

Osteoporosis is defined as: a systemic skeletal disease characterised by low bone mass and microarchitectural deterioraton of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.

If you have an early menopause, it is recommended that hormone therapy is taken at least until the average age of the menopause (early 50s) even if you are not having menopausal symptoms. Hormone therapy in this situation provides significant benefits for bone health, reducing the risk of osteoporosis and fracture.

Bone loss itself does not cause any symptoms until a fracture occurs, often as a result of a simple fall. Fractures commonly occur in the wrist, spine and hip. It has recently been estimated that by the age of 70, one in two of all women will have had a fracture related to osteoporosis.

The Royal Osteoporosis Society has information about osteoporosis, osteopenia and how to eat and exercise for bone health.

Osteoporosis risk checker

Nutrition for bones

Exercise for bones

Updated July 2024 Dr Carys Sonnenberg

Being proactive about future health awareness can make a huge difference. It is never too late to make some simple changes which can help you enjoy good health in the future. We all have modifiable risk factors, these are things we may be able to change, like stopping smoking. Here are some things which we can bear in mind when making choices.

We all want to be able to look after ourselves when we are older and to make it upstairs to go to the loo without help. Simple changes now can support health in the future.

Heart and blood vessel health:

When hormones change at menopause, metabolic health can also change, affecting where we store body fat, blood pressure, blood lipids and blood sugar. Metabolic syndrome increases the risk of cardiovascular disease and diabetes.

• Blood pressure rises as we age - it is sensible to check it at least once a year
• Blood lipids rise - we recommend you have your NHS health check to check yours, or have this done using a private blood test
• There is natural gain weight through aging, which is accelerated around the time of menopause. The way we store body fat changes, encouraging more to store around the middle, which increases the risk of metabolic syndrome. Our lean muscle reduces. For health reasons it is important to try to keep a healthy waist to height ratio (<0.5 if possible) and keep our BMI in the healthy range. This varies according to ethnic group and age, and in those with high muscle mass. In general if you have a BMI > 35 then it is helpful to measure your waist -height ratio, with a tape measure, which should be less than 0.5. If it is more than this please speak with your Dr about how we can help.
• Insulin resistance increases. Insulin is a fat storage hormone that helps to regulate blood sugar. Insulin resistance can increase risk of developing Type 2 diabetes

Recommended books:

• The Full Diet by Dr Saira Hameed - really helpful advice about weight management
• A woman's heart by Dr Angela Maas

Bone health: the risk of osteoporosis increases after menopause.

• One in two women will suffer a fracture after the age of 50.
• HRT has a protective effect against osteoporosis, and related fragility fractures, while is is being taken.

Recommended website to find out more about bone health, look at the Royal osteoporosis Society for advice about nutrition and exercise for bone health, check you are taking enough calcium in your diet using this link. Supplementing with Vitamin D 1000iu daily long term may be beneficial

Cancer

• We cannot change our genetics but we can use healthy lifestyle choices to help protect us from cancer, for example it is widely known that smoking cigarettes is associated with lung cancer so stopping smoking is a modifiable risk factor
• Attending regular screening when invited: breast, cervix and bowel can pick up cancers early
• Other examples of modifiable risk factors are obesity, drinking alcohol above the recommended limit each week, and exercising.

Pelvic floor, vaginal and bladder health

• Keep the pelvic floor muscles strong to avoid weakness causing bladder and bowel problems or prolapse.
• Pelvic floor exercises need to be done about 4-5 x a day
• If you are struggling a pelvic floor physiotherapist may be able to help. Please try using the Squeezy app to remind you or look at this link: how to do your pelvic floor exercises 
• Genitourinary Syndrome of the menopause: This is a term used to describe how low oestrogen levels affect the genitals and the bladder causing symptoms which affect almost 80% of women, but often they do not speak about them, due to embarrassment or thinking it is a normal part of aging. Vaginal dryness and bladder symptoms are common.
• Treatment using intimate care regimes, pH balanced non hormonal moisturisers and lubricants, and with addition of low dose vaginal oestrogen products are really effective, take time to work and need to be used regularly, long term to help manage the symptoms. This treatment can be used safely by most women, please seek advice from your Dr.

Recommended websites to get more information about bladder health: Pelvic floor muscles, a guide for women and POGP (Pelvic obstetric & gynaecological physiotherapy)

Dry skin and hair

• Simple advice of finding a moisturiser you enjoy using, vaseline is fine
• Wearing sunscreen daily even in the winter and even inside will help protect against sun damage

The book What every woman needs to know about skin and hair by Dr Mandy Leonhardt is an excellent resource

Brain health

• It is common for women to struggle with brain fog and memory problems
• Prioritising sleep, reducing stress, eating a mediterranean diet, drinking alcohol less than 14 units a week, socialising and learning a new skin can help with brain health; this video is helpful:
  • International Menopause Society: Professor Maki: short video
  • How Menopause affects the brain with Lisa Mosconi: 15 minute TED talk
  • We need more research about HRT and dementia, the evidence from four properly conducted studies in post menopausal women is currently reassuring. The British Menopause Society advises gives the following advice "Women should be reassured that HRT is unlikely to increase the risk of dementia or to have a detrimental effect on cognitive function in women initiating HRT before the age of 60."

Body checks

• Breasts: please do monthly body checks of your vulva, skin and breasts and attend regular mammograms.
• The British menopause Society advice about breast cancer and HRT is that "current evidence suggests that oestrogen alone HRT is associated with little or no change in the risk of breast cancer while combined HRT can be associated with an increased risk which appears dependent on how long HRT is taken for, and may vary with the type of progestogen used. However, this risk is low, particularly when it is compared to lifestyle risk factors such as obesity, alcohol intake and smoking, which can also increase the risk of breast cancer. For more information click this link.
• If you have questions about individual risk and benefit and require more information about this please make an appointment to talk about us about it.

Mental health

There are lots of ways we can positively support our mental health. Using nature and having a daily walk is the most simple and easy way to do this, evidence shows even just looking at greenery for less than a minute can improve mental health.

Reducing stress and finding things which bring you pleasure are simple starting points to support mental health.

You may need more help with mental health so please talk with us if this is the case.

Do speak with us if you have any questions about this advice, Dr Carys Sonnenberg Rowena Health

We love this lifestyle medicine screening questionnaire from the British Society of Lifestyle Medicine. This can help you focus on what matters most to you right now, and which areas of your lifestyle you might want to focus on.

What does matter to you?

The 12 pillars of good health, a healthy lifestyle should focus on appropriate levels of physical activity, eating real foods and undertaking activities that promote health, quality sleep, effective stress management, avoiding toxic overload, developing healthy relationships, and feeling a sense of purpose.

Genetics play a 20-30% role in our lifespan and our health span (the time where we enjoy good health without chronic illness) but 70-80% of our health span is due to factors in our environmental, like those above. Making even small changes, and starting slow can have a hugely positive effect.

Here are some of our tips, do share yours with us if you find something useful.

Activity:

How can you add physical activity into your daily life and spend less time sitting? Regular exercise can help us live longer, reduce periods of ill health in our lives and increase the all-important health span. Can you write down some ways to improve your aerobic exercise? Can you add 2-3 sessions to improve muscular strength each week? When do you practice balance? Do you remember your pelvic floor exercises?

Do you love being with nature? Might ecotherapy, connecting with nature, be something you would enjoy? Clear and abundant evidence demonstrates that interaction with nature affects not only our well-being but our health throughout life. A simple walk in nature can reduce anxiety, lift your spirits, and even improve memory. Do read more about the benefits of ecotherapy in this article if it interests you.

These are some examples you might enjoy, if you are exploring different ideas:

• Aerobic: Whole body work out 7 minutes
• Strength: these are just some options for you to explore if you like online classes:  
  • Carolines Circuits offers great online classes designed to improve strength and overall fitness
  • Kate Oakley Your Future Fit
• Balance practice - help to protect yourself from falls: 10 minute balance exercise class
• Pelvic floor exercises: the muscles in the pelvic floor help prevent prolapse, bladder and bowel problems: Pelvic floor Exercises and Bladder leaking

Sleep

Ensuring we get enough, good quality sleep is vital for our overall health and wellbeing, and so it is for good reason that sleep is one of the six pillars of Lifestyle Medicine. Sleep is essential for restoring our energy levels and giving our bodies a much-needed rest. We are becoming increasingly aware of its wider health benefits – as well as the harmful effects of poor sleep and sleep deprivation. There are benefits of getting between seven – nine hours of sleep every night. Do you need to explore this further?

For adults, getting between seven – nine hours of good quality sleep can help to build up our long-term disease immunity. The maintenance of healthy immune cells relies on us getting enough sleep if we are to effectively fight infections and even some cancer cells. The body’s microbiome, the trillions of microorganisms which perform a variety of important tasks for us, also needs sleep to perform its functions effectively.

Our body’s metabolism, which balances our insulin as well as our glucose intake, is in part dependent on sleep. Increased appetite and calorie intake is also associated with sleep deprivation, and may contribute to weight gain.

Cognitive function, memory and mental health are all dependent on good quality sleep. Studies show that when we sleep our brains are busy cementing new learning and processing new information. Lack of sleep reduces concentration, impairs memory, and evidence shows it can contribute to cognitive decline.

To help manage stress and support mental health, good quality sleep is essential. We know that high cortisol levels are associated with anxiety and stress, getting the right amount of sleep can help to manage these. Sleep can also reduce the risk of anxiety, depression, PTSD and the long-term effects of grief. Sleep helps us to process difficult emotions and experiences, giving us a better chance of staying resilient, positive and happy.

Tips for good sleep:

• Maintain the same wake and sleep time each day
• Ensure your bedroom is dark, cool and quiet
• Avoid caffeine after 2pm and limit alcohol consumption
• Try to spend some time each day outside in natural light to ensure your body gets a good dose of the melatonin it needs to sleep well. This also helps your hypothalamus to understand the difference between light and dark, triggering your natural body clock and helping you sleep better.
• Keep active: ensuring you are physically active can help you to enjoy better sleep

Mental wellbeing

None of the six pillars of lifestyle medicine exists in isolation, and mental health is no exception. There is a clear link between all of the other five pillars and mental health – what we eat, how active we are, harmful substance reduction, sleep and healthy relationships.

Tips to improve mental health:

• Disconnect to Connect- reduce screen time and limit social media use, increase meaningful social connection
• Practice Mindfulness, meditation, yoga or Tai Chi and spend time in nature to relax and reduce stress and anxiety
• Avoid unhealthy habits – we often mistakenly think smoking and drinking alcohol will reduce stress but in the long-term these toxic substances harm our mental and physical health
• Sleep well – getting good quality sleep for seven to nine hours each night can help to improve mental health
• Physical activity has been shown to reduce stress hormones such as cortisol and adrenaline while releasing positive “feel good” hormones such as endorphins, serotonin and dopamine. Regular physical activity also increases brain-derived neurotrophic factor (BDNF) which has generative effects in the brain, improving cognition and memory and reducing the risk of neurodegenerative disorders like Alzheimer’s Dementia and Parkinson’s Disease.
• Keep a gratitude journal to nurture positive psychology and focus on the good things in life, and maintain meaningful social connections and be kind to others to improve health, happiness and well-being

This FAQ is about how lifestyle can improve our pillars of health, but if you need support with your mental health please speak with your Dr.

Healthy eating

There is no one diet or way of eating which suits every one for good health. These are some tips and include advice from the BSLM:

• Explore how you can enjoy protein in every meal and snack
• Eat the rainbow, aiming for 30+ different plants each week and vary them: fruit, vegetables, nuts, seeds, beans and legumes
• If choosing meat or fish, choose unprocessed – and if you can choose food with high welfare credentials with less hormones and antibiotics in the processing the better.
• Advice is to eat ultra-processed food and drinks sparingly. These are foods which have been processed with the addition of additives and preservatives and are high in salt, fat and sugar.
• Choose wholegrain or wholemeal varieties of starchy foods such as rice, pasta and bread
• Ensuring you have adequate dietary calcium, about 1000mg a day
• Ensuring you have adequate Vitamin D levels from sunshine on your skin or consider taking a supplement
• Gut health is important: learn more about fermented foods, fibre, probiotics, prebiotics and polyphenols from the Zoe podcasts and this might be helpful: The Zoe gut guide

The Mediterranean diet pyramid

How to balance your plate to eat well

• Hydrate well with water
• Consider reducing caffeine, if necessary and think about when you are drinking caffeine and might it be having an effect upon your sleep?

Minimising harmful substances

The risks associated with harmful and toxic substances – such as alcohol, tobacco or recreational drugs – are well known. Smoking and heavy drinking in particular are key behavioural risk factors associated with many chronic physical and mental health conditions.

Achieving positive behaviour change is the difficult part – and this is perhaps most challenging when it comes to reducing or stopping harmful substances like smoking or drinking too much alcohol.

Lifestyle medicine can help to support with replacing harmful – and largely ineffective – ways to “feel good” and reduce stress with healthy alternatives such as physical activity, connecting with nature, sleeping well, eating healthy food, meditation, listening to music and improved social connections.

Listen to the BSLM podcast on creating healthy habits

Healthy relationships

Enjoying healthy and meaningful relationships and better social connection is essential for good mental and physical health.

As human beings we are hard wired to connect with each other; we are social beings and our family and community relationships give our lives purpose and meaning. Connecting with others not only helps us to survive but to thrive.

There is a growing evidence demonstrating a link between the quality of our social connections and the associated risk of conditions including obesity, heart disease and even some cancers. Our mental health too is closely linked to our relationships with others, and loneliness is a key risk factor for depression. High levels of loneliness can increase the risk of heart attack and strokes by 30 per cent.

How often do you see others?

Social connection and healthy relationships are critical to a lifestyle approach to healthy longevity alongside being active, a healthy diet, getting good quality sleep, avoiding harmful substances, and reducing stress.

Other recommendations

• Book: 'Get well stay well' by Dr. Gemma Newman
• Women's health concern wellness hub
• The ZOE podcasts
• Weight gain is common as we age and as we go through menopause, this book can be helpful: The Full Diet by Dr Saira Hameed

Lifestyle medicine calls for a move away from the traditional doctor-patient relationship where the clinician is the expert information provider. This is needed because we now know that giving simple lifestyle advice such as “eat less and move more” is often ineffective. At Rowena Health we want to work with you to improve your hormonal health and your general health, we feel lifestyle plays a vital part.

Dr Carys Sonnenberg Rowena Health

Dr Carys Sonnenberg is trained in nutrigenomics and can work with a clinic and a nutritionist to offer you completely individual approach to your health. What is Nutrigenomnics?

Genomics is changing the future of health and medicine. Developments in genetic testing enables us to look in detail at our DNA – the chemical instructions present in every body cell that make us who we are and drive every body function.

This biological code tells the body how to do everything, including how well you absorb and use specific nutrients like vitamins, affecting your nutrient needs. It impacts production of sex hormones, reproduction and fertility, and neurotransmitters, influencing thinking and emotional wellbeing. It regulates how well your cells can grow and repair, even how efficiently they produce energy, or how readily you store excess energy as fat.

Common variations in our genetic code, called SNPs (Single Nucleotide Polymorphisms), result in small but important differences in function, affecting, for example, how much of a chemical in the body is made, how well it works or how our cells respond to it. These SNPs don’t create ill-health in themselves, but in combination they can affect our energy, mental wellbeing, detoxification and beyond, impacting health and contributing to development of specific health conditions. Looking at your genetic differences unlocks a personal health blueprint, offering a detailed insight into your unique biological strengths and weaknesses and a deeper understanding of your health.

The environment plays a big part too. What we do and what we are exposed to interacts with our body’s ability dynamically.

Nutrigenomics looks at how these nutrition and lifestyle factors impact our genetic potential. We can’t change our genes, but we can change what we do to make them less significant. Nutrigenomic testing gives us an understanding of how our life choices interact with what makes us tick, so we can make positive changes that align with our genetics and optimise our health and wellbeing.

There are thousands of potential genes and SNPs, this is complex. Dr Carys Sonnenberg has completed the training with LifecodeGX and she can advise you about this, referring you to a reputable clinic and nutritionist to give you a completely individual approach to your health. Common nutrigenomics testing questions.

These nutrigenomics reports give you an individual assessment of your body, your DNA:

• The Nutrient core report - this test analyses how gene variants can affect food tolerance (and intolerance), appetite control and blood sugar balance, vitamin and mineral needs, detoxification ability, and susceptibility to inflammation and infection
• The Metabolics report - This presents the genes that can powerfully influence key pathways driving human metabolism. It incorporates over 40 genes and 50 SNPs across 6 pathways, including appetite regulation, nutrient sensing, sugar and fat metabolism, cholesterol and bile, mitochondria and inflammation.
• The hormones report - this analyses genes involved in the regulation, synthesis, signalling, transport and metabolism of corticosteroids and sex steroids hormones. It looks at how gene variants affects hormones imbalance and details the nutrients and environmental factors that can influence and improve their balance.
• The Methylation report - Methylation is the process of adding methyl groups, consisting of one carbon and three hydrogen atoms, to other molecules. It is involved in almost every metabolic process in the body, occurring billions of times every second in our cells and contributing to numerous crucial functions. Imbalances in methylation - too little or too much - can increase susceptibility to chronic health conditions such as heart disease, circulatory problems, chronic fatigue, infertility, immune and autoimmune conditions, food and chemical sensitivities, and mood and psychiatric disorders, as well as cancer and premature ageing. The Methylation test examines genes involved in five sub-cycles - folate, methionine, neurotransmitter, transsulphuration and urea. Genetic results will inform whether someone is likely to be poor or overly efficient at processing cofactors - B6, B9 (folate) and B12 (cobalamin), methionine, betaine, choline, zinc and magnesium; and inhibitors - chemicals, moulds, drugs, hormones and heavy metals and provide guidance on how to support or bypass bottlenecks or weaknesses.
• Histamine intolerance report - This test analyses the genes and nutrients needed to breakdown and remove histamine, showing where disruptions occur and how to support optimal function.
• Oestrogen balance report - This test analyses genes involved in the oestrogen lifecycle. It looks at how gene variants affects production, activation and elimination of oestrogens as well as detailing the nutrients and environmental factors that can influence and improve their balance. The Oestrogen Balance report is recommended for women who suspect oestrogen-linked conditions.
• The Detoxification report - this report identifies personalised nutritional support required to optimise detoxification.
• The nervous system report - this analyses gene variants that impact serotonin (contentment) and melatonin (sleep), dopamine (motivation), noradrenaline and adrenaline (fight or flight); glutamate (the major excitatory neurotransmitter); GABA (the major inhibitory neurotransmitter) which is critical for relaxation; and endocannabinoids (AEA/ anandamide) which regulate other neurotransmitters. The report provides detailed recommendations for nutritional support to alleviate symptoms and to optimise mental health.
• APOE report - the Apolipoprotein E (APOE) gene is best known for its role in lipid (fat) metabolism by helping to remove cholesterol from the bloodstream. It can exist in three main forms known as E2, E3 and E4. The E4 form of the APOE gene has been associated with increased plasma cholesterol and triglycerides and susceptibility to cardiovascular disease - heart attacks or strokes due to atherosclerosis, insulin resistance and Alzheimer’s disease. However, having an E4 genotype is one of many risk factors and does not mean you will develop any of these conditions. In addition to APOE, this test examines genes involved in methylation, inflammation, toxicity and neuroprotection, to enable individuals to take preventative action by adopting personalised nutrition and lifestyle changes to optimise their future, long term health.
• Thyroid balance report - This report analyses the genes involved in the thyroid hormone lifecycle: synthesis - centrally (in the thyroid) and in activation in peripheral tissues, transport and metabolism, processing of cofactors (vitamins D and A) and inhibitors (stress and toxins). It also examines genes that confer susceptibility to inflammation and autoimmunity.

We highly recommend you watch some of the crowdcast videos from LifecodeGx as they are absolutely fascinating.

Do make an appointment if you would like to talk more about this.

Dr Carys Sonnenberg Rowena health