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Learn how to use Testosterone effectively with guidance from Bristol Menopause & Wellwoman Clinic. Expert advice for safe and personlised hormone therapy. How to Use Your Testosterone Replacement Therapy 1. Choose the Application Site The gel should be applied to clean, dry skin on the lower abdomen, bikini line or behind the knee. Do not apply the gel to areas that will come into direct contact with other people (e.g., hands or chest) to avoid transferring the gel. 2. Prepare the Gel or Cream Follow the specific instructions provided with your testosterone gel or cream. It usually comes in sachets, tubes, or pump dispensers. Use only the prescribed amount, which is typically a pea-sized amount, or as directed by your healthcare provider. 3. Application Clean Skin : Ensure the application site is clean and dry before applying the gel. Apply the Gel : Squeeze the gel out of the sachet, tube, or pump. Rub it gently onto the skin and allow to dry before putting on clothes. Rotate application sites and do not apply the gel to the same area each day to avoid side effects. Wash Hands: After application, wash your hands thoroughly to avoid spreading the gel to other areas or people. Dosage and Frequency Check the dose listed on your prescription. This may vary depending on the type of testosterone you have been prescribed but it is normally a small amount. Consistency is important for maintaining stable hormone levels. Typical amounts are listed below: Testogel 1%: pea sized amount, daily, one sachet to last 8 days Tostran 2%: One pump, three times a week Androfeme 0.5mls, once daily Effectiveness Monitor how you feel and report any changes or side effects to your healthcare provider. It can take a few months to notice the full effects of testosterone therapy. You should have a review after 3 months and then annually but you can make an appointment any time in between if you are experiencing problems. Side Effects Please contact us if you experience of any side effects such as acne, excessive hair growth, male pattern hair loss or voice changes. We will need to check your bloods and can adjust your treatment plan if needed. Safety and Precautions Avoid direct contact with others, particularly children and pregnant women, in the area where the gel was applied until the gel has dried completely. Keep the gel in a cool, dry place, away from direct sunlight. Follow the storage instructions on the packaging. Blood Tests & Review You will need a blood test after being on testosterone for 3 months and then every 6 months. This is to ensure safe prescribing and avoid side effects. (Sex Hormone Binding Globulin, SHBG, and Testosterone) DO NOT use gel on the morning of your blood test appointment – this will result in an abnormally high result. Wait until after the blood test to apply to your gel that day. Blood tests can be booked here You will need a review appointment 3 months after commencing testosterone, followed by annual reviews. Make sure you have your testosterone results 1-2 weeks before either your review or your repeat prescription request as these will be needed to issue a further prescription. Follow up appointments can be scheduled here

Clifton College In Partnership with Bristol Menopause & Wellwoman Clinic We are committed to prioritising women’s health in the workplace, creating a supportive environment where every woman feels valued, empowered, and cared for! Our Menopause Support Benefit in partnership with Bristol Menopause & Wellwoman Clinic Initial Menopause Consultation Your consultation will include: Health assessment Review current lifestyle Provide advice and guidance on treatment options Prescribe appropriate treatments Discuss supplements and lifestyle changes Personalised management plan Letter Informing GP of consultation Book here Follow-up Menopause Consultation Your review will include: Review Current Symptoms & Assess Needs Review Health Assessment Review Current Lifestyle Adjust Treatment if Necessary & Prescribe Update Your GP Personalised management plan Book here

< Back Menopause and Brain Health: What Every Woman Should Know Brain fog. Forgetfulness. Difficulty concentrating. Mood swings. These are some of the most common and frustrating symptoms women report during menopause. For many, the changes feel frightening. Women worry about early dementia or losing their edge at work. Yet brain health in menopause is rarely discussed openly. Why Does Menopause Affect the Brain? Oestrogen plays a crucial role in brain function. It influences: Neurotransmitters like serotonin, dopamine, and acetylcholine. Blood flow to the brain. Protection of neurons against inflammation and oxidative stress. When oestrogen levels decline, women may experience memory lapses, poor sleep, low mood, and changes in cognitive performance. Is It Dementia? The good news: for most women, menopause brain fog is temporary . Studies show that memory and concentration often improve after the menopausal transition. But there is a long-term connection. After menopause, women face a higher lifetime risk of Alzheimer’s disease and other dementias compared to men. What Can Women Do to Protect Brain Health? Exercise regularly — physical activity increases blood flow and stimulates new brain cells. Prioritise sleep — poor sleep worsens memory and mood. Eat a Mediterranean-style diet rich in vegetables, whole grains, fish, and healthy fats. Stay mentally active — learning, reading, problem-solving keep neural connections strong. Manage stress — chronic stress accelerates cognitive decline. Consider HRT — for some women, starting HRT around the time of menopause may support memory and mood, though evidence is still evolving. Menopause is a brain health milestone as much as a hormonal one. By recognising the connection and taking proactive steps, women can support their memory, mood, and long-term cognitive resilience. Talk to a specialist at Bristol Menopause Clinic about protecting your brain health during menopause and beyond. Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us

< Back Sleeping Better Through Menopause: Navigating Sleep Disturbances and Cultivating Healthy Habits Menopause Advice, Wellbeing Quality sleep is vital for overall well-being, yet menopause often brings about changes that can disrupt a woman's sleep patterns. Quality sleep is vital for overall well-being, yet menopause often brings about changes that can disrupt a woman's sleep patterns. Understanding these disturbances, adopting effective sleep hygiene practices, and seeking professional guidance can significantly improve sleep quality during this phase of life. Understanding Sleep Disturbances during Menopause Hormonal Changes Fluctuating hormone levels, particularly declining oestrogen and progesterone can contribute to sleep disruptions. These changes can lead to night sweats, hot flushes, and increased sensitivity to environmental factors, impacting sleep quality. Night Sweats and Hot Flushes : Episodes of sudden heat and sweating, especially at night, can awaken women, interrupting their sleep cycles and leading to fragmented and insufficient rest. Mood and Stress: Emotional fluctuations and increased stress levels experienced during menopause can also affect sleep, leading to difficulties in falling or staying asleep. Certain foods and drinks can promote better sleep by providing nutrients essential to sleep. Kiwi, cherries, milk, fatty fish, nuts, and rice have been found to aid in relaxation and sleep. Avoid caffeine, alcohol, and heavy meals 2 hours before bed so you are not still trying to digest food as you try to sleep. If you need to get up to the loo in the night, try not to drink for 2 hours before bed. If you are getting urge during the day as well speak to your Healthcare professional to discuss vaginal oestrogen replacement. Maintain a Consistent Sleep Schedule: Establishing a regular sleep routine by going to bed and waking up at the same time each day helps regulate the body's internal clock, promoting better sleep. Create a Relaxing Bedtime Ritual: Engage in calming activities before bed, such as reading, taking a warm bath, practicing relaxation exercises, or meditating to signal to your body that it's time to wind down. Optimise Your Sleep Environment: Ensure your bedroom is conducive to sleep by keeping it cool, dark, and quiet. Consider using blackout curtains, white noise machines, or earplugs if needed. No television or phone, social media scanning before bed. Limit Stimulants and Screen Time: Avoid caffeine and electronics at least an hour before bedtime, as these can interfere with your ability to fall asleep due to their stimulating effects. Practice CBT-i (Cognitive Behavioural Therapy for Insomnia): CBT-i is a structured programme that helps address underlying issues causing sleep disturbances. It focuses on changing negative thoughts and behaviours around sleep, promoting relaxation techniques, and restructuring sleep patterns. Seeking Professional Help for Sleep Issues Consulting Healthcare Professionals: If sleep disturbances significantly affect your quality of life, consulting a healthcare professional is crucial. They can assess your symptoms, recommend lifestyle changes, and discuss potential treatments, including hormone therapy if necessary. Developing Good Sleep Habits: CBT-i is an evidence-based approach that helps individuals develop good sleep habits, improve sleep quality, and manage insomnia. It involves setting consistent sleep schedules, stimulus control techniques, and relaxation strategies to retrain the mind and body for better sleep. Conclusion: Navigating sleep disturbances during menopause requires a multifaceted approach that includes adopting healthy sleep hygiene practices and seeking professional guidance when needed. Understanding the factors contributing to sleep disruptions and implementing strategies like CBT-i and good sleep habits can significantly improve sleep quality, allowing women to better manage this phase of life with improved rest and vitality. Remember, individual experiences with sleep during menopause can vary, so finding a personalised approach that works for you is key to achieving better sleep quality and overall well-being. Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us

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Specialised care for PMDD at Bristol Menopause & Wellwoman Clinic. Offering expert treatments, guidance, and compassionate support for managing Premenstrual Dysphoric Disorder. Premenstrual Dysphoric Disorder Expert Premenstrual Dysphoric Disorder (PMDD) Care At Bristol Menopause Clinic, we provide expert, evidence-based care for Premenstrual Dysphoric Disorder (PMDD), supporting you at every stage of your health journey. Whether you're experiencing severe mood changes, emotional distress, cycle-related anxiety, or debilitating symptoms, our specialist-led appointments offer personalised guidance tailored to your needs. Our doctors take the time to understand your unique concerns, offering expert advice on lifestyle strategies, medical management, and hormonal balance. From mood stabilisation and sleep disturbances to coping strategies and long-term wellbeing, we empower you with the knowledge and care you need to regain control of your health. Book an appointment today and receive the specialist support you deserve for managing PMDD with confidence. PMDD Initial Consultation See the details PMDD Follow up See the details

< Back Women's Health and Sleep: Prioritising Rest for Well-being Alternative Therapies, Managing Symptoms, Self-Care, Wellbeing As we celebrate World Sleep Day, it’s the perfect time to shed light on the crucial yet often overlooked relationship between women’s health and sleep. Sleep is not just a time of rest it is a foundation for physical, mental, and hormonal well-being. However, many women experience unique sleep challenges due to hormonal fluctuations, lifestyle demands, and societal pressures. Understanding these challenges and implementing effective strategies can lead to healthier, more restorative sleep. The Unique Sleep Challenges Women Face Women’s sleep patterns change throughout life, influenced by hormonal shifts during puberty, pregnancy, perimenopause, and menopause. These fluctuations can contribute to a range of sleep disturbances, including: Menstrual Cycle and Sleep Disruptions: Many women experience poor sleep quality, increased night awakenings, and fatigue during their menstrual cycle due to hormonal changes, particularly in progesterone and oestrogen levels. Pregnancy and Postpartum Sleep: Pregnancy often brings sleep challenges due to discomfort, frequent urination, and hormonal fluctuations. After childbirth, sleep is further disrupted due to night time feedings and postpartum hormonal shifts, increasing the risk of insomnia and mood disturbances. Perimenopause and Menopause: Hormonal changes in midlife can significantly impact sleep. Hot flushes, night sweats, and increased anxiety are common symptoms that disturb sleep. Lower oestrogen levels can also reduce the production of melatonin, the hormone responsible for regulating sleep cycles. Stress and Mental Health: Women are more likely to experience anxiety and depression than men, both of which can negatively impact sleep. Chronic stress and the mental load of balancing work, family, and personal responsibilities can lead to difficulty falling or staying asleep. Lifestyle Factors: Busy schedules, caregiving responsibilities, and increased screen time can lead to poor sleep hygiene, further compounding sleep issues. The Importance of Quality Sleep for Women's Health Quality sleep is vital for overall health and well-being. It plays a crucial role in: Hormonal Balance: Sleep regulates the endocrine system, including hormones like cortisol, insulin, and leptin, which influence metabolism, appetite, and stress levels. Cognitive Function: A well-rested brain improves memory, concentration, and decision-making. Mental Health: Quality sleep reduces stress, anxiety, and the risk of depression. Weight Management: Poor sleep disrupts hunger hormones, increasing cravings for unhealthy foods and making weight management more difficult. Heart Health: Chronic sleep deprivation increases the risk of hypertension, heart disease, and stroke. Immune Function: Sleep strengthens the immune system, helping the body fight infections and inflammation. How to Improve Sleep for Better Health If you’re struggling with sleep, making intentional lifestyle changes can significantly improve your rest. Here are some science-backed strategies: Establish a Sleep Routine: Going to bed and waking up at the same time every day, even on weekends, helps regulate your body’s internal clock. Optimise Your Sleep Environment: Keep your bedroom cool, dark, and quiet. Invest in comfortable bedding and consider using blackout curtains and white noise machines if necessary. Limit Stimulants and Screens: Avoid caffeine and alcohol before bedtime, and reduce exposure to blue light from screens at least an hour before sleep. Practice Relaxation Techniques: Try mindfulness meditation, deep breathing, or progressive muscle relaxation to calm the nervous system before bed. Stay Active: Regular exercise promotes better sleep, but avoid vigorous activity too close to bedtime. Manage Hormonal Symptoms: If menopause or other hormonal changes are affecting your sleep, consider speaking with a healthcare provider about treatment options, such as hormone replacement therapy (HRT) or cognitive behavioural therapy for insomnia (CBT-I). Prioritise Self-Care: Managing stress through activities like journaling, yoga, or spending time in nature can support better sleep and overall health. On this World Sleep Day, let’s recognise the critical role sleep plays in women’s health. Prioritising rest is not a luxury it’s a necessity for maintaining hormonal balance, mental well-being, and overall vitality. By understanding and addressing the unique sleep challenges women face, we can empower better health outcomes and a higher quality of life. If you’re experiencing persistent sleep issues, don’t hesitate to seek professional guidance. Improving your sleep is one of the most powerful steps you can take for your long-term health and well-being. Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us

Learn more about the menopause and discover our top tips for managing symptoms from our healthcare professionals. Blog Below are some useful tips and insights from the team here at Bristol Menopause, acknowledged industry experts and trusted advisors, which will hopefully trigger some thoughts or ideas. Alternative Therapies Cardiovascular Advice Diet Exercise Gum Disease HRT Managing Symptoms Managing Weight Menopause Advice Mental Health Pelvic Organ Prolapse Perimenopause Polycystic Ovaries Post Menopause Self-Care Stress Wellbeing Dry January & Women’s Health: A Powerful Reset for Your Body and Mind Dry January isn’t about restriction or punishment. It’s about pressing pause, giving your body time to reset, and noticing how you actually feel without alcohol in the background. Read More Menopause & Weight Gain — What’s Normal and What You Can Change Midlife weight gain is common but manageable. Discover the real reasons it happens and practical steps to support healthy, sustainable weight control. Read More When Menopause Anxiety Strikes — How to Feel More in Control Menopause anxiety can feel overwhelming. Learn why it happens and discover evidence-based strategies to regain calm and confidence. Read More HRT Explained: What the Latest Guidelines Really Say (2025 Update) Confused about HRT? Get clear, evidence-based guidance on safety, dosing, benefits, and who is eligible according to the 2025 BMS and NICE updates. Read More Why Perimenopause Symptoms Vary So Much And What You Can Do About It Perimenopause symptoms can be confusing and unpredictable. Learn why they vary so much and discover practical, specialist-approved strategies to feel more in control. Read More Healthy Ageing: Thriving Beyond Menopause Reframing Ageing Ageing is inevitable, but the way we age is not fixed. Healthy ageing is less about adding years to life and more about adding life to years. It means maintaining vitality, independence, and joy in the decades after menopause. Read More Simple Nutrition Strategies to Ease Your PMDD Symptoms If you experience Premenstrual Dysphoric Disorder (PMDD), you know the cyclical surge of symptoms such as anxiety, irritability, depression, and fatigue is debilitating. Read More Breast Cancer & Midlife: Why Stress and Lifestyle Matter More Than You Think As women reach midlife, we face a perfect storm, hormonal change, busy lives, and rising health demands. It’s no coincidence that this is also when breast cancer risk begins to increase. Read More Let’s talk honestly about HRT and breast cancer There’s a lot of fear flying around online right now, especially after recent headlines, so let’s set the record straight with facts, not fear. Read More Redefining Healthy Ageing: Menopause as the Gateway, Not the End Challenging Old Narratives: Menopause has long been painted as the start of decline. Lifestyle medicine reframes it as a gateway to healthy ageing. Midlife is an opportunity to protect health for decades to come Read More 10 Page 1

Explore the social values at Bristol Menopause & Wellwoman Clinic, committed to empowering women through compassionate care, inclusivity and community support. Our Social Values At Bristol Menopause Clinic, our commitment to the community goes beyond education and awareness—we are dedicated to creating social value by ensuring that all women, regardless of their financial circumstances, have access to menopause care. We understand that many women may face financial barriers in accessing the specialised care they need during menopause, which is why we offer funding support for those who struggle to afford menopause care. This social value initiative is at the heart of our mission to support women through this important life stage. By collaborating with organisations like the Avon and Wiltshire Partnership (AWP), Bristol Women’s Voice, and Formed Films, we not only raise awareness but also ensure that menopause care is more accessible to the women who need it most. Our talks to local communities, including Somalian and Chinese women’s groups, and healthcare professionals, as well as our contributions to International Women’s Day events, reflect our drive to make a real difference in the lives of women across the region. Through our funding support and educational outreach, we aim to reduce inequalities in healthcare and provide every woman with the tools and care she deserves during menopause. We are deeply committed to supporting our local community by raising awareness and providing education around menopause, particularly for women facing mental health challenges. In collaboration with the Avon and Wiltshire Partnership (AWP), we have developed specialised menopause awareness programmes tailored to women with mental health conditions, ensuring they receive the support they deserve. We are proud to contribute to the vital work of Bristol Women’s Voice, including participating in International Women’s Day events, where we help amplify the conversation around menopause and its impact on women's lives. Additionally, our collaboration with Formed Films, along with menopause support led to the creation of an informative animated film aimed at educating viewers about menopause and health. Our efforts extend to local communities as well. We have delivered talks to Portishead Town Council, engaging with residents to provide valuable information on menopause. We have also had the privilege of speaking to the Somalian and Chinese women’s communities, ensuring that information and support reach diverse groups. Our commitment to healthcare extends to professionals as well, as we regularly provide educational talks for local healthcare professionals to improve the care, they offer to women going through menopause. By continuously engaging with a wide range of groups, from local residents to healthcare professionals, we aim to foster a supportive environment where menopause is understood, and women can feel empowered. If you are you are in the Voluntary, Community and Social Enterprise sector (VCSE) please do not hesitate to get in touch with us. Please contact us on: Email: hello@bristolmenopause.com Phone: 0117 452 5747

< Back Menopause and Diet: How Food Can Be Your Strongest Ally Written By Dr Rebecca Hiscutt Diet is one of the most powerful tools you can use to support your body through menopause. What and when you eat can amplify symptoms or help steady your energy, mood and metabolism. Below are some of the most common menopause symptoms, why diet matters, and simple, evidence-informed strategies to help you feel more like yourself again. Aches and Pains More than half of women report joint or muscular discomfort during menopause, with about 20% saying it’s their worst symptom. This isn’t just ageing, it’s often driven by inflammation. Why diet matters • Hormonal shifts increase inflammation. • Fatigue, poor sleep and mood changes can lead to quick-fix eating (sugar, processed carbs) which drives inflammation further. • Stress depletes key nutrients like magnesium and B vitamins, important for joint and muscle function. Dietary strategy • Focus on whole, anti-inflammatory foods: lean protein, non-starchy vegetables, and natural fats. This will help you feel fuller and reduce cravings for sweet or salty carbohydrate foods. • For the next two weeks spend 15 minutes each week planning meals and writing a shopping list. Take photos of these. Now you have a two week meal plan you can cycle through saving you headspace and time. Just repeat, tweaking one or two meals if you like for variation. Top tip: omega 3 fats are highly anti-inflammatory. Build oily fish into your weekly meals. e.g. Salmon, broccoli and asparagus tray bake with lemon and garlic. If yon’t eat oily fish consider an omega 3 supplement. Cognition and Brain Fog Around 60% of women report memory problems, difficulty concentrating, or that vague ‘cotton wool brain.’ Falling oestrogen affects brain regions linked to focus and recall. Why diet matters • Key nutrients (B12, folate, choline, iron, zinc, magnesium) are essential for brain health. • Blood sugar instability can worsen fatigue and fog. • Nutrient gaps can occur in midlife due to busier lives, stress, restrictive diets or increased need (stress, heavy periods). Dietary strategy • Prioritise nutrient-dense foods such as: eggs, oily fish, leafy greens, meat, pumpkin seeds • Check and optimise B12, iron and folate levels if low or borderline. • Stabilise blood sugar: build meals around protein, healthy fats and fibre to help minimise grazing on sugary snacks. Hot Flushes and Night Sweats Around 80% of post-menopausal women experience vasomotor symptoms like hot flushes and night sweats. While hormone changes are the main driver, blood sugar fluctuations can also trigger symptoms. Why diet matters • Spikes and crashes in blood glucose can trigger or intensify hot flushes. • Evening hyperglycaemia worsens night-time sweating and poor sleep. Dietary strategy • Make protein the anchor of every meal to reduce glucose spikes. • Finish eating at least 3 hours before bed to support stable blood sugar overnight. • Hydrate well as dehydration can increase blood glucose levels. Sleep Disturbance Sleep disruption is one of the earliest and most common menopausal symptoms. Just one poor night of sleep increases insulin resistance, making other symptoms worse the next day. Why diet matters • High sugar or alcohol at night destabilises blood sugar and cortisol rhythms. • Magnesium supports relaxation and the production of GABA and melatonin. Dietary strategy • Eat a balanced evening meal: protein + natural fats + a small portion of fibre-rich carbs. • Consider trialling magnesium glycinate supplementation if needed (gentle and well tolerated). • Be mindful of how alcohol and caffeine impact your sleep Exhaustion Falling oestrogen makes the body less sensitive to insulin, so it struggles to move sugar into cells for energy. This creates an energy ‘block’, driving fatigue, inflammation, and fat gain. Why diet matters • Elevated insulin traps energy in fat stores, rather than releasing it for energy • Sugary snacks make energy highs and lows worse. Dietary strategy • Reduce refined carbohydrates and close your ‘eating-window’ earlier in the evening. • To help with this start your day with a high-protein breakfast to curb cravings and stabilise energy. Irritability and Anxiety Mood swings, irritability and anxiety are often some of the first symptoms to appear in perimenopause impacting quality of life and relationships hugely. Why diet matters • Fluctuating hormones affect the production of neurotransmitters that help us feel calm and motivated, such as serotonin and GABA • Low levels of magnesium, zinc, B vitamins and omega-3s can increase anxiety • Blood sugar crashes can heighten irritability. Dietary strategy • Look for every opportunity to provide your body and brain with the ingredients it needs to produce calming neurotransmitters. • Support gut health by choosing whole foods over processed, sugar-rich foods, including fermented foods and natural probiotics • Start by stocking up on unprocessed foods you love to replace processed snacks. E.g apples cooked with cinnamon and creme fraiche or Greek yoghurt, watermelon and feta cubes, your favourite olives. Weight Gain and Visceral Fat The combination of falling oestrogen, rising insulin and higher cortisol shifts fat storage to the abdomen, increasing Visceral fat, a more metabolically active and inflammatory type of fat. Why diet matters • High refined carb intake keeps insulin levels high, promoting fat storage. • Adequate protein helps preserve lean muscle mass, increasing metabolic rate. Dietary strategy • Adjust macronutrient balance for what you need now. Tweak carbohydrate, protein and fat so you feel full and satisfied but enable insulin levels to come down and burn fat. • Pair diet with resistance training, steady-state movement, small bursts of HIT and sleep optimisation. • Put in place a stress management plan as cortisol impacts fat distribution. Your Personalised Menopause Nutrition Toolkit Menopause calls for a different nutritional approach. Small, targeted shifts can ease symptoms and build long-term health: • Eat protein first at each meal. • Cut back on refined carbohydrates. • Support key nutrients like omega-3, magnesium and B vitamins. • Pair food strategies with movement, stress support and sleep. Note: Nourishing yourself through diet alongside movement, stress management and sleep is key for symptoms management, wellbeing and long-term health whether as an independent strategy or alongside HRT. Dr Rebecca Hiscutt . PhD is a registered dietitian with a specialist interest in women’s health and works alongside Bristol Menopause Clinic to provide holistic and comprehensive care for their patients. Nutrition support and guidance can be provided in person at Bristol Menopause Clinic on virtually. Find out more here References: Donga, E. et al. (2010). A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. Journal of Clinical Endocrinology & Metabolism, 95(6), 2963–2968 Dormire S, Howharn C. The effect of dietary intake on hot flashes in menopausal women. J Obstet Gynecol Neonatal Nurs. 2007;36(3):255-262 Greendale, G. A. et al. (2021). Changes in regional fat distribution and anthropometric measures during the menopause transition. Journal of Clinical Endocrinology & Metabolism, 106(9), 2523–2533 Lovejoy J.C. The menopause and obesity. Medical Clinics of North America, 2018; 102(2): 305-318 Mauvais-Jarvis, F., Clegg, D. J., & Hevener, A. L. (2013). The role of estrogens in control of energy balance and glucose homeostasis. Endocrine Reviews, 34(3), 309–338 Kim Y., Je Y. Dietary patterns and hot flashes: A systematic review and meta-analysis. Maturitas, 2017; 100: 83-90 Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us

< Back 10 Proven Ways to Sleep Better During Menopause & Perimenopause When it comes to sleep, women often draw the short straw. Not only are we more prone to insomnia and disrupted sleep than men, but certain life stages, particularly menopause and the menopause transition (perimenopause), can make sleep even more elusive. For many, difficulties begin in the early 40s and peak shortly after menopause. As sleep quality declines, other menopausal symptoms, like hot flushes, anxiety, and mood swings, often intensify. Blog written by Dr Caitlin Chasser - Cofounder of The Sleep Project Oestrogen and progesterone receptors are found throughout the brain, influencing stress responses, mood, memory, temperature regulation, and sleep itself. In a typical menstrual cycle, many women experience better sleep in the oestrogen-rich first half (from the start of a period until ovulation). However, sleep can become lighter and more disturbed in the second half, especially just before menstruation. During perimenopause, hormone levels often become erratic. After menopause, they drop significantly, leading to much lighter sleep, more frequent night-time awakenings, and waking feeling unrefreshed. Despite research showing women typically need 8–9 hours of sleep per night - often more than men - achieving this during menopause can feel near impossible. Fortunately, there are evidence-based strategies to restore restful sleep. Whether you’re dealing with night-time disruptions or persistent insomnia, here are 10 proven solutions to help you get the rest your body needs. 1. Hormone Replacement Therapy (HRT) HRT is one of the most effective treatments for menopause-related sleep issues. By stabilising hormone levels, it reduces hot flushes, night sweats, and other symptoms that disrupt sleep. If you're already taking HRT and still sleeping poorly, it may be a matter of finding the most 'sleep-friendly' combination getting the right preparation, at the right dose, and at the right time. If your sleep remains a struggle, Cognitive Behavioural Therapy for Insomnia (CBT‑I) is the recommended next step. Why it works: HRT reduces the frequency and intensity of hot flushes major culprits behind sleep disturbances. It also helps relieve anxiety and mood symptoms that are often linked to poor sleep. Research shows HRT improves sleep stability, reducing awakenings and promoting more restful nights. 2. Cognitive Behavioural Therapy for Insomnia (CBT‑I) CBT‑I is the most effective non-medical treatment for insomnia and works just as well as HRT for improving sleep. While it may seem counterintuitive to use a behavioural therapy when the root cause feels physical, CBT‑I enhances sleep by increasing deep sleep and teaching you how to get back to sleep quickly after waking whether from hot flushes, anxiety, or other menopausal symptoms. During a 4 week programme, you’ll learn proven techniques to fall asleep faster, reduce night-time awakenings, and improve the overall quality and quantity of your sleep. Why it works: When we have insomnia, the brain becomes hyper-aroused too alert at night. CBT‑I teaches us how to quieten the mind and reshape negative sleep patterns. It improves both the quality and depth of sleep, even during hormonal fluctuations. Find out more. 3. Optimise Sleep Hygiene Creating a sleep-supportive environment is crucial, especially when your sleep is more fragile. Keep your bedroom dark (use an eye mask if needed), cool (ideally 16–19 °C), and quiet (try earplugs or pink/white noise). Use layered bedding so you can easily adjust temperature, and consider a cool shower before bed to help lower your core temperature. Why it works: A cool, dark, and quiet room reduces night-time awakenings and helps maintain sleep despite hot flushes and night sweats. Good sleep hygiene creates the ideal conditions for better-quality rest. 4. Exercise Regularly Physical activity supports your body’s natural sleep–wake rhythm and helps manage menopause-related anxiety and low mood, both of which can interfere with sleep. All forms of exercise help, but resistance or weight training may offer the most benefit for deep sleep. Why it works: Exercise boosts mood, reduces stress, and enhances sleep quality. Aim for 20–30 minutes of movement on most days consistency matters more than intensity. 5. Limit Alcohol and Caffeine Alcohol may make you feel sleepy, but it disrupts sleep later in the night by reducing REM (dream) sleep and increasing night-time wakefulness. It can also trigger hot flushes. Caffeine, a stimulant, can delay sleep if consumed too late in the day. Why it works: Cutting back on alcohol and caffeine improves sleep continuity and depth. Consider alcohol-free alternatives if you enjoy a relaxing drink in the evening. 6. Practice Mindfulness and Relaxation Techniques Techniques like meditation, deep breathing, or progressive muscle relaxation help calm the mind and body before bed. These are especially useful if anxiety or stress is contributing to poor sleep. Try our Mindfulness Body Scan before bed or during the night if you wake and can’t drift back off. Why it works: A consistent, relaxing bedtime routine prepares your mind for rest and supports deeper, more restorative sleep. 7. Manage Hot Flushes Hot flushes and night sweats are major sleep disruptors. Keep your sleeping environment cool with a fan or open window, wear moisture-wicking nightwear, and use breathable bedding. If symptoms persist, consult your doctor, medications like SSRIs can reduce flushes and support better sleep. Why it works: Minimising temperature fluctuations at night helps reduce awakenings triggered by hot flushes, allowing for more consistent sleep. 8. Try Melatonin Melatonin supplements can help women over 55 fall asleep faster. While it’s not as powerful as CBT‑I, melatonin can still be a low-risk option particularly for those who struggle with sleep onset. Why it works: Menopause can disrupt natural melatonin production. Supplementing melatonin helps regulate the body’s circadian rhythm, improving sleep timing and continuity. 9. Rule Out Underlying Sleep Disorders Conditions like obstructive sleep apnoea (OSA) and restless legs syndrome (RLS) become more common during menopause. Signs of OSA include loud snoring, pauses in breathing, dry mouth upon waking, and excessive daytime tiredness. If you suspect a disorder, a sleep study may be necessary. Unsure? Try our Diagnose Your Sleep quiz . Why it works: Treating undiagnosed conditions such as OSA or RLS can significantly improve sleep quality and reduce long-term health risks. 10. Be Consistent A regular sleep–wake schedule going to bed and waking up at the same time each day supports your body’s natural rhythm. If you’re struggling to fall asleep, you may be going to bed too early. Use our Bedtime Planning for a Great Night’s Sleep tool to find your optimal sleep window. Why it works: Consistency strengthens your circadian rhythm and improves overall sleep quality particularly important during menopause, when sleep can become fragmented. If you're struggling with sleep and think it's just something you have to endure during menopause stop! Poor sleep can be fixed, and the solution is probably easier than you think. Often, it’s not one magic bullet, but a series of small adjustments that make the biggest difference. When you’re utterly exhausted, that first step can feel overwhelming but deciding, this has to change, is the most powerful thing you can do. Need support figuring out your next step? Our Menopause Support Package gives you everything you need to return to the restful, energising sleep you deserve. Find out more here . Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us

< Back How can pelvic physiotherapy support perimenopause? Alternative Therapies, Exercise, Managing Symptoms, Pelvic Organ Prolapse, Wellbeing Like puberty, menopause transition involves a complex cascade of hormonal changes. We spend on average over 40% of our lives in post-menopause, so it is crucial to understand and get ahead of these changes to optimise our long term well-being. Poor pelvic health, such as bladder, bowel and sexual dysfunction, is a leading barrier to continuing exercise and can be detrimental to our mental health. For much of our lives, oestrogen is our power house - it’s what keeps muscles, tendons and connective tissue stretchy, subtle and strong, our joints healthy and lubricated. It keeps the vaginal and urethral walls moist and elastic, with capacity for distention and constriction. We go through life not fully appreciating the wonderful things oestrogen does for us. A reduction in oestrogen levels can cause local changes to the vaginal and vulvar tissues and muscles which we call Genitourinary Syndrome of Menopause (GUSM). This describes a collection of symptoms which are all caused by this hormonal shift. Symptoms of GUSM include: Vaginal dryness, burning or sandpaper-like feeling Pain with sex and decreased lubrication Vaginal and vulvar itching - Changes in odor and discharge UTI’s or vaginal infections Skin irritation Change in orgasm Reduced strength or takes longer to achieve Smear tests or tampon insertion (if still using) become uncomfortable Symptoms of prolapse, such as heaviness or pressure - Increased frequency and urgency to empty bladder Leaking urine with exertion or not making it to toilet on time Firstly, bringing attention to our vulvar skin care, and use of lubricants, vaginal moisturisers (like YesYesYes ) and a prescription for vaginal oestrogen could be instrumental for managing these symptoms. Depending on the person, HRT can also play a role in improving these issues, too. Pelvic floor Physiotherapy can be a game changer, and is actually a gold standard treatment for managing GUSM symptoms. So how does physio work? Leaking urine on coughing, running or jumping (called stress urinary incontinence or SUI) is extremely common. If the pressure in our tummy is less than the pressure created by the muscles surrounding the urethra, then we are protected from leaking. This urethral closure pressure is created in two ways: 1. Like the vaginal walls, the urethral walls fold in on themselves to allow for considerable expansion when emptying the bladder, and creating a leakproof closure pressure when at rest. 2. Abdominal pressure presses down onto the bladder neck, and compresses it - stopping the flow of urine, like stomping on a garden hose. Any changes to tissue quality, like GUSM, can alter this mechanism, as the plump urethral walls become drier and thinner, and the connective tissue supporting the bladder weakens. However, learning how to fully contract and relax the pelvic floor muscles has been shown to increase blood flow, tissue elasticity and muscle bulk, improving tissue quality and often improving or resolving SUI. Pelvic organ prolapse (POP) symptoms may also begin or worsen during perimenopause or post-menopause. This is where there is an excess of downwards movement in the vaginal walls and connective tissue that provide support for your pelvic organs, causing descent to or past the entrance of the vagina. Childbirth, pregnancy, hypermobility and chronic straining are all examples of risk factors for pelvic organ prolapse, and declining oestrogen levels and tissue quality could contribute to an increase in symptoms. Types of pelvic floor prolapse Thankfully, we can use pelvic floor muscle training to create a hammock of support from underneath to manage prolapse symptoms. A pelvic floor physiotherapist will also look at your whole body biomechanics to help you optimise support from below and minimise pressure from above, as well as optimising bowel habits and toileting postures to minimise straining. Keep exercising! Pelvic health concerns should never be a barrier to exercise. Exercise and keeping muscles strong is especially crucial during this stage of life, as it also helps body weight, bone density, cardiovascular health, and supports mental well-being by managing anxiety and depression. Exercise has even been shown to improve vasomotor symptoms like hot flushes! If you’re experiencing pelvic floor symptoms or want to protect your pelvic floor for the future, reach out to a pelvic floor physiotherapist for support. Alma Physiotherapy offer a Menopause Pelvic Floor Assessment & Treatment appointment with their specialist physios, and you can get 10% off the first session with code BM10 . Meg is a sports (MSK) and pelvic health physiotherapist based at Alma Physiotherapy, 25 Lower Redland road, Bristol, BS6 6TB. Book via: www.almaphysiotherapy.co.uk/book-online Email her PA Zainab pa@almaphysiotherapy.co.uk or call 07942 494506 for help booking. References: Russo et al. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2021 Jan;143:223-230. doi: 10.1016/j.maturitas.2020.09.005. Epub 2020 Sep 30. PMID: 33008675. Mercier et al. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric. 2020 Oct;23(5):468-473. doi: 10.1080/13697137.2020.1724942. Epub 2020 Feb 27. PMID: 32105155. Mercier et al. Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: A single-arm feasibility study. Maturitas. 2019 Jul;125:57-62. doi: 10.1016/j.maturitas.2019.03.002. Epub 2019 Mar 29. PMID: 31133219. Get in Touch If you would like a personal Wellwoman Check, or are suffering from any of the symptoms of the menopause and would like to learn more, please head to our contact page to book an appointment. You'll be so glad you did! Contact Us