Read our Cookies Policy to understand how we use cookies to improve website performance, user experience and data security. Cookies About Cookies Cookies are small text files that are placed on your device when you visit a website. They help the website recognise your device and remember information about your visit, such as your preferences or items in your shopping basket. When you visit our website, our server may ask your browser to store one or more cookies. When you return, your browser sends these cookies back to us, allowing us to recognise you and improve your experience. How We Use Cookies We use cookies to: Make our website function properly Remember your preferences Improve website performance Measure the effectiveness of our marketing Cookies may be set by us (first-party cookies) or by trusted third-party providers. Your Choices and Control When you first visit our website, you will be shown a cookie banner giving you the option to accept or reject non-essential cookies. You can also change or withdraw your consent at any time by using the cookie settings on our website. You can block or delete cookies through your browser settings (Chrome, Firefox, Safari, Edge). Please note that blocking essential cookies may cause parts of our website to stop working. Types of Cookies We Use 1. Strictly Necessary (Essential) Cookies These cookies are required for the website to function properly and cannot be switched off in our systems. Stores your cookie preferences 30 days 2. Analytics Cookies (Optional) We use Google Analytics to understand how visitors use our website and to help us improve it. These cookies are only set if you give consent. Limits request rates 1 minute For more information, please see the Google Analytics section in our Privacy Policy. 3. Marketing Cookies (Optional) We use the Facebook (Meta) Pixel to measure the effectiveness of our advertising and deliver more relevant adverts. These cookies are only set if you give consent. For more information, see the Facebook Pixel section of our Privacy Policy. Third-Party Cookies Some features on our website are provided by third parties. These providers may set cookies and may track your activity across multiple websites. Examples include: Facebook Page Widget The Facebook widget may set cookies when it loads. See the relevant section in our Privacy Policy for details. Vimeo Video Player Vimeo sets cookies when you play embedded videos. See the relevant section in our Privacy Policy for more information. How to Change Your Cookie Settings You can change or withdraw your cookie consent at any time by: Using our cookie settings tool on the website Adjusting your browser settings Useful browser guides: Chrome | Firefox | Safari | Edge Updates to This Policy We may update this Cookie Policy from time to time. Any changes will be posted on this page.

< Back Nourishing Your Brain Through Menopause: The Power of Diet Menopause Advice, Wellbeing, Diet In this blog post, we'll explore the importance of diet on brain health during menopause and discuss specific dietary choices that can support your mental and emotional well-being. Menopause is a natural phase in a woman's life, marked by various physical and hormonal changes. While these changes are well-known, many women are unaware of the profound impact menopause can have on brain health. Maintaining cognitive function and emotional well-being is essential during this time, and one powerful tool at your disposal is your diet. In this blog post, we'll explore the importance of diet on brain health during menopause and discuss specific dietary choices that can support your mental and emotional well-being. These hormonal changes can lead to cognitive issues, mood swings, and even an increased risk of conditions like Alzheimer's disease. The Role of Diet in Brain Health During Menopause Diet plays a pivotal role in brain health during menopause. What you eat directly impacts brain function and emotional well-being. Here's how: Maintaining Hormonal Balance: Certain foods can help support hormonal balance. Phytoestrogens, found in foods like soy, flaxseeds, and legumes, may help mitigate some of the hormonal fluctuations associated with menopause. Neuroprotective Nutrients: Nutrients like omega-3 fatty acids, antioxidants (such as vitamin E and C), and B vitamins are known for their neuroprotective properties. They help shield the brain from oxidative stress and inflammation, both of which can negatively affect cognitive function. Blood Sugar Regulation: A diet rich in complex carbohydrates, fibre and lean proteins can help stabilise blood sugar levels. Fluctuating blood sugar levels can impact mood and cognitive function, so it's crucial to maintain stability. Dietary Recommendations for Brain Health During Menopause Omega-3 Fatty Acids: Incorporate sources of omega-3 fatty acids into your diet. Fatty fish like salmon and trout, flaxseeds, chia seeds, and walnuts are excellent choices. Omega-3s are known for their brain-boosting properties. Antioxidant-Rich Foods: Consume a variety of colourful fruits and vegetables. Berries, leafy greens, broccoli, and citrus fruits are packed with antioxidants that protect brain cells from damage. Lean Proteins: Choose lean sources of protein like poultry, beans, lentils, and tofu. Protein provides amino acids necessary for neurotransmitter production, which can influence mood and cognitive function. Whole Grains: Choose whole grains like brown rice, quinoa, and whole wheat bread over refined grains. They provide a steady release of energy, helping to stabilise blood sugar levels. Phytoestrogen-Rich Foods: Incorporate foods rich in phytoestrogens, such as soy products (tofu, edamame, tempeh), flaxseeds, and legumes, to help balance hormonal changes. Hydration: Stay adequately hydrated. Dehydration can impair cognitive function, so aim for at least eight glasses of water a day. Limit Sugar and Processed Foods: Minimise your intake of sugary snacks and processed foods, as they can lead to blood sugar spikes and crashes that affect mood and energy levels. Navigating the menopause can be challenging but remember that your diet can be a powerful ally in maintaining brain health. By making thoughtful food choices rich in omega-3s, antioxidants, and other brain-boosting nutrients, you can support cognitive function, emotional well-being, and overall vitality. Consult with a healthcare professional or nutritionist for personalised dietary recommendations to help you thrive during this new chapter of your life. For personalised, evidence-based menopause care and support, visit Bristol Menopause 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 Testosterone in Women: Symptoms, Decline & Why It Matters in Menopause Discover the role of testosterone in women, symptoms of low levels, and why it matters in perimenopause and menopause. Expert guidance from a menopause specialist. Testosterone is often incorrectly described as a “male hormone.” In reality, it plays a significant and well-established role in female physiology across the lifespan. Despite this, its clinical relevance in women remains under-recognised, particularly in the context of perimenopause and menopause. This article, the first in a two-part series, outlines: The physiological role of testosterone in women The causes and timing of decline The clinical features associated with reduced levels The second article will address assessment, diagnosis, and prescribing within current UK guidance. Androgen Function and Clinical Relevance Testosterone is an androgen and represents the most abundant biologically active steroid hormone in women during both reproductive and post-reproductive life.¹ It is produced by: The ovaries The adrenal glands Peripheral conversion in tissues including adipose Testosterone exerts its effects through: Direct binding to androgen receptors Conversion to oestradiol via aromatisation Androgen receptors are widely distributed, including in: Central nervous system Bone and skeletal muscle Cardiovascular tissue Skin and hair follicles Vulvovaginal and urogenital tissues This distribution underpins the broad clinical impact of testosterone in women. Clinical Features of Low Testosterone in Women Reduced testosterone levels may present with a constellation of symptoms affecting multiple domains: Reduced sexual desire, arousal, and response Persistent fatigue and reduced motivation Low mood and diminished emotional resilience Impaired concentration, memory, and cognitive function Loss of muscle strength and reduced physical performance Reduced bone mineral density Changes in skin integrity, hair quality, and joint health Vulvovaginal and urogenital symptoms The 2019 Global Consensus Position Statement (endorsed by the British Menopause Society and other international bodies) identifies hypoactive sexual desire disorder (HSDD) as the primary evidence-based indication for testosterone therapy in women.³ However, in clinical practice, presentations are frequently multifactorial and extend beyond sexual function alone. Timing and Causes of Testosterone Decline Testosterone levels decline progressively from the late twenties onwards .⁴ While gradual, several factors may accelerate or exacerbate this reduction: Perimenopause and Menopause The most common cause of clinically significant androgen decline, reflecting changes in ovarian function. Surgical Menopause Bilateral oophorectomy results in an abrupt reduction of approximately 50% of circulating testosterone , often associated with significant symptom burden. Combined Oral Contraceptive Use Suppression of ovarian androgen production Increased Sex Hormone Binding Globulin (SHBG) Reduced free (bioavailable) testosterone Chronic Stress Sustained cortisol elevation may impact androgen synthesis and availability. Endocrine Disorders Including hypothyroidism and hyperprolactinaemia. Medications Including: Antidepressants Antihypertensives Long-term corticosteroids Surgical Menopause: A Clinical Gap Women undergoing surgical menopause experience a sudden and substantial reduction in androgen production . Despite this, testosterone replacement is not routinely incorporated into standard management alongside oestrogen and progesterone.⁷ This may contribute to persistent symptoms such as: Fatigue Reduced libido Mood disturbance Cognitive changes This remains an area where clinical awareness and practice continue to evolve. Relevance in Perimenopause and Menopause Hormone Replacement Therapy (HRT) effectively addresses many symptoms related to oestrogen deficiency, including: Vasomotor symptoms Sleep disturbance Vaginal dryness However, some women report ongoing symptoms despite appropriate oestrogen therapy, including: Reduced libido Persistent fatigue Cognitive symptoms Reduced sense of wellbeing In such cases, androgen insufficiency may be a contributing factor. Clinical Importance The focus of women’s hormonal health has traditionally centred on oestrogen. While appropriate, this approach does not fully reflect the complexity of endocrine physiology. The evidence base supporting testosterone therapy in women has expanded , with international consensus recognising its role within defined clinical indications.³ However: Awareness among patients remains limited Training in prescribing testosterone for women is variable Access to specialist assessment is inconsistent Next Steps The second article in this series will address: Clinical assessment of suspected androgen insufficiency Appropriate use of blood testing Prescribing considerations in line with NICE and British Menopause Society guidance Monitoring and safety Testosterone is a physiologically important hormone in women, with effects across multiple systems. Declining levels, particularly during midlife or following surgical menopause, may contribute to a range of symptoms affecting quality of life. Recognition of its role is essential to ensure a comprehensive and evidence-based approach to women’s health. 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 Breast Cancer & Midlife: Why Stress and Lifestyle Matter More Than You Think Cardiovascular Advice, Diet, Managing Symptoms, Managing Weight, Menopause Advice, Mental Health, Self-Care, Wellbeing, Stress 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. But here’s the empowering truth: our daily choices can make a real difference. The Stress Connection Chronic stress isn’t just emotional, it’s biochemical . When cortisol and adrenaline stay high, they: Disrupt immune function and oestrogen metabolism Drive inflammation and fatigue Make it harder to maintain healthy habits Midlife often means juggling everything : careers, ageing parents, children, and our own health. But even small acts of self-care walking, breathing deeply, spending time outdoors, saying “no” when needed help to reset the nervous system and support hormonal balance. Stress won’t “cause” breast cancer, but it can tip the balance in the wrong direction if left unchecked. Prioritising calm is not indulgent, it’s protective . Lifestyle as Medicine Lifestyle is our most powerful prevention tool. Move regularly, aim for 150 minutes/week of moderate exercise + strength work. Eat mostly plants, oily fish, wholegrains, and minimise ultra-processed foods. Limit alcohol, even small amounts raise oestrogen levels. Maintain a healthy weight post-menopause, body fat produces oestrogen. Prioritise sleep and meaningful connection, both lower stress hormones. These choices don’t have to be perfect; they just need to be consistent . Each decision shifts your biology towards balance and resilience. A Message of Empowerment We can’t control everything, not our age or genes but we can influence the environment our cells live in. Supporting stress recovery, nourishing our bodies, and making informed decisions about HRT are all part of living well through menopause and beyond. Midlife isn’t a decline, it’s a redesign . 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 Alcohol and Perimenopause: How Alcohol Affects Hormones, Symptoms and Your Health Many women notice that alcohol affects them differently during perimenopause. A single glass of wine that once caused no problems may now trigger poor sleep, hot flushes, anxiety or leave you feeling exhausted the next day. Alcohol and Perimenopause: Why Does Alcohol Affect You Differently? Many women notice that alcohol affects them differently during perimenopause. A single glass of wine that once caused no problems may now trigger poor sleep, hot flushes, anxiety or leave you feeling exhausted the next day. If this sounds familiar, you are not imagining it. Hormonal changes during perimenopause alter the way your body processes alcohol, making many women more sensitive to its effects. Understanding the relationship between alcohol and perimenopause can help you make informed choices that support your health and wellbeing during midlife. What Is Perimenopause? Perimenopause is the natural transition leading up to menopause, when ovarian function gradually declines and hormone levels begin to fluctuate. It commonly starts in a woman's 40s, although it can begin earlier. During this stage, levels of oestrogen and progesterone become increasingly unpredictable. These hormones influence far more than the menstrual cycle—they play important roles in: Brain function and mood Sleep regulation Bone health Cardiovascular health Metabolism Temperature regulation Bladder and vaginal health Because these systems are already adapting to hormonal changes, alcohol can have a much greater impact than it did previously. Why Does Alcohol Affect Women More During Perimenopause? Hormonal Changes Alter Alcohol Metabolism Your liver is responsible for breaking down alcohol. During perimenopause, hormonal fluctuations may reduce the efficiency of alcohol metabolism, meaning alcohol remains in your bloodstream for longer. As oestrogen levels decline, body composition also changes. Most women naturally experience: Reduced lean muscle mass Lower total body water Increased body fat Because alcohol dissolves in water rather than fat, lower body water concentrations result in higher blood alcohol levels after drinking the same amount. The result is that alcohol often feels stronger, lasts longer and recovery takes more time. Alcohol Disrupts Hormonal Balance Alcohol temporarily increases circulating oestrogen while also interfering with the body's ability to regulate both oestrogen and progesterone. During perimenopause, when hormone levels are already fluctuating, alcohol can amplify symptoms including: Hot flushes Night sweats Anxiety Mood swings Sleep disturbance Fatigue How Alcohol Can Worsen Perimenopausal Symptoms Alcohol and Hot Flushes One of the most common links between alcohol and menopause symptoms is worsening hot flushes. Alcohol causes blood vessels near the skin to dilate, increasing heat loss from the body. For women already experiencing temperature regulation problems due to falling oestrogen, this can trigger or intensify hot flushes. Many women find that: Hot flushes occur shortly after drinking Night sweats become more severe Symptoms are worse after wine or spirits Recovery the following day is slower Alcohol and Sleep During Perimenopause Although alcohol may initially make you feel sleepy, it significantly reduces sleep quality. Alcohol suppresses REM (Rapid Eye Movement) sleep, the restorative stage responsible for: Memory consolidation Emotional processing Learning Mental recovery Instead of restorative sleep, alcohol often causes: Frequent night waking Early morning waking Restless sleep Reduced deep sleep Increased night sweats Since sleep is already commonly disrupted during perimenopause, alcohol can significantly worsen fatigue and daytime functioning. Alcohol, Anxiety and Mood Changes Many women experience increased anxiety, irritability and low mood during perimenopause due to fluctuating oestrogen levels. Oestrogen helps regulate neurotransmitters including serotonin, dopamine and GABA, all of which influence emotional wellbeing. Alcohol temporarily alters these brain chemicals before causing a rebound effect as it leaves the body. This can result in: Increased anxiety Irritability Low mood Poor concentration Feeling emotionally overwhelmed Many women describe experiencing "hangxiety" a combination of anxiety, restlessness and emotional sensitivity after drinking, even when alcohol intake has been relatively modest. Alcohol and Weight Gain During Perimenopause Weight gain around the abdomen is common during midlife due to hormonal changes and reduced metabolic rate. Alcohol may contribute through several mechanisms. Extra Calories Alcohol contains approximately 7 calories per gram, making it one of the most calorie-dense nutrients after fat. These calories provide virtually no nutritional benefit. Reduced Fat Burning Your body always prioritises metabolising alcohol before burning carbohydrates or fat. While alcohol is being processed: Fat burning slows Dietary fat is more likely to be stored Energy expenditure decreases Increased Appetite Alcohol may: Increase hunger hormones Reduce feelings of fullness Lower inhibitions around food choices This often leads to higher calorie intake than intended. Increased Inflammation Alcohol can increase systemic inflammation, which has been associated with: Central weight gain Insulin resistance Metabolic dysfunction Alcohol and Bone Health Declining oestrogen accelerates bone loss during menopause. Excessive alcohol intake may further increase osteoporosis risk by: Reducing calcium absorption Interfering with vitamin D metabolism Suppressing bone formation Increasing falls and fracture risk While occasional light drinking is unlikely to have a major effect, regular heavy alcohol consumption is associated with lower bone mineral density and increased fracture risk. Alcohol and Nutrient Deficiencies Alcohol acts as a diuretic, increasing fluid loss and the excretion of important vitamins and minerals. One nutrient particularly affected is magnesium. Low magnesium levels may contribute to: Muscle cramps Poor sleep Headaches Fatigue Increased anxiety Palpitations Alcohol may also reduce levels of: B vitamins Zinc Folate Potassium Maintaining good nutrition becomes increasingly important during perimenopause. Alcohol and Heart Health The relationship between alcohol and cardiovascular health is more complex than previously thought. Earlier studies suggested small amounts of alcohol may have cardiovascular benefits. However, more recent research indicates that these benefits are likely smaller than previously believed, while alcohol clearly increases the risk of several health conditions. For women, alcohol has been associated with increased risks of: Breast cancer High blood pressure Atrial fibrillation Liver disease Weight gain Current evidence suggests that less alcohol is generally associated with lower overall health risks. Practical Tips for Managing Alcohol During Perimenopause Track Your Symptoms Keeping a simple symptom diary can help identify patterns. Record: What you drank How much you drank Sleep quality Hot flushes Mood Energy levels Anxiety Many women are surprised by how clearly alcohol affects their symptoms. Consider an Alcohol-Free Break Many women are now exploring a sober-curious approach to drinking. Rather than giving up alcohol permanently, taking a planned break allows you to see how your body responds. Some women choose: Dry January A 30-day reset A 100-day alcohol-free challenge Benefits commonly reported include: Better sleep Improved energy Fewer hot flushes Reduced anxiety Improved concentration Weight loss Better skin Greater emotional resilience Many also discover new ways of socialising that don't revolve around alcohol. Helpful Books If you're interested in reducing your alcohol intake, many women find these books supportive: Tired of Thinking About Drinking – Belle Robertson The Unexpected Joy of Being Sober – Catherine Gray These books encourage a compassionate, practical approach rather than focusing on deprivation. If You Choose to Drink You do not necessarily need to avoid alcohol completely. If you decide to drink, consider: Limiting alcohol to special occasions Choosing lower-alcohol drinks Mixing wine with sparkling water Alternating alcoholic drinks with water Eating before and while drinking Avoiding alcohol within 3–4 hours of bedtime Exploring high-quality alcohol-free alternatives Small changes often make a significant difference. Support Your Body During Perimenopause Alongside moderating alcohol intake, you can support your health by: Drinking plenty of water throughout the day Eating magnesium-rich foods such as leafy greens, nuts, seeds and whole grains Ensuring adequate calcium and vitamin D intake Eating a balanced, protein-rich diet Exercising regularly with a combination of strength training and cardiovascular activity Maintaining good sleep habits Managing stress through mindfulness, relaxation or breathing exercises These lifestyle measures work together to support hormonal health and reduce common perimenopausal symptoms. Perimenopause is a significant stage of hormonal transition, and it is completely normal for alcohol to affect you differently than it once did. For many women, reducing alcohol intake can lead to noticeable improvements in: Sleep quality Hot flushes Anxiety Mood Energy levels Weight management Overall wellbeing Rather than viewing this as giving something up, many women discover it is an opportunity to develop healthier habits that better support life in midlife. Listening to your body, understanding your personal triggers and making informed choices can help you navigate perimenopause with greater confidence and improved long-term health. References Alcohol Intake and Endogenous Sex Hormones in Women: Meta-Analysis of Cohort Studies and Mendelian Randomization. Cancer. 2024. Tin Tin S, Smith-Byrne K, Ferrari P, et al. Acute Effect of Alcohol on Estradiol, Estrone, Progesterone, Prolactin, Cortisol, and Luteinizing Hormone in Premenopausal Women. Alcoholism, Clinical and Experimental Research. 1999. Sarkola T, Mäkisalo H, Fukunaga T, Eriksson CJ. The Effects of Moderate Alcohol Consumption on Female Hormone Levels and Reproductive Function. Alcohol and Alcoholism. 2000. Gill J. The Effect of Alcohol on Subsequent Sleep in Healthy Adults: A Systematic Review and Meta-Analysis. Sleep Medicine Reviews. 2025. Gardiner C, Weakley J, Burke LM, et al. Optimizing Sleep Across the Menopausal Transition. Climacteric : The Journal of the International Menopause Society. 2023. Baker FC. Different Patterns of Alcohol Consumption and the Incidence and Persistence of Depressive and Anxiety Symptoms Among Older Adults in Ireland: A Prospective Community-Based Study. Journal of Affective Disorders. 2018. Carvalho AF, Stubbs B, Maes M, et al. The Effect of Alcohol on Osteoporosis: A Systematic Review and Meta-Analysis. Drug and Alcohol Dependence. 2019. Cheraghi Z, Doosti-Irani A, Almasi-Hashiani A, et al. 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 Genitourinary Syndrome of Menopause (GSM): Symptoms, Causes and Effective Treatment Genitourinary Syndrome of Menopause (GSM) is one of the most common yet under-recognised aspects of menopause. Many women experience vaginal dryness, painful sex, bladder symptoms or recurrent urinary tract infections (UTIs) during the perimenopause and after menopause, yet these symptoms are often not discussed or treated. Unlike hot flushes or night sweats, GSM symptoms usually do not improve without treatment. In fact, they often become progressively worse over time. The good news is that effective, evidence-based treatments are available. What is Genitourinary Syndrome of Menopause (GSM)? Genitourinary Syndrome of Menopause (GSM) is the medical term used to describe the changes affecting the vulva, vagina and lower urinary tract caused by declining oestrogen levels during the perimenopause and menopause. Common symptoms include: Vaginal dryness Vaginal burning or irritation Itching Pain during sex (dyspareunia) Reduced natural lubrication Urinary urgency Frequent urination Recurrent urinary tract infections (UTIs) Stress urinary incontinence Research suggests that up to 87% of peri- and postmenopausal women experience symptoms of GSM, making it one of the most prevalent long-term consequences of menopause. Why does menopause cause vaginal and urinary symptoms? Oestrogen plays a vital role in maintaining the health of the vaginal tissues, vulva, bladder and urethra. These areas contain a high concentration of oestrogen receptors, making them particularly sensitive to hormonal changes. As oestrogen levels decline: The vaginal lining becomes thinner and more fragile. Natural lubrication decreases. The tissues lose elasticity. Blood supply to the vagina reduces. Vaginal pH becomes less acidic, increasing susceptibility to infection. These changes contribute to symptoms such as vaginal dryness, irritation, discomfort and painful intercourse. The urinary tract is equally affected. Oestrogen helps maintain healthy bladder and urethral tissues, and when levels fall many women experience: Urinary urgency Increased urinary frequency Recurrent urinary tract infections Worsening stress urinary incontinence Symptoms of Genitourinary Syndrome of Menopause Symptoms may develop gradually during the perimenopause or become more noticeable after menopause. They commonly include: Persistent vaginal dryness Burning, soreness or itching Pain during sexual intercourse Light bleeding after sex Reduced sexual comfort and pleasure Frequent UTIs Bladder urgency Needing to pass urine more often Leakage of urine when coughing, sneezing or exercising Unlike vasomotor symptoms, such as hot flushes, GSM symptoms rarely resolve without treatment and generally progress over time. How does GSM affect quality of life? Genitourinary Syndrome of Menopause can have a significant impact on both physical and emotional wellbeing. Women frequently report: Reduced confidence Anxiety about intimacy Pain affecting sexual relationships Discomfort during exercise Difficulty wearing certain clothing Sleep disruption due to bladder symptoms Fear of recurrent urinary tract infections Many women delay seeking help because they assume these symptoms are a normal part of ageing or feel embarrassed discussing intimate concerns. However, GSM is a recognised medical condition with highly effective treatment options. Treatment for Genitourinary Syndrome of Menopause The most appropriate treatment depends on symptom severity and individual circumstances. Vaginal moisturisers and lubricants For mild symptoms, regular vaginal moisturisers can improve hydration and reduce dryness. Lubricants (water-based, silicone-based or oil-based where appropriate) can improve comfort during sexual activity. Pelvic floor exercises Pelvic floor muscle training may improve bladder control and help reduce symptoms of stress urinary incontinence. Lifestyle measures Simple changes can also help protect vulval and vaginal health: Avoid perfumed soaps and intimate washes. Wear breathable cotton underwear. Stay well hydrated. Maintain regular sexual activity if comfortable, as this can help support tissue health. Vaginal (local) oestrogen For many women, low-dose vaginal oestrogen is considered the most effective treatment for GSM. Available as creams, pessaries, tablets or vaginal rings, local oestrogen restores hormone levels directly within the vaginal tissues. Treatment helps: Improve vaginal thickness Increase natural lubrication Restore elasticity Improve vaginal pH Reduce recurrent urinary tract infections Improve bladder symptoms Because absorption into the bloodstream is minimal, local vaginal oestrogen is considered safe for long-term use for most women. It is also important to know that approximately one in four women using systemic HRT continue to experience symptoms of GSM and benefit from adding local vaginal oestrogen alongside their existing HRT regimen. When should you seek help? If you are experiencing vaginal dryness, painful sex, bladder symptoms or recurrent UTIs during the perimenopause or after menopause, you do not need to simply accept these symptoms. If self-care measures are not providing sufficient relief, speak to a healthcare professional about your treatment options, including vaginal oestrogen. Healthcare professionals do not always ask about vaginal or urinary symptoms during menopause consultations, so it is important to raise these concerns yourself. In the UK, some forms of vaginal (local) oestrogen are now available over the counter through participating pharmacies for eligible women aged over 50 who are postmenopausal. Specialist Menopause Care At Bristol Menopause & Wellwoman Clinic, we regularly assess and treat Genitourinary Syndrome of Menopause as part of our comprehensive menopause care. If you are experiencing symptoms of GSM, our menopause specialists can provide an individual assessment and recommend the most appropriate evidence-based treatment to help improve your comfort, bladder health, sexual wellbeing and overall quality of life. References Portman DJ, Gass MLS. Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Menopause. 2014. Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014. The British Menopause Society. Management of Genitourinary Syndrome of Menopause. Updated consensus statement. Kingsberg SA, et al. Vulvar and Vaginal Atrophy in Postmenopausal Women. J Sex Med. 2013. National Institute for Health and Care Excellence (NICE). Menopause: Diagnosis and Management (NG23). Updated guidance. The British Menopause Society. Management of the Menopause. Current clinical recommendations. 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 7 Top Tips For Eating Well Over Christmas Alternative Therapies, Exercise, Diet, Self-Care, Wellbeing Eating well during the busy Christmas period can be a fine balance between enjoying festive treats and maintaining your overall health. We all know this time of year is associated with overeating, unhealthy food and excess alcohol. On Christmas day we consume, on average 6000 calories which is over three times an adult’s daily intake. So, it can be all too easy to put on half a stone over Christmas without really realising. Whether you are living an active lifestyle or not, Christmas can be a challenge for everyone, but it is possible to indulge without overdoing it or feeling like you’ve thrown your health goals out the window. Here are some tips on how to eat well during the Christmas period so that you start the new year without feeling bloated, sluggish and tired but energised, healthy, happy and ready to welcome in another year. Up your vegetable intake - Aim to fill half your plate with vegetables, whether it's roasted, steamed, or in a salad. They’re low in calories but high in nutrients, and they’ll help you feel satisfied without overloading on heavy foods. Also, keeping your digestive healthy and prevent you from feeling bloated and sluggish Portion control - This can be one of the easiest ways to help yourself and not overeat. So, try to avoid pilling your plate full, having seconds and instead of eating a whole serving of pudding or cake, have a smaller portion, and enjoy it slowly. A lot of force feeding goes on at Christmas so be sure to make mindful decisions yourself Prepare in advance - Before heading off to a party eat a protein-based snack beforehand so that you are less likely to overeat or make impulse choices Enjoy your indulgences and special treats, but in moderation - Avoid the all or nothing mindset, food guilt and don’t use Christmas as a license to eat everything that comes your way. Christmas treats like mince pies, Christmas pudding, or chocolates are part of the fun but try to limit sugary snacks to once or twice a day and enjoy them mindfully Stay hydrated - Drink plenty of water to stay hydrated. Even mild dehydration can leave you feeling sluggish, irritable, dry your skin, headaches to name a few. Make smart choices when drinking as alcohol is high in calories with zero nutritional value. Have a glass of water between each alcoholic drink can be a good way to pace yourself and reduce the amount of alcohol you are drinking Prioritise sleep and rest - Try to keep to regular sleep times when possible and ensure you have a couple of early nights over the holiday time. Lack of sleep can increase cravings for sugary foods, playing havoc with your hormones and we know good quality sleep is essential for digestion and overall well-being Get Moving and stay active - If possible, get outside for a winter walk, jog or cycle or play an active game with family. Exercise can help balance out extra calories, aid sleep and support your mental health. If you're stuck indoors why not try simple body weight exercises like squats, lunges or stretching to get your body moving. Do whatever you enjoy keeping your blood flowing! Aim for balance and moderation . All your healthy habits don’t have to go out the window. You don’t need to deprive yourself. The holidays are about enjoying time with loved ones, and food is just one part of the celebration. It’s important to keep yourself nourished, maintain your health and healthy immune system especially during the winter months. If you need help with your health goals, you’ve lost your mojo and need some support then why not put your health and well-being first and book in to see our Nutritionist? If you are struggling with your health, please do get in touch Or if you’re stuck for Christmas present ideas for yourself or that difficult-to-buy-for friend or relative, why not give a gift that will improve their health and inspire them to feel their best? You can 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 Hazel Hayden Founder Hazel Hayden is a Consultant Nurse and a highly respected British Menopause Society Registered Specialist, with a passion for empowering women through every stage of menopause. She’s also trained in sleep and insomnia therapy, Cognitive Behaviour Therapy (CBT) for menopause, and has a diploma in nutrition. Hazel’s expertise extends to weight management through her training in the National Medical Weight Loss Programme. As a member of both the International Menopause Society and the International Association for Premenstrual Disorders, Hazel stays at the forefront of advancements in women's health. She’s a sought-after speaker at local and international conferences, where she shares her insights on menopausal health as well as its impact on mental health. In addition to her speaking engagements, Hazel remains committed to her clinical work, supporting women through their unique menopausal health journeys. Her areas of expertise also include cardiovascular disease, type 2 diabetes, and respiratory disorders, ensuring a holistic approach to patient care. Hazel goes beyond individual care, training other healthcare professionals to become British Menopause Society Specialists, helping to raise the standard of menopause care for women everywhere. With a deep dedication to improving women’s health, Hazel has also combined her clinical knowledge to create specialist supplements tailored to support women navigating menopause, offering them practical solutions to thrive during this transformative but sometimes challenging time. I have dedicated my career to supporting the health and wellbeing of my patients. I have combined my knowledge to also provide specialist supplements for menopausal women.

< Back Iron Deficiency in Midlife Women: What Works, What Does Not, and Why Alternative Therapies Understanding Ferritin, Fatigue, Brain Fog, Hair Loss, and Why “Normal” Blood Tests Are Not Always Optimal Iron deficiency is one of the most overlooked contributors to fatigue, brain fog, low mood, poor concentration, hair thinning, and reduced exercise tolerance in women during perimenopause and menopause. Yet despite how common it is, many women are told their blood tests are “normal” when, clinically, their iron stores are far from optimal. At Bristol Menopause Clinic , we frequently see women whose menopausal symptoms only partially improve with HRT because an underlying iron deficiency has never been properly identified or treated. The reality is simple: treatment is not just about taking iron. The type of iron, how it is taken, what is preventing absorption, and understanding the root cause all matter enormously. Why Iron Deficiency Is So Common in Midlife Women Iron depletion often develops gradually over years. Heavy menstrual bleeding, restrictive dieting, gastrointestinal conditions, thyroid disease, stress-related digestive issues, and long-term medication use can all contribute. The challenge is that the symptoms overlap significantly with menopause itself: Fatigue Brain fog Poor concentration Anxiety or low mood Hair thinning Reduced stamina Poor sleep Palpitations Restless legs As a result, many women assume hormones are the only explanation. Treatment Options: What Actually Works 1. Iron Supplementation Iron supplementation can be highly effective — but the form of iron matters considerably. Many women are prescribed traditional ferrous salts, which are inexpensive and clinically effective, but often poorly tolerated. Gastrointestinal side effects are one of the biggest reasons women stop treatment too early. Form Typical Dose Tolerability & Clinical Notes Ferrous sulphate 200mg twice daily Effective but commonly causes constipation, nausea, bloating, and abdominal discomfort Ferrous fumarate 210mg twice daily Similar efficacy to ferrous sulphate; slightly better tolerated in some women Iron bisglycinate 25–50mg elemental iron Chelated form with superior absorption and significantly fewer gastrointestinal side effects Liquid iron As directed Useful for women unable to tolerate tablets; often gentler on digestion IV iron infusion Clinician-administered Reserved for severe deficiency, malabsorption, or failure of oral therapy Alternate Day Dosing: A More Effective Strategy Emerging evidence suggests that alternate-day dosing may actually improve iron absorption compared with daily supplementation. This relates to the hormone hepcidin, which rises after taking iron and temporarily blocks absorption for up to 24 hours. Taking iron every other day may therefore improve overall uptake while reducing gastrointestinal side effects. For many women, this approach is both more effective and easier to maintain long term. Optimising Iron Absorption Iron is one of the most absorption-sensitive nutrients in human physiology. Two women taking the same supplement can absorb vastly different amounts depending on timing, medications, and dietary habits. Take Iron with Vitamin C Vitamin C improves the absorption of non-haem iron by converting it into a more absorbable form. Helpful combinations include: Iron with kiwi fruit Iron with berries Iron with citrus juice Iron with tomatoes or peppers Avoid Tea and Coffee Around Supplement Timing Tea and coffee contain tannins that significantly reduce iron absorption. Even herbal teas such as peppermint may interfere. Avoid these for at least one hour either side of taking iron. Separate Iron from Calcium Calcium competes directly with iron absorption. Avoid taking iron alongside: Milk Cheese Calcium supplements Calcium-fortified products Ideally, allow a two-hour gap. Thyroid Medication Timing Matters Iron can reduce the absorption of levothyroxine. Women taking thyroid medication should separate iron and levothyroxine by at least two hours. Cooking in Cast Iron Cooking acidic foods such as tomato sauces or stews in cast-iron cookware can meaningfully increase the iron content of meals, a simple but clinically useful habit. Dietary Optimisation Diet alone is rarely enough to correct significant iron depletion, but it plays an essential role in long-term maintenance. Haem Iron: Best Absorbed Haem iron is absorbed efficiently regardless of other dietary factors. Best sources include: Red meat Lamb Dark poultry meat Shellfish Clams Oysters Liver (avoid during pregnancy) Non-Haem Iron: More Difficult to Absorb Plant-based iron sources are less efficiently absorbed and highly dependent on what they are eaten with. Sources include: Lentils Chickpeas Kidney beans Tofu Pumpkin seeds Quinoa Fortified cereals Dark leafy greens Improving Plant-Based Iron Absorption Pairing plant iron with vitamin C-rich foods significantly improves absorption. Examples include: Lemon juice on spinach Tomatoes with lentils Red peppers in bean dishes Citrus dressings on salads For vegetarian and vegan women with depleted ferritin levels, supplementation is often clinically necessary rather than optional. Addressing the Underlying Cause Correcting ferritin without understanding why it became depleted often leads to recurrence. Common reversible causes include: Heavy Menstrual Bleeding Perimenopausal bleeding changes are one of the most common contributors to iron depletion. Appropriate hormonal treatment, including HRT, may significantly reduce ongoing losses. Coeliac Disease Undiagnosed coeliac disease can impair iron absorption even in women with an otherwise healthy diet. Women with persistently low ferritin despite supplementation should be screened. Helicobacter pylori Infection This common stomach bacteria can interfere with iron absorption. Eradication therapy may restore normal absorption. Proton Pump Inhibitors (PPIs) Long-term reflux medications reduce stomach acid, impairing iron absorption. Medication reviews are often worthwhile. Thyroid Disease Hypothyroidism is associated with impaired iron absorption and reduced energy metabolism. Treating thyroid dysfunction frequently improves iron status. Monitoring Your Response Iron replacement is not a quick fix. Expect a 3–6 Month Process Ferritin restoration takes time. Many women feel discouraged when they do not notice immediate improvement. Meaningful replenishment usually takes: Around 3 months for early improvement Up to 6 months or longer for full restoration Recheck Blood Tests Repeat testing should ideally include: Ferritin Full blood count CRP Vitamin B12 Folate Monitoring ensures levels are improving appropriately and helps guide maintenance therapy. Optimal Ferritin Matters Many laboratories classify ferritin levels around 15–30 µg/L as “normal”. Clinically, however, many symptomatic women feel significantly better when ferritin reaches: 70–100 µg/L Normal is not always optimal. The Menopause Connection Iron deficiency and menopause frequently coexist — and they often amplify one another. In clinic, we commonly see women whose HRT has improved symptoms partially, but who continue to experience: Fatigue Brain fog Hair shedding Low resilience Reduced exercise tolerance When ferritin is investigated and corrected appropriately, the improvement can be significant. Equally, effective menopause management may help preserve iron stores by reducing heavy or erratic bleeding patterns. Treating hormones without addressing nutritional status often produces incomplete results. The best outcomes come from looking at the whole picture. When Should You Seek Further Investigation? If you are experiencing persistent: Fatigue Brain fog Hair loss Poor recovery Low mood Symptoms despite otherwise healthy lifestyle habits …it is worth investigating iron properly. Recommended blood tests include: Serum ferritin Full blood count Active B12 Folate CRP Thyroid function Vitamin D If ferritin is below 70 µg/L and symptoms are present, treatment may still be clinically appropriate, even if you are not anaemic. “Normal” is not always the same as optimal and you deserve to know the difference. 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 Why Many Women Are Misdiagnosed in Midlife (and How to Get the Right Care) HRT, Menopause Advice, Post Menopause The Silent Struggle of Women in Midlife. For many women, their 40s and 50s come with a cascade of mysterious health symptoms fatigue, anxiety, joint pain, brain fog, weight gain, and irregular periods. Yet, when they seek medical help, they’re often told: "It’s just stress." "You’re depressed, here’s an antidepressant." "It’s normal aging—nothing to worry about." But what if these symptoms are actually hormonal shifts linked to perimenopause and menopause? The truth is, many women in midlife are misdiagnosed or dismissed, leading to years of unnecessary suffering. This blog explores: Commonly overlooked conditions during perimenopause Why women’s symptoms are often misunderstood How to advocate for better healthcare. If you’ve felt unheard or misdiagnosed, you’re not alone—but with the right knowledge, you can take control of your health and life. Why Women in Midlife Are Often Misdiagnosed The Medical System Wasn’t Designed for Perimenopause Historically, women’s health research has been underfunded, and medical training often lacks education on perimenopause and menopause. Many doctors are trained to recognise menopause only when periods stop completely, but perimenopause can last 5-10 years before that. Symptoms of hormonal changes mimic other conditions (like depression, thyroid disease, or autoimmune disorders), leading to misdiagnosis. The Fix: Find a menopause specialist or doctor trained in hormonal health. Women’s Symptoms Are Often Dismissed as “Psychological” Did you know? Women are more likely than men to be prescribed antidepressants for unexplained symptoms—when the root cause is actually hormonal. Mood swings, anxiety, and brain fog are common symptoms of perimenopause due to fluctuating oestrogen and progesterone. Instead of investigating hormone levels, many women are told they have anxiety, depression, or burnout. The Fix: If your symptoms started in your 40s or 50s, ask your doctor: “Could this be perimenopause?” “Can we discuss hormone testing or HRT options?” Commonly Overlooked Conditions in Perimenopause Many women are misdiagnosed with other conditions when perimenopause is the culprit. Thyroid Disorders vs. Perimenopause Symptoms that Overlap: Fatigue, brain fog, weight changes, hair thinning Mood swings, anxiety, depression Irregular periods What’s Happening? Declining oestrogen impacts thyroid function, making perimenopausal women more likely to develop hypothyroidism. Thyroid disorders are often overlooked or not tested properly. What to Ask Your Doctor: “Can we check full thyroid function (TSH, Free T3, Free T4, thyroid antibodies)?” Depression & Anxiety vs. Hormonal Changes Symptoms that Overlap: Low mood, loss of motivation, increased anxiety Irritability, anger, panic attacks What’s Happening? Oestrogen and progesterone affect serotonin and dopamine (brain chemicals that regulate mood). Fluctuations in perimenopause can mimic depression or anxiety. Antidepressants may help some women but don’t address the root hormonal cause. What to Ask Your Doctor: “Could my mood symptoms be related to hormonal fluctuations?” “Can we discuss HRT as an option instead of (or alongside) antidepressants?” Fibromyalgia vs. Menopausal Joint Pain Symptoms that Overlap: Muscle and joint pain Fatigue and sleep disturbances Brain fog What’s Happening? Oestrogen supports joint lubrication and muscle recovery—low oestrogen increases pain sensitivity. Many women with menopausal joint pain are misdiagnosed with fibromyalgia. What to Ask Your Doctor: “Could my joint pain be hormone-related?” “Are there lifestyle or HRT options to help?” IBS (irritable bowel syndrome) vs. Oestrogen-Related Gut Issues Symptoms that Overlap: Bloating, constipation, diarrhoea Food intolerances Unpredictable digestion What’s Happening? Oestrogen and progesterone influence gut motility and microbiome health. Low oestrogen affects gut bacteria, leading to bloating and IBS-like symptoms. What to Ask Your Doctor: “Could my digestive symptoms be linked to perimenopause?” “Would probiotics or dietary changes help?” How to Work with Your Doctor for Better Care If you suspect perimenopause but aren’t getting the help you need, here’s how to advocate for yourself: Track Your Symptoms Keep a journal of: Changes in mood, sleep, energy, digestion Irregular periods or new symptoms Any triggers (stress, diet, sleep changes) Why? Having clear records makes it easier to discuss concerns with your doctor. Ask for the Right Tests Many doctors only check basic hormone levels, but in perimenopause, hormones fluctuate daily, making single tests unreliable. Recommended Tests for Midlife Women: Comprehensive Hormone Panel – Oestrogen, Progesterone, Testosterone, FSH, LH –these maybe difficult to get on the NHS. Thyroid Function – TSH, Free T3, Free T4, Thyroid Antibodies Vitamin Deficiencies – Vitamin D, B12, Iron, Magnesium Explore Treatment Options (Beyond Antidepressants) If your doctor immediately prescribes antidepressants or dismisses your symptoms, ask about: HRT (Hormone Replacement Therapy): Proven to relieve perimenopausal symptoms and protect long-term health Lifestyle changes: Strength training, diet adjustments, stress reduction Supplements: Magnesium, Omega-3s, adaptogens (like ashwagandha) Pro Tip: Find a BMS (British Menopause Society) Specialist or menopause-literate doctor who understands hormonal health. You Deserve the Right Diagnosis & Care Misdiagnosis in midlife is common—but it’s NOT normal. Your symptoms are real, and they deserve attention. If your doctor isn’t listening, seek a second opinion. Knowledge is power—track your symptoms, ask the right questions, and advocate for better care. Perimenopause is a natural transition, but you don’t have to suffer—there are treatments that work! Act Today: If you suspect perimenopause but feel unheard, book an appointment with a menopause specialist—because your health matters. 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 Alex Gear Nutritionist Alex is a registered Nutritional Therapist, Naturopath and Health Coach. She trained in Nutrition and Naturopathy at the renowned The College of Naturopathic Medicine and is a member of The British Association for Applied Nutrition and Nutritional Therapy (BANT) and The Complementary and Natural Healthcare Council (CNHC). Alex is very passionate about helping people to feel their best through food and lifestyle. Alex knows what it’s like to juggle many balls and is very much in touch with the challenges people face in their everyday lives. Alex inspires and motivates people, yet her approach is a balanced and realistic one. Alex has been involved in the food industry for over 20 years, but her underlying passion has always been about health and nutrition. It gives her great pleasure to help people to overcome their health issues so that they look and feel better. Having overcome her own health issues, Alex really understands how her clients feel when they first come to see her. Alex works very closely with her clients to ensure that they take positive steps to a healthier life. Clients often lack confidence and may often feel very daunted at the prospect of making changes, so she supports and guides them and gives them the tools to be able to maintain long-term health with renewed confidence and enthusiasm. Alex combines her understanding, enthusiasm and passion with her love of food to help people to become the best versions of themselves. Alex follows the principles of Functional Medicine and so her aim is to get to the root cause of her clients’ issues. She treats everyone as an individual as we are all different and have different sets of circumstances. Alex is passionate about helping women look & feel amazing every day through midlife and beyond.

< 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