This week: Is your arthritis worse since menopause and what do you do about swollen legs?
Straight in with our subscriber questions this week…two of them for you – bonus!
Is my osteoarthritis caused by menopause?
First, L says she used to have one finger with arthritis but since menopause, it is now appearing in other fingers and getting worse. She wonders if her hormones are related to it, having come off HRT a while ago. She had a DUTCH test done quite recently so I suggested we start by looking at that. Here’s my response to her in case it resonates with more of you.
The short answer is: yes, a drop in oestrogen and/or testosterone (in both women and men) trigger any mild form of inflammation you already had to get worse. Lovely. Thanks Nature.
Your results do indeed show that you are on the lower end of normal with your hormone output as a menopausal woman. I can see better with serum but there is enough here to see your oestrogen is too low – right on the bottom end of the range – progesterone is just within range (although DUTCH is not great for measuring progesterone) and testosterone is too low. So, it could well be that the oestrogen or in fact testosterone drop could be causing more inflammation, as we suspected.
Here’s a bit from my forthcoming hormone plan in case it helps. First a bit of the section on inflammation after perimenopause:
Inflammation When women enter the transitional peri menopause state (natural or induced by surgery etc), there is often a sudden and dramatic decline in health – it’s like the body’s not needed any more for bearing children, so it might as well give up! Much of this is because inflammation levels go up without the hormones to control them as well as before.
The oestrogen spikes trigger an inflammatory reaction, so that whatever level of inflammation a woman had pre-peri will now get worse both locally (ie. hand pain, foot pain, gut swelling etc) and systemically. Basically, we can see more pain, neurodegeneration (cognitive loss), bone loss, cardiovascular changes and just generally higher levels of inflammation throughout the body. If a person had a little arthritis or IBS, even mild coeliac disease or food/chemical sensitivity, for example, before peri starts, it is likely to get worse. (I’m sorry; I’m even depressing myself writing this stuff!)
I write quite a bit more on this in the plan, but we’ll stop there, lol!
And next, more from my plan on how to get the hormones back up. Usually, we can get them back up enough if they are less than 20% below range – based on dried urine results, you are within that, but we usually take it from serum.
In perimenopause, many women turn to so-called phyto-oestrogens like isoflavones from soy or other plants like hops because of the elements like genistein and daidzein which are thought of as a form of plant oestrogen. They are actually SERMs (selective estrogen (sic) receptor modulators), which means that they compete with real oestrogens at the receptors. That means they can either augment the amount of oestrogen docking at the receptors and therefore increase oestrogen in the body OR they can dock at the receptors and block excess ‘real’ oestrogens, therefore reducing the overall level of oestrogen in the body.
A lot of people are confused by information out there suggesting you can get too much oestrogen from them – very unlikely because of their adaptogenic nature.You can use them in times of fluctuating oestrogen. Most often this will be in perimenopause or after stopping HRT to help balance oestrogens, but also in men aromatising too much, therefore creating more oestrogen, even sometimes in oestrogen-sensitive conditions in men or women to compete with the oestrogens at receptors and to help modulate levels. eg prostate, fibroids, breast cancer etc.
They don’t actually raise hormone levels so you won’t see any rise on test results, actually, but they have an effect at receptor level and a tissue effect; you can feel them working even if you can’t see it on results. Studies show that, contrary to popular belief, there is no negative effect on men for fertility or testosterone levels. Some people might get hormone type symptoms like hot flushes when they start, which usually suggests they need them and they will work so keep at it; the body will usually adapt quite quickly.
It seems to work best as a synergistic mix. Isoflavones in food can help, but you really need genistein, daidzein, black cohosh and dong quai to get some work done. Some people will do better with single types. Dose is dependent and varies as some will only need a small amount, others loads. It’s best to start low and build to find your particular dose. It works for many, but not all.
That might be because SERMS only become active when modulated into different metabolites in the gut and liver, so must have a good gut microbiome with plenty of bacterial diversity for best effect. If someone doesn’t, sometimes the polyphenols/flavones themselves can improve diversity and they start to work. For this reason, it can be a good idea to give your gut and liver some support at the same time – like probiotics and milk thistle, for example. If they are not working, think: how is your gut and liver?
Note, too, that they are best taken with carbohydrates. Low carb diets will affect how the SERMS are metabolised and they may not work as well as they might.
The testosterone is low too. It might come up as your oestrogen rises. In the meantime, we could help it by adding Fenofem, which is used to help boost low testosterone in women and it can also help raise oestrogen:
Hormones: complex, huh? But I suspect that pattern is VERY common in post menopausal women (12 months since last period). There’s quite a bit more we can do about the increasing inflammation and there will be a whole section in it in the plan, if I ever get it finished!! I will also use some of this to update the menopause factsheet when I get a mo.
What can I do about swollen legs/lymphoedema?
Next, J says her legs are constantly swollen with fluid – no cardio issues found on tests, thankfully as that would be a major thing to check out if your legs are swelling, please. What might cause excess fluid to pool in her lower legs, and what can she do about it?
Here’s some of my answer in case it helps you. Note J has a history of horse riding.
It sounds to me like you have a compromised lymphatic system, maybe genetically and then, certainly for your legs, the horse riding has caused some trauma to lymph nodes or channels. That would be my best guess.
If that is the case, then it is a question of management really. Hydrating properly, keeping legs raised, exercising limbs a lot and doing some lymphatic massage at home most days – maybe see an MLD (manual lymphatic drainage) person and chat it through, ask them to show you home self-care techniques.
I found this overview of natural methods to help which I thought was quite good.
I would say the fennel or juniper essential oil massage is a good option – I used to make an oil in the clinic and that usually helped. Or Weleda do a good birch oil and you can take birch juice in water too. Birch is a natural lymphatic cleanser so worth a go. This is what Weleda advises anyway. I know it’s not cellulite, but the principle is similar.
For a more technical overview of lymphoedema generally, check here and here.
OK. Hope those both help both L and J, but also you!
Obviously, these are my thoughts and ideas. You are not my patient and I don’t have your full case, so please do discuss this with your chosen health professionals. These are for your consideration only.
Thanks for your feedback
Thanks, by the way, for your feedback on my questions last week – emails, on here and Facebook. The general feeling is that you want me to do what is best for me (lovelies) and that you really enjoy what I am writing about, so we seem to have that bit right :).
However, quite a few of you said that the longer format is a little much for you and you might prefer individual posts and a summary like I used to send once a month. Some said you were really enjoying Substack now I’ve introduced you to it, and have found some great newsletters and writers here (how fab!), but again quite a few of you said you couldn’t really get on with Substack.
So, as per, I had it right before I changed it! I thought Substack might be an all-in-one place for us, but it seems not to be working out like that. I need to have a think how I can continue to do a paid subscriber option as these newsletters take a lot of time to write for you and, as I explained before, I’m trying to be part of the movement to ensure that good writers (and practitioners) get paid for their skill and time, and differentiate us from the crappity, AI-ridden content across the rest of the t’internet!
I shall continue to cogitate and learn about different software for the blog etc, but have shortened today’s newsletter for you whilst I have a think and play. Hope that helps.
And finally…because I like writing this lighter, non health bit! Whilst I was doing the migraine advanced functional medicine course last week (hard work, 100% on the exam, I thank you!), I learned all about how important the allostatic load is. What, in layman’s terms, we might think of as similar to the histamine bucket analogy. In other words, it’s all about how many factors build up and bring you close to migraine neuronal threshold.
Oh hang on, I wasn’t supposed to be writing about health here! Bear with me.
Anyway, it made me think about what I can do to lower my sensory load. In this flat, we have enormous windows and enormous sky, sea and light! How gorgeous, I know; so lucky. But, I have been finding the light in May and June so far to be too much for me. The sun rises in the east and the sea sparkle is beautiful but high-glare. We call it Tony Glare (political joke). I find it tires my head, you know.
So, and here’s the point of the lighter bit…I bought us a remote-control William Morris voile roller blind so I can adjust the light when I need to. I mean: come on: remote control, William Morris. I can’t wait.
Photo from Blinds2Go. Of course, I’m a bit concerned that we have to get the ladders out after P-gate, but needs must, and we have new rubber feet on them and I grip onto his legs like a mad woman! I wouldn’t normally go for remote control, obvs, but the windows are 12 ft high and at just over 5ft, I’m never going to reach a chain, am I? Expensive, but the cost is worth it to keep my allostatic load lower and avoid a return of migraines, trust me.
(And yes, I will be writing about migraine soon – I’ll try and get a new factsheet in the A-Z for you asap. The existing one is here for now.)
That’s it for this issue, folks!
I truly hope you find my Purehealth newsletters useful. If you like what I’m doing, please subscribe here, like and share on your socials; it really helps others get life-changing info they may need x
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