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I don't often share my own health journey but this particular topic is sensitive to me and something I see often in my clinic. With persistent media messaging pushing athletes to pursue leanness as well as obsess over 'clean eating' - it is also something I am becoming increasingly worried about. I hope this story helps others who may be experiencing something similar. As a teen, like many young women and men - I struggled with my appearance for a period of time. I was playing a lot of sport - skating, soccer, social sport - training 9+ hours a week. I began restricting my food intake. At first it was quite dramatic resulting in some doctors visits. Eventually, I was eating enough to not have a diagnosed disorder or flagged concern but still chornically underfuelling based on my needs and experiencing ongoing symptoms of this that were flying under the radar. This low grade chronic underfuelling went on for years. Thankfully, I did not end up in a RED-s situation where I needed medical intervention and a removal from my sport (which happens by the way), however, I was experiencing a range of symptoms that in hindsight would have likely been flagged as Low Energy Availability including: mental health (anxiety/depression), recurrent infections, hormone issues, slow injury healing, thyroid issues and persistent gut issues. It goes without saying that my performance was also paying a price and not where it could have been. For the purpose of this blog - I want to focus on the underfuelling and the gut. I will say though - underfuelling can impact your health systemically in a big big way. I had significant gut issues throughout my teens/university/early adult years. Doctors chalked it up to - chronic IBS (constipation at first and then mixed). I suffered from abdominal pain that, at times, had me buckled over, terrible mobility patterns, chronic bloating. Doctors sent me for colonscopies, which came back clear; stool tests that came back clear; and blood tests. I saw holistic doctors that had me do restrictive diets and 'cleanses' - occasionally some things helped temporarily as the downstream effects of underfuelling can be food sensitivities and micriobiome imbalances. These diets were not ideal for me as they often contributed to further underfuelling by way of restriction and an overemphasis on 'clean foods'. Eventually, symptoms came back because the upstream issue was not being addressed - underfuelling. It was not until I started to make the connection with my fuelling needs that things started to turn a corner. As I started to eat more and meet my needs, everything improved and my gut symptoms eventually disappeared - regular motility patterns, no more bloating, no more pain. Yes - there can be a range of things that impact our gut health it's true and it is important to look at what's going on comprehensively. For all you athletes out there however, I would definitely do a fuel check - MANY MANY people are not getting enough - whether it is by accident or by chronically keeping themselves in a small deficit. Obsession over eating clean can often lead to underfuelling by accident - not to mention, is not great for mental health - nor is it even evidence based. I often say, that when it comes to nutrition, the two most common patterns I see are the following: Undernourished and underfed Undernourished and overfed In both contexts - many people are not eating of enough of what they need. They either also completely miss the energy needs or overcompensate, often in survival mode, and get more calories out of low nutrient/low volume foods - likely still resulting in fatigue and just not feeling great. We need to focus on nourishing ourselves well in a non-obsessive balanced way. This is hard sometimes - but worth the pursuit if you are strugglign with health stuff and nutrition is a contributro. If your symptoms are getting in the way of life and what matters, I strongly recommend you chat with someone who is qualified about it. If you have diagnosed disordered eating, it is important to work with a registered practitioner where this is in their scope - e.g. sports dietician/psychologist (Working with diagnosed eating disorders is out of my scope of practice). If you are training a lot - I would highly recommend you consult with a registered sports nutritionist or dietician. Here is a directory of registered sports nutritionists to start: https://www.sportsnutritionistregistry.com

Our environment supports our nutrition (often more than we realise). When we think of nutrition, we often think about what is on our plate. The truth is - good nutrition involves a lot more than what is on the plate. Having our environment set up to support us is important. Behaviour science shows that when we have more friction with the behaviours we want to be doing less and less friction with the behaviours we want to do more of - the more likely we can change behaviour. If you know that certain foods make you feel better and more nourished - we want our environment set up to support that. Having things in the fridge and pantry, prepped, planned. With the foods that maybe don't serve us as well - creating a little more friction with these can be helpful. Friction increases the cognitive energy required to do a thing. We have a limited amount of this energy and so having our environment support us can be a way to freee up some of that cognitive energy. Here is a tool that can help you assess how well your kitchen is supporting you. Let me know what you think!

It’s 3am. You’re wide awake. Your heart is beating a little too fast, your mind has already started running through tomorrow’s to-do list, and you’re too warm despite the window being open. You finally fall back asleep around 5am... just in time for the alarm to go off. This is a common pattern I see in clinic and have experienced myself during this season of life. Sleep disruption is one of the most common and most debilitating experiences women report during perimenopause. In clinical practice, sleep is one of the first things I address with perimenopausal clients because it is often an upstream contributing factor to almost everything else presenting. Poor sleep drives fatigue, amplifies stress reactivity, disrupts appetite regulation, impairs metabolic function, reduces recovery leading to injury vulnerability and compounds mood instability. You cannot sustainably support health and wellbeing in a woman who isn’t sleeping. Everything else we do therapeutically is built on this foundation. Why Perimenopause Disrupts Sleep Sleep architecture is hormonally regulated. During perimenopause, the fluctuating and gradual decline of oestrogen and progesterone creates a cascade of changes that make restorative sleep significantly harder to achieve. Progesterone has a direct sedating effect. It acts on GABA-A receptors in the brain, the same receptors targeted by anti-anxiety medications. As progesterone declines in perimenopause (often before oestrogen), this natural calming effect is diminished. Women frequently describe this as a new inability to “switch off” at night, or as waking in the early hours with a sense of anxiety or restlessness that didn’t exist before. Oestrogen plays a key role in thermoregulation via the hypothalamus. Declining oestrogen narrows the thermoneutral zone (the temperature range in which the body feels comfortable) making women more susceptible to vasomotor symptoms such as hot flushes and night sweats. Even subclinical temperature dysregulation can fragment sleep and reduce slow-wave (deep) and REM sleep. HPA axis reactivity also increases as oestrogen declines. Oestrogen normally exerts a moderating influence on cortisol output; without it, the stress response becomes more sensitive and harder to downregulate. Evening cortisol that should be low can stay elevated, keeping the nervous system in a state of arousal that directly interferes with sleep onset and maintenance. The result is a perfect storm: reduced GABAergic calm, temperature instability, and a dysregulated stress response. A Naturopathic Approach to Sleep during Perimenopause There is no single intervention that will fix perimenopausal sleep disruption and anyone claiming otherwise is oversimplifying. What works is a layered, consistent approach that addresses the underlying drivers. Here’s where I often start clinically. 1. Sleep Hygiene Generic sleep hygiene advice The following are important foundations: Keep the bedroom cool. Given the narrowed thermoneutral zone, ambient temperature matters more than ever. Aim for 16–19°C. Breathable, natural-fibre bedding helps considerably. Protect morning light exposure. Bright natural light in the first hour after waking anchors your circadian clock and supports the cortisol awakening response, which in turn supports melatonin production that evening. This is particularly important when HPA dysregulation is in the picture. Create a genuine wind-down window. This is usually the hardest for people to implement along with boundaries around devices. A minimum of 60 minutes before bed without bright overhead lighting, screens, or cognitively demanding tasks. Giving the nervous system a signal that the day is ending, helps shift it out of survival mode into recovery mode. Limit alcohol. Alcohol disrupts sleep architecture significantly, particularly REM sleep and sleep in the second half of the night. In perimenopause, where sleep is already fragile, even one to two standard drinks can meaningfully worsen sleep quality. This is not always what clients want to hear, but the evidence is clear. 2. Nutrition for Circadian and Sleep Support What and when you eat has a direct bearing on sleep quality (a connection that is frequently overlooked). Eat regular, balanced meals throughout the day. Skipping meals or eating reactively/erratically creates blood glucose instability that dysregulates cortisol, particularly in the evening. A small blood sugar dip at 2–3am is a common driver of the classic perimenopausal night waking. Prioritising protein and fat at dinner can support overnight glucose stability. Include tryptophan-rich foods. Tryptophan is the precursor to serotonin and melatonin. Good sources include turkey, eggs, dairy, nuts, seeds, and oats. Pairing these with a small amount of complex carbohydrate in the evening supports tryptophan transport across the blood-brain barrier. Reduce stimulants after midday. Caffeine has a half-life of approximately five to even 12 hours for many people. A 2pm coffee can still meaningfully elevate circulating caffeine at 9pm, competing directly with adenosine (your sleep-pressure signal). In women with HPA dysregulation, caffeine sensitivity is often heightened. 3. Exercise Regular physical activity is one of the most evidence-supported interventions for sleep quality in perimenopausal women. It supports slow-wave sleep, reduces anxiety and HPA reactivity, improves thermoregulation, and supports body composition. FIRST - Any movement/exercise is better than none - doing something is better than nothing. Morning or early afternoon exercise may support sleep better than late evening training, which can delay sleep onset in some women with already-elevated evening cortisol. A combination of resistance training and moderate-intensity aerobic exercise appears most beneficial for both sleep and hormonal health in this cohort. Gentle evening movement (a 20-minute walk, yoga, or stretching) can support nervous system downregulation without the cortisol-raising effect of intense training. 4. Targeted Supplementation Supplementation works best layered on top of solid foundations, not instead of them. That said, two common things I often recommend that have good evidence and are particularly relevant to perimenopausal sleep include: Magnesium glycinate is my most consistently clinically useful supplement for sleep in this population. Magnesium supports GABA activity (directly relevant given declining progesterone), modulates HPA reactivity, and supports muscle relaxation. The glycinate form has superior bioavailability and tolerability compared to other forms. Meta-analyses support magnesium supplementation for improving subjective sleep quality, particularly in adults with low dietary intake. A typical therapeutic dose is 300–400mg elemental magnesium as glycinate, taken 60–90 minutes before bed. Withania somnifera is an adaptogenic herb with a well-characterised HPA-modulating mechanism, which is directly relevant to the elevated evening cortisol and stress hyperreactivity that can often contribute to perimenopausal sleep disruption. Research has suggested that 600mg of ashwagandha root extract taken daily can significantly improve sleep quality, sleep onset latency, and total sleep time compared to placebo in adults with insomnia. It also has been found to reduce perceived anxiety (addressing the “wired but tired” presentation that is so common). It is well-tolerated for most women at standard doses, though it is worth noting it should be used cautiously in thyroid conditions. Having a chat with a registered herbalist is always a good idea:) A Note on Menopausal Hormone Therapy (MHT) For women with significant vasomotor symptoms driving sleep disruption, MHT can be genuinely effective and is worth a conversation with your GP or gynaecologist. MHT isn’t appropriate for everyone, and it isn’t a sleep hygiene replacement but for many women where it is warranted, it removes a significant physiological barrier that makes everything else more effective. In summary, perimenopausal sleep disruption is not something you simply have to endure. Sleep is a critical pillar for health and needs to be protected and supported. Key takeaways ALWAYS start with and prioritise the the foundations: temperature, light, wind-down routine, and alcohol reduction. Layer in regular meals, morning movement, and targeted supplementation. And if vasomotor symptoms continue to drive significant disruption, have an honest conversation with your GP about whether MHT is appropriate for you. If you’ve tried the basics and you’re still struggling, it’s worth working with a practitioner who can assess the full clinical picture including cortisol patterns, nutrient status, and any underlying drivers that a generic protocol won’t reach. Ready to get to the root of your sleep issues? Book a free 20 min Meet and Explore Call to find out how Wellkind can support your health and wellbeing journey.

There are a cluster of symptoms that affects the majority of women during perimenopause and beyond - yet many women are not comfortable discussing it and therefore not being supported . Genitourinary symptoms are common, affecting 50-70% of women through this transition and beyond. Changes to the vagina, vulva, bladder, and pelvic floor that can quietly erode comfort, confidence, and quality of life. Unlike other menopause symptoms like hot flushes, which tend to ease over time, genitourinary symptoms often persist and can even worsen without support as women age. The good news? There is a lot you can do. Why This Happens: It Starts With Estrogen Estrogen is not just a reproductive hormone - it is a tissue architect. It maintains the health, moisture, and structural integrity of the entire genitourinary tract. When estrogen levels begin to fluctuate and decline in perimenopause, this environment in this region also changes. Tissue changes. Estrogen maintains tissue tone. As levels drop, the vaginal walls become thinner, drier, and less elastic. The vulva may lose fullness, the labia majora and clitoral hood can contract, and the vaginal opening may narrow over time. Tissue that was once resilient becomes fragile and prone to irritation, tearing, and discomfort during sex. Microbiome shifts. Healthy estrogen levels support a vaginal microbiome dominated by Lactobacillus species, which produce lactic acid and keep vaginal pH low (around 3.8–4.5). As estrogen declines, Lactobacillus populations fall, pH rises above 4.5, and the environment becomes more alkaline. This shift can increase vulnerability to bacterial vaginosis and UTIs. Sexual symptoms Dyspareunia (pain during sex), reduced lubrication, post-coital bleeding, decreased arousal, orgasm and desire, loss of libido, and dysorgasmia are all recognised. Vaginal dryness and dyspareunia are the two most commonly reported symptoms overall. Bladder and pelvic floor effects. The urethra and bladder are estrogen-sensitive tissues too. As estrogen declines, urethral tissue thins, bladder urgency and frequency increase, and stress incontinence (leaking with coughing, sneezing, or exercise) becomes more common. Pelvic organ prolapse is also associated with pelvic floor weakening in this stage of life. Sensory changes. Some women notice altered sensation in the clitoris and vulva, either hypersensitivity or reduced feeling, which can significantly impact sexual pleasure and intimacy. This constellation of symptoms is now formally recognised as Genitourinary Syndrome of Menopause (GSM) - a term that reflects how interconnected these changes are. What Can Help Localised Topical Vaginal Estrogen This is the most evidence-based intervention available, and it is significantly underused. Unlike systemic hormone therapy, vaginal estrogen works locally. It restores tissue health, supports the vaginal microbiome, reduces recurrent UTIs, and improves bladder symptoms without substantial systemic absorption. Current evidence supports its long-term use, and it is considered safe for most women, including many breast cancer survivors (in consultation with their oncologist). If this has been recommended to you, or you are curious about it, it is worth a direct conversation with your GP or gynaecologist. Phytoestrogens Soy isoflavones and flaxseed lignans act as weak estrogen modulators. Research suggests they can offer modest support for vaginal tissue health and symptom relief, particularly in women who either cannot or prefer not to use hormonal options. These can also be consumed alongside HRT and vaginal estrogen support. Some evidence shows that phytoestrogens can improve the moisture of tissue. Here is a recipe you can try: Flaxseed loaf I simply add 1-2 tbsp to my oats everymorning:) Targeted Probiotic Support Specific Lactobacillus strains, including L. rhamnosus, L. reuteri, and L. crispatus, have emerging evidence for supporting vaginal microbiome health. Both oral and intravaginal delivery have been studied. If you are dealing with recurrent infections or dysbiosis, this is an area where personalised probiotic support can make a real difference. Working with a trusted practitioner who can look more closely at your genitourinary microbiome and provide personalised support can be helpful. Pelvic Floor Rehabilitation For bladder symptoms, prolapse, and pelvic floor weakening, working with a pelvic floor physiotherapist is one of the most effective things you can do. This is specialised, hands-on care (not just Kegels). A physiotherapist can assess your specific patterns of tension or weakness and provide a tailored rehabilitation plan. Moisturisers and Lubricants Non-hormonal vaginal moisturisers used regularly (not just at sexual activity) can help maintain tissue hydration. Look for products that are pH-balanced and free from glycerine, parabens, and fragrances. This is a supportive measure, not a replacement for addressing the underlying hormonal shift but it can meaningfully improve day-to-day comfort. Nutrition and the Gut–Vaginal Axis This is an area that is easy to overlook, but it matters more than most people realise. What you eat directly shapes your gut microbiome and your gut microbiome has a measurable influence on estrogen metabolism, systemic inflammation, and the health of the vaginal environment. The connection runs through the estrobolome: the collection of gut bacteria that produce an enzyme called beta-glucuronidase, which deconjugates estrogen in the gut and allows it to be reabsorbed into circulation. A well-nourished, diverse gut microbiome helps maintain this recycling process, supporting circulating estrogen levels even as ovarian production declines. A disrupted gut microbiome can reduce estrobolome activity, accelerating the drop in bioavailable estrogen. General guidelines to support your gut microbiome: Include prebiotic fibre - feeding the right bacteria Prebiotics are non-digestible fibres that selectively feed beneficial bacteria, particularly Lactobacillus and Bifidobacterium species. Two that are worth knowing about specifically: Galactooligosaccharides (GOS) and fructooligosaccharides (FOS) have both been studied for their ability to stimulate vaginal Lactobacillus populations - not just gut bacteria. Research has shown these compounds can directly support Lactobacillus growth in the vaginal environment, making them particularly relevant for genitourinary health rather than gut health alone. FOS and GOS are found in foods like leeks, onions, garlic, asparagus, legumes, and chicory root, and are also available in supplement form. A diverse, fibre-rich diet more broadly supports the gut microbial diversity that underpins estrobolome function. Greater microbial diversity has been positively associated with improved estrogen regulation during perimenopause. Polyphenols - prebiotic-like and anti-inflammatory Polyphenols are plant compounds found in berries, pomegranate, green tea, dark chocolate, walnuts, apples, red onion, olive oil, and more. They act as prebiotic-like substrates, meaning they selectively feed beneficial bacteria including Lactobacillus and Bifidobacterium while inhibiting pathogenic species. Dietary polyphenols contribute to intestinal health by preserving microbial balance through stimulation of beneficial bacteria and inhibition of pathogenic bacteria. They also support the cells that create a healthy barrier in our mucous membranes as well as reduce inflammation and oxidation. Fermented foods Fermented foods deliver live bacteria directly to the gut and support microbial diversity. Aim to include at least one serve daily: natural yoghurt (with live cultures), kefir, miso, tempeh, sauerkraut, or kimchi. Practical nutrition foundation priorities Rather than a supplement-first approach, a dietary foundation matters. Ensure you are getting enough fibre in general. Prioritise a diverse range of vegetables and fruits (aiming for 30+ different plant foods per week), legumes and pulses as regular staples, fermented foods such as kefir, yoghurt, miso, and kimchi to introduce live cultures, and extra-virgin olive oil, berries, and green tea as daily polyphenol sources. Reduce ultra-processed foods, which are consistently associated with lower microbial diversity and higher systemic inflammation. A Note on Normalisation Too many women are are not talking about the genitourinary symptoms they are experiencing. They are common and they are something you simply have to accept or be embarrassed about. They are physiological changes with real mechanisms, and they respond to targeted support. If any of this resonates with your experience, it is worth bringing it into a clinical conversation with a trusted qualified practitioner. You deserve care that takes the full picture seriously.

If symptoms are starting to get in the way of life - your sleep, your mood, your energy, your relationships - you are not alone, and you do not have to push through. What Is Perimenopause? Perimenopause is the transitional phase leading up to menopause (the point at which a woman has gone 12 consecutive months without a period). This transition can begin anywhere from the mid-30s to the early 50s and typically lasts four to eight years, though this varies considerably between individuals. During this phase, oestrogen and progesterone levels become increasingly erratic before eventually declining. It is this hormonal fluctuation (not simply low oestrogen) that drives many of the symptoms women experience. Common signs include irregular periods, sleep disruption, hot flushes, mood changes, brain fog, joint pain, and changes in libido or vaginal comfort. For more information on how to identify whether or not you are in perimenopause, you can read this blog. The Foundations: Why Lifestyle Still Matters Before we get to specific interventions such as herbal medicine and HRT, it is worth emphasising something that the research is unambiguous about: how you live during this transition directly influences how you experience it and wider health outcomes. The truth is - the basic pillars that apply to support health generally still apply in this season of life; they are evidence-based tools that can reduce symptom severity and more importantly, mitigate possible health concerns down the road. Importantly, we likely do not need to do some 'special perimenopause protocol' as often marketed online. Sleep Sleep is one of the first casualties of perimenopause. Falling and fluctuating oestrogen disrupts the architecture of sleep, reducing slow-wave (deep) sleep and increasing night-time waking. A 2021 systematic review found that sleep disturbance affects up to 60% of perimenopausal women, with hot flushes and mood changes frequently contributing to the picture. Practical steps that are consistently supported in the literature: Keep a consistent sleep and wake time - even on weekends. Reduce alcohol, which fragments sleep architecture even in moderate amounts. Keep your bedroom cool (hot flushes are worsened in a warm environment). Limit screens and bright light in the hour before bed. If waking with anxiety or racing thoughts, consider whether stress management needs attention (see below). Exercise Exercise is arguably the single most evidence-supported lifestyle intervention in perimenopause. A 2023 Cochrane systematic review found that exercise (particularly aerobic and resistance training) significantly reduced the frequency and severity of vasomotor symptoms (hot flushes and night sweats) compared to no intervention. Resistance training deserves special attention. From the mid-30s onward, women lose muscle mass at an accelerating rate: a process driven in part by declining oestrogen. This matters not just for strength and body composition, but for metabolic health, bone density, and long-term independence. Aim for at least two resistance training sessions per week in addition to regular cardiovascular movement. Is there a special perimenopause workout I should do? Not really. Beyond doing resistance and cardiovascular training - there is no good evidence for this at this time for specific 'perimenopause' protocols. The truth is - How you decide to do some resistance cardiovascular training should be based on what is safe, what you prefer, what you will be consistent with, what works for you. Also - any exercise is better than no exercise. Nutrition There is no single “menopause diet”, but the fundamentals of good nutrition become especially important during this phase. Key evidence-backed principles: Adequate protein to support muscle retention and metabolic health. Fibre-rich foods to support gut health, oestrogen clearance, and blood glucose stability. A wide variety of vegetables and fruit for micronutrient density and anti-inflammatory benefit. Adequate micronutrients such as calcium and vitamin D to support bone health - particularly important as fracture risk rises post-menopause. Minimising ultra-processed foods, added sugars, and alcohol, which may worsen hot flushes, sleep, and mood. Nutrition needs beyond the basics should be really looked at on a individualised bases - not just considering nutrient specific needs but also wider context factors such as preferences, home situation, time, resource/access, etc. Stress Management Chronic stress activates the HPA (hypothalamic-pituitary-adrenal) axis, which directly interacts with the HPG (hypothalamic-pituitary-gonadal) axis that governs reproductive hormones. Put simply: chronic, unmanaged stress compounds hormonal dysregulation and can exacerbate symptoms. Research has consistently found associations between high perceived stress and greater vasomotor symptom severity. Mindfulness-based stress reduction (MBSR) has the strongest evidence base among mind-body interventions, with a 2019 meta-analysis demonstrating meaningful reductions in hot flush frequency and self-reported symptom burden. Yoga, breathwork, and regular time in nature are also well-supported for general stress physiology. Social Connection and Community This one is often overlooked but should not be underestimated. Social isolation is independently associated with worse mental health outcomes during perimenopause. Conversely, strong social support is protective against depression and anxiety, which are disproportionately common during this transition. Investing in meaningful relationships and community, whether that is friendships, a group class, or a support network , is genuinely therapeutic and associated with positive health outcomes. Regular Health Checks Due to the physiological change that is happening (physiological change = stress on the body), perimenopause can be a window of increased vulnerability for certain health concerns. Oestrogen has a protective effect on cardiovascular and metabolic health - as it declines, risk profiles shift. Research shows that women with pre-existing metabolic dysfunction (e.g. insulin resistance, elevated triglycerides) tend to experience more severe vasomotor symptoms, and vice versa. During this phase, it is worth discussing the following with your GP: Cardiovascular health: blood pressure, cholesterol (including LDL, HDL, and triglycerides). Metabolic health: fasting glucose or HbA1c. Bone health: consider a DEXA scan if you have risk factors for osteoporosis. Thyroid function: thyroid disorders are common in perimenopausal women and can mimic or worsen symptoms. Stress/mood - depression/anxiety, other mental health concerns may need more targetted comprehensive treatment. Individuals who have had a history of mental health concerns may be more at risk in this season of life to developing a mental health episode that needs support. Remember also that there is a bidirectional relationship between mental health and hormone health - in other words, mental health can impact how we go through perimenopause. What About HRT? “I’m doing all of the above and still struggling.” I hear you - this was me too. These foundations are not optional, but for many women they are not enough on their own. You do not have to just cope. Hormone replacement therapy (HRT), now more commonly called menopausal hormone therapy (MHT), has had a complicated history. A large study published in 2002 (the Women’s Health Initiative) generated widespread fear about the risks of HRT, leading to a dramatic decline in prescribing that lasted nearly two decades. However, this study has since been extensively critiqued. Its findings were misrepresented in media reporting, the formulations studied are now considered outdated, and the risk data was largely driven by a specific subgroup (older women who started HRT more than 10 years after menopause). The evidence we have today is far more reassuring. For example, the 2022 NICE (National Institute for Health and Care Excellence) guidelines on menopause concluded that for the majority of women under 60, or within 10 years of menopause, the benefits of HRT outweigh the risks. Similarly, the Australasian Menopause Society and the International Menopause Society have issued updated guidance aligning with this position. A few important points to understand about HRT: HRT does not restore hormone levels to what they were at 25. It supplements them sufficiently to buffer symptoms during the transition - think of it as taking the edge off a volatile process. HRT can be provided in different dosages, forms and combinations - depending on individual needs. HRT is often offered in a form that is bio-identical to our hormones such as estradiol and utrogestin. Combined oral contraceptives actually contain significantly higher doses of oestrogen than standard HRT. If you are still on the pill in your 40s, the idea of HRT being “high dose” is a misconception. Transdermal (skin patch or gel) forms of oestrogen carry a lower risk of blood clots than oral forms, and are generally preferred in modern prescribing. There are contraindications for a small proportion of women but even in some of these cases, options exist and research is continuing to be developed. For example, localised vaginal oestrogen (applied directly to the vaginal tissue) is not meaningfully absorbed systemically and may still be appropriate for women with a history of hormone-sensitive cancers who are experiencing genitourinary symptoms such as vaginal dryness, recurrent UTIs, or urinary incontinence. Some of the systemic benefits of HRT include: relief from hot flashes and night sweats relief from vaginal dryness (vaginal estrogen) improved sexual health better bone health improved sleep lower risk of depression/anxiety improved joint pain, skin, hair In Australia and New Zealand, these are the guidelines that GPs should be following: Potential side effects and risks of systemic therapy: Possible side effects include: vaginal spotting or bleeding, which usually stops within 6 months temporary breast soreness bloating (fluid retention) headaches Talk with your GP or ob-gyn if these side effects trouble you or last longer than expected. In some cases, dosages can be lowered alleviated these side effects. Furthermore, the form you use may be relevant to types of symptoms - the body processes different forms in different ways Whilst the risks have been found to be far less than previous thought, HRT, like most medications still may pose some risks in some individuals. You should always ask your GP or OB-GYN what these small risks are and if they are relevant to you. How long should I be on HRT When to stop HRT is an individual decision that should be discussed with your GP or ob-gyn. Some women stop within five years or when their symptoms stop being bothersome. Most women will no longer have hot flashes by 7-10 years after their final menstrual period. But others continue to use HRT after their 50s to relieve sypmtoms. Use of HRT should always be based on their risks, benefits, and symptoms of each individual. Coming off HRT can cause sypmtoms to come back. These sypmtoms can be temporary, however, for some they can be as severe as when they first started. Symptoms such as vaginal dryness should be expected to get worse when HRT stops, which underscores the importance of local (vaginal) hormone therapy. As a naturopath and nutritionist, it is not within my scope of practice to prescribe medications including HRT. What is within my scope is to help you understand all the tools available, stay up to date with evidence, work collaboratively with your GP or specialist, and advocate for you within that relationship. If you feel your symptoms are not being taken seriously, I strongly encourage you to ask for a referral to a GP that has up-to-date menopause training or gynaecologist. What About Natural Alternatives? Herbal Medicines Several herbal medicines have some reasonable evidence for symptom support in the later stages of reproductive phase and earlier stages of perimenopause, or for women where HRT is not appropriate or not desired. However, they must be individually considered - what works well for one hormonal pattern may be counterproductive for another. Furthermore, we can also use herbal medicine and nutrients to support HRT in some contexts based on presentation and needs. A couple herbs that come up frequently in media deserve some honest context: Black cohosh (Cimicifuga racemosa): Has some evidence for vasomotor symptoms in the early phases. A 2010 Cochrane review and several subsequent meta-analyses support a modest but meaningful reduction in hot flush frequency. It does not appear to have oestrogenic activity, however, which is why it has less efficacy in the later phases of perimenopause and will not support wider systemic symptoms associated with estrogen decline. Chaste tree / Vitex agnus-castus: Primarily useful in the earlier perimenopausal period, where progesterone deficiency relative to oestrogen is more relevant. Evidence supports its use for luteal phase symptoms (e.g. PMS-type changes, breast tenderness, irregular cycles), and primary ovarian insufficiency, especially when trying to support fertility. It is Less useful once ovulation has largely ceased and is appropriate in some presentations such as a higher LH:FSH ratio often seen in PCOS phenotypes. Soy Isoflavones: The Nuanced Case Of all the non-pharmaceutical options, soy isoflavones have the strongest and most clinically relevant evidence base for support perimenopause and menopause. They are also relatively safe and can be used across a range of contexts. Soy isoflavones act as phytoestrogens, plant compounds with a weak oestrogen-like structure that can bind to oestrogen beta receptors and modulate their activity. Crucially, they appear to behave differently depending on the hormonal context: they have a mild oestrogenic effect when oestrogen is low (as in menopause), and may have a mild anti-oestrogenic effect when oestrogen is relatively high. For more information on soy isoflavones - I wrote another blog on soy isoflavones here. An important reality check: once oestrogen is genuinely declining and ovulation is no longer occurring (meaning progesterone is not being produced), herbal medicines cannot replicate the physiological role of these hormones. No herb equates to HRT when true hormonal depletion is the issue. HRT can be extremely helpful - but it may not be the magic bullet social media is telling us it is I want to be transparent: I am a strong advocate for HRT and have personally benefitted enormously from it. But it would be doing you a disservice to present it as a complete solution in isolation, which is what is happening online in some cases. Here is what HRT does and does not do: HRT can significantly improve sleep, hot flushes, mood stability, and brain fog. Better sleep and mood have downstream benefits for energy, motivation, food choices, and the capacity to exercise. HRT does not build muscle on its own - resistance training does that. (This claim circulates on social media and is not supported by evidence.) HRT does not correct metabolic dysfunction. If insulin resistance or elevated HbA1c is part of your picture, targeted nutrition and lifestyle intervention is still essential. Alcohol will still disrupt your sleep on HRT. Sleep hygiene still matters. HRT does not replace the protective value of exercise for cardiovascular health, bone density, and muscle mass. HRT can improve mood, however, if depression/anxiety is still getting in the way of day to day life, it is important that this is followed up with appropriate support. The truth is the most effective approach to perimenopause is not any single intervention - it is a genuinely a comprehensive and holistic one. Furthermore, the basics outlined above still crucially matter. HRT (where appropriate and desired) works best as part of a broader strategy that includes the foundations covered above. Where to From Here? If you are in the perimenopause transition and want personalised support - whether that is navigating your options, working on the foundations, or preparing for a conversation with your GP, I offer a complimentary Vitality Strategy Call to help identify where to start. You can book directly at wellkind.co.nz. We also have a monthly fireside chat, a free online group call to address topics covered over the month in newsletters and blogs. Key References American College of Obstetricians & Gynecologists. (2026). Menopause: What your ob-Gyn wants you to know. Vis N.E. et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531–539. Baber R.J., et al. (2016). IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric, 19(2), 109–150. Daley A. et al. (2015). Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews, (9). Franco O.H. et al. (2016). Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA, 315(23), 2554–2563. Peng W. et al. (2019). Mind-body therapies for menopausal symptoms: A meta-analysis. Climacteric, 22(4), 359–369. Rietjens I.M.C.M. et al. (2017). The potential health effects of dietary phytoestrogens. British Journal of Pharmacology, 174(11), 1263–1280. This blog is for educational purposes only and does not constitute medical advice. Please consult a qualified health professional before making changes to your health management.

Perimenopause and menopause are having a moment - it does not take long before something flashes before your eyeballs making you question whether every physiological sensation may in fact be a sign that you are in perimenopause. Whilst I am happy that women's health is getting some more attention, remembering that there are some generations including my mother's, that had a blackout of information and support during this phase of life, it is important that we do not pathologise this period of life or get caught up with mis/dis - information. So, whilst I often eye-roll at a lot of content out there, I am pleased to see that research and medical advice is catching up and that women are beginning to get better support to transition through this stage of life. One question I get asked a lot in the clinic when someone is experiencing menstrual cycle stuff with other symptoms - am I in perimenopause? Officially, based on what's called the STRAW +10 criteria, early perimenopause for those that have a uterus, is defined by persistent variability in menstrual cycle length; specifically, a difference of 7 or more days in consecutive cycles, recurring within 10 cycles of first occurring. At first changes might be subtle, like a shorter cycle, fewer days of bleeding, heavier or lighter flow, spotting instead of a period. In other words, cycles continue but become persistently irregular. If a cycle is missed (≥60 days of amenorrhea), this signals the a likely later phase in the menopausal transition, which is often accompanied by consistently elevated FSH (>25 IU/L) and greater symptom burden. (Harlow et al., 2012) Menopause itself is defined retrospectively; confirmed 12 months after the final menstruation. The menopausal transition can last anywhere from around 4 to 8 years on average, though individual experience varies considerably. As noted in the STRAW +10, there are two late reproductive phases (3a and 3b) just before perimenopause, where women may experience symptoms such as worsening PMS. These individuals may have regular cycle lengths to slightly shorter, normal to slightly rising/variable FSH, low AMH, low follicular count. The worsening of PMS symptoms can be a first sign of transition. Typically, women enter perimenopause in their 40s, though it is possible to have symptoms earlier. Early menopause is defined by having the last period before the age of 45. If the last period is before the age of 40 this is defined as premature menopause. There is another condition call Premature Ovarian Insufficiency (POI), that looks like early/premature menopause but it is not. For early/premature menopuase or POI - it is important to understand what this means for long term health as well as the support/treatment that is available (more to come on this in another blog). Beyond physiology - the broader implications of this period of life to consider include: Associated symptoms of menopause transition can impact the quality of life of women and all those with ovaries The impact on workplace performance impacts both personal and societal financial outcomes. Some symptoms may be a sign of future health risks for some women (e.g. vasomotor symptoms and sleep issues may be associated with increased risk of bone and cardiovascular risk; vasomotor symptoms and depression may be associated with increased risk for cognitive decline) Geographical location and ethnicity influence the prevalence of varying symptoms. Individual factors such mental health, stress & trauma, metabolic health and socioeconomic status may considerably worsen the experience of menopause. Potential for significant influence on interpersonal relationships and family structure. Importantly - perimenopause and menopause are not pathologies but a natural transitional stage of life. Some women will transition without too much distress or needing too much support. If the changes do not interfere with quality of life and your daily functioning, support may not be necessary. However, for many women, the symptoms experienced during this season of life can impact day to day life and quality of life. For these women, research and clinical evidence suggest that support is well indicated and that early and comprehensive management improves both short-term symptoms and long-term health outcomes. When bleeding changes raise a red flag Many changes in the menstrual cycle are normal but some changes can be unsettling and impact quality of life. If you have any of the following changes in bleeding/cycles for more than 2 cycles, it is a good idea to chat with your GP and see an ob/gyn for evaluation: bleeding that soaks through one or more tampons or pads every hour bleeding that lasts more than 7 days flooding or gushing when you stand up passing large blood clots the size of a quarter or larger bleeding or spotting after sexual intercourse bleeding between cycles cycles longer than 35 days or shorter than 21 What is actually happening in this phase of life? As we age, so do our ovaries. This impacts our hormones produced by the ovaries as well as from other sites in the body. Before estrogen does its decline, it rollercoasters often resulting in ‘high estrogen-like’ symptoms such as heavier bleeding, breast pain, mood symptoms/anxiety. This is compounded by the declining progesterone from poor ovulatory cycles. (Hardringham, 2025) These changes in hormones impact more than just our reproductive system and this is because our hormones play important roles throughout our body. This image shows how estrogen functions in different parts of the body... (Farkas et al, 2022) (Monteleone et al., 2018) With estrogen having wide multi-systemic functions - it makes sense that individuals can experience multi-systemic symptoms during perimenopause/post-menopause. This is where things can get a little messy, however, as many of these symptoms can be related to other things going on and not necessarily perimenopause. It is therefore, important to discuss your symptoms in context with a practitioner who can look at the big picture, rule out possible other causes, and support your individual needs. What else might contribute to timing and earlier onset Other things that may be relevant to when you might go through menopause is family history. Knowing when your mother went through menopause can be helpful. Other factors that can influence the timing of perimenopause include trauma/stress, health conditions, smoking, other chemical exposure, ethnicity, & short menstrual cycles. The take away…. We do have guidelines that can help us determine whether you are in perimenopause. If you are not feeling yourself, it is always worth talking to your doctor. Tracking your cycle & symptoms can be a helpful way to identify with a practitioner what you are experiencing as well as the patterns that may be happening to get a holistic picture. You can download this tracker linked below or use one of the many apps available to help you. Hormone blood tests are not necessary to determine whether someone is in perimenopause or prescribe support such as HRT but they can be a helpful way to assess what is actually going on with your hormones and provide more personalised comprehensive support. Key hormone blood tests that can be helpful and the days to test them if you are still cycling: Day 2 of your cycle test (second day of full menstruation): FSH LH E2 Prolactin Free testosterone DHEA Day 21 of your cycle test or 7 days post-ovulation: Free T (including SHBG) A Point on Differential Diagnosis As mentioned above, there can be other things that result in missed/irregular periods as well as other symptoms that can be associated with perimenopause. I am brining this up because in the age of social media and dr. google - it is very easy to self-diagnose and possibly incorrectly. There are other reasons we may be experiencing our symptoms. PCOS for example can result in metabolic changes, weight changes, irregular/missed cycles. Other conditions that need careful consideration - especially if someone is younger than 40 - include hypothalamic amenorrhea and primary ovarian insufficiency. Thyroid issues can also lead to period changes, metabolic changes, poor temperature regulation, reduced libido. Not only are there possible other contributing factors that may need to be considered or at least ruled out - it can be more than one thing at once. For me personally - I have a thyroid condition and had primary ovarian insufficiency that likely kicked off my perimenopause early - both needed to be addressed. The point is - whilst, yes, a range of symptoms can be perimenopause - they can also be other things and it is important to look at whole picture and assess what is really going on - identifying other potential contributors that may require different or additional support. ...More posts to come on how to support yourself through this phase of life. If you are wanting some more support, --> stay tuned to our weekly newsletters this month focused on perimenopause. --> join our fireside chat at 12pm nz time on Saturday May 30th. Subscribers get free access. --> for more 1:1 support schedule a free vitality strategy call to discuss pathways of support.

How your mental health and nervous system may be contributing to your gut issues We often hear about how the gut can impact the brain but the relationship runs both ways. Mental health is now recognised as a key contributing driver in many cases of IBS subtypes and functional dyspepsia. This has given rise to the field of neurogastroenterology, which explores the gut-brain axis in clinical depth, and to a formalised diagnostic framework for disorders of gut-brain interaction (Rome IV, 2016). "The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions" ~ (Carabotti et al., 2015). (Carabotti et al., 2015) How the brain and nervous system can impact your gut 1. Pain perception  For some people, the way pain signals are processed between the gut and the brain becomes dysregulated, a phenomenon known as visceral hypersensitivity. The nervous system loses its ability to appropriately downregulate pain, leading to heightened and persistent discomfort. Both neuromodulator therapies and behavioural interventions (such as gut-directed hypnotherapy and CBT) have demonstrated efficacy in resetting this system and reducing symptoms. (Rome, 2021) 2. Motility  The autonomic nervous system directly regulates gut motility. When autonomic function is disrupted, digestion can slow or accelerate, contributing to symptoms such as constipation, diarrhoea, or bloating. Research in neurological injury models, including traumatic brain injury, demonstrates that neuroinflammation can impair autonomic control and significantly disrupt motility patterns (Hanscom et al., 2021), illustrating how upstream nervous system dysfunction translates to downstream gut consequences. 3. Gut immune function and intestinal barrier integrity  nervous system imbalance via the autonomic system or the HPA axis, commonly associated with chronic, unmanaged stress,  can impact gut immune function and promote a pro-inflammatory state. Evidence indicates this increases vulnerability to intestinal barrier permeability, a mechanism that may underlie stress-related flares in gut symptoms (Leigh et al., 2023). 4. Microbiome composition  Emerging evidence from observational and animal studies suggests that chronic stress can alter gut microbiome composition, though robust human RCT data in this area remains limited (Leigh et al., 2023). This is an active area of research with clinical relevance that warrants monitoring.  The Autonomic Organisation of The Gut (Leigh et al., 2023) Because the gut-brain relationship is bidirectional, the downstream gut changes described above can in turn further dysregulate nervous system function, creating a reinforcing cycle that can be difficult to break without addressing both systems holistically. If you notice that stress reliably worsens your digestive symptoms, nervous system support should be part of your gut health plan. Here are some things to consider for nervous system support that supports gut health… Protect your sleep : sleep is the primary period of nervous system repair and regulation. Move your body :  regular exercise supports autonomic balance and reduces stress reactivity. Build sustainable stress management strategies :  this looks different for everyone - the goal is not to remove stress but rather ensure you can manage it constructively and recover. There is a lot of evidence based tools that you can be supported with including: mindfulness, CBT, hypnotherapy, counselling, etc.  Slow down at mealtimes : This is HUGELY underrated and yet so important.  Sitting down, taking a few slow breaths before eating, and chewing thoroughly helps shift your nervous system into parasympathetic ('rest and digest') dominance, which is the optimal state for digestion. Prioritise nutrient-dense wholefoods : Key nutrients including B vitamins, zinc, magnesium, and omega-3 fatty acids are essential precursors for neurotransmitter synthesis and neurological resilience, which in turn supports gut-brain signalling. Address underlying anxiety or depression :  If these are present, they are likely bidirectionally reinforcing gut symptoms. Seek appropriate support.  Supporting gut health can also positively feedback to the brain and nervous system. For more on targeted gut support, see post on fibre, prebiotics and polyphenols and find some more practical gut health foundations here. If symptoms persist, personalised clinical assessment is recommended as the mechanisms above interact differently in each person. If you would like more support in this area... --> join our fireside discussion - a live group call at the end of every month (last saturday of the month at 12pm) with a registered practitioner to discuss topics highlighted in monthly newsletters and blogs. Subscribers to the newsletter get complimentary access to these live events. Subscribe via www.wellkind.co.nz . --> to begin a personalised 1:1 support journey schedule a complimentary vitality strategy call.

An evidence-based tool frequently utilised in my clinic to evaluate an individual's gut health is the Bristol Stool Chart. Along with some clinical questioning, this chart aids us in starting to comprehend the state of a person's gut health. (ROME, 2000) The optimal frequency for bowel movements is 1 to 3 times daily, with a consistency corresponding to type 3, 4, or 5 on the Bristol Stool Chart. The ROME criteria serve as the current diagnostic tool for evaluating IBS subtypes. If an individual experiences abnormal stools more than 25% of the time, they might qualify for an IBS subtype diagnosis. The Bristol stool chart can help identify warning signs of other digestive problems that might need additional examination. For instance, the presence of blood in stools is a warning sign and should always be investigated further by your primary care physician (GP). If you find that your bowel motion frequency and type are not ideal, it is a good idea to talk to a registered practitioner. References The Rome Foundation - https://theromefoundation.org

The dietary foundations for good gut health include adequate fibre, prebiotics, and polyphenols. Fibre Fibre is important. It helps keep our gut healthy, which has a positive knock on effect to other systems in body including cardio metabolic. The Ministry of Health recommmends that adult women need at least 25 g of fibre a day and men need at least 30 g. The fact is, a large portion of the population are not meeting these daily requirements. There are different types of fibre: soluble, soluble, prebiotic (Hechtman, 2025) Fibre helps improve satiety, motility patterns as well as feed beneficial bacteria in the gut, which produce short chain fatty acids, lower inflammation, and modulate the immune and metabolic system. Fibre can also help increase mucus membrane secretion, protecting gut barrier function, which also helps immune function. Prebiotic Fibre There are many types of prebiotic fibre - all of which modulate and improve the microbiome helping increase beneficial bacteria and reduce pathogenic bacteria. (Hechtman, 2025) Benefits of Prebiotic Fibre (Scott et al., 2020) Polyphenols Polyphenols are phytochemicals found in plant foods (e.g. berries, cocoa, green tea, turmeric). Polyphenols are antiinflammatory and antioxidants. They also modulate and improve our gut microbiome, increasing beneficial bacteria such as bifidobacterium spp. akkermansia spp, and lactobacillus spp.. They support the health of barrier function and help it specifically reduce pathogenic bacteria growth. Foods that heal (Hechtman, 2025) Eating mostly wholefoods and eating a diverse range of plants is one of the best ways to access fibre, prebiotics, and polyphenols. By doing so we can protect and improve not only our gut health but health overall. NOTE: If fibre causes more digestive issues, it is important to address the root cause and work with a practitioner. Some of the underlying issues may include SIBO, dysbiosis, and thyroid issues. In these circumstances, specialised therapeutic care may be required. Wanting to learn more? ---> join our monthly live fireside chat (last saturday of the month at 12pm). Subscribers to the Wellkind newsletter get free access. ---> for more personalised support, schedule a 1:1 vitality strategy call here

“I am seeing you to help me with my period, why are you asking about my gut???” In my clinical practice I specialise in AFAB’s (assigned female at birth) reproductive health (e.g. menstrual cycle health) BUT at the root of so many of these presentations, we often find the gut being an upstream contributing driver of what is going on. So, while I wouldn't have called myself a gut specialist when I started out, I continue to upskill in evidence-based gut health support because whether someone is dealing with PMS, PMDD, PCOS, endometriosis, hypothalamic amenorrhea, or perimenopause symptoms, we need to consider the gut as a possible contributing factor. Naturopathic medicine has long placed the gut at the centre of whole-body health. More current research is now clarifying how  this works, not just that it matters, but the specific biological mechanisms involved - which is so cool. The microbiome and gut barrier is very important in immune signalling, inflammation, neurotransmitter production, nutrient metabolism, and hormone metabolism/regulation. Our gut health is therefore, deeply interconnected with nearly every system in our body. Let’s look at a few big reasons how your gut health connects with your hormones…. The estrobolome Within your gut microbiome lives a functionally distinct subset of bacteria more recently referred to as the estrobolome .   These bacteria produce enzymes called β-glucuronidase and β-glucuronidase is responsible for deconjugating oestrogen in the gut (essentially stripping off a molecule that tagged with in the liver and signalling  it for excretion via the colon) allowing it to be reabsorbed into circulation.  Now β-glucuronidase activity is not uniformly "good" or "bad",  its up- and down-regulation appears to be partly life-stage dependent, and both excess and deficiency have clinical relevance depending on the individual's hormonal context. When the estrobolome is healthy and diverse, this recycling is well-regulated.  When it is disrupted, however, through dysbiosis (when opportunistic bacteria that produce it overcrowd the beneficial bacteria), excess reabsorption may contribute to oestrogen dominance symptoms, while an underactive estrobolome may contribute to lower circulating oestrogen.  In other words, the health of your microbiome impacts how oestrogen is regulated in your body and we actually have tools that can improve this directly when things get out of whack.  LPS, inflammation, and reproductive health In addition to β-glucuronidase activity, other aspects of gut health can impact our hormones and cycle. Opportunistic bacteria can also produce lipopolysaccharide (LPS): an inflammatory molecule. LPS causes inflammation in the gut and can also translocate into circulation if the barrier of the gut is compromised, triggering low-grade systemic inflammation and elevating further inflammation and immune activation.  Elevated LPS has been associated with both endometriosis, PCOS, PMS, PMDD, and may contribute to severe perimenopause symptoms in some cases. Addressing these bacteria can help lower LPS and therefore inflammation and immune activation.  Histamine Some gut bacteria are histamine-producers, and when these are overrepresented, histamine load can become excessive. Oestrogen upregulates histamine receptors, meaning the oestrogen-histamine relationship is bidirectional: high histamine can worsen oestrogen-related symptoms, and high oestrogen can increase histamine sensitivity. This is particularly relevant for women with premenstrual or perimenopausal mood symptoms, anxiety, as well as allergy hypersensitivity & reactivity.  Absorption issues Finally, we need nutrients to support the production, metabolism, and function of hormones as well as reproductive health in general. Things impacting absorption such a lack of the good bacteria that help convert certain nutrients into their active forms, digestive enzymes, and inflammation may impact our nutrient status, which can then impact our hormone/reproductive health.  What about perimenopause?  Whilst we are still needing stronger evidence and better controlled trials, some research suggests that gut health may impact symptom severity during the perimenopause/menopause transition. For example, some studies suggest that post-menopausal women with menopausal syndrome  (symptomatic menopause) have higher rates of gut health issues compared to asymptomatic menopausal women, which  suggests the microbiome may modulate symptom burden. It is interesting research that we need more of! Soy isoflavones are evidence based nutrients we can use to support all reproductive health issues including perimenopause symptoms as well as protect long term health with AFABS. For more information on this read our previous blog on soy isoflavones . Improved gut health may help with better absorption and, therefore utilisation of these nutrients. In general, it is suggested that aging alone impacts the health of our microbiome with a likely decrease in microbiome diversity and more wear and tear on barrier function through an increase in oxidative stress. Whether it is the perimenopause transition or just aging - the main point is, we can definitely support our gut health to support our overall health throughout our lifetime as a protective factor for overall health. What this all means and what you can do: practical starting points Supporting your gut health is a protective factor not just for reproductive health but health overall. Some of the basic evidence based things to consider: Prioritise wholefoods: A wholefoods diet rich in lean protein, omega 3 fatty acids, veggies, whole grain, legumes, etc provide nutrient density as well as keep inflammation and oxidative stress down. This in general supports gut health.  Eat for diversity: Aiming for 30+ different plant foods per week (vegetables, fruits, legumes, nuts, seeds, wholegrains) has been shown to be a strong predictor of microbiome diversity (McDonald et al., 2018). Make sure you are getting enough fibre: Fibre in general is really great for gut health and research shows most of us are not getting enough. Adult men need a minimum of 30 g and women 25 g. Fibre keeps motility patterns healthy (which helps the excretion part of conjugated estrogen, which supports gut health.  Fibre also feeds beneficial bacteria in the gut acting as a prebiotic.  Include fermented foods if tolerated: A more recent randomised control trial showed that a high-fermented-food diet significantly increased microbiome diversity and reduced inflammatory markers (Wastyk et al., 2021). If an individual has histamine issues, they may not tolerate fermented foods well. Addressing the root cause of this so that you can tolerate these foods and get the benefit from them is possible - find some support if needed.  Prioritise sleep & manage stress: The gut-brain axis is bidirectional and mechanistically well-established. Sleep deprivation and chronic stress alters gut motility, barrier function, and microbial composition.  Move your body and recover: Exercise is also shown to have a relationship with our gut health. Varghese et al. (2024) in a literature review discuss how combining aerobic and resistance training significantly affects bacterial diversity, linked to a lower prevalence of chronic metabolic disorders. Furthermore, exercise enhances gut microbiome diversity, increases SCFA production, improves nutrient utilization, and modulates neural and hormonal pathways, improving gut barrier integrity. Recovery is important as some literature also suggests that high-intensity exercise for a long duration can cause a leaky gut and consequent systemic inflammation, which may disrupt the microbial balance. Protect your microbiome and gut barrier:  Minimise unnecessary long term antibiotic use, NSAID use, excessive alcohol, smoking, processed food that can disrupt microbial balance and barrier integrity. If you do need to use these medications long term, speak with your practitioner about how you can protect your gut health in the process.  Consider working with a qualified practitioner and testing if symptoms persist.  If you've been doing "all the right things" and still struggling, further testing and targetted support may be a good idea. Seeing your GP can be a great start as they can do some routine tests. Working with a naturopath for more targeted gut support is helpful as well.  If you would like more support in this area.... --> join our fireside discussion - a live group call at the end of every month (last saturday of the month at 12pm) with a registered practitioner to discuss topics highlighted in monthly newsletters and blogs. Subscribers to the newsletter get complimentary access to these live events. Subscribe via www.wellkind.co.nz . --> to begin a personalised 1:1 support journey schedule a complimentary vitality strategy call.

When we think of gut health - we mostly think about what is happening in our puku but oral health is part of gut health.  Digestion starts in the mouth with the action of chewing as well as the release of a digestive enzyme amylase. We also have an oral microbiome, which research is learning more about.  Once again there is a bidirectional relationship between our oral health and other systems in the body.  For example, there is a bidirectional relationship between oral health and our cardiometabolic system. Periodontitis (gum disease) is an inflammatory disease of the soft and hard tissues supporting the teeth that has been associated with cardiometabolic disease. A meta-analysis found that individuals with diabetes had an increased risk of developing peridontal disease and those with peridontal disease also had an increased risk of developing diabetes (Sanz et al., 2021). Other research showed that even people without diabetes had more chances of having higher hba1c (a marker of glucose control) if they had oral health issues (King et al., 2022).  The risk factors for periodontitis are poor oral hygiene and also risk factors known for cardiometabolic disease, including tobacco smoking, poor nutrition, poor sleep and physical inactivity. Another important oral health presentation associated with increased risk of oral health conditioners as well as cardiometabolic disease is dry mouth. Dry mouth further impacts mucous membranes, reducing beneficial bacteria and creating conditions for pathogenic bacteria to thrive. Excessive mouth breathing can exacerbate this as well as sleep issues associated with mouth breathing such as snoring and sleep apnea.  Inflammation created by bacteria in the mouth can also lead to systemic inflammation, which further exacerbates possible underlying mechanisms associated with cardiometabolic conditions. Furthermore, pathogenic bacteria in the mouth can also be found systemically.  Taking care of your oral health is important beyond just what is happening in your mouth.  —> make sure to see the dentist regularly and follow their advice for maintaining good oral hygiene  —> Take care of your metabolic health (read previous blog post on this ) —> make sure you are mostly breathing through your nose, especially when you sleep —> if sleep issues like snoring persist, consider further investigation for possible sleep apnea —> support gut health in general (read this post for more information) —> seek personalised holistic health support if symptoms persist If you would like more support in this area.... --> join our fireside discussion - a live group call at the end of every month (last saturday of the month at 12pm) with a registered practitioner to discuss topics highlighted in monthly newsletters and blogs. Subscribers to the newsletter get complimentary access to these live events. Subscribe via www.wellkind.co.nz . --> to begin a personalised 1:1 support journey schedule a complimentary vitality strategy call.

Malnourishment is something I see frequently in clinic. The two most common nutrition patterns I observe are: Overfed and undernourished (too many calories for energy demand plus a deficit in nutrients) Underfed and undernourished (too little calories for energy demand plus a deficit in nutrients) In fact, I do not think I have ever done a nutritional analysis with a client where there was not at least a few nutrient needs identified and likely contributing to their health concern. The underlying commonality is the same: undernourishment. One specific pattern stands out that I often see ---> In the pursuit of weight loss, many people become highly focused on calories in versus calories out. While thermodynamics cannot be argued, this narrow focus often overlooks an important factor: micronutrient sufficiency. Individuals are willing to sacrifice consistency of nutrient status for maintaining the 'deficit'. TRUTH - Micronutrient sufficiency is required for sustainability of health - and can even be argued for sustainabiliity of weight loss. This is why I never look at weight loss in isolation as a practitioner - I prioritise health...always. When the body is undernourished, health becomes compromised and compromised health is a major risk factor for chronic disease - including metabolic disease. Some may argue that weight loss alone improves metabolic markers. While weight loss can certainly contribute to metabolic improvements, research in pre-diabetes and diabetes shows that weight loss in isolation has less impact than addressing overall health holistically. In other words, improving nourishment and supporting metabolic health leads to better long-term outcomes. A wide range of micronutrients are required to support healthy metabolic function, including (but not limited to): B vitamins, Omega-3 fatty acids, Vitamin D, Chromium, Zinc, Taurine, iron, Magnesium. Nutrient deficiencies can also disrupt other physiological systems that influence metabolic health. For example, nutrient inadequacy can impair sleep quality , which in turn increases insulin resistance . It can increase stress hormones, which puts more pressure on a range of systems including the metabolic system. It can impact hormone balance, neurotransmitter synthesis, bone health, gut health, liver function....the list could go on. There is also the concept of sarcopenic metabolic dysfunction , where low muscle mass contributes to impaired metabolic health. Not getting enough protein impacts muscle synthesis and maintenance. This is why health needs to be viewed through a holistic lens . A calorie deficit alone may result in weight loss, but if health becomes compromised in the process, the long-term outcome is not necessarily better - and in many cases can be worse. Checking in on your micronutrient status can be valuable. Routine blood tests can assess several key nutrients, including: B12, Folate, Iron, Vitamin D. Other labs can also indicate possible deficiencies including a complete blood count, inflammatory markers like CRP/homocysteine. Another option is to track food intake for a short period using a credible nutrient analysis program. Cronometer is one tool I often recommend, as it provides detailed micronutrient tracking. Malnourishment compromises overall health and contributes to metabolic dysfunction. It is never worth the sacrifice. To learn more about how to support your metabolic health holistically, check out my previous blog on metabolic health. If you want more personalised support with your health: --> As a subscriber to Wellkind's newsletter, you are invited to a monthly Fireside Chat live online. --> Schedule a 1:1 vitality strategy call to talk about your personalised health needs with a registered practitioner.