Tipping the balance- Drop in oestrogen and the connection with increased inflammation

The hormone oestrogen is anti-inflammatory (reducing inflammation in the body) and as women transition through the menopause we start to notice a decline in oestrogen. This can have an impact on our immune and inflammatory processes increasing the risk of osteoporosis, cardiovascular diseases, vasomotor disturbances and cognitive deterioration.

Other hormones, for example- progesterone can affect our physical and psychological conditions and changes to lipid (fat) structure, this leads to increased abdominal fat in postmenopausal women (Tan et al, 2023), additional body fat also increases inflammation.

Did you know there are two types of inflammation known as acute and chronic. Acute (short term) inflammation can be when we get a cut and it swells for a short period of time and then goes down within a few hours or days, it is part of the natural healing process. If we get chronic (long period) inflammation this can persist for months or years which can damage healthy cells, tissues and organs and can lead to diseases such as autoimmune, cardiovascular (heart disease), lung (Asthma), metabolic, neurodegenerative (Alzheimer’s) as well as gastrointestinal disorders, mental illnesses and some cancers.

In post-menopausal women due to the oestrogen decline is why we see an increase in inflammatory responses, which can be the route cause to infections, joint pain and a higher rate of autoimmune conditions. The deficiency of ovarian steroidal hormones creates a pro-inflammatory state within the body, meaning an increase in inflammation, particularly higher levels of circulating proinflammatory cytokines, interleukins (IL)-1, IL- 6, or tumour necrosis factor (TNF-α) (Cioffi et al, 2002).

This decline in oestrogen can be challenging during perimenopause to regulate inflammation. While the hormonal changes are inevitable there are many nutrition and lifestyle adjustments that women can do.

It is important to work on the five pillars which can reduce inflammation:

• Diet

• Stress and sleep management

• Mindset

• Physical activity, exercise and movement

• Lifestyle including supplement support

Diet

We can make dietary changes to help reduce inflammation such as the Mediterranean or the DASH diet. It is important to note that there are other components of a holistic approach, including regular physical activity, exercise, socialisation, and plenty of down time (rest).

It is also worth mentioning foods that are proinflammatory (increase inflammation) which typically consists of processed meats, high omega-6, saturated fats, refined sugars, artificial sweeteners and too much animal fats. An example of this diet is the Western diet we have in the UK, combined with overeating and frequent snacking. The Western diet tends to lack vital nutrients (vitamin and minerals) and contain food additives and preservatives like emulsifiers and sweeteners which all contribute to overall chronic inflammation. Emulsifiers found in fat-based foods can also affect the gut barrier and innate immune system (Cordain et al,2005).

When consuming high amounts of refined grains and sugar in the diet it raises the glucose load within our blood stream, this increases insulin production, a proinflammatory hormone. With this increasing over time can increase our risk of developing metabolic syndrome (Cordain et al, 2005). Proinflammatory diets are high in sodium (salt) and low in potassium which contribute to the development and progression of diseases such as high blood pressure, stroke, kidney stones and some cancers. They also increase the acid load leading to conditions such as acid reflux and heart burn (Scheiber & Mank, 2023).

Stress and sleep

 Stress comes from psychological, environmental, or physiological processes affecting our sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. When we are stressed hormones such as dopamine, epinephrine (adrenaline) and norepinephrine (Noradrenaline) elevate to increase blood pressure and heart rate to help us with “fight or flight” to protect our body from survival and recovery.

The issues are if stress is raised for a prolonged period (chronic), can lead to increased risk of physical and psychiatric disorders, known as stress related diseases. In fact, stress is a common risk factor for 75%- 90% of diseases (Liu, Wang & Jiang, 2017); with the most common being cardiovascular disease including high blood pressure and atherosclerosis (high cholesterol), metabolic diseases (type 2 diabetes and non-alcoholic fatty liver disease), psychotic and neurodegenerative disorders (depression, Alzheimer’s and Parkinson’s disease) and cancer (Cohen et al, 2007). It is important to note that daily stressors can accumulate and build up over time, a bit like a bucket of water filling up unless you turn the tap off! To turn the tap off or to slow down the speed of the water (stress) building up it is important to work on nutrition, lifestyle and mindset this will also help to improve sleep. To find out more about how to improve sleep click here Here are just a few things we can do to support ourselves.

Mindset

It is important to stay within the right mindset to be able to make informed choices, not focusing on mindset can have a negative impact on our overall long-term health.

Daily positive experiences are associated with lower levels of inflammation, CRP and IL-6 levels (Sin et al, 2015).

To support our mindset there is strong evidence that meditation combined with physical activity and social support can be supportive to reducing inflammation and pain. The important thing is to do something that you love and enjoy, it will be different for everyone. Here are just a few ideas to support positivity:

• Daily journaling

• Affirmations

• Taking up a new hobby

• Speaking to friends and family

• Meditation

• Deep breathing

  
  

**Headspace or Calm are Apps you can follow daily for support with meditation and deep breathing if you find it difficult to do on your own, it does take practice to get into a daily habit.

Physical activity and exercise

Inactivity can lead to visceral fat accumulation which in turn increases chronic inflammation, fatigue and muscle wasting (Burini et al, 2020). I am not talking about high intensity exercise here, moderate or even exercises such as Pilates can positively affect antioxidative markers in high blood pressure as well as musculoskeletal conditions significantly reducing back, osteoporosis and knee pain (Denham-Jones et al, 2022). Therefore, moderate to light exercise that requires movement is beneficial to support pain management by reducing pro-inflammatory cytokines in menopausal women (Tan et al, 2023). To Find out more how Pilates can help you Click here.

Supplements

There are benefits to taking certain supplements to support inflammation. They can significantly reduce stiffness and decrease inflammation markers.

Supplements vary on dose and duration depending on the pain you are trying to support. For example, studies on ginger significantly reduce pain scores in people who suffered with osteoarthritis but the length of time taking this supplement varied depending on the strength of the dose (Mathieu et al, 2022). Some supplements would not be recommended for long term use and nutrition, and lifestyle changes are important as the first line of support for long term quality of life.

PLEASE NOTE: It is important to make sure you are guided by a registered nutritional therapy practitioner or qualified health care professional to check for any contraindications of any medications you may be taking as well as the dose and frequency based on the symptoms you are trying to support.

If you don’t know where to start and are suffering with overwhelm then why not book a free 30-minute support call or sign up to my FREE Wellness Tribe Newsletter where you will get evidenced based nutrition and lifestyle information straight to your inbox, by signing up today.

References:

• Burini, R., Anderson, E., Durstine, L. and Carson, J (2020) ‘Inflammation, physical activity, and chronic disease: An evolutionary perspective’, Sports Medicine and Health Science, 2 (2020), pp. 1-6. doi: 10.1016/j.smhs.2020.03.004

• Cioffi, M., Esposito, K., Vietri, M., Gazzerro, P., D’Auria, A., Ardovino, I., Puca, G. and Molinari, A (2002) ‘Cytokine pattern in postmenopause’, Maturitas, 41 (3), pp.187-192. doi: 10.1016/s0378-5122(01)00286-9

• Cohen, S., Janciki-Deverts, D. and Miller, G (2007) ‘Psychological stress and disease’, JAMA, 298, pp. 1685- 1687. doi: 10.1001/jama.298.14.1685

• Cordain, L., Eaton, S., Sebastian, A., Lindeberg, S., Watkins, B., O’Keefe, J. and Bran-Miller, J (2005) ‘Origins and evolution of the Western diet: health implications for the 21st century’, American Journal of Clinical Nutrition, 81 (2), pp.341- 354. doi: 10.1093/ajcn.81.2.341

• Denham-Jones, L., Gaskell, Y., Spence, N. and Pigott, T (2022) ‘A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions’, Musculoskeletal Care, 20 (1), pp. 10-30. doi: 10.1002/msc.1563.

• Liu, Y., Wang, Y. and Jiang, C (2017) ‘Inflammation: The common pathway of stress-related diseases’, Frontiers in Human Neuroscience, 11 (316), pp.1-11. doi: 10.3389/fnhum.2017.00316

• McCathy. M and Raval, A (2020) “The Perimenopause in a woman’s life: a systematic inflammatory phase that enables later neurodegenerative disease”, Journal of Neuroinflammation, 17 (317), pp. 1-14. doi: 10.1186/s12974-020-01998-9

• Scheiber, A. and Mank, V (2023) Anti-inflammatory Diets. Available at: https://www.ncbi.nlm.nih.gov/books/NBK597377/ (Accessed: 3 March 2025)

• Sin, M., Granham-England. And Almeida, D (2015) ‘Daily positive events and inflammation: Findings from the National Study of daily experiences’, Brain Behaviour immunity, 0, pp.130-138. doi: 10.1016/j.bbi.2014.07.015

• Tan, L., Yan, W., Yang, W., Kamionka, A., Lipowski, M., Zhao, Z. and Zhao, G (2023) ‘Effect of exercise on inflammation markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis’, Experimental Gerontology, 183 (2023), pp. 1-10. doi: 10.1016/j.exger.2023.112310