Niki Bezzant: Understanding menopause

We sat down with Niki Bezzant, a leading voice in menopause education and author of ‘This Changes Everything: The Honest Guide to Menopause and Perimenopause’. Niki’s work promotes greater understanding, empathy and empowerment, encouraging women to embrace this significant life transition rather than shying away from it.

It is important to remember, that menopause is normal and there is support available. In this article, we share a helpful guide to menopause and expert insights from Niki.

Menopause, technically speaking, is the point in time where it has been a year since a woman’s last period. It is a natural phase that marks the end of the menstrual cycle and fertility. Menopause is characterised by a decline in the production of oestrogen and progesterone, and typically occurs between the ages of 42 and 56, with the average age in New Zealand being 51.5 years. 

Perimenopause is the transitional phase leading up to menopause, typically beginning in a woman’s 40s. During this stage, the ovaries gradually produce less oestrogen, causing changes in the menstrual cycle, which is often accompanied by common and normal symptoms including hot flushes, sleep disturbances and mood swings. Perimenopause can last between two and 10 years, when the ovaries cease to release eggs¹.

The symptoms of menopause differ from person to person, and are influenced by biological and social factors, such as genetics, diet, lifestyle, and physical and mental health.

While there are varying symptoms, the most common include:

• Irregular periods
• Hot flushes
• Night sweats
• Mood swings
• Brain fog or short-term memory problems
• Disturbed sleep patterns
• Headaches and migraines
• Joint pain
• Fatigue 
• Anxiety or irritability
• Concentration issues 
• Joint pain 
• Lower libido or sex drive 
• Vaginal dryness

Wondering if you or a loved one might be experiencing menopause? Niki says confirming menopause relies on personal observation rather than a medical test. Symptoms, which can range from changes in menstrual cycles to physical and emotional changes, coupled with age, provide a strong indication of entering the perimenopause stage. Although, it is important to note that these symptoms can vary greatly in individuals. If you think you might be going through menopause, consider visiting a doctor or healthcare professional for advice and support.

Managing menopause symptoms requires a combination of healthy lifestyle changes and medical treatment options. It involves understanding and addressing the physical and emotional changes associated with this transitional phase in a woman’s life.

According to Niki, it is important for women to look after themselves during this time. During the perimenopause phase, women are often juggling careers, family responsibilities and aging parents, with “hormonal turbulence.”

To best support themselves, Niki recommends prioritising self-care by incorporating healthy habits like regular exercise, a nourishing diet, quality sleep and stress management techniques. This is in addition to considering medical treatments, like Menopausal Hormone Therapy (MHT), also known as Hormonal Replacement Therapy (HRT).

MHT involves the use of hormone therapy – in the form of tablets, patches or cream – to supplement the oestrogen your ovaries cease to produce pre and post menopause. It has the potential to alleviate some menopausal symptoms, significantly enhancing the quality of life for certain individuals².

According to Niki, while there are many natural remedies marketed towards women, few have substantial evidence backing their effectiveness, with most studies indicating MHT is most effective. However, Niki says, if women find remedies that they feel help, are affordable for them, and don’t cause negative side effects, they should continue using these.

The mental health impact of menopause can be significant, with changes in the brain affecting mood and exacerbating other symptoms like sleep issues and hot flushes. Women may experience a recurrence of previous mental health challenges or new issues, often feeling alone in their struggles. Menopause can also affect cognition, which Niki describes as the brain “rewiring, like a computer updating its operating system”.

Niki says it is essential to remember that these experiences are common, and various measures, including MHT, antidepressants, therapy or personalised treatment can provide support. It is important to speak to your doctor for individual advice.

Post menopause is a unique experience for each woman, similar to menopause itself, with some continuing to experience symptoms like hot flushes. However, Niki outlines that the primary concern in post-menopause is the increased risk of various health conditions due to the loss of oestrogen’s protective effects, such as heart disease, osteoporosis and Alzheimer’s. 

Maintaining good health practices and proactive management of these risks is crucial for supporting brain, heart, bone and gut health in the post-menopausal phase. On a positive note, Niki reports many post-menopausal women report feeling great, with renewed energy, self-knowledge, and a sense of rejuvenation. This is due to hormones stabilising at lower levels, eliminating the turbulence of perimenopause, and this stability persists for the rest of a woman’s life.

Niki has been invited to numerous workplaces to initiate and encourage open dialogue about menopause. She says workplaces can support their employees through menopause by initiating open conversations about the subject and providing education to all staff members. 

Implementing a menopause policy that includes practical adjustments like room temperature control, flexible uniform policies, and easy access to bathrooms, as well as high-level support such as flexible working hours, menopause leave, and mental health support, can be incredibly beneficial. 

It is important that this level of understanding and empathy is encouraged across the entire organisation, not just among women. Managing symptoms of menopause at work can be difficult. If you feel comfortable, it is important to talk to your workplace about the support available and possible work adjustments.

AIA NZ was proud to launch its Menopause Toolkit for employees in 2022. The Toolkit helps those looking to understand and support employees going through menopause.

Diet and exercise play a pivotal role in managing menopause symptoms. A balanced diet and regular physical activity not only help in maintaining overall health, but also aid in managing the hormonal changes and associated symptoms that occur during this phase. 

We asked Niki how women can best prepare for menopause, while in the early perimenopausal stage. Niki outlines that preparing for menopause involves adopting healthy habits, which could include incorporating strength training exercises into your routine to protect bone health and maintain muscle mass as oestrogen levels drop. Additionally, adopting a whole food diet, minimising processed foods and alcohol consumption, can promote overall wellbeing in this transitional phase. 

Niki states: “Alcohol is terrible for everything in perimenopause – from affecting sleeping patterns, altering body composition, adding to mood swings and triggering hot flushes – there is nothing good about it in perimenopause."

Niki stresses the importance of partner and family support by demonstrating empathy and understanding that menopause is a natural, albeit sometimes challenging, transition. Offering support, validating experiences, and acknowledging that the symptoms are hormone-driven, not personal, can alleviate relationship strain. 

Many families experience a “hormone storm” with both menopause and teenage hormone changes in the household at one time. High-level of support is crucial in these families, creating an environment of mutual acknowledgement and support.

Niki recommends a mix of resources for women going through the menopause transition. Niki is the author of ‘This Changes Everything,’ the must-have guide to perimenopause and menopause for every woman. This is a really good place for women to start, as Niki shares the latest specialist research and advice, along with personal stories from real women, answering the most important questions women have about menopause. 

The Australasian Menopause Society (AMS) has a useful website monitored by doctors and health care professionals, with special interest in women’s health in midlife and menopause. Whether you are looking for information on perimenopause, MRT/HRT or alternatives, or how to locate a doctor specialising in women’s health, the AMS provides accurate, evidence-based information to the wider Australasian community. 

Niki also recommends the use of apps like ‘Balance’ which allows you to track your symptoms and access personalised expert content.

Regular exercise can also be very helpful. For some, this might involve going to the gym or working with a personal trainer who understands the affect menopause has both on the body and overall fitness. For other’s wanting to exercise in their own space and time, there are numerous online fitness apps that can offer strength training for home and the gym, HIIT workouts, yoga, and age-appropriate mobility, balance, agility and core workouts. Having access to trainers and services who understand this life stage is crucial for a more comfortable and effective fitness journey. 

Niki’s ultimate goal is for menopause to be normalised and discussed consistently beyond Menopause Awareness Month. Menopause, often misunderstood and not spoken about for generations, should be part of regular conversation, eliminating any discomfort around it. 

Understanding menopause is essential for everyone, regardless of gender or age, as it is a normal life stage for half of the world’s population. Its impact extends beyond the individual experiencing it, and support from friends, family and others is essential.

According to Niki, menopause as an opportunity, or a transitional moment for women to reflect on how we want the next phase of our lives to unfold. Rather than focusing solely on the challenges and symptoms, it is a chance to reset and envision how we want to feel and live for the rest of our lives.

• This Changes Everything: the honest guide to menopause and perimenopause by Niki Bezzant
• Australasian Menopause Society (AMS): Fact Sheets and Infographics or Find an AMS doctor
• NZ Early Menopause Support Group
• Healthline – 0800 611 116