Episode 23 - Managing Menopause with Nicki WIlliams

5 Aug

Healthily | 08/5/21

Happily, the peri-menopause and menopause are now big news, and there has been a real shift in attitude towards talking about and supporting women through this life stage. Over the past 20 years or so, working in the health and nutrition industry, I’ve seen a significant increase in interest in the menopause. There are now many practitioners, including doctors, nutritionists, and life coaches, who are making it their business to work in this field.

I’ve always worked with a predominantly female client base, so supporting women as they transition through the peri-menopause and into menopause (and beyond) isn’t new to me. It’s for this reason I wanted to speak to Nicki Williams about this crucial time in a woman’s life, because I know so many people will enjoy taking a listen.

There is so much us women (and men!) need to understand about menopause, because it’s so much bigger than having hot flushes and becoming a bit forgetful. As I always say, knowledge is power, and this episode of Healthily is packed with education about the hormonal interplay that happens as we reach midlife, and what we need to know to stay fit and healthy through the second half of our lives.

In this episode, I talk to Nicki about all things hormones, from oestrogen and progesterone through to thyroid and insulin. We also cover the subject of HRT, as Nicki has plenty to say on this.

At my clinic, we offer testing support for women who are interested in understanding more about their hormone levels, and importantly, hormone metabolites, so this is also covered in the episode.

It was great to be able to capture this conversation with Nicki, who has so much to say and such a passion for helping women understand the options available to them. I hope you enjoy listening, and please do share with anyone you feel would benefit from this episode.

TAKEAWAYs

✔️ Perimenopause can start earlier than you think

Perimenopause can begin as early as the mid-30s, with symptoms often intensifying through the early to mid-40s. Many women experience changes long before menopause itself — yet remain undiagnosed or misunderstood.

Common symptoms extend far beyond hot flushes and may include:

Fatigue and inner exhaustion
Brain fog and poor concentration
Mood swings, anxiety, irritability
Weight gain around the middle
Sleep disruption
Changes to periods
Reduced resilience to stress

There are thought to be up to 48 recognised symptoms, many of which are still overlooked in conventional healthcare.

✔️ Hormones affect the whole body — not just reproduction

Hormones are chemical messengers that influence every system in the body, including:

Brain and mood
Energy and metabolism
Appetite and digestion
Immune health
Weight regulation
Bone, heart, and cognitive health

Nikki highlights that while there are over 100 hormones in the body, four play an outsized role during midlife.

✔️ The “Feisty Four” hormones

Nikki refers to the “Feisty Four” — the hormones that account for roughly 80% of hormone-related symptoms in midlife:

Cortisol (stress hormone)
Insulin (blood sugar regulation)
Thyroid hormones (metabolism and energy)
Estrogen (working closely with progesterone)

When one is out of balance, the others often follow. For example:

Chronic stress and raised cortisol can suppress thyroid function
Cortisol imbalance can worsen PMS, menopause symptoms, and libido
Declining estrogen and progesterone can alter insulin sensitivity and weight regulation

✔️ Stress — both external and internal — is a major driver

Stress isn’t only emotional or psychological. Internal stressors such as:

Blood sugar imbalances
Gut infections or inflammation
Poor sleep
Hormonal transitions themselves

can all raise cortisol and disrupt hormonal balance. Perimenopause alone is a biological stressor, even in women who feel their lives are otherwise “manageable”.

✔️ Weight gain in midlife is not a failure of willpower

Weight changes during perimenopause are often driven by:

Slower metabolism
Declining or fluctuating estrogen
Thyroid suppression
Chronic stress and adrenal strain

The body may also hold onto fat as a secondary source of estrogen when ovarian and adrenal production declines. In this context, intense exercise and calorie restriction can backfire by further raising cortisol.

✔️ Exercise should nourish — not punish

What worked in your 20s and 30s may not work in midlife. High-intensity exercise can be helpful for some, but exhausting for others.

Key message:

If exercise leaves you depleted rather than energised, your body is giving you important feedback.

Gentler, supportive movement such as:

Walking
Strength training
Yoga
Moderate cardio

can support metabolism, insulin sensitivity, testosterone levels, and stress regulation more effectively during this phase.

✔️ Estrogen & progesterone changes drive many symptoms

Progesterone declines first, as ovulation becomes less consistent
Estrogen fluctuates, often swinging between highs and lows

This combination explains why women can experience symptoms of both high and low estrogen at the same time, alongside anxiety, poor sleep, and heavy or irregular periods.

✔️ Post-menopause hormones still matter

Even after periods stop, hormones remain essential for long-term health. Low estrogen levels post-menopause are associated with increased risk of:

Osteoporosis
Heart disease
Cognitive decline and dementia

Hormones are not just about fertility — they are vital for bones, brain, heart, vaginal health, and quality of life.

✔️ Testing can provide clarity

Blood tests offer only a snapshot and often miss the complexity of hormone patterns. Nikki explains the value of 24-hour urine hormone testing, which can reveal:

Daily hormone rhythms
Estrogen–progesterone balance
Adrenal hormone patterns
How hormones are being metabolised and cleared

This allows for targeted, personalised support, rather than guesswork.

✔️ Body-identical HRT: informed choice matters

Modern body-identical (bio-identical) HRT uses hormones that are molecularly identical to those made by the body.

Key points discussed:

Delivered transdermally (gels, patches, sprays)
Generally better tolerated than older synthetic forms
Evidence to date suggests safety and potential protective effects
Best results come from low, individualised doses
Estrogen should always be balanced with progesterone

HRT supports sex hormones — but it doesn’t address cortisol, insulin, thyroid, or gut health, which also need attention.

✔️ The “Four Steps to Happy Hormones”

Nikki’s framework for sustainable hormone health:

Eat – a nourishing, blood-sugar-supportive diet
Rest – sleep, stress management, nervous system support
Cleanse – reduce endocrine disruptors
- Plastics, Pesticides, and Phthalates (synthetic fragrances)
Move – in ways that support, not stress, the body

Small, consistent changes are far more effective than drastic overhauls.

✔️ Support before overhaul

When women are exhausted and depleted, targeted supplements can help restore nutrient levels and energy first — creating the capacity for sustainable lifestyle change later.

Common areas of support discussed: