Healthy Aging

Managing Menopause

How diet, exercise, and nutrition can ease the menopausal transition

 “I’m still hot, it just comes in flashes.”

This slogan makes me smile. It means that we can approach menopause with confidence and with humor, especially with the help of friends! Studies have proven that supportive friends play a major role in helping women deal with the stressors associated with menopause.[1],[2]

It also helps to focus on the long game. By the time women experience this mid-life change, we still have a third or more of our lives ahead of us (and for some even half!).

Another term for menopause is “climacteric”, which refers to “a critical period or event”, which it very much is. It is a critical time for adopting healthy behaviors and preventive strategies so we can remain vital for the years ahead.[3]

Let’s look at some of the challenges of menopause, and how lifestyle changes can help.

The challenge of menopause

Menopause results in cessation of the ovarian cycle and its cyclical production of estrogens and progesterone, which are hormones that help protect against obesity and age-related diseases such as osteoporosis and cognitive decline.[4],[5],[6] About 80% of menopausal women experience hot flashes and/or night sweats as their hormone levels drop.[7] Hot flashes are a rapid and exaggerated heat dissipation response, consisting of sweating, peripheral vasodilation, and feelings of intense internal heat. Changes in mood (depression, anxiety) and in sleep patterns are also common in menopause and the time leading up to this, known as perimenopause.[8],[9]

Many peri- and post-menopausal women experience weight gain, which is frequently combined with a shift in body composition. Lean muscle mass declines, and body fat increases, especially in the abdominal area.[10],[11] Not surprisingly, weight gain has a negative effect on one’s quality of life. Over the short term, it can reduce one’s self-esteem, energy, and mood. Over the long term, weight gain can increase the risk of insulin resistance (metabolic syndrome) and heart disease.[12],[13]

Okay, so menopause is not a bed of roses. But here’s the good news: the proper exercise, diet, and nutrition can ease the menopausal transition.

Menopause is an opportunity for lifestyle change

A sedentary lifestyle exacerbates the symptoms of menopause. If we can boost physical activity and improve our diets, we may be able to alleviate these symptoms, and also decrease the risk of many age-related diseases.

Physical activity naturally tends to decline at midlife, as shown in a study of healthy women over the age of 43 who were nearing menopause.[14] Researchers followed the women for four years, during which time some women became postmenopausal. Over the four-year period, physical activity declined by more than 50%. Moreover, total energy expenditure declined by the equivalent of 200 calories per day, which is a very significant change. This suggests that, to avoid gaining weight after menopause, women would have to burn an extra 200 calories per day through exercise, or reduce their daily calorie intake accordingly.

Consistent with these results, a five-year controlled study known as the Women’s Healthy Lifestyle Project showed that the one factor most consistently related to weight gain is physical activity.[15],[16] “To avoid weight gain, women should make regular physical activity a priority,” said the authors.[16]

Physical activity can even lower the number and/or intensity of hot flashes.

Amazingly, physical activity can even lower the number and/or intensity of hot flashes. In one study, women experiencing hot flushes underwent measurements of physiological changes and hot flash frequency before and after 16 weeks of supervised exercise training (three times per week).[17] Women who participated in the program experienced lower core body temperatures, better dissipation of heat through the skin, and fewer hot flashes.

In two studies, women who exercised reported that they had fewer menopausal symptoms and they enjoyed life more.[8],[18] Physical activity improved their hot flushes and night sweats, as well as sleep quality, physical health, and psychological well-being.

A great way to exercise is to start walking with friends of a similar age. In one four-month study, walking was shown to be effective in reducing menopausal symptoms and depression.[19] The walking group met three times per week for 16 weeks. In each session, participants walked for 40 min at an intensity equivalent to 60% of heart rate reserve. All aspects of menopausal symptoms (psychological, physical, and satisfaction with life) were improved by walking.

In addition to its immediate benefits, regular exercise can help stave off a myriad of age-related conditions, including muscle loss (sarcopenia) and frailty,[20],[21], osteoporosis, [22],[23], metabolic syndrome,[24], atherosclerosis,[25], cognitive decline,[26], and heart failure,[27] along with diabetes, heart attack, stroke, breast cancer, and colorectal cancer.[28] In short, physical activity is one powerful tool!

The influence of diet

Individuals who consume more vegetables and fruit, and less meat and other animal foods, have less bothersome menopausal symptoms.

A study of adults aged 49 years and older found that those with the highest dietary fiber intakes had the greatest odds of aging healthfully, compared to those consuming low-fiber diets.[29] High-fiber, nutrient-dense diets, which emphasize fruits and vegetables, nuts, seeds, legumes and whole grains, can also accelerate weight loss in postmenopausal women.[30] Population surveys have shown that individuals who consume more vegetables and fruit, and less meat and other animal foods, have less bothersome menopausal symptoms.[31],[32]

Along these lines, studies have shown that adherence to a Mediterranean diet enables menopausal women to lose weight, reduce body fat, and maintain muscle mass.[30],[32] The Mediterranean diet is a healthy dietary pattern characterized by an adequate consumption of vegetables, fruits, whole grains, and legumes, with a reduction of saturated animal fats in favor of unsaturated vegetable fats, and a high intake of polyphenols and omega-3 polyunsaturated fatty acids (PUFAs).

Such diets, which provide high levels of fiber and phytonutrients, can facilitate weight loss and ameliorate hot flashes. In one nationwide survey, more than 48,000 post-menopausal women were randomly assigned to a dietary intervention (DI) or a control group for a year.[33] Women in the DI group were asked to adopt a low-fat dietary pattern emphasizing fruits and vegetables (five servings per day) and whole grains (six servings per day). The results showed that women in the DI group were significantly more likely to lose weight, and to eliminate hot flashes and night sweats, than in the control group.

It’s important to correct nutrient deficiencies

The decline in nutrient intake and absorption that accompanies aging can exacerbate menopausal disorders. A few of the nutrients associated with menopausal symptoms are discussed here:

Magnesium: Up to 80% of all adults are not achieving the recommended dietary allowance (RDA) for magnesium.[34],[35] Insufficient  magnesium may increase the risk of migraines, bone loss, muscle weakness, heart problems, and many other conditions.[36],[37],[38],[39] Studies of post-menopausal women suggest that those with lower magnesium levels are more vulnerable to depression.[39] Also, in a study of post-menopausal women who consumed a typical Western-type diet for several months, five out of 14 women developed heart rhythm changes (atrial fibrillation).[40] Magnesium supplementation may be advisable to correct deficiencies.[35],[37],[39],[40]

Vitamin D: Deficiencies of vitamin D are widespread in the U.S. and other countries.[41],[42] Vitamin D deficiency is associated with menopausal symptoms,[43] and with numerous acute and chronic illnesses.[41],[44],[45] In postmenopausal women, supplementation with vitamin D and calcium has been shown to reduce the risk of bone loss and hip fractures.[46],[47] Having low levels of vitamin D also negatively affects balance and increases the risk of falls.[48] In combination with regular walking, vitamin D supplementation was shown to significantly reduce depression, and to improve all aspects of cognitive functioning in older women.[49]

B vitamins: Low levels of B vitamins, including folic acid, vitamin B12, and vitamin B6, appear to increase the risk for age-related cognitive decline.[50],[51] In a study of older women and men with mild cognitive impairment, daily supplementation with B vitamins reduced the rate of brain atrophy by 53% over a two-year period.[52] Research also suggests that these B-vitamin-dependent effects can only be realized if there are adequate levels of omega-3 polyunsaturated fatty acids (PUFAs).[53]

Omega-3 fatty acids: Higher intakes of omega-3 PUFAs are associated with fewer menopausal symptoms.[54] In a randomized, double-blind, placebo-controlled trial, postmenopausal women who were supplemented with omega-3 PUFAs (1000 mg daily for 12 weeks) had fewer menopausal symptoms according to a menopause rating scale score.[55] Additional evidence suggests that omega-3 PUFAs may reduce the risk for depression.[56],[57]

Phytoestrogens: Although hormone replacement therapy (HRT) can ameliorate hot flashes, there are concerns about the risks of HRT over the long term. Many women instead seek relief from natural sources. Phytoestrogens, such as soy isoflavones and hop flavanones, are plant-based compounds that mimic estrogen in the body. These substances have mild estrogenic effects that may help compensate for the loss of natural estrogen during menopause.[58],[59],[60]

Soy isoflavones have been shown to reduce the incidence of hot flashes and improve quality of life in menopausal women.[61],[62] A systematic review of 68 studies concluded that the evidence favors the use of isoflavones, due to their health benefits and good safety profile.[63] A separate meta-analysis of 10 randomized, controlled trials, involving more than 1000 women, concluded that soy isoflavone consumption was associated with an improvement in cognitive function and visual memory.[64]

As an herbal supplement, extracts of Humulus lupulus L. (hops, which of course we know best for their use in beer) have long been used for the relief of menopausal discomforts. Hops contain 6-prenylnaringenin (6-PN), one of the most potent phytoestrogens found in nature.[65] Promising results have been obtained in placebo-controlled trials, showing that standardized hop extracts could reduce the frequency and/or intensity of hot flashes in menopausal women.[66],[67],[68],[69]

Although concern has been raised surrounding the intake of phytoestrogens in women with estrogen-sensitive breast cancers, because of their weaker binding to estrogen receptors and other effects, more recent research has shown they may even be protective.[70] Indeed, a 2020 systemic review and meta-analysis investigating the relationship between dietary phytoestrogen intake and survival from breast cancer found a significant inverse relationship between dietary isoflavone intake and cancer recurrence and overall mortality.[71]

 

In sum, making physical activity a priority – and adopting a nutrient-dense diet – can work wonders for your quality of life during menopause. It’s worth paying attention to vitamin and mineral intakes as deficiencies are all too common. Many women find that natural supplements, including phytoestrogens, can provide relief from short-term symptoms. Last but not least, friendships and humor can help us navigate through midlife… and beyond!

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