Thriving During and After Menopause

The perimenopause, menopause, and postmenopausal life stages arise with a variety of health concerns – primarily associated with diminished levels of sex hormones, including estrogen, progesterone, and testosterone. Although the acute signs and symptoms associated with menopause, including hot flashes, night sweats, irritability, brain fog, insomnia, mood swings . . .  and the list goes on, can be very uncomfortable and even debilitating, the increased risks for chronic health conditions is often overlooked because they are less evident – quieter.

It’s hard to ignore sweat dripping down your forehead, while increased blood pressure might go unnoticed. This blog is intended to shine some light on these less evident but potentially serious health risks following menopause.

This article discusses four areas of your health and wellness to be extra mindful of during menopause.

1. Bone health

The health of your bones is probably the first long-term health concern that comes to mind when you think of menopause. Both osteopenia (characterized by low bone mineral density [BMD] that is not extreme enough to be called osteoporosis) and early-to-middle stages of osteoporosis are silent diseases because they have no outward symptoms. Thus, getting a bone density test can determine if you have signs of osteopenia or osteoporosis. Although testing is recommended for all women older than age 65, if you have an increased risk for diminished bone density, then it should be done earlier. Some factors that can increase your risk are:

Early menopause from a hysterectomy, breast cancer treatment, or other reason

• An inactive lifestyle

• Heavy use of alcohol, tobacco, caffeine, sugar, or carbonated beverages

• Chronic health condition, such as diabetes, malabsorption, celiac disease, or hyperthyroidism

• Being small-boned and consistently below normal weight for someone your size

• Long-term use of certain prescription medications, such as steroids or anticonvulsants

• A deficiency of certain key nutrients, including vitamins D and K and the minerals calcium and magnesium

• A family history of osteoporosis

In addition to monitoring your bone health, there are things you can do to support the health of your bones as you age.

Dietary factors. Although you could find a rationale for nearly every vitamin or mineral playing a role in bone health, the four stars are vitamins D and K and the minerals magnesium and calcium. And don’t forget protein – half of your bone volume is made up of protein. Support your bone health with these foods:

• Green leafy vegetables like kale, Bok choy, broccoli, and cabbage are sources of calcium, magnesium, and vitamin K1.

• If you aren’t a vegan or milk intolerant, then dairy products like milk, cheese, and yogurt are good sources of protein, calcium, vitamin K2, and vitamin D (most U.S. milk and all Canadian milk is fortified with vitamin D).

• Fish, such as sardines with small, edible bones, are good sources of calcium; oily fish, especially wild-caught salmon, are good sources of vitamin D and omega-3 fatty acids (also important for bone health); and all fish provide good sources of protein.

• Soy products are sources of calcium, magnesium, vitamin K2 (fermented soy), and protein.

• Almonds and sesame seeds/sesame butter are good sources of calcium and magnesium.

• Beans and other legumes are good sources of calcium, magnesium, and protein.

• Avocadoes provide a good source of magnesium.

• And finally – dark chocolate is high in magnesium.

• For added insurance, consider supplementing with bone-supportive nutrients (reach out and we can help you decide which ones would be most beneficial for you)

Exercise.  It’s well known that lack of exercise can contribute to bone loss – and loss of muscle mass too. There is no starker illustration of this than the case of astronauts on long space flights, where they can lose as much as 1-2 percent of their bone mineral density per month. And yes, while weightlessness certainly plays a part, your bones need to bear weight on Earth too – gravity isn’t enough. This is clearly illustrated by bone loss seen in bed-ridden or wheelchair-bound individuals. Weight-bearing exercises, key to improved bone health, are those that put mechanical stress on your bones, which in turn increases bone density. These include exercises like walking, jogging, dancing, hiking, playing sports like pickleball, stair climbing and more.

In addition, strength-training exercises increase muscle mass. Because muscles are connected to bone, when they contract, they put stress on the bone, increasing bone density too. In addition, muscle strength helps prevent falls and subsequent fractures, both far more likely as you age. Exercises in this category include lifting weights, weight machines, resistance bands, and exercises like squats and deadlifts.

2. Cardio/metabolic health

Another sad reality of menopause is an increased risk for various cardiovascular and metabolic issues. For example, estrogen is involved in fat metabolism in the liver. So, when estrogen level drops, blood fats, including total cholesterol, LDL cholesterol, and triglycerides, can go up. And unfortunately, HDL – the “good cholesterol” – tends to go down. Decreased hormone levels also contribute to weight gain and increased blood pressure.

Dietary factors. Entire books have been written about the optimal diet for cardiovascular health. Many of the same dietary factors that support healthy bones also support heart and metabolic health, the common denominators being a focus on veggies/fiber, fish, olive oil, and legumes.

Exercise. It’s likely no surprise to anyone reading this blog that exercise is essential for maintaining good cardiovascular health – it improves blood flow, reduces weight, improves sleep, decreases stress, and builds muscle mass to decrease blood sugar and improve insulin sensitivity.

Sleep. Sleep problems are common around menopause and can continue post menopause. But getting sufficient quality sleep each night is so important for maintenance of good cardiometabolic health, it should not be considered an afterthought. Poor sleep is linked to increased risk for high blood pressure and heart disease.

Tips for maintaining good sleep hygiene:

• Go to bed and get up about the same time each day, preferable early to bed and early to rise.

• Create a cool, dark sleep environment.

• Avoid exposure to light from blue screens (TV, smartphone, tablet, etc.) for an hour or two before bed.

• Avoid alcohol consumption too close to bedtime and try to restrict alcohol to a night or two a week.

• Do not go to bed on a full stomach, try to give your body 2-3 hours to digest after eating your last meal.

• Get natural light as early as you can in the day to set your circadian rhythm properly.

3. Brain health

Although it isn’t recognized as often as some of the other chronic effects of menopause, brain fog, accompanied by forgetfulness and poor concentration, is also a common occurrence during menopause and can sometimes continue after menopause. Because there are estrogen receptors scattered throughout the brain, a decline in estrogen can impact memory and other cognitive functions. 

In addition to direct effects of estrogen on cognitive function, the weight gain that often accompanies menopause can affect your brain too. You might think of fat accumulation and weight gain as issues that mostly affect your heart and blood vessels, or also maybe your joints. But fat cells increase inflammation throughout your body, and that in turn can affect your brain. The inflammatory chemicals circulating in your body can cross the blood-brain barrier and negatively impact your brain in numerous ways.

Diet. So, step one – focus on eating an anti-inflammatory diet. You guessed it, the Mediterranean style diet detailed above will benefit brain health too. Omega-3 fatty acids from fish oil are essential components of a brain health diet. They are found in high concentrations in the brain – especially DHA. Since easily metabolized omega-3 sources are limited to fatty fish, a DHA/EPA supplement is recommended (reach out and one of our nutrition experts can help you with this)

Exercise. Exercise is essential for strong bones and a healthy heart, but it’s also essential for brain health. In addition to increasing oxygen to your brain, exercise increases a substance called brain-derived neurotrophic factor (BDNF). BDNF is important for our brains because it has been shown to increase new nerve cells and strengthen nerve connections in the brain. And did you know regular exercise can decreases inflammation? The anti-inflammatory effect of regular exercise is partly associated with its effect on reducing body fat.

Sleep. Sleep is as or more important for brain health as it is for cardiovascular health. Believe it or not, your brain detoxifies when you are sleeping – a process that does not take place when you are awake. Poor sleep is related to poor memory, cognitive slowing, and even plaque buildup in the brain.

In addition to developing good sleep hygiene (discussed above), a nutritional supplement might provide some benefit. The level of melatonin, a hormone essential for restful sleep, tends to drop as a woman ages. In addition to supporting a good night’s sleep, melatonin also supports bone health.

Postmenopausal health prescription

As you can see, there is overlap across the major health concerns associated with menopause – both in terms of causes and potential solutions. To summarize:

• Consider an anti-inflammatory Mediterranean diet, with an added focus on bone-supportive foods and omega-3 fatty acids.

• Exercise – both weight bearing and strength training. Work up to 30 minutes of weight-bearing exercise five days a week and strength training a minimum of twice a week. And don’t forget the brain exercises. Reading a book, learning a new skill, playing word games – these can all help your brain stay healthy.

• Stress reduction – engage in stress-reduction techniques – meditation, mindfulness, yoga – whatever works for you.

• A good night’s sleep – engage in good sleep hygiene as described above and consider a nutritional supplement, such as melatonin or a combination of melatonin and supportive botanical extracts.

We are here to support you.  Reach out and we can help create your personalized health and wellness plan that will have you thriving well into your golden years.  Thank you for reading.