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Life after Menopause

How to maintain and improve health

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When it comes to menopause, Sara McKinley, 55, never looks back. “It’s the most liberating thing,” she says. After “years of painful, heavy, and irregular periods, and the stress about having to stock up on extra pads just in case,” McKinley is happy to move on, even if the trade-off includes hot flashes/flushes.

No two stories are alike, and menopausal symptoms range from mild to debilitating, yet there is a common denominator to all menopause journeys: the increased risk of certain medical conditions such as cardiovascular disease, type 2 diabetes, osteoporosis, and dementia that follow.

 

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A guide to the menopause journey

The average age for Canadian women to reach menopause is 51, after going through perimenopause, when around 70 to 80 percent of women experience vasomotor symptoms (hot flashes/flushes and night sweats), sleep disturbance, irregular periods, anxiety, and vaginal dryness.

Menopause, a blip in time, marks 12 months since the last period, and is followed by postmenopause, when symptoms may ease, but the risk of osteoporosis, type 2 diabetes, cardiovascular disease, and dementia goes up.

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There’s no one hormone to rule them all

Throughout life, and particularly around puberty and menopause, the brain and ovaries are engaged in a complex dialogue including the menstrual cycle. This involves many other hormones, including progesterone, testosterone, luteinizing hormone, and follicle-stimulating hormone. Their fluctuation also influences the plethora of menopausal symptoms.

Estrogen holds a special place though, as there are estrogen receptors found in many organs, resulting in many, and often overpowering, symptoms when levels drop.

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Cardiovascular health—in menopause and beyond

Cardiovascular disease is the leading cause of death for women globally, and the risk increases as women reach menopause and beyond. Estrogen has a protective effect on the blood vessels, hence there’s an increased risk of atherosclerosis when levels start declining.

Lower levels of estrogen lead to an increase in blood pressure, compared to men in the same age group. An increase in LDL (“bad”) cholesterol during menopause, along with other changes in blood lipids, can further contribute to an increased risk of cardiovascular disease.

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Metabolic health matters

If you’re transitioning through menopause and have been noticing hunger and satiety signals going haywire, you’re not alone (or wrong). Hormonal fluctuations, estrogen in particular, can do that. Also, in midlife, women often have children and parents to care for, jobs and possibly divorce to worry about, and less time for exercise and self-care, which can all affect eating habits.

These life-stage challenges can increase stress (and comfort eating), which can result in weight gain, particularly around the middle (thank dropping hormones and aging for this). Insulin resistance also increases after menopause, which increases the risk of type 2 diabetes and metabolic syndrome.

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Bone health and menopause

Our bones are constantly being broken down (at a cellular level) and then built up, reaching peak mineral density around age 30. Women have a lower peak bone density and experience a sharper decline as they go through menopause.

Age-associated bone mass and density loss (known as osteopenia) can further progress into osteoporosis as estrogen levels plummet. By the time we reach age 80, half of women may have osteoporosis, making them vulnerable to fractures, particularly in the hip, spine, and wrists. Genetics play a big role in bone density, but nutrition, smoking (or not), medication, and exercise matter too.

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Brain health and menopause

Many women experience “brain fog” during the menopause transition, but that’s not an indication of loss of cognitive function and/or memory, and luckily, these symptoms subside in postmenopause. However, as estrogen and progesterone are no longer able to exercise their neuroprotective role after menopause, the risk of neurodegenerative conditions such as dementia, especially Alzheimer’s disease, increases. Entering menopause transition early can also be a risk factor.

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Lifestyle things you can do more of

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Exercise

Resistance exercise can particularly increase bone density in postmenopausal women. Exercise also preserves and boosts muscle mass and strength, and combined with cardiovascular exercise, it can improve metabolic health and decrease chronic disease risk by promoting fat loss and better weight management.

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Get tested

Talk to your family doctor about getting regular blood tests to check lipid and glucose levels and measuring blood pressure. Ask about a bone density scan, particularly if there is a family history of osteoporosis, or you had an early start on menopause transition.

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Prioritize sleep and stress management

Even small increments can help mitigate menopause symptoms such as anxiety and low mood and help with appetite control and weight management, which has a positive effect on cardiovascular and metabolic health.

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Engage your brain

Social interactions, hobbies, and learning new things can help maintain brain health (and mood).

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Eat and drink for better postmenopausal health

Eat balanced meals including adequate protein (this helps both muscle and bone tissue) and lean toward fibre-rich whole foods, healthy fats such as olive oil, and of course, carbohydrates—mostly complex but fit in the occasional dessert. Get enough calcium via greens (also great for brain health), dairy products, and dairy alternatives up to 1,200 mg daily.

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Limit alcohol and stop smoking

Alcohol can worsen vasomotor symptoms and sleep quality, and it increases the risk of osteoporosis and breast cancer. Smoking is a big no—it increases the risk of osteoporosis and cardiovascular disease.

Menopause is an inescapable part of life, but succumbing to chronic diseases associated with it doesn’t have to be. Moreover, one change can have a compounded positive impact and also encourage us to do more. It’s the best kind of self-love.

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Estrogen fluctuation field guide

Too much estrogen (present in perimenopause and before) can lead to bloating, breast tenderness, and heavy bleeding.

Low levels (also present in perimenopause and beyond) may result in hot flashes/flushes and night sweats, heart palpitations and anxiety, vaginal dryness, bone loss, mood swings, sleep disturbances, and headaches.

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Menopause stats

·         Over 80 percent of women report hot flashes/flushes and night sweats during perimenopause.

·         Up to 70 percent of women in postmenopause experience various symptoms related to the genitourinary syndrome of menopause, including vaginal dryness and pain during sex.

·         There is a three-fold increased risk of depression in perimenopause, compared to during pre- and postmenopause.

 

This article was originally published in the May 2024 issue of alive magazine.

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