Your health during the menopause – making it a positive experience

The menopause is a natural part of ageing that typically affects women between the ages of 45 and 55, and is triggered as a woman’s oestrogen levels begin to decline. In the UK, the average age for a woman affected by the menopause is 51. However, it has been known for women to experience it before they reach 40 years of age. Figures suggest that 1 in 100 women suffer from this early menopause which is also known as premature menopause or premature ovarian insufficiency.

The menopause can be a controversial subject, particularly with regard to hormone replacement therapy. Last month a large scale study reported that HRT does not shorten lifespan and that the benefits of HRT outweighed the risks. The Women’s Health Initiative trial, found that HRT was not associated with risk of all cause, cardiovascular, or cancer mortality in postmenopausal women during an 18 year follow-up of 27,000 women(1).

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The WHI trial began in 1991, and initial findings were that women using HRT were more likely to develop breast cancer. This was also supported by the findings of The Million Women Study, a collaborative project between Cancer Research UK and the NHS, which analysed data from more than 1 million women(2).
The most recent findings from the WHI, although positive in some respects, are perhaps controversial in that the results primarily focus on mortality only. The safety of taking artificial hormones and the potential increased risk for cancer is still likely to be a concern for women regardless of whether it may or may not lead to an early death.
The menopause affects every woman, and for many this natural stage in life can become a time of physical and emotional discomfort. The most common symptoms include hot flashes, night sweats, insomnia, anxiety, mood swings and weight gain, which are in part caused by the diminishing levels of oestrogen.
Longer-term concerns can include osteoporosis, cancer, dementia and heart disease. The average age for a woman to reach the menopause is 51 years (NHS) and with an ageing population, it is predicted that the number of post-menopausal women will increase to over 1 billion by 2025(3).

Menopause transition
Perimenopause or ‘menopause transition’ is the time when the ovaries will start to decrease the amount of oestrogen they produce and physiological changes first become noticeable, usually beginning on average 3-4 years before the menopause. During menopause, the ovaries no longer release eggs and oestrogen production slows drastically.

Menopause occurs when there has been a permanent cessation of menstruation for 12 months. The majority of menopausal symptoms usually improve within 5 years of the final menstruation. It is estimated that around 80% of women will experience symptoms and for 10% of women, symptoms can last for up to 12 years(4). A survey conducted on behalf of the British Menopause Society revealed that half of women in the UK go through the menopause without ever consulting their doctor. This is despite women reporting on average seven different symptoms and 42% saying their symptoms were worse than expected(5).
Women have a hard decision to make therefore with regard to the menopause, and for many the risks of HRT may still outweigh the benefits. Whichever decision women choose to make, the menopause can become less overwhelming if we gain an understanding of the hormonal changes that occur during this time, their effect on the body, and what we can do to support the body to adapt to these changes – by doing so we can help to make the menopause a positive experience rather than one to fear!

Diet
Consuming a nutrient dense diet as well as optimising the intake of specific nutrients can offer significant help in maintaining a healthy menopause and make a real difference to how you feel.

Phyto-oestrogens
Foods rich in plant phyto-oestrogens are believed to help maintain hormonal balance. Phyto-oestrogens are oestrogenic plant compounds that resemble the chemical structure of human oestrogen molecules. They are abundant in pulses, seeds, beans and soya, and can bind with oestrogen receptor sites, which act to mimic oestrogen in the body. The mild oestrogenic effect can help to reduce menopausal symptoms. A meta-analysis of clinical trials concluded that phytoestrogen supplementation was associated with modest reductions in the frequency of hot flashes and vaginal dryness(6).

Populations that consume predominantly plant-based diets generally experience lower rates of menopausal symptoms. For instance, Asian cultures have historically experienced less symptoms due to the traditional diet being rich in soy. It is important to note that traditional soy diets are made up of fermented soy, eaten regularly and in small quantities. The bacteria found in fermented soy foods help to nurture and support the digestive flora, which enhances digestion and the absorption of nutrients. Fermentation also decreases the anti-nutrient content and lowers phytates, which inhibit the absorption of minerals. Another benefit of eating fermented soy is for its vitamin K2 content which is important for bone health, particularly during the menopause

Asian cultures typically consume around 2 teaspoons per day of fermented soy. Western populations generally consume unfermented soy products on a much larger scale, which is not recommended. Good sources of fermented soy include miso, natto and tempeh whilst Western diets often include unfermented tofu, soy protein isolates, soy milk, soy flour and numerous convenience foods that contain soy derivatives. Unfermented soy may contain large amounts of anti-nutrients that can act as endocrine disruptors and enzyme inhibitors.
Adrenal Glands
There is a link between an increased severity of menopausal symptoms and women who experience high levels of stress. The adrenal glands produce stress hormones including cortisol and adrenaline, which helps the body to deal with stress. They will also take over some of the work of the diminishing ovaries by continuing to produce oestrogen after the menopause. The adrenal glands however, will always favour the production of the stress hormones over the production of oestrogen (survival rather than fertility). If menopausal women are overly stressed, the adrenals can become worn out and oestrogen production will drop as the adrenals find it difficult to meet demands.
Stress can be a key factor in causing hot flushes and night sweats through the release of adrenaline. Adrenaline causes increased heart rate and vasodilation leading to a rise in temperature. A hot flush is your body’s reaction to an increase in temperature, which it attempts to cool down by sweating etc. Optimum adrenal function is therefore important and hence support for the adrenal glands:

Reduce/Avoid Stimulants – Reducing or avoiding stimulants such as caffeine can be beneficial. Caffeine increases the production of cortisol and adrenaline and therefore can affect oestrogen levels. It can also affect your sleep cycle, which puts further pressure on the adrenals. Fatigue and insomnia are common menopausal symptoms. It can take several hours to metabolise caffeine, so limiting intake to the morning is recommended to prevent it impacting on sleep. A study published by the journal Menopause, found an association between caffeine intake and hot flashes and night sweats in postmenopausal women(7). Caffeine is found in tea and coffee, chocolate, fizzy drinks, sports drinks, and even some pain killers so being mindful of this may be beneficial.
Balance blood sugar – Adrenal gland function is considerably influenced by blood sugar levels. A high sugar diet can cause the body considerable stress. Eating excess sugars and starches will cause blood sugar to rise quickly, triggering insulin to deal with the high amount of glucose in the bloodstream. Blood sugar then crashes after the spike in insulin, which the adrenals respond to by releasing cortisol to bring blood sugar back up. This process over time will exhaust the adrenals.

Balancing blood sugar levels will prevent insulin levels from spiking and reduce the burden on the adrenal glands. Opt for a diet rich in fresh vegetables, nuts, seeds and oily fish and reduce your intake of refined and processed foods, chocolate, sweets, cakes, and biscuits.

Nutrients and Herbs that can help to Support Adrenal Gland Function

Vitamin C – In the body, the highest concentration of vitamin C resides in the adrenal glands and is used here for the production of the adrenal hormones, including cortisol. Stress increases the demand for vitamin C and chronic stress can rapidly deplete levels, so it is important to ensure there are plenty of vitamin C rich foods in the diet, such as leafy green vegetables and citrus fruits to help support oestrogen production.

Magnesium – Another necessary nutrient for addressing stress. Stress can deplete magnesium and when levels are low symptoms can occur such as lack of energy, sleep disturbances, anxiety and depression. Magnesium is a catalyst for over 200 metabolic reactions in the body, so symptoms are wide-reaching when levels are depleted. With a large percentage of the population likely to be deficient, including magnesium-rich foods during menopause such as nuts, seeds, beans and green leafy vegetables can boost levels and help relieve symptoms.
B vitamins – Help to support the functioning of the adrenal glands, provide energy and regulate mood swings.

Studies have shown that pantothenic acid in particular, can boost adrenal hormone production. Vitamin B1 and B6 have been shown to be beneficial in reducing hot flushes and mood swings. B3 and folate are needed for the production of oestrogen. Good sources include wholegrains, nuts, seeds and dark green leafy vegetables.
Adaptogenic Herbs – Ashwagandha, is an adaptogenic herb used traditionally in Ayurvedic medicine and has demonstrated great results for lowering cortisol and balancing hormones in small trials. Ashwagandha can therefore help to mediate the stress response and promote balance. Results of an RCT concluded that ashwagandha root extract safely and effectively improves an individual’s resistance towards stress(8).

Menopause and Osteoporosis
Oestrogen helps to prevent deterioration of bone tissue and maintains bone density. The long-term effects of low oestrogen levels can therefore increase the risk for postmenopausal osteoporosis. It is estimated that women lose on average 10% of bone mass within 5 years of the menopause. It is important therefore to maintain a healthy bone density with correct nutrition before, during and after the menopause. Healthy bones need specific nutrients, and without these the cycle of bone formation and bone resorption is disturbed, resulting in alterations in bone mass, distribution of bone etc.
Including plenty of food sources of vitamins D, K, C, magnesium and calcium will help to support the integrity of the bone.

Phosphorus – An essential nutrient for the regulation of calcium and strong bones. Consuming too much phosphorous however can contribute to the loss of minerals such as calcium and magnesium from the bone. A typical Western diet can be high in phosphorus as it is found in meats, processed foods, dairy, fizzy drinks, grains and chocolate. The bioavailability of phosphorus in these foods is very high. Eating whole natural unprocessed foods can help as they don’t contribute as much to the accumulation of phosphorus in the body.

Sodium – Consuming foods high in sodium can cause the body to lose calcium, so aim to eliminate processed and convenience foods from the diet as these often contain high amounts of salt. Soups, sauces, condiments and canned foods are usually high in salt also.

Stress – As discussed above, high levels of stress and poor sleep raise cortisol levels in the body and this too has been associated with bone loss. Without adequate sleep, rest and repair, the body will not be able to up keep up the bone building process. High cortisol levels disrupt the formation of osteoblasts and considerably decrease bone density, resulting in more bone tissue being broken down than deposited.

Exercise
A recent study found that women who are sedentary are 28% more likely to have severe menopausal symptoms than active women(9). Women with depleted adrenal function however, may find cardiovascular intensive exercise will further diminish adrenal reserves. Gentle exercise is favourable and useful for relieving stress and anxiety and weight-bearing exercises can help to strengthen bones and improve density. Yoga is very relaxing which can help with common symptoms such as anxiety and depression – the breathing exercises can also help reduce hot flushes and mood swings. Meditation is another good way to calm your mind and address anxiety. Oestrogen helps lift our mood so, when levels drop, we may feel more depressed. Getting outdoors in the fresh air and connecting with your surroundings and nature has been shown to boost mood and relieve anxiety. Being physically active is associated with a lower risk of depression and cognitive decline.

Sleep
Sleep is fundamental for health and regeneration and the healthy production and balance of hormones. During the menopause declining levels of oestrogen and progesterone can be unsettling and may contribute to insomnia, night sweats and other sleep issues. Adults aged 18 to 64 need to sleep for 7 – 9 hours a night.
Meditation/Mindfulness. Research has shown that mindfulness training reduced the distress associated with hot flashes and improved physical, psychosocial and sexual functioning. Improved sleep was an important outcome of the study(10)
An RCT concluded that yoga may be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia(11)

Key Takeaways
Consuming a nutrient dense diet as well as optimising the intake of specific nutrients can offer significant help in maintaining a healthy menopause and make a real difference to how your patients feel
Foods rich in plant phyto-oestrogens are believed to help maintain hormonal balance. The mild oestrogenic effect can help to reduce menopausal symptoms
Optimum adrenal function is important and hence support for the adrenal glands. Reduce/avoid stimulants, balance blood sugar and include nutrients and herbs to support adrenal function such as vitamin C, magnesium, B vitamins and adaptogenic herbs
The long-term effects of low oestrogen levels can increase the risk for postmenopausal osteoporosis. Maintain a healthy bone density with correct nutrition before, during and after the menopause. Including plenty of food sources of vitamins D and K2, and C, magnesium and calcium to help to support the integrity of the bone. Be mindful of too much phosphorus, sodium and stress which have negative effects on bone density
Women who are sedentary are more likely to have severe menopausal symptoms. Being physically active is associated with a lower risk of depression and other menopausal symptoms

Sleep is fundamental for health and regeneration and the healthy production and balance of hormones. Be consistent with sleep and wake times, avoid stimulants such as caffeine and exposure to blue light emitted by electronics prior to bed. Meditation, mindfulness and yoga have been shown to help address menopausal symptoms.

clare@cytoplan.co.uk, Clare Daley and the Cytoplan Editorial Team