Menopause – not just symptoms and whether or not to take HRT!

Let’s take Emma, a baby girl born in the UK. At birth, her life expectancy is 83.1 years. If she gets to age 65, she can expect to live approximately a further 21 years, taking her to 86.1 Since the UK average age of menopause (when periods finally stop) is 51, this means that 40% of her life will be spent post-menopause, and potentially at risk of its negative consequences. Furthermore, if Emma experiences perimenopause (the period leading up to menopause, when symptoms begin and are often at their worst), or becomes menopausal, in her early 40’s, she will potentially be impacted for half of her life.

Not another article about Menopause!

Menopause seems to be everywhere in the news these days with much discussion about the effect of symptoms such as hot flushes, sweats, mood changes, and brain fog on women’s quality of life and work. While finding the right solutions to minimise these symptoms is important, it’s also crucial to understand the impact of menopause beyond just managing symptoms.

So why does Menopause matter?

Before menopause, women are protected from cardiovascular (heart disease), osteoporosis (bone thinning) and Alzheimer’s disease by estrogen, a hormone produced in the ovaries.  Cardiovascular disease, for example, is 2-5 times more common in men than in pre-menopausal women, but after menopause, as a result of declining estrogen production, this changes, and women are affected as commonly as men.  And what isn’t widely known, is that cardiovascular disease is the leading cause of death in women and causes twice as many deaths as breast cancer.

Loss of estrogen also results in muscle decline as well as alterations in body fat distribution (greater deposition around the abdomen [tummy area]), as well as an increased risk of other long-term conditions such as mental ill-health, sexual and bladder dysfunction, and skin and hair changes.

Can anything be done?

Research shows that estrogen-based hormone replacement therapy (HRT), when started within 10 years of menopause onset or before age 60, reduces the risk of heart disease, osteoporosis, Alzheimer’s disease and several other long-term health conditions, including type 2 diabetes, and is safe for the majority of women. But while HRT can play a major role in preventing long-term ill-health, other things also matter, such as the right diet, exercise, and attention to lifestyle.

What else can I do?

Research shows that a diverse diet (i.e. consisting of a wide range of different foods) of minimally processed, high-fibre, plant-based whole foods is important for the growth of healthy ‘good’ gut micro-organisms which have been shown to influence our moods, how we gain weight and control our blood sugar and how we metabolise food. This is particularly important in menopause.

Diets that are low in diversity and that contain lots of highly processed foods have been shown to favour the growth of micro-organisms linked to poor metabolic responses and long-term health. A plant-based diet doesn’t mean that you can’t eat meat, fish or dairy products, just that these shouldn’t be the main constituents of your diet.

What about exercise?

The right kind of exercise is important to maintain muscle and bone strength and reduce the risk of falls and fractures as you get older, as these may cause significant long-term complications.

During the menopause transition, and afterwards, aerobic exercises that focus on improving cardiovascular health, that increase the heart rate and make you breathless (but still able to speak!), such as fast walking, running, and riding a bike, for example, are important, but so is strength training – with weights or resistance bands, or yoga and Pilates.

And don’t neglect your mental health

Falling estrogen levels in menopause have an effect not only on our mood, but also on how our brains function. HRT has been shown to improve the brain fog, low mood, and anxiety associated with menopause for many women, but there’s also good evidence that cognitive behavioural therapy (CBT) and mindfulness also help reduce some menopausal symptoms and improve general well-being. Exercise has also been shown to be beneficial for mental health.

References:

• Life Expectancy – Office for National Statistics
• https://www.bhf.org.uk/informationsupport/conditions/heart-attack/women-and-heart-attacks

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