WHAT IS MENOPAUSE?
Spontaneous menopause (or natural menopause) means the end of female reproduction and is the stage in life when a woman stops having menstrual periods. It is prompted as oestrogen, progesterone and testosterone levels start to decline and a diagnosis is confirmed retrospectively after 12 consecutive months of the absence of menstruation. Menopause typically occurs between the ages of 45 to 55 although for the majority of women, menopause is more frequent around the age of 51.
Vasomotor symptoms (such as hot flushes and night sweats) are the most telltale signs associated with menopause. These episodes accompanied by profuse sweating occur predominantly around the head, neck, chest, and upper back. They can last for about 30 seconds and up to 10 minutes. This rush of heat could lead to heart palpitations and dizziness. Some women may experience vasomotor and other symptoms even before the onset of menstrual irregularity and transition into menopause.
UNDERSTANDING MENOPAUSE
Did you know that women who smoke reach menopause earlier than those who do not smoke? Does this matter? Very much so because women who go through menopause at a later age appear to have significantly better health outcomes than those who experience early menopause? This is attributed to having longer protective benefits of oestrogen, progesterone, and testosterone levels that decline significantly after menopause.
Chemical messengers called hormones dictate how your body functions. These hormones travel throughout the body coordinating complex processes and influencing the function of other body systems. The ovaries are the glands that secrete reproductive hormones such as oestrogen, progesterone and testosterone in women. During the years leading up to menopause (i.e. perimenopause or menopause transition), fluctuating and declining levels of these hormones produced by the ovaries signal changes in your body. As this occurs, menopause symptoms can present themselves.
Oestrogen is the primary female hormone which promotes the growth and health of the female reproductive organs. It is also responsible for regulation of skeletal homeostasis, lipid and carbohydrate metabolism, electrolyte balance, elasticity of the skin through collagen production, the cardiovascular system and the central nervous system.
Progesterone helps regulate your menstrual cycle, sustains pregnancy and helps to regulate breast health.
Testosterone (aka the “male” hormone) is vital to women’s sexual health. This hormone maintains oestrogen production in female, promotes libido and maintains muscle mass and bone density.
In perimenopause, menopause and, more particularly in the postmeopausal years, the reduction in reproductive hormones together with the biochemical effects of ageing, are likely to present an environment that increases the propensity for health problems to arise.
Healthy lifestyle changes and keeping the body balanced will reduce the risk of some of the conditions associated with menopause. Every woman’s risk is different.
ABOUT PERIMENOPAUSE
What many people call menopause is in fact perimenopause and is the time leading up to menopause. Perimenopause is the preceding phase when your body begins to transition into menopause which is why it is also called menopause transition. This stage is marked by both fluctuating and declining levels of oestrogen in the ovaries, with profound reproductive and hormonal changes. It is at this stage that your menstrual cycle may lengthen or shorten and physiological changes first become noticeable. During this transitional phase, women can experience menopausal symptoms which could have a significant impact on their quality of life and physical health.
As the woman progresses closer to menopause, the body will produce less and less oestrogen. This transitional phase can last anywhere between a few months and up to 5 years and sometimes even longer. It is still possible for a woman to get pregnant during this phase even with the sharp drop in oestrogen levels.
On average about 55% of women will experience hot flushes in the perimenopausal phase. Poor sleep also appears to be a common symptom at this stage. Depressive mood and anxiety intensifies as women approach the later stages of the menopausal transition.
HOW LONG DO SYMPTOMS LAST?
Around 85% of women will experience menopause symptoms although the intensity, regularity, duration and health risks vary considerably among women. Perimenopausal symptoms predominantly will last for up to 5.2 years although some women can continue to experience symptoms for a further 5 years after menopause. For a small percentage of women, menopause symptoms can persist beyond that. The main symptoms associated with perimenopause/menopause are outlined in the diagram below.
WHAT IS POSTMENOPAUSE?
Postmenopause is the stage after menopause. This is the rest of a woman’s life after going through menopause. During this stage, your hormones will not fluctuate to the same extent as in perimenopause and many of the symptoms experienced before menopause tend to ease. The experience of menopause however is different for every woman. A small number of women will continue to experience hormone fluctuations following menopause and symptoms can continue for some time after the menopause transition.
Menopause appears to be a marker not only for reproductive ageing but also for general health and biological ageing. There are numerous changes that happen in the body during menopause and the sharp decline in oestrogen, progesterone and testosterone mean that women in their postmenopause years are at increased risk of a number of health issues.
POSTMENOPAUSE – MAIN RISKS
- OSTEOPOROSIS – When oestrogen levels decrease after menopause your bones become weak and are more prone to fractures and breaking. As such, postmenopausal women have a higher risk of developing osteoporosis. Most women do not know that they have osteoporosis and often the first time they find out is when they have a fracture. Women who experience early menopause lose the protective effect of oestrogen earlier and when hormone levels drop, so does bone density. Also, if you have a family history of osteoporosis your risk increases. Smokers, heavy drinkers, those with gastric issues (such as Crohn’s disease, colitis, or had weight loss surgery) may be more susceptible to osteoporosis. This is because you may not be absorbing calcium and vitamin D as well.
- MOOD – Testosterone is one of several androgens (male sex hormones) produced in the ovaries in much smaller amounts. These hormones contribute to proper ovarian function, sexual behaviour and bone strength. Reduced testosterone production in postmenopausal women can lead to low libido, reduced bone strength as well as poor concentration and depression.
- METABOLIC SYNDROME – Postmenopausal women are at increased risk for the development of the metabolic syndrome including decreased energy and development of increased visceral fat, increased weight gain, and increases in triglycerides and cholesterol levels. With the increasing incidence of obesity there is a concurrent increase in the prevalence of type 2 diabetes.
- INSOMNIA – Hormones are also important for regulating sleep. Low progesterone levels lead to insomnia, restlessness and anxiety.
- BLOOD FLOW – Oestrogen is involved in the relaxation and expansion of blood vessels and helps to accommodate blood flow. Decreased levels of oestrogen result in stiffer blood vessels, endothelial dysfunction, inflammation, and immune dysfunction. These processes are linked to cardiovascular disease, diabetes, and hypertension.
- LIVER DAMAGE – The reduction in oestrogen levels as well as the biochemical effects of ageing increases the propensity for damage within the liver. Lower oestrogen levels affect enzymes in the liver that help break down alcohol compounds and metabolise them in the body. Low amounts of these enzymes mean that you cannot convert your usual amounts of alcohol through the normal pathways in the liver. So the more you drink, the harder your liver is working. On top of this, if you are trying to lose weight and your liver is busy processing the sugars from the alcohol that you consume, it will not be able to burn up fat stored in fat cells when you exercise.
- LIVER DISEASE – Growing oestrogen deficiency impedes mitochondria/cell function, immune responses to injury; and causes other imbalances in the body. The accumulated effect of these increases the likelihood for the development of significant liver pathology, including nonalcoholic fatty liver disease (NAFLD), the accelerated progression of fibrosis in liver diseases and other liver problems.
WHAT IS PRE-MENOPAUSE?
The terms pre-menopause and perimenopause are sometimes used interchangeably. These, however, have very different meanings. “Pre” as in pre-menopause is when the woman is still in her reproductive years and so will not have any symptoms associated with perimenopause or menopause. She still has menstrual periods (whether regular or irregular). Perimenopause, on the other hand, refers to the transitional time leading up to menopause where typical menopausal symptoms are experienced.
WHAT IS PREMATURE MENOPAUSE?
If a women enters menopause before the age of 40 this is considered ‘premature’. Only about 2% of women will experience premature menopause and this signifies that the woman can no longer get pregnant. The cause for this can be natural or it can be associated with surgery, chemotherapy, radiation or disease related. Women with premature menopause can go through perimenopause and may experience the same symptoms as women with ‘typical’ natural menopause. The main difference however, is that premature menopausal women appear to be at greater risk of osteoporosis and heart disease because of the earlier drop in oestrogen levels and the lack of protective effect of this hormone.
WHAT IS EARLY MENOPAUSE
If a woman enters menopause before the age of 45 this is considered ‘early’ menopause and about 5% of women will experience early menopause.
WHAT IS PRIMARY OVARIAN INSUFFICIENCY?
Primary ovarian insufficiency (POI) is when the ovaries stop functioning normally before a woman reaches age 40. With POI, the ovaries do not produce the typical amounts of oestrogen or release eggs regularly. This results in the woman not having menstrual periods for some time or even not at all and could result in infertility. Unlike premature menopause, however, women with POI can have irregular or the occasional period and during these times, might even get pregnant. Usually the first symptom associate with POI is irregular or missed periods.
Symptoms of POI (similar to menopause) include:
- Hot flushes
- Night sweats
- Mood changes
- Palpitations
- Poor concentration
- Decreased sex drive
- Dyspareunia (painful intercourse)
- Vaginal dryness
- Longer term risk of cardiovascular disease
- Longer term risk of osteoporosis
- Other complications
WHAT IS SURGICAL MENOPAUSE?
Surgical or induced menopause refers to the permanent cessation of menstruation brought about when the ovaries are surgically removed (oophorectomy), either with or without removing the uterus (hysterectomy). This causes an immediate and total loss of ovarian function accompanied by an abrupt and more severe onset of menopausal symptoms, with accompanying hormonal changes. Women with induced menopause appear to have more severe symptoms compared with those who have spontaneous/natural menopause. Symptoms related to surgical menopause include:
- Rapid onset of hot flushes
- Vulvovaginal atrophy
- Mood changes
- Sleep disturbance
- Headaches
- Joint pain
- Dyspaneuria (painful intercourse)
- Sexual problems
- Other complications
Surgical menopause may be done for any of the following reasons:
- Endometriosis
- Ovarian torsion (the ovary becomes twisted)
- An abscess in a fallopian tube or ovary
- Benign ovarian tumors or cysts
- Reduce ovarian or breast cancer risk
- Ovarian Cancer
RELIEF AND TREATMENT
It is never too late to start adopting a healthy lifestyle. Some women go through menopause without experiencing any of the associated symptoms. For others, however, symptoms can range from disruptive to debilitating. Fortunately, there are treatment options that can help to keep your symptoms under control. Exercise and dietary advice designed for younger people may not be right for you given the many changes your body is going through during menopause. Symptom management and weight loss demands a different approach in the face of declining oestrogen, progesterone and testosterone levels. Some women opt for Hormone Replacement Therapy (HTR). Others prefer to follow a more natural approach and some opt for a combination of both.
VITAMIN AND MINERAL DEFICIENCIES
Menopause demands a lot from your body and this can cause vitamin and mineral deficiencies. Most people fail to realise that deficiencies in vitamins and minerals can be associated with a range of health related issues as well as damage to DNA.
There are enzymes in the brain for example that require minerals to actually create serotonin and form melatonin. These enzymes depend on minerals like magnesium, calcium, zinc, and others which most people are deficient in.
The decline in oestrogen levels during menopause can affect the amount of calcium in your bones which can result in osteoporosis (a bone disease that causes weak, brittle bones that are prone to fracture and breakage). This increases your need for this mineral. Other symptoms of calcium deficiency include osteomalacia (softening of the bones), bone pain, muscle weakness, brittle nails and tooth decay.
Menopause is a risk factor for oxidative stress. Vitamins A, C and E are known for their antioxidant properties which help neutralize oxidative stress in the body.
Magnesium deficiency can cause a whole range of symptoms for menopausal women including weakness, tiredness, joint pain and arthritis, itching, insomnia, irregular heartbeat/palpitations, nervousness and more.
Low levels of zinc can cause hair loss, poor wound healing, loss of taste and smell, etc.
There are so many brands of vitamin and minerals on the market which come from different sources and knowing which ones are right for you is key to helping you feel better.
A well balanced diet will provide the nutrition that you need but you may still be lacking in certain vitamins and minerals. There are also specific hormone balancing herbs that help to balance the hormones naturally.
TIPS FOR MENOPAUSE MANAGEMENT
Diet and Blood Sugar Levels – After menopause, changes in hormone levels can cause fluctuations in blood sugar levels. This is because the lack of oestrogen causes the body to use blood sugar and starch less efficiently which can result in weight gain. If this gets out of control, your risk of developing diabetes increases. Avoid sweets, refined carbohydrates, processed foods, and eating large meals as these can spike blood sugar levels.
Water – Your body now holds less water and this can lead to dry ageing skin, dry eyes, brain fog, fatigue, headaches and other symptoms. Increasing your water intake will help with this. You also need essential fatty acids to help you hold on to the water you are drinking.
Caffeine – Caffeine is associated with more bothersome vasomotor symptoms in menopausal woman. Caffeine is found in tea, coffee, chocolate, sodas, sports drinks, and some over-the-counter medication.
Stress Reduction – Techniques like mindfulness, breath-work practices, meditation, Qi Gong, Tai Chi and yoga can be helpful in relieving symptoms of fatigue and insomnia.
Alcohol – With age, a woman’s body becomes more sensitive to the effects of alcohol which affects sleep and lead to more bothersome vasomotor symptoms.
Salt– Reduce your daily intake of salt – aim for less than 6g of salt per day (less than 1 teaspoon). Consider switching to Himalayan salt which contains less sodium per serving than table salt and also contains traces of essential minerals.
Exercise – During menopause metabolism slows making it more difficult to maintain or lose weight. Regular exercise can help with weight gain issues, improve mood and reduces the risk of osteoporosis. Also, women who live a more sedentary lifestyle are more likely to have severe menopausal symptoms than active women. Weight bearing exercise slows the loss of bone mass and can help to improve bone density.
Insomnia – Sleep plays such an important role in your overall health. If you suffer from insomnia you should not ignore this. Relaxing activities right before bed, such as gentle yoga or meditation can be helpful. Talk to your health care professional if this continues to be an issue for you.
Smoking – Cigarette smoking has been linked to early menopause, shorter reproductive years and also increased risk of osteoporosis.
Mental Stimulation – Concentration and memory problems can be associated with menopause. Mentally stimulating activities and cutting down on passive activities can help rejuvenate your memory.
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