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    Menopause

    Transitioning through menopause happens for most people with ovaries between the ages of 49 and 52 and marks the end of a the production of hormones such as estrogen and progesterone 1. Throughout reproductive life the ovaries are responsible for monthly hormone production and ovulation and as people age, and ovarian function declines, egg production eventually stops, marking the transition into menopause2. The true definition of menopause is the cessation of the menstrual period for at least 12 months. The perimenopause period leading up to menopause is often where most symptoms occur, with the true menopause transition bringing new health changes to address2.

    People with ovaries spend a third of their lives in menopause1,  and benefit from a proactive health approach that focuses on prevention and wellness. All people with ovaries transition through menopause – it’s the natural course of life! The loss of estrogen and progesterone production can be supported with positive health and lifestyle changes to help support people in feeling their best during this time in life.

    As hormone production declines, people may experience day to day symptoms such as hot flashes, vaginal dryness, insomnia, and changes to mood1. Many of these symptoms will resolve with time and may have been experienced in the perimenopause period prior to the last menstrual bleed. Menopause brings additional health changes including changes to bone mass3 and cardiovascular risk4, which are influenced by the loss of estrogen. Estrogen exerts a protective effect on bone, encouraging bone formation and the maintenance of bone mass. 3As estrogen levels decline, bone begins to resorb and decreases in strength3. The sharp increase in osteoporosis risk after menopause is due to these bone changes from the loss of estrogen.3 Estrogen also protects people with ovaries against cardiovascular disease in the premenopause phase of life.3As estrogen levels decline, cholesterol levels rise and overall cardiovascular risk rises4. Often people are unaware of the bone and cardiovascular risks associated with menopause. Each of these health changes require a proactive health approach.

    Body and Health Changes That Happen During Menopause

    • Hot flashes and night sweats
    • Changes to mood
    • Difficulty staying asleep
    • Increased cholesterol levels
    • Changes to bone mineral density
    • Vaginal dryness, urinary incontinence and genitourinary syndrome of menopause
    • Joint pain and reduced muscle mass
    • Body composition changes and weight gain

    Getting Checked Out

    Lab testing in menopause can help guide patients and practitioners in supporting symptoms and promoting overall health and wellness. In addition to hormone lab testing, patients benefit from baseline cholesterol tests, vitamin D and bone mineral density testing1. Patients may also notice subtle changes to blood sugar levels and liver function as they transition into menopause1. During this period of life patients are encouraged to have their regular physical exam and any screening tests such as mammograms or colonoscopies that they are eligible for. The focus on screening and assessment during this time points to the dramatic impact that hormone changes have on the body.

     Test Perimenopause Menopause
    FSH (Follicle Stimulating Hormone) May be normal, may be slightly elevated Very elevated
    LH (Luteinizing Hormone) May be normal, may be slightly elevated Very elevated
    Estrogen Often elevated in the early stages of perimenopause. May be low during the menstrual cycle Low
    Progesterone May be low during anovulatory cycles. May be normal if an egg happens to be released Low

     

    Hormone tests will look different in menopause compared to the decade before the last period. In menopause FSH and LH levels rise as the body tries to ovulate2. Estrogen levels and progesterone levels fall to menopausal levels and are often undetectable in the blood. This signifies the transition into menopause as there are no longer any follicles in the ovary2.

    Supporting Yourself Through Menopause

    Although menopause is not something that people can prevent, the changes that occur can be lessened through supporting nutrition, exercise, mindset and through interventions such as hormone therapy and nutrients.

    Nutrition for Menopause

    Nutrition changes in menopause can support both the increased risk of health changes after menopause as well as the symptoms experienced during this phase of life.

    Weight management and body changes during this phase of life are complicated and often require a detailed look at the impact of how people are feeling on appetite and food choices. Estrogen is partly responsible for supporting a person’s shape and appetite prior to menopause, causing weight gain in the hip and buttock area through reproductive life and an ebb and flow in appetite through the 28 days of the menstrual cycle5. After menopause, the decline in estrogen can change both appetite and where a person gains body weight6. Appetite and weight management during this time are challenging because people are often not sleeping, are struggling with mood and have changes to metabolism2. Nutrition for menopause should focus on improving satiety (meaning how full people feel after a meal) and supporting an adequate number of calories to achieve a person’s goals7.

    The secondary goal of nutrition in menopause should be to support bone health and future cardiovascular risk. This can be achieved in most people though focusing on a Mediterranean diet pattern of eating8 as well as focusing on protein adequacy. Protein supports both bone and muscle maintenance during the menopausal years, when typically bone and muscle mass decline. The Mediterranean diet focus on complex carbohydrates, healthy fats from olive oil and nuts and an abundance of fruits and vegetables. Focusing on this pattern, and decreasing saturated fats, have been shown in large scale research studies to reduce the risk of cardiovascular disease in people in menopause9.

    Some patients may derive a benefit from phytoestrogen containing foods on symptoms of menopause such as hot flashes10. Not all people can convert the phytoestrogens from soy in their digestive system to equol, the active ingredient required for reducing symptoms11. Including soy products in the diet have positive impact on cholesterol and are a healthy source of plant based protein12.

    Lifestyle and Menopause

    A person’s lifestyle including their mental health and mindset as well as exercise can influence the way people feel day to day, as well as the long-term risks associated with low hormone levels. Cognitive behavioural therapy13, mindfulness14,15 and practices that improve self compassion and gratitude16 have all been shown to reduce the symptoms of menopause.

    Exercise can be any form of movement including aerobic exercise or strength training. Most research suggests that the choice of exercise in menopause is less important than the consistency and commitment to daily movement. People in menopause who intentionally exercise may see reductions in their blood pressure17

    Nutrients and Botanicals for Menopause

    Nutrients such as calcium and vitamin D are essential nutrients during the phase of menopause to prevent changes to bone health18. The North American Menopause Society’s position on the treatment of osteoporosis suggests that people in menopause achieve a daily intake of calcium of 1200 mg18. This amount should include both calcium from diet as well as supplements19. Some people who eat sufficient calcium may not require additional calcium to meet this level18. Vitamin D deficiency can affect bone mineral density. It is suggested that people in menopause have their vitamin D levels tested and have deficiencies treated with their health professional20.

    Botanical medicine may play a role in supporting people in menopause through the reduction of symptoms that are often experienced during this phase of life. Sage has been shown to reduce the frequency and duration of hot flashes21,22. Sage may also reduce joint pain and sleep in people in menopause23. Black Cohosh has also been studied extensively for menopause symptoms and may reduce hot flashes24. Tribulus is a herb traditionally used to support libido and sexual function in patients in menopause25,26.

    Menosmart+ is a combination of research backed herbs used to reduce the symptoms of menopause like hot flashes and night sweats and to ease nervous tension.27It’s formulated specifically for women who are experiencing mild to moderate symptoms associated with menopause.  Imagine taking back control of your hormonal health, and celebrating the woman you are now and forever!


    References

    1. Koothirezhi, R. & Ranganathan, S. Postmenopausal Syndrome. in StatPearls (StatPearls Publishing, 2021).
    2. Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
    3. Keen, M. U. & Reddivari, A. K. R. Osteoporosis In Females. in StatPearls (StatPearls Publishing, 2022).
    4. El Khoudary, S. R. et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation 142, e506–e532 (2020).
    5. Hildebrandt, B. A. et al. The effects of ovarian hormones and emotional eating on changes in weight preoccupation across the menstrual cycle. Int J Eat Disord 48, 477–486 (2015).
    6. Greendale, G. A. et al. Changes in body composition and weight during the menopause transition. JCI Insight 4,.
    7. Westenhoefer, J., von Falck, B., Stellfeldt, A. & Fintelmann, S. Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study. Int J Obes Relat Metab Disord 28, 334–335 (2004).
    8. Barrea, L. et al. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists. Crit Rev Food Sci Nutr 61, 1201–1211 (2021).
    9. Prentice, R. L. et al. Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. J. Nutr. 149, 1565–1574 (2019).
    10. Daily, J. W. et al. Equol Decreases Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food 22, 127–139 (2019).
    11. Mayo, B., Vázquez, L. & Flórez, A. B. Equol: A Bacterial Metabolite from The Daidzein Isoflavone and Its Presumed Beneficial Health Effects. Nutrients 11, 2231 (2019).
    12. Moradi, M., Daneshzad, E. & Azadbakht, L. The effects of isolated soy protein, isolated soy isoflavones and soy protein containing isoflavones on serum lipids in postmenopausal women: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 60, 3414–3428 (2020).
    13. Guthrie, K. A. et al. Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep 41, (2018).
    14. Sood, R. et al. Association of mindfulness and stress with menopausal symptoms in midlife women. Climacteric 22, 377–382 (2019).
    15. Garcia, M. C., Kozasa, E. H., Tufik, S., Mello, L. E. A. M. & Hachul, H. The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study. Menopause 25, 992–1003 (2018).
    16. Brown, L., Bryant, C., Brown, V., Bei, B. & Judd, F. Investigating how menopausal factors and self-compassion shape well-being: An exploratory path analysis. Maturitas 81, 293–299 (2015).
    17. Xi, H. et al. Effect of combined aerobic and resistance exercise on blood pressure in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Exp Gerontol 155, 111560 (2021).
    18. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society - PubMed. https://pubmed.ncbi.nlm.nih.gov/34448749/.
    19. E Hassan, N. et al. Dietary Pattern and Bone Health in Pre and Post-menopausal Obese Women. Pak J Biol Sci 23, 602–611 (2020).
    20. Pludowski, P. et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol 175, 125–135 (2018).
    21. Bommer, S., Klein, P. & Suter, A. First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv Ther 28, 490–500 (2011).
    22. Rahte, S. et al. Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles. Planta Med. 79, 753–760 (2013).
    23. Zeidabadi, A. et al. The effect of Salvia officinalis extract on symptoms of flushing, night sweat, sleep disorders, and score of forgetfulness in postmenopausal women. J Family Med Prim Care 9, 1086–1092 (2020).
    24. Castelo-Branco, C. et al. Black cohosh efficacy and safety for menopausal symptoms. The Spanish Menopause Society statement. Gynecol Endocrinol 1–6 (2022) doi:10.1080/09513590.2022.2056591.
    25. Tadayon, M., Shojaee, M., Afshari, P., Moghimipour, E. & Haghighizadeh, M. H. The effect of hydro-alcohol extract of Tribulus terrestris on sexual satisfaction in postmenopause women: A double-blind randomized placebo-controlled trial. J Family Med Prim Care 7, 888–892 (2018).
    26. de Souza, K. Z. D., Vale, F. B. C. & Geber, S. Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial. Menopause 23, 1252–1256 (2016).
    27. Dadfar, F. & Bamdad, K. The effect of Saliva officinalis extract on the menopausal symptoms in postmenopausal women: An RCT. Int J Reprod Biomed (Yazd) 17, (2019).
    28. Angelou, K., Grigoriadis, T., Diakosavvas, M., Zacharakis, D. & Athanasiou, S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus 12, e7586 (2020).
    29. Vale, F. B. C., Zanolla Dias de Souza, K., Rezende, C. R. & Geber, S. Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded, placebo-controlled trial. Gynecol. Endocrinol. 34, 442–445 (2018).
    30. Proserpio, P. et al. Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric 23, 539–549 (2020).
    31. Lee, J., Han, Y., Cho, H. H. & Kim, M.-R. Sleep Disorders and Menopause. J Menopausal Med 25, 83–87 (2019).
    32. Treister-Goltzman, Y. & Peleg, R. Melatonin and the health of menopausal women: A systematic review. J Pineal Res e12743 (2021) doi:10.1111/jpi.12743.

     

      Getting Checked Out

      Lab testing in menopause can help guide patients and practitioners in supporting symptoms and promoting overall health and wellness. In addition to hormone lab testing, patients benefit from baseline cholesterol tests, vitamin D and bone mineral density testing1. Patients may also notice subtle changes to blood sugar levels and liver function as they transition into menopause1. During this period of life patients are encouraged to have their regular physical exam and any screening tests such as mammograms or colonoscopies that they are eligible for. The focus on screening and assessment during this time points to the dramatic impact that hormone changes have on the body.

       Test Perimenopause Menopause
      FSH (Follicle Stimulating Hormone) May be normal, may be slightly elevated Very elevated
      LH (Luteinizing Hormone) May be normal, may be slightly elevated Very elevated
      Estrogen Often elevated in the early stages of perimenopause. May be low during the menstrual cycle Low
      Progesterone May be low during anovulatory cycles. May be normal if an egg happens to be released Low

       

      Hormone tests will look different in menopause compared to the decade before the last period. In menopause FSH and LH levels rise as the body tries to ovulate2. Estrogen levels and progesterone levels fall to menopausal levels and are often undetectable in the blood. This signifies the transition into menopause as there are no longer any follicles in the ovary2.

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