Menopause: The female nightmare
Menopause is the permanent termination of menstruation that occurs most often between 45 and 50 years of age, and lasts until around 55 years of age. A woman is considered post-menopausal when she has not menstruated for one full year. The wild hormonal changes that accompany menopause, namely a drop in estrogen levels, are responsible for most of the symptoms associated with this challenging life event. The most common of these are menstrual irregularities; hot flashes, flushes and sweats; stress; mood alterations including depression, irritability and anxiety; sleep disorders; leakage of urine; rapid heart beat; concentration and memory changes, and a reduced libido. Fortunately, the symptoms of menopause vary in severity and duration, and for some lucky women, are completely absent. It’s important to remember that menopause marks the beginning of a new stage of life, not the end of womanhood: keeping this in mind will make for an easier transition.
Along with the more obvious symptoms listed above, other more gradual changes in the body occur. During the pre-menopause years, high estrogen levels promote the storage of fat around the hips for reproductive purposes. Since menopause marks the end of reproductive function, a decrease in blood estrogen prompts the body to store more fat centrally around the stomach and less around the hips. Despite leaner legs, this shift in body fat places women at greater risk for heart disease and stroke. In addition, similar hormonal changes cause bone resorption (loss), increasing the risk of developing osteoporosis, a bone-thinning disorder that leads to fractures and disability.
The good news?
Early menopause may reduce a woman's risk of developing cancers of the endometrium and breast. The age at which menopause occurs is therefore a major factor in the lifetime risks of these diseases.
Heart disease is the leading cause of death in Canada. Prior to menopause, women have a lower risk of developing heart disease than men. However, with the onset of menopause, women’s heart disease risk equals that of men. Luckily, research has provided us with a pretty clear picture of its cause and how to prevent it. The following are tips from the Canadian Heart and Stroke Foundation for reducing the risk of heart disease.
- Identify your risk factors
- Quit smoking
- Eat healthy foods
- Get active
- Maintain a healthy blood pressure
- Maintain healthy blood sugar levels if you have diabetes
- Achieve and maintain a healthy body weight
- Identify stress factors and coping strategies
- Reduce alcohol intake
- Take medications exactly as prescribed
Key to this list is the importance of a healthy diet and adequate physical activity. Canadian Guidelines for Healthy Eating recommend that we consume no more than 30% of our calories as fat, with less than 10% of these as saturated fat. Meals and snacks should emphasize dark and colorful fruits and vegetables, lean meat, low fat dairy foods and whole grains. Limiting the consumption of alcohol, caffeine and salt will also help you on your way to a healthy heart. Many individuals adopt this way of eating after their first cardiac event occurs. However, following this dietary pattern early in life will give you extra insurance against the onset of heart disease.
Although symptom management during menopause may be complex, the road to reducing your risk of osteoporosis is well established. The deterioration of bone accompanying menopause is due to a drop in estrogen levels, as well as less efficient calcium absorption. Although bones can't be built after menopause, the rate at which they deteriorate can be nearly ground to a halt given proper attention. Ensuring that your diet is rich in calcium and vitamin D (which is needed for calcium absorption) is essential to saving your bones.
Foods that will maximize your calcium intake include low-fat milk and yogurt, cheese, fortified soymilk, tofu made with calcium sulfate, almonds, sardines, canned salmon with the bones, oranges, figs, sesame seeds and sesame tahini, blackstrap molasses, and dark green leafy vegetables such as broccoli and kale. Good sources of vitamin D in Canadian foods include fortified milk and soymilk, margarine and fish oils. If incorporating these foods into your diet is a problem, you should consider using a supplement to help meet your needs. Decreasing your intake of red meat, alcohol, salt and caffeine will also help keep your bones healthy. Excess animal protein intake can cause increased urinary calcium losses, hence, caution should be taken if following very high protein diets long term. Excess caffeine can also lead to dehydration, and alcohol causes small blood vessels to dilate, triggering “hot flashes”. Clearly these foods should be consumed in moderation!
In addition to proper nutrition, weight-bearing exercise helps build and maintain bone structure. Activities such as weight lifting (including children and big toys!) and heavy household chores will do the trick. If you are not used to these activities, begin with a small weight and ensure that your follow the proper technique to avoid injury. The best resource is a personal trainer or physiotherapist. Underweight women are at an increased risk for developing osteoporosis due to a lack of fat for adequate estrogen storage. It is therefore important that these individuals take extra measures to protect against bone loss.
Hormone Replacement Therapy
The most common treatment for managing menopause is Estrogen Replacement Therapy (HRT). A cautionary note: women with a history of breast cancer should investigate all options and risk factors with their physician before deciding to start HRT. There are as many benefits to HRT as there are drawbacks. On the bright side, HRT helps manage symptoms such as hot flashes and results in a 25-50% reduction in cardiovascular disease and bone loss. New research has even shown that HRT may protect against Alzheimer’s disease. Unfortunately, HRT may also cause breast tenderness, weight gain, nausea, irritability, continuation of menstruation, and an increased risk of breast cancer for some. Interesting to note is that although HRT protects against bone loss, women on this therapy seem to have the same calcium requirements as those not on therapy, 1300mg elemental calcium per day.
Because of hormonal changes, women on a whole seem to have more experience dealing with mood and energy fluctuations than males. Menopause is no exception. Although no all women encounter such obstacles, for those that do, mood swings and a lack of energy can cast a cloud over the best of days. Fortunately, many drug-free options exist for minimizing these negative effects.
The mood roller coaster that many women experience during menopause may be related to low blood sugar levels and serotonin levels in the body. To maintain stable blood sugar levels, aim to eat every 3 hours, alternating meals and snacks. Once you have achieved this pattern of eating, aim to include both protein and carbohydrates at your main meals. The protein acts like an anchor for the carbohydrate energy and will prevent low blood sugar levels after a meal. Serotonin, a neurotransmitter (brain chemical) that regulates sleep, certain hormone secretions, and pain perception, may also be useful in alleviating menopausal symptoms such as moodiness and low energy levels. A diet high in complex carbohydrates such as fruits, vegetables and whole grains will help boost serotonin levels in your body. Moreover, you will have more energy to conquer the day and your body will be thanking you for all the extra fiber, vitamins and minerals. As a matter of fact, a high intake of fruits and vegetables will also help you reduce your risk of cancer and heart disease.
It is not surprising that physical activity plays a key role during menopause. Being active improves mood, increases energy and motivation levels, boosts self-esteem and confidence levels, and provides an overall positive effect on one’s quality of life. Physical activity causes the body to release endorphins, natural painkillers that improve mood and increase energy. Sadly, exercise has gotten a reputation as being an arduous task meant only for young, athletic individuals. Important to note is that physical activity doesn’t have to mean pushing yourself to exhaustion. Just moving can have a major impact on improving your health and state of mind. Activities such as taking a stroll through your neighborhood or dancing around your room to your favorite song can be a fun and effortless way to incorporate exercise into your day. Other mood enhancers include yoga, relaxation exercises, and massage therapy. Simply taking time out of your day to focus on the messages your body is sending you can be an effective way to reduce stress and mood fluctuations.
An Ounce of Prevention
Menopause is not just a concern for “older” women. All women will get older and hence, menopause is a concern for all women at any age. Most women don’t give menopause much thought until it hits them between the eyes. The recommendations for reducing the related health risks are endless, so what about prevention? Chances are that if all women where to follow the guidelines for healthy living given to menopausal women (i.e.: diet and exercise), menopause would be a much easier transition.
A note to smokers: Quit now. Smoking decreases estrogen levels, and these individuals may therefore enter menopause up to 5 years earlier than non-smokers! Smoking is also toxic to ovaries, leads to wrinkled skin, and is associated with osteoporosis and heart disease, just to name a few.
For women seeking alternative remedies, herbal therapy has emerged as a popular treatment for menopausal symptoms. Unfortunately, the effectiveness and safety of these therapies remains unclear. Some products are unsafe, and little scientific evidence exists to support their use. If you choose an herbal therapy for relief of symptoms, be sure to contact a knowledgeable health care professional in advance.
Once again, it appears that soy is in the spotlight. Thought to protect against heart disease and some forms of cancer, this wonder food may also help women during menopause. Research has shown that soy may actually mimic estrogen in the body, possibly providing relief from menopausal symptoms such as hot flashes. However, the debate still rages as to whether soy really does lead to an 'easier' menopause. Important is that the amount of soy necessary to consume in order to reap these benefits is relatively large: around the equivalent of 3 servings per day (1 serving is equal to 1 cup soy milk or 1/3 cup tofu). The sporadic consumption of smaller amounts of soy may not actually provide the associated health benefits, and according to new research may be contraindicated for those with a high risk of certain types of cancer. Clearly, more research is needed in order to develop guidelines for optimal intakes.
For most, the benefits of eating soy seem to outweigh the drawbacks. However, the thoughts of eating a tasteless white block of soft food have dissuaded many from digging in. The great news is that soy doesn’t have to be boring. The abundance of products and recipes offered, able to transform soy into a delicious dish, have left North American’s with a world of options. A few suggestions for boosting your soy intake:
- Substitute ground beef in a chili recipe for crumbled firm tofu
- Use soy milk (or half soy, half cow’s milk) in your cereal for breakfast
- Crumble firm herbed tofu over your favorite pizza before baking
- Stir-fry chunks of firm tofu in a sesame sauce with seasonal vegetables
- Add crumbled firm tofu to your family lasagna recipe and cut back on the beef
- Try one of the new meat alternatives such as veggie chili wieners or breakfast links
- Throw some marinated tofu on the grill when barbequing for the family to add to the meal
- Marinate soy in your favorite sauce and bake until golden brown.
- Make a veggie dip out of blended soft tofu and your favorite flavorings
- Whip up a fruit smoothie to go in a blender using soft tofu, fruit and juice
- Add cubed tofu marinated in a tasty dressing to a light salad
- Dip fresh fruit in “almond dessert tofu”
- Make a tofu cheesecake
- Add dessert tofu as a topping to a fruit crisp
If you want something a little jazzier, try the following recipes for your family or dinner guests: they will never know its tofu!
Tofu chocolate Mousse with Raspberry Sauce
This satin smooth mousse will leave your guests begging for the recipe. The best part is that it’s a breeze to make!
- 1/2c semi-sweet chocolate chips
- 2 Tbsp water
- 1 Package (10.5 oz) light silken tofu
- 3 Tbsp cocoa powder
- 3 Tbsp icing sugar
- 1 tsp vanilla
- 2 cartons (10 oz each) sweetened frozen raspberries, thawed (reserve the juice)
- 2 Tbsp cornstarch
- Combine chocolate chips and water in a 2-cup glass measuring cup or glass bowl. Microwave on HIGH for 1-3 minutes, checking and stirring frequently to make sure the chips do not burn or boil over.
- Combine the tofu, cocoa, icing sugar, vanilla, and melted chips in a blender or food processor, and blend until smooth and creamy. Refrigerate until ready to serve.
- Drain juice from raspberries into bowl, add the cornstarch to the juice and whisk to mix thoroughly. Microwave on HIGH for 1-2 minutes, checking often and stirring to prevent lumping.
- When the juice mixture has thickened, gently fold into the raspberries. Serve each person a 1/4c scoop of chocolate mousse and cover with raspberry sauce.
Makes 7 servings. 4 g fat/ serving
Roasted Red Pepper Dip
Try this with toasted pita, raw vegetables, or whole grain crackers
- ½ c soft tofu
- ½ cup plain yogurt
- 2 red or yellow peppers, roasted with skins, membranes and seeds removed, diced
- 1 tsp chopped garlic
- 2 chopped green onions
- 2 tsp tomato paste
- 1 Tbsp low fat mayo
- 1-2 tsp hot sauce
Place all ingredients in a blender and mix until smooth. Vary the amount of hot sauce depending on the intensity of heat desired.
Take Home Message
Menopause is a complex phase of life, and the experience is different for each woman. Figuring out the approach you’ll take to make the transition smoother will depend on many factors. Remember that menopause is a natural part of female life and you’re not alone! Eating a well balanced diet, getting plenty of fresh air and exercise, and making your living environment as pleasant as possible are all ways of accomplishing this task. Remember that even if you have not yet reached menopause, the lifestyle choices you make will affect your health down the road.
Technology and research have provided us with the tools to live longer and better quality lives. As a result, women now spend a greater proportion of their years post-menopausal. Fortunately, new therapy options are being explored every day, and relief from symptoms is more promising than ever. Listen to your body during these changes, and be sure to discuss any health concerns you may have with your doctor.
- Foods that Harm, Foods that Heal. Reader's Digest Association, 1997.
- Slaven L., and Lee C. Mood and Symptom Reporting Among Middle-Aged Women: The Relationship Between Menopausal Status, Hormone Replacement Therapy, and Exercise Participation. Health Psychology. 1997;(16)No. 3, 203-8.
- Ivarsson T, et al. Physical exercise and vasomotor symptoms in postmenopausal women. Maturitas, 1998;(29), 139-46.
- Sternfeld et al. Habitual physical activity and menopausal symptoms: a case-control study. Journal of Women's Health. 1999;(8) No.1, 115-22.