Although menopause cannot be cured there are ways to reduce the impact of symptoms on daily life, as well as to reduce the risks and impact of the long-term health consequences. In this article we explain what menopause exactly is; what the physical and mental health consequences are; how it affects the quality of daily life; and how lifestyle adjustments can help women to stay healthy and deal with this inevitable process that can last for many years. Nutritional adjustments, high intensity resistance training and hormone therapy are key.
Menopause
Menopause is the point in time twelve consecutive months after a woman had her last period. Most women experience menopause between the age of 40 and 55.
Health consequences
The time leading up to the menopause is called the perimenopause, in which approximately 80% of women experience several symptoms due to hormonal changes, mostly fluctuations and decreasing production of the hormones estrogen and progesterone, that affect many biological systems (Hormones and vague symptoms). Menopause includes central nervous system-related disorders; metabolic, weight, cardiovascular and musculoskeletal changes; urogenital and skinatrophy; and sexual dysfunction. Women experience changes in their period, hot flashes, emotional disturbances (often wrongly diagnosed as burnout or depression), increased fat tissue, thyroid problems, changes in bone and heart health, bladder control problems, pelvic problems and poor sleep.
The perimenopause can take as long as 15 years. The length and course of this phase depend on several factors among which genetics, race, geographics, ethnicity and lifestyle factors such as smoking and a Western diet. For some women symptoms are mild. For others they can severely impact the quality of daily life for many years.
After menopause, women can still experience symptoms. Furthermore, postmenopausal women are more vulnerable to several health risks. Low levels of estrogen lead to altered metabolism, higher risk of diabetes type 2, higher risk of thyroid disorders, increased cholesterol levels and blood pressure and decreased bone density. After menopause, women have a higher risk of cardiovascular diseases. One third of women after menopause have a high blood pressure and two third of these women have high cholesterol levels. Cardiovascular disease is the number one cause of death in women over 60 years of age. This risk is higher for women who had blood pressure issues during pregnancy and women with a family history of cardiovascular diseases.
Furthermore, hormonal fluctuations in postmenopausal women can lead to an increase in fat tissue (belly fat), causing a change in the ratio of body fat percentage to lean body mass, leading to water loss and obesity. The decrease of estrogen leads to the loss of bone mass density, affecting muscle tissue and increasing the risks of fractures. Decreased estrogen also leads to sarcopenia, diminishing the rate of muscle repair and adaptive capacity. According to research, this might affect 30% of women, and 50-year-old women have a 40%–50% chance of suffering from fractures for the rest of their lives.[i]
Quality of daily life
It is estimated that globally approximately 50 million women go into menopause annually. The global population of postmenopausal women aged 50 and over, currently account for 26% of all women. This number is growing partly because women are living longer. [ii]
Over 80% of women experience menopausal symptoms, which reveal themselves precisely during one of the busiest stages in life.[iii] Of the 3.8 million employed women in The Netherlands, 1.8 million are aged between 45 and 60. The highest sick leave is in this age group and 35% seems to be directly related to menopause. [iv] Menopause seems to play a role in reduced work ability.[v] Research demonstrates that symptomatic women are 8.4 times more likely to report low work ability than their healthy counterparts. Over three-quarters of symptomatic menopausal women report serious problems in dealing with the physical and mental demands of their work, and these women might be at risk of prolonged sickness absence from work.[vi]
Research among US women shows that menopausal symptoms can significantly reduce mental and physical quality-of-life scores, negatively affect relationships, decrease occupational productivity, and impair daily activities. The psychological impact of symptoms on general well-being is comparable to that experienced with housing insecurity (the lack of confidence about continuing to afford one's current living accommodation).[vii]
It is clear that menopause affects the quality of life of millions of women. It is a serious public health issue that needs to be addressed globally because it lacks awareness among women, health professionals, employers, politicians and many more group in society. Adequate information is still insufficient in most countries.[viii] Menopause need not and should not be seen as a phenomenon associated with unavoidable and untreatable suffering.
In many cases menopausal symptoms are not diagnosed as such, leaving women with a wrong diagnose and as a result the wrong treatment plan. Symptoms are often diagnosed as burnout and treated as such, leading to ongoing problems on several aspects of life: physical, mental and emotional health, work, relationships etcetera. One of the issues is that menopausal symptoms can be vague, a- symptomatic, and hard to recognize, by women themselves but also by their health professionals. Diagnose of menopausal transition via a blood test can be misleading, because hormone levels can fluctuate widely.[ix]
The importance of treatment: three tracks
Treatment during peri- and post menopause is important to improve the quality of daily life and to minimize the long-term health risks. Treatment involves three tracks: Nutritional adjustments, high intensity resistance training and hormone therapy.
1. Nutritional adjustments
To minimize the previously mentioned long- term health risks of low estrogen levels, women need to make nutritional adjustments. This also helps to prevent unnecessary weight gain. An increase of 2 to 3 kilograms body weight during menopause is considered normal, everything above is unnecessary and increases the risk of chronic diseases.
Mediterranean diet
Evidence suggests that low-fat, plant-based diets are associated with beneficial effects on menopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the post- menopausal period.[x] Additionally a daily supplement of 10 micrograms of vitamin D is advised in The Netherlands (Do you need supplements?). There are also foods to avoid when dealing with menopausal symptoms such as alcohol, spices and caffein (Read more in this article).
“The Mediterranean diet is one of the most widely described and evaluated dietary patterns in scientific literature. It consists of highintakes of vegetables, legumes, fruits, nuts, grains, fish, seafood and olive oil. There is strong observational and experimental evidence that higher adherence to this diet is associated with lower risk of mortality, cardiovascular disease, metabolic disease, and cancer.”[xi]
2. High intensity resistance training
According to the Dutch Health Council, all adults should exercise at least 2,5 hours per week at moderate intensity and do muscle and bone strengthening activities at high intensity at least twice per week. Elderly should add balance exercises. All with the aim to maintain current health and to lower the risk of chronic diseases and bone fractures. [xii] According to the World Health Organization people who areinsufficiently active have a 20% to 30% increased risk of death compared topeople who are active.[xiii]
In general, the benefits of regular exercise are improved muscular and cardiorespiratory fitness; improved bone and functional health; reduced the risk of hypertension, coronary heart disease, stroke, diabetes, various types of cancer and depression; reduced risk of fractures; and reduced risk of overweight.[xiv]
It seems that women who participate in high intensity resistance training on a regular base, experience less menopausal symptoms, especially urogenital symptoms, and have a lower risk of menopausal health consequences.[xv] The importance of training is also emphasized in relation to the increased risk of cardiovascular diseases. Postmenopausal women have lower resting cardiac function than premenopausal women. They have a reduced aerobic adaptability to exercise: The increase of VO2 max after training seems 9% smaller in postmenopausal than in premenopausal women. [xvi]
Resistance training
Resistance training seems a crucial part of healthy ageing in women. It can delay several inevitable ageing processes that are the result of decreased hormone production, such as sarcopenia (loss of muscle mass) and osteoporosis (loss of bone density). Furthermore, resistance training can lower the risk of chronic diseases such as diabetes type 2 and obesity.[xvii]
Resistance training increases concentrations of the hormones testosterone, estrogen, growth hormone, and insulin-like growth factor, which activate muscle growth. Especially testosterone has a significant role. Besides its effect on muscle growth, power, strength and endurance, it also effects the development of bone, connective and neural tissue. This is relevant for the delay of osteoporosis.
In women, testosterone plays a role in the conversion of progesterone to estrogens. Estrogens have a role in regulating skeletal muscle growth, the muscles connected to bones, in response to exercise. It seems that resistance training acutely results in an increase of testosterone and estrogen levels in women. The effects of acute estrogen release may relate to a reduction in exercise-induced muscle damage and an improvement in recovery from training. Furthermore, estrogen activates insulin growth factor, which is associated with improvements in handgrip strength and physical performance as well as in life-span. Furthermore, higher levels of Insulin growth factor are linked with increases in muscle growth and improvements in insulin sensitivity, relevant for lowering the risk of diabetes type 2 and obesity.
The relation between testosterone and resistance training in women is not fully clear. In some women testosterone increases after resistance training, but not in all women. Furthermore, a decrease in testosterone in women does not occur independently of a decrease in other hormones such as estrogen during menopause.
Lower levels of anabolic hormones such as estrogen and testosterone in menopausal women may partially explain their lower sensitivity to a given training stimulus. This emphasizes the importance of regular and consistent resistance training at a sufficient intensity level.[xviii]
High intensity training
Compared to moderate- intensity continuous training, high intensity interval training, combined with resistance training, three times per week, is more effective in reducing abdominal fat and increasing muscle mass in women before and after menopause.[xix]
Furthermore, high intensity training elevates levels testosterone, growth hormone and insulin-like growth factor.[xx] Postmenopausal women can even increase insulin sensitivity and skeletal muscle mass to the same extent as premenopausal wome nafter 3 months of high-intensity training.[xxi]
Even among postmenopausal women with osteoporosis, high intensity resistance training three times per week can have positive effects on the risk factors and symptoms related to the menopausal transition. Significant effects were observed in bone mineral density at the lumbar spine; improvements in lean body mass, total and abdominal fat mass, in menopausal symptoms and in hip/leg strength and power. [xxii]
3. Hormone therapy
Hormone therapy under medical supervision is advised especially for women with severe menopausal symptoms and women in early menopause. The longer women delay hormone therapy, the more health problems may occur. The earlier women start, as soon as symptoms rise, the more beneficia ltreatment may be. There are several options available for hormone therapy such as pills, sprays, gels, and patches. For women who cannot or do not want to take hormones, non- hormonal options are also available such as anti- depressants.
Risks and benefits
According to Dutch experts, ideally women take some form of hormone therapy during their entire life after symptoms occur, simply because they will benefit from it and it will improve the quality of life. However, officially this is not allowed in The Netherlands at this time.[xxiii]
In 2002, a study part of the Women’s Health Initiative raised concerns about the higher risk of breast cancer, stoke, heart attacks, dementia and several other diseases in women taking oral hormone therapy of estrogen with progesterone. Sub analysis of these results showed that the increased health risks applied mainly to women who started hormone therapy after age 60 or ten years past menopause.
Furthermore, the 18 years of follow up research showed no difference in cause specific mortality or all-cause mortality in women treated with hormone therapy versus a placebo. In fact, research shows a favorable safety profile of hormone therapy when started early in menopause. Also, newer hormonal formulations seem to have even lower risks.
All in all, the risks of hormone therapy are low for healthy women under the age of 60 or within ten years from menopause. The benefits of hormone therapy for management of symptoms are likely to outweigh the risks. Furthermore, hormone therapy has an important role in increasing muscle and bone mass and in preventing osteoporosis and sarcopenia [xxiv]
Alternatives
Alternative non-medical treatment such as soy isoflavones and phyto- estrogens found in some cereals, vegetables, and legumes, and herbs may work in the body like a weak form of estrogen, but they have not been consistently shown to b eeffective in research studies, and their long-term safety is unclear.[xxv]
Conclusion
Menopausal symptoms affect the quality of life of millions of women. Health consequences are unmistakable and should be considered a public health issue that needs to be addressed globally .Menopause need not and should not be seen as a phenomenon associated with unavoidable and untreatable suffering.
Women can take matters into their own hands with a Mediterranean diet and high intensity resistance training such as CrossFit. Nutritional adjustments can be made on a daily base, with fairly little effort. According to researchers, exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the decrease of estrogen during menopause.[xxvi]
Additionally, women can consult a health professional on hormone therapy. According to the North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society for most healthy, recently menopausal women hormone therapy is the most effective treatment for menopausal symptoms.[xxvii]
Create your own health!©
References
Picture retrieved from: https://wodprep.com/blog/crossfit-masters-athlete/
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[xiv] Idem
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[xxvi] Hettchen M, von Stengel S, Kohl M, MurphyMH, Shojaa M, Ghasemikaram M, Bragonzoni L, Benvenuti F, Ripamonti C, BenedettiMG, Julin M, Risto T, Kemmler W. Changes in Menopausal Risk Factors in EarlyPostmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: TheRandomized Controlled ACTLIFE-RCT. Clin Interv Aging. 2021 Jan 11;16:83-96.doi: 10.2147/CIA.S283177. PMID: 33469276; PMCID: PMC7810823.
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