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Condition - Menopause

By Nutri People

What is the menopause?

The menopause is sometimes known as the ‘change of life’ and marks the end of your reproductive years. It is virtually unique to human females and may confer an evolutionary advantage. Reproductive functions cease, your periods come to an end and childbearing is no longer possible. It's a natural process that every woman goes through and every woman has a different experience during the menopause.

The average age of the menopause in the UK is 52, but it can happen earlier or later than this. A woman is said to have reached the menopause once she has not had a period for a year, and, after this point, she is described as post-menopausal. The time leading up to the menopause is known as the peri-menopause. During this phase, your periods generally become irregular, bleeding often becomes heavier and the hormonal and biological changes that are associated with the menopause begin. Around 20% of women seek medical help for symptoms related to the menopause. 

What causes it?

A woman’s ovaries contain eggs and also produce hormones for reproduction. An egg grows and develops within a follicle, which is the name given to an egg and the layer of protective and supportive cells (called follicular cells) that surround it. 

Your brain provides a hormone signal that stimulates the development of these follicular cells, which produce oestrogen as they develop. The brain then responds to the oestrogen by switching off this hormone signal until the next cycle and by producing another hormone signal, which stimulates the release of an egg from a follicle (called ovulation). After ovulation, the follicular cells produce progesterone instead of oestrogens. 

At birth, about one to two million eggs are contained within the ovaries. At puberty, this number drops to about 400,000. As women get older, they continue to run out of eggs. This gradual decline in the number of eggs results in the ovaries producing less oestrogen and progesterone. By the time a woman reaches the menopause, the production of hormones by the ovary, including oestrogen and progesterone, falls to very low levels. Oestrogen and progesterone normally stop the hormone signals from the brain, but now, because of their very low levels, they are unable to do this. As a result, the brain sends much higher levels of hormones to try to make the ovaries produce eggs. This increase in hormones from the brain can cause the symptoms of the menopause. 

Symptoms of the menopause

  • Hot flushes
  • Night sweats
  • Depression
  • Anxiety
  • Irritability
  • Mood swings
  • Fatigue
  • Poor memory/concentration
  • Sleep disturbances
  • Vaginal dryness
  • Increased body and facial hair and thinning of scalp hair
  • Loss of breast fullness
  • Increased abdominal fat
  • Irregular cycles
  • Heavy periods
  • Palpitations
  • Problems caused by thin bones (osteoporosis) 

Dealing with menopause

Some women take hormone replacement therapy (HRT) to relieve these symptoms. There are two types of HRT. One type contains only oestrogen (oestrogen-only HRT) and the other contains both oestrogen and progesterone (combined HRT). HRT works by increasing the levels of hormones in the blood with the aim of suppressing the release of hormones by the brain and preventing symptoms. However, recent studies have associated HRT with an increased risk of breast cancer and also suggest that it may not be as protective against cardiovascular disease as it was first thought.  

Nutrition and the menopause

  • Phytoestrogens*.Isoflavones are oestrogen-like chemicals (also known as phytoestrogens) found in high amounts in fermented soya foods. They include genistein and daidzein. Accumulating evidence suggests that phytoestrogens may help to support menopausal symptoms, cardiovascular health, bone health and breast health. An exciting study, published in the scientific journal Biology of Reproduction found that when daidzein is acted upon by gut bacteria, it produces a molecule called equol. Not all of us are able to produce equol from daidzein. Research suggests that those that can make equol may derive more health benefits from soy foods than those who are non-producers. There is evidence that long-term and consistent intake of soy isoflavones may help to encourage equol production in those who are non-producers. Equol producers have been shown to consume greater amounts of green tea and soybeans than non-producers. Another study found that the addition of seaweed to soy further increased equol production.  
  • Hot flushes are a common symptom of the menopause. They were originally thought to be caused by the action of a special branch of the nervous system called the ‘sympathetic nervous system’, which is also responsible for making your heart beat faster during exercise. However, a study published in the medical journal Fertility and Sterility suggests that hot flushes are caused by a lack of oestrogen. Oestrogen can act as a messenger in the brain, helping to transfer messages. A lack of oestrogen may result in the hypothalamus (a gland at the base of the brain that controls body temperature) going haywire. It now thinks that every time your body temperature rises naturally (during the afternoon or evening), you have a fever and causes the blood vessels near the surface of the skin to open (dilate). This creates a reddish (flushed) appearance of the skin. It also makes you sweat which eventually cools the body. Synthetic oestrogens were originally the only means of addressing hot flushes, but studies by menopause researchers Drs Catherine and Patricia Eagon in Pittsburgh showed that oestrogen-like chemicals present in certain plants may help to support normal oestrogen levels in the body. Hops, dong quai, sage and the fruits of Schizandra chinensis are sources of phytoestrogens.
  • Flax seeds. Plant lignans are a group of chemical compounds present in a variety of plants. These plant lignans are acted upon by bacteria in our gut and converted into active, oestrogen-like compounds (phytoestrogens) called enterodiol and enterolactone. A study in the British Journal of Nutrition showed that women with the highest levels of enterolactone in the blood tend to have a lower body mass index (a measure of your weight in relation to your height), less body fat and better sensitivity to insulin. The findings of another study, published in the American Journal of Clinical Nutrition, suggest that a high intake of lignans may reduce a post-menopausal woman’s risk of breast cancer by about 15%. Flax seeds (in particular sprouted flax seeds) are by far the richest dietary source of plant lignans. 
  • Studies suggest that agnus castus and Siberian ginseng may help to maintain healthy female hormone balance. Siberian ginseng may also help to support the body’s natural ability to deal with stress. 
  • Rhodiola. Fatigue, anxiety and depression are associated with the menopause. Rosavins, rosiridin and salidroside may help support balanced moods, sleep and the natural ability to deal with stress. Rhodiola rosea is a source of rosavins, rosiridin and salidroside. 
  • Ashwagandha root. Substances called withanolides have been reported to have stress-relieving and mood-elevating properties. Withanolides are present in roots of ashwagandha.  
  • Calcium and Vitamin D. Calcium may help to support bone strength, especially when consumed consistently and long-term. Many post-menopausal women have been shown to have low levels of vitamin D, which is likely to be the result of reduced sun exposure and a low intake of foods high in vitamin D. Vitamin D regulates calcium balance and is required for optimal calcium absorption, so may therefore help support normal levels of bone mineral density. Higherlevels of vitamin D are also associated with a reduced risk of breast cancer. A large, double-blind, placebo-controlled study, published in the Archives of Internal Medicine, found that a combination of calcium and vitamin D reduced the risk of post-menopausal weight gain. The effects were greater in women not consuming the recommended amount of daily calcium. 
  • Magnesium may help to maintain bone health. 
  • Vitamin E may help to ease menopausal hot flushes. A double-blind, placebo-controlled study, published in the journal Gynecologic and Obstetric Investigation showed that vitamin E significantly reduced the number and severity of hot flushes in menopausal women.  
  • Fish oil. Omega 3 fatty acids (including EPA and DHA) may help to reduce the risk of cardiovascular disease, which generally increases after the menopause. And according to the results of a double-blind, placebo-controlled, randomised study, published in the American Journal of Clinical Nutrition, and conducted by researchers at Laval University’s Faculty of Medicine in Canada, omega 3 fatty acids may also help to improve the psychological well-being of menopausal women. Dr Michel Lucas and colleagues recruited 120 women and divided them into two groups. Women in the first group took omega 3 fatty acids (EPA and DHA) for eight weeks. Those in the second group took a placebo (sunflower oil). The results showed that omega 3 fatty acids reduced the symptoms of psychological distress and mild depression. Interestingly, many women also noted a reduction in the number of hot flushes they experienced. 

Diet, lifestyle and the menopause

  • Plant lignans are the main source of phytoestrogens in the typical Western diet and are found in a wide variety of plant foods, including seeds (flax, pumpkin and sesame), legumes, wholegrains (oats, rye and wheat), fruits (especially berries) and vegetables. Flax seeds are by far the richest dietary source of plant lignans.
  • Soy foods high in isoflavones include tofu, soy milk, tempeh and miso.
  • Nuts and seeds are rich sources of vitamin E.
  • Eat foods high in calcium and vitamin D. Good sources of calcium include moderate amounts of low-fat dairy products (avoid excess) and dark green, leafy vegetables. Good sources of vitamin D include oily fish and free range eggs.
  • Increase your intake of whole grains, green leafy vegetables, nuts (especially almonds), bananas and apricots, which are rich in magnesium.
  • Avoid an excessive intake of foods that may aggravate menopausal symptoms, including pungent foods (onions, garlic, mustard and chillies), vinegar and curds.
  • Quit smoking. Smokers are at a greater risk of experiencing hot flushes and other menopausal symptoms.
  • When preparing foods,grill, bake or stir-fry with extra virgin olive oil.
  • Alcohol. Consume alcohol in moderation only.
  • Get regular sensible sun exposure. 5-15 minutes of sunlight exposure on the hands, face and forearms, two to three times per week (in the morning or late afternoon and during spring, summer and autumn), will help to boost your body’s production of vitamin D. You can put your sunscreen on after exposure to minimise the risk of skin damage. 
  • Include omega 3 fatty acids in your diet. Cold-water, oily fish (sardines, mackerel and salmon) are good sources of both omega 3 fatty acids and vitamin D. Cold pressedflax seed oil (preferably organic) and walnuts are also good sources of omega-3 fats.
  • Avoid vegetable oils, including margarines and vegetable shortening and foods that contain trans-fatty acids, including hydrogenated fats and oils (read the food labels).
  • Massagingthe inner arms or thighs with a cream containing a mixture of phytoestrogens may provide some benefit.
  • Control stress levels. Practice relaxation techniques (e.g. yoga).
  • Belly fat. During the menopause, women typically gain inches on the waist, as extra pounds tend to accumulate around their bellies. This is known as abdominal or visceral fat and may contribute to inflammation and insulin resistance, as well as increasing the risk of cardiovascular disease, diabetes, breast cancer and possibly dementia. So, what can be done about the belly fat? Well actually, quite a lot. Both diet and physical activity play very important roles: 
  • Pay attention to portion size.As you get older, there is a shift from lean muscle mass to increased fat mass and a consequent slowdown in metabolism. This means your body needs fewer calories and so you should aim to reduce your food intake.
  • Eat low-glycaemic-index foods.This simply means eating foods that release their sugar more slowly into your blood stream. Replace foods such as sugar, chocolates, cakes, biscuits, pastries, white bread made with refined white flour, white rice and refined-grain pasta, sweets, starchy vegetables, sugary drinks and fruit juice, with nutrient-dense unprocessed foods, including whole grains, fruits, legumes (beans, peas and lentils), nuts and seeds and non-starchy vegetables. Eat root vegetables (potatoes, carrots and beets) and fruits with other foods, rather than on their own, which will also help to control blood sugar levels. Try to eat small frequent meals throughout the day and avoid skipping meals, especially breakfast.
  • Trim any visible fat off meat or poultry before cooking.
  • Get moving. Regular physical exercise, such as brisk walking (30 minutes per day), helps to control weight and combat abdominal fat. Strength training (exercise with weights) may also help fight abdominal fat. Regular exercise also helps to keep your bones strong, protect your heart, lower your risk of stroke and breast cancer and alleviate some of the symptoms of the menopause, including hot flushes, night sweats, insomnia, depression and anxiety.

*(Note: Women who have any contra-indications to using oestrogen, such as a history of endometrial or breast cancer, should talk to their doctor about using phytoestrogens.) 

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