Once a taboo subject, the menopause was for many years incorrectly associated with mood swings, overwhelming depression and the loss of sexual desire.
Only recently, these negative stereotypes have begun to crumble, according to the Harvard Guide to Women's Health. Consequently, the menopause is increasingly seen as a natural part of life, with both positive and negative aspects.
There are considerable differences in women’s descriptions of how they first began to identify themselves as menopausal. We normally experience the menopause when other stresses are present, so it is difficult to unravel the impact of other life events from symptoms associated with the menopause. Typical stresses at this stage in life include worries related to teenage or adult children, our own health problems, ailing parents, moving house or separation.
Many of us will visit the GP and have the menopause medically confirmed. Even if we haven’t seen a doctor for some time, this is a good time to have a quick check-up and discuss symptoms, recommended tests (such as a bone DXA scan), a management plan or treatment options if necessary.
Hot flushes are a common symptom of menopause, making some women feel self- conscious or panicked. A small number of Irish participants in the Women's Experiences and Understandings of Menopause study reported very frequent flushes, some every 15 minutes.
Night sweats or episodes of perspiring can affect many women’s sleep. The associated sleep deprivation can leave women and their partners exhausted.
It is no surprise that weight can creep up during this time of emotional, physical and social change. Nibbling, comfort snacking or relaxing with an additional glass of wine instead of a quick walk can end up in a slight increase in calories. Women frequently report a difference in fat distribution after menopause. They concentrate fat more in the abdomen and above the waist, whereas before the menopause they were prone to fat deposits on the hips and thighs.
In general we need fewer calories as we get older. As we become less active, we lose muscle mass and our metabolism slows. Whether weight gain is linked to the menopause itself or to our declining activity, studies demonstrate that weight gain during these years can be prevented by lifestyle improvements in exercise and diet.
Minimising fat gain and maintaining muscle by means of a combination of resistance and aerobic exercise help with hormonal challenges. Women with a normal body mass index report fewer hot flushes and have a better quality of life.
Supplements
It would be great if there was a quick fix for the hot flushes, night sweats, exhaustion, accumulating work and growing irritation. A lot of money is spent in the hope that botanical extracts and supplements will help, but their effectiveness is limited.
Certain supplements on the Natural Medicines Comprehensive Database look promising, but women should be aware of the lack of conclusive scientific evidence and of when not to use them. For example, taking 15mg of a genistein extract from soya bean every day may reduce the number and severity of hot flushes, but a woman who has had breast cancer or who has a family history of breast cancer should not take these supplements without consulting a medical herbalist. The same applies to red clover, another source of phytoestrogen. This should be avoided if your medicines include either a blood thinner or tamoxifen.
Certain foods naturally contain these phytonutrients and a myriad of other nutrients essential for overall health. Postmenopausal women are at an increased risk of heart disease, bone loss and certain cancers. If woman ensure a good supply of fruits, vegetables (especially legumes), seafood, poultry and lean meat, low-fat dairy, wholegrains, nuts and seeds, this helps to manage not only their menopause symptoms but their immune, cardiovascular and bone health too.
Soya foods
Legumes such as soya beans are naturally rich in phytoestrogens. While genistein supplements may present a cancer risk, modest amounts of soya foods eaten as part of a balanced diet appear to be safe. Studies have shown that taking between 20g and 60g of soya protein daily can moderately reduce the incidence and severity of hot flushes. However, this amount of plant protein is difficult to eat if you are not a fan of frozen soya beans, tofu and soya milk.
There is also some evidence that 40g of linseed daily can significantly improve hot flushes. This amount is high in omega 3 fatty acids and calories and so it is best to cut other less nutritious fats from your diet if you want to avoid gaining weight. It is also important not to eat excessive amounts of linseed if you take a blood thinner.
Hot flushes
The Women's Health Council report gives a summary of the evidence base in Managing Menopause, A Review of the Bio-Medical Evidence. Dietary changes such as avoiding spicy foods and eating cold foods and drinking cool beverages instead can relieve hot flushes. Adequate calcium and vitamin D has been shown to reduce bone loss in peri- and postmenopausal women.
A high salt intake is linked with high blood pressure and women with higher blood pressure excrete more calcium in their urine.
Calcium lost in urine is replaced by calcium stripped from bones. Therefore, lowering the salt content of the diet is beneficial for both stroke prevention and bone health.
Vitamin E was thought to be a natural treatment for hot flushes but there is very little scientific evidence to demonstrate its effectiveness. Women are best to ensure an adequate intake of vitamin E from food (see panel) rather than from supplements as a general rule. Alcohol can trigger hot flushes, and drinking more than the recommended target of 11 standard drinks a week damages bone, can raise blood pressure and risk of stroke and heart disease and can lead to poor sleep patterns and depression.
As with any other time in life, it is important to aim for a varied and well-balanced diet at menopause. Snacking on different fruits and vegetables can help instead of tucking into a croissant or muffin.
Choosing smaller servings of wholegrain cereals and bread will provide sufficient energy and fibre. Fortified lower-fat milks, cheeses and yogurts are important sources of calcium. Fish (especially oily), legumes, nuts, flaxseed and other seeds are rich in protein and provide some iron.
Caffeine, spices and alcohol trigger hot flushes and what you exclude can be as effective as what you include to manage symptoms. Many women navigate through this natural life stage with little discomfort and a fresh outlook on life by making small deliberate changes to prioritise and nurture themselves.
Foods with vitamin E
Rapeseed oil; olive oil; soya bean oil; hazelnuts, almonds and other nuts; sunflower seeds; flax or linseeds; wheatgerm; kale; crab; eggs; tomatoes
Paula Mee is a dietitian and member of the Irish Nutrition and Dietetic Institute (INDI). She works in Medfit Proactive Healthcare medfit.ie and tweets @paula_mee
