How to survive menopause – a nutritional perspective

Menopause is literally a challenging life changer. While you are going through hormonal changes your life, your body and your emotions are drastically affected. It can be overwhelming and confusing. Menopause takes more than just sitting it out while feeling terrible about it. It means adjusting your life towards these changes. Easier said than done! But with the right support and understanding of you and your body, you might be able to find ways of adjusting and improving.

What is menopause?
Derived from the Greek words meno (month) and pausis (to stop) it literally means: stopping menstruation. Because of a decline in ovarian follicles, the body’s natural secretion of the hormones progesterone, testosterone and oestrogen decline. This process leads to the cessation of the menstrual period. Menopause is often diagnosed after a menstrual period absence of 12 months or more. The process of declining hormones and follicles is called peri-menopause. This period is characterised by hormonal and emotional fluctuations and a more irregular period. On average, a woman arrives in menopause at 51 years old. Menopause can come naturally or prematurely due to premature ovarian failure or medical intervention.

Menopause comes with an increased risk of developing osteoporosis, breast cancer, diabetes and cardiovascular disease. That is why nutritional treatment focusses not only on symptomatic support but also on helping to prevent (future) risk related diseases.

What Do Menopausal Symptoms Look Like?
There are a large variety of symptoms related with menopause. As we are all unique, the variety and the severity of symptoms are experienced differently.

1. Hot flushes and night sweats.
   Some women feel slightly hot and sweaty while other women go red in the face, get palpitations, and drench in sweat. A flush varies from a few seconds up to ten minutes. Dizziness, headaches or pressure on the head, vagueness, fatigue, chills, and nausea can accompany hot flushes and night sweats. Sweats can cause sleep disturbance, reduced energy during the day and increased stress. Hot flushes occur in up to 74% of postmenopausal women and can have a negative impact on quality of life; they can still be experienced by some women in their seventies.
2. Emotional and mental changes
   Hormonal changes can lead to depressed feelings, anxiety, sleep disturbances, and memory and concentration problems. Many studies have shown that physical exercise has positive effects on these symptoms.
3. Physical changes
   Sleep disturbance (periods of wakefulness), fatigue, headaches, muscle/joint pain and a crawling sensation on the skin are all common symptoms of peri-menopause. Weight gain is also very common and this can increases the risk of diabetes, cardiovascular disease and breast cancer. In menopausal women cholesterol raises and oestrogen deficiency decreases insulin secretion. Low oestrogen levels increase bone breakdown which can develop into osteoporosis. That is why exercise and proper nutrient support is important. Diets low in sugar, with good fats, lots of vegetables and animal- and plant-based proteins are important to keep your body healthy and strong.
4. Sexual and urinary changes
   Physical and emotional changes can decrease your libido, and can cause vaginal dryness, pain during intercourse, and urinary frequency and urgency. The decline in oestrogen and progesterone causes vaginal dryness and sometimes a feeling of itchiness, burning or even bleeding. Sexual intercourse can be painful and awkward. A water based lubricant might reduce the pain and increase pleasure. Approximately 15% of menopausal women get urinary tract infections which can cause a decreased acidity of the urine and a loss of bladder elasticity.

What Lifestyle Adjustments Can You Make
Besides physical, emotional and hormonal changes menopause involves self-care and a change in lifestyle.

1. Stress management can reduce irritability and help improve sleep disturbances. Yoga, acupuncture, massage, meditation, and counselling can be helpful and improve energy levels.
2. Acupuncture: Research shows that acupuncture can reduce the severity of symptoms of menopause such as hot flushes. The exact mechanism behind acupuncture and hot flushes is not clear but it is thought that acupuncture can increase endorphin concentrations within the hypothalamus and thus can help improve thermoregulation.
3. Exercise influences the mood positively, helps to maintain a healthy weight, and reduces the chance of diabetes and cardiovascular disease. Exercise has shown to help improve bone strength, decrease cholesterol levels, improves circulation, cardiovascular health, and stress-handling abilities. It reduces blood pressure, relieves hot flushes, and increases self-esteem, mood and mind. Exercise can be daily moderate exercise such as walking for 90 minutes or 45 minutes of intense exercise 3-4 times a week.

Diet: go Mediterranean
A Mediterranean style diet is low in saturated fats and transfats, rich in unsaturated fats, complex carbohydrates and fibre, and contains a lot of nutrients that support health. It contains whole grains, a variety of vegetables and legumes, cheese (feta, mozzarella), nuts and fruit. The diet is low in meat but has eggs, some poultry, seafood and fish. Main sources of fat are from fish, nuts and olive oil. Traditionally a Mediterranean diet contains low amounts of pasta.

1. Phyto-oestrogens
   A deficiency of oestrogens in the body causes a lot of the menopausal symptoms such as hot flushes. By introducing phyto-oestrogens from foods, in particular isoflavones, symptoms can be reduced. Isoflavones are found in flaxseeds, legumes, lentils, and beans such a lima beans, chickpeas, kidney beans, and broad beans. Richer sources also include soy beans. Include these foods if symptoms are related to oestrogen deficiency. Discuss this with your health practitioner.
2. Calcium rich foods
   Calcium rich foods support bone building and may prevent osteoporosis. Calcium rich foods are: dairy products, bok choy, parsley, broccoli, oysters, canned fish with bones, seaweed products (nori), tahini, pulses, nuts and seeds.
3. Foods to avoid
   Caffeine: decreases the absorption of calcium, therefore resulting in decreases in bone density. It increases stress.
   High GI foods and refined sugar: these foods increase the chance of diabetes and metabolic syndrome. Sugar should be avoided.
   Spicy food: to prevent heat in the body and, with that, hot flushes

Nutrients
Depending on the severity of your symptoms your nutritionist might prescribe supplements.
Consult a qualified nutritionist before taking any supplements. Self-prescribing can worsen your condition.

1. B-vitamins
   These vitamins support mood, libido, and cognitive function and can help decrease severity of hot flushes and disturbed sleep.
2. Calcium and vitamin D
   Supplementation with calcium (especially during hormone replacement therapy) in combination with vitamin D can reduce bone loss: Vitamin D levels need to be checked before subscribing a dosage. Vitamin D can reduce the risk of breast cancer.
3. Essential fatty acids (EPA + DHA) + Vitamin E
   This combination can reduce hot flushes. Vitamin E can help to lubricate the vagina. Vitamin E can help reduce blood pressure and cholesterol and is an antioxidant which can help in cancer prevention.

Personalised support
Depending on your lifestyle and health history you might need specific support in helping to reduce risk and prevent worsening of symptoms. See one of our nutritionists or naturopaths for optimal support.

*Bonus recipe: Mediterranean eggplant stack*
Ingredients:

• 1 eggplant
• Tomato slices
• Capsicum
• Fetta
• Grated almonds
• Olive oil
• Herbs such as rosemary, basil, oregano

Method:

1. Pre-heat oven to 180 degrees.
2. Layer all the ingredients except the fetta and almonds. Cook in oven for about 25 minutes.
3. In the last 5 minutes, top up with fetta and almonds. Serve with sardines.

Contains: calcium, magnesium, vitamin E, Essential fatty acids.

During the month of September, all clients of Health Space can have the opportunity enter them and a friend to WIN a free nutrition consult, month of sauna, 2 weeks of a detoxification supplement program, and gut health ebook. Enter your name and your friends name in clinic, or at this link.

Jan is a passionate nutritionist in Health Space Rozelle, who has years of experience in the health industry. Starting in his home country of the Netherlands, Jan was an editor of a health and weight loss magazine before migrating to Australia. He is also a qualified yoga instructor. He has a special interest in weight loss, hormonal issues, digestive health and allergies.

References:

Braun, L., & Cohen, M. (2010). Herbs & Natural Supplements, An evidence-based guide (3^rd ed.).

Chatswood, Australia

Chen, M., Lin, C., & Liu, C. (2014). Efficacy of phytoestrogens for menopausal symptoms:

meta-analysis and systematic review. Climacteric, 18(2), 260-269.

http://dx.doi.org/10.3109/13697137.2014.966241

Chiu, H., Pan, C., Shyu, Y., Han, B., & Tsai, P. (2014). Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause. Menopause, 1. doi:10.1097/gme.0000000000000260

Hechtman, L. (2012). Clinical naturopathic medicine (1^st ed.). Chatswood: Elsevier Australia

Jane, F.M., & Davis, S.R. (2014) A practitioner’s toolkit for managing menopause. Climacteric17: 564–579

Risco, L. (2010). Menopausia: efectos de cambios hormonales en ánimo y cognición. Medwave, 10(3). http://dx.doi.org/10.5867/medwave.2010.03.4407

Soares, C., & Cohen, L. (2001). The perimenopause, depressive disorders, and hormonal variability. Sao Paulo Medical Journal, 119(2), 78-83. http://dx.doi.org/10.1590/s1516-31802001000200008

Stute, P., Becker, H.G., Bitzer, J., Chatsiproios, D., Luzuy, F., von Wolff, M., Wunder, D., & Birkhäuser, M. (2014). Ultra-low dose – new approaches in menopausal hormone therapy. Climacteric, just accepted (not published yet): 1-11

Sarris, J., & Wardle, J. (2014). Clinical Naturopathy An evidence-based guide to practice (2^nd ed.). Chatswood; Elsevier Australia

Trickey, R. (2011). Women, hormones the menstrual cycle (3^rd ed.). Fairfield: Trickey Enterprises

Whitney, E., Ray, Rolfes, S., Crow, T., Cameron-Smith, D. & Walsh, A. (2011). Understanding Nutrition, Australian and New Zealand Edition (1^st ed.), South Melbourne, Victoria Australia: Cengage Learning Australia

Villaseca, P. (2011). Non-estrogen conventional and phytochemical treatments for vasomotor symptoms: what needs to be known for practice. Climacteric, 15(2), 115-124. http://dx.doi.org/10.3109/13697137.2011.624214

Villaverde Gutiérrez, C., Torres Luque, G., Ábalos Medina, G., Argente del Castillo, M., Guisado, I., Guisado Barrilao, R., & Ramírez Rodrigo, J. (2012). Influence of exercise on mood in postmenopausal women. Journal Of Clinical Nursing, 21(7-8), 923-928. http://dx.doi.org/10.1111/j.1365-2702.2011.03972.x

Weiss, G., Skurnick, J., & Goldsmith, L. (2004). Menopause and Hypothalamic-Pituitary Sensitivity to Estrogen. JAMA, 292(24), 2991-2997

menopause naturopathy nutrition recipes