Trying to lose weight during menopause has its challenges with many women saying that weight loss is hard if not impossible. Pinpointing the exact cause can be challenging and include many factors such as genetics, lifestyle, getting older, environmental and hormonal. Reported symptoms and treatments seem to vary greatly from women to women, this blog will give an overview of what menopause is with a focus on how positive lifestyle factors can help manage this natural life stage event.
What is menopause?
A woman goes through three hormonal changes throughout her life.
- Premenopause is when a woman is in her reproductive life and fertile, this starts with the first period and ends with the last one.
- Perimenopause is the period of time where specific hormones such as estrogen and progesterone start to decline and fluctuate. This can happen around the age of 40 and can last for several years. It is during this time that women start to notice changes in mood and body. Their periods become less regular, sleep patterns shift, sex drive can lower and body temperature fluctuates.
- Menopause is official when a woman has not had a menstrual period for a year and this is when the ovaries have stopped releasing eggs.
Hormones and Menopause
The ovaries produce estrogen, progesterone and androgens (androgens are a group of hormones that play a role in male traits and reproductive activity. However they are present in both males and females). The hormone FSH (follicle-stimulating hormone) and LH (luteinising hormone) which are released from the pituitary gland in the brain instruct the ovaries to release estrogen, progesterone and androgens, it is these hormones that gradually decrease with age. During perimenopause, progesterone levels decline slowly and steadily by about 75% from the age of 35-50, whereas estrogen levels fall about 35% and seem to fluctuate the most from day to day and even within the same day, at menopause, there is still a relatively higher level of estrogen compared to progesterone.
During the early stages of perimenopause, the ovaries can produce very high amounts of estrogen and this has been linked to disrupted feedback signals between the ovaries, hypothalamus and pituitary gland. During the later stages of perimenopause when the menstrual cycles become irregular the ovaries produce less estrogen and even less during menopause. These lower levels of sex hormones are compensated for with fat cells and other organs such as the adrenal glands secreting these hormones to try and make up for the deficiency, however this can cause a disruption in hormone balance and therefore keeping body fat within a healthy range becomes even more important.
Some studies suggest that the higher estrogen levels found in women during the reproductive years are associated with increased fat storage around the hips, thighs and subcutaneous fat (below the skin). However, as estrogen levels lower during menopause women tend to store fat in the belly as visceral fat and this is linked to health problems such as diabetes and heart disease. In addition to the sex hormones, other hormones such as Growth hormone, IGF-1 and DHEA are decreased due to a loss in muscle and bone mass because of the ageing process. One study also found that the hunger hormone ghrelin was significantly higher amongst perimenopausal women compared to premenopausal/postmenopausal women. A couple of studies have also found that low estrogen levels may impair the function of leptin and NPY, the hormones that make you feel full. These issues could make it harder to control hunger pains and maintain a healthy weight. As hormone levels change a perimenopausal women should be aware of the typical symptoms which include:
- Hot flushes and sweats
- Emotional changes
- Cardiovascular disease
- Osteoporosis (bone thinning)
- Menstrual cycle changes
Hot flushes and sweats
Luteinising hormone triggers the release of the egg from its follicle during a normal menstrual cycle, however, with decreased estrogen the ovaries do not respond. Therefore the hypothalamus releases a hormone called GnRH in order to stimulate more LH to be secreted from the pituitary, but as before the ovaries do not respond. The hypothalamus is then subjected to a rush of adrenaline, with all this going on the hypothalamus gets confused and tries to reset to a higher body temperature. The result is an increased blood flow to the skin and blood vessels dilate in an attempt to cool the body down. Although there are many foods and supplements that are promoted to reduce flushes, many have mixed results, some menopause experts suggest that rather than trying to reduce the frequency of flushes, women should try to integrate them into their daily life such as dress in layers, go outside in the fresh air and use a fan etc. Other lifestyle factors which can help include exercise, yoga, massage, meditation, etc.
Emotional changes include a wide range of symptoms such as crying, sadness, irritability, anger, panic and depression. The best way to maintain a stable mood includes:
- Being active/exercising
- Limiting processed foods
- Eating whole foods
- Limit foods with added sugar, alcohol or caffeine
- Include omega 3 fats from oily fish, flax, hemp, chia and walnuts
- Include foods rich in vitamin B for the nervous system. Examples of these include green leafy veg, wild and brown rice, quinoa and buckwheat.
- Include foods rich in vitamin C. Examples of these include sweet peppers, citrus fruits, broccoli and teas.
- Consider counselling
- Consider factors such as stress, lack of sleep, relationship issues
Insomnia can be due to factors already discussed such as hot flushes and emotional changes as well as various hormone disruptions. To improve sleep consider:
- Improving sleep hygiene practices
- Limit caffeine a few hours before bed
- Limit alcohol as this can reduce liver function and the ability to metabolise estrogen
Cardiovascular disease (CVD)
With the decline in estradiol as a women ages (which is cardioprotective) along with any increase in body fat, there is an increased chance of developing insulin resistance/metabolic syndrome which can lead to developing type 2 diabetes and increases the risk of CVD. To reduce this risk consider:
- Maintaining a healthy body fat range
- Keeping blood pressure below 120/80 mmHg
- Keep HDL cholesterol above 1.0 mmol/L
- Monitor QRISK score to assess the risk of CVD in the next 10 years. www.qrisk.org
- Manage stress
- Don’t smoke
- Exercise regularly
- Avoid processed food
- Eat a wide range of whole foods such as vegetables, fruit, whole grains, nuts and seeds
- Drink alcohol in moderation (14 units per week)
- Stay hydrated with non-sugary drinks
One of the roles of Estrogen is to help prevent bone breakdown and fractures which it does by switching on Vitamin D receptors in the gut. Although calcium absorption is approximately 50% below the adolescent peak rate, it appears that it is probably down to a lack of vitamin D because of not spending enough time outdoors and less being eaten in the diet. To help keep bones strong during menopause consider:
- Eating calcium-rich foods such as green leafy veg, nuts, seeds, beans, peas and lentils
- Get outside in the sunshine to get a natural source of vitamin D, also eating foods such as oily fish, seafood, liver, eggs and wild mushrooms during winter can help. The UK government recommends that everyone should consider taking 10 mcg (400IU) per day as a supplement from September until March.
- Eat some soy-based foods as this can increase calcium absorption
- Don’t smoke
- Try to do some weight-bearing activity such as weight training, walking, skipping, HIIT etc
Take home message
The symptoms of menopause vary and are unique to each woman. The mechanisms are complex and inter-related and can be challenging both emotionally and physically. However, following a dietary approach that includes non-processed, nutritious real food and getting enough exercise and sleep can help manage the symptoms. If symptoms cannot be managed naturally then always consult your healthcare team.
Hormone Replacement Therapy (risks and benefits)
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