Menopause

Women go through three main phases of hormonal changes throughout their lives: reproductive age, perimenopause, and menopause. Perimenopause is marked by a decline in estrogen, irregular cycles, and symptoms like vasomotor symptoms (VMS), which can last several years. Menopause, on the other hand, is characterised by the cessation of the menstrual cycle for 12 consecutive months, typically occurring around age 51.

During perimenopause and menopause, the body undergoes various changes. The ovarian follicle numbers decrease, which ultimately leads to less estrogen production. This hormonal shift can result in symptoms such as hot flushes, night sweats, vaginal dryness, anxiety, depression, low libido, fatigue, and palpitations.

Estrogen, a steroid hormone produced by the ovaries, plays a crucial role in various bodily functions. It helps in bone development and maintenance by inactivating osteoclast activity, which can degrade bone. Estrogen also impacts cardiovascular health by improving plasma lipid profiles, leading to increased high-density lipoprotein (HDL), aka ‘good’ cholesterol and decreased low-density lipoprotein (LDL) cholesterol, aka ‘bad’ cholesterol.

Understanding these changes is crucial for promoting healthy ageing and quality of life. While menopause marks the end of the reproductive age, it also signifies the beginning of a new phase of life with many decades ahead. However, the decline in estrogen levels during menopause increases the risk of chronic diseases such as cardiovascular disease, type 2 diabetes, and osteoporosis, highlighting the importance of proactive health management.

Maintaining bone health is essential during menopause, as estrogen decline increases the risk of osteoporosis. Adequate intake of calcium (from dairy, fortified foods, leafy greens, almonds, and fish) and vitamin D (from sunlight, fortified products, and mushrooms) is crucial.

A heart-healthy diet rich in complex carbohydrates, polyphenols (found in plant foods), antioxidants, and unsaturated fats can help reduce the risk of cardiovascular disease. The Mediterranean diet, which emphasises fruits, vegetables, whole grains, legumes, nuts, fish, lean protein, and olive oil, has shown benefits in reducing cardiovascular risk factors.

While there is no one-size-fits-all diet, the Mediterranean diet is often recommended for its health benefits. It includes high amounts of polyphenols, antioxidants, and unsaturated fats. However, individualization is key, and other diets like the Dietary Approaches to Stop Hypertension (DASH) diet or adherence to national dietary guidelines can also be beneficial. Limiting alcohol and spicy foods, managing stress, and incorporating regular physical activity can also improve well-being during this phase.

During perimenopause and menopause, women may notice changes in body composition, including increased abdominal fat and decreased muscle mass. Maintaining muscle mass is crucial for overall health and can help mitigate some of the body composition changes that occur during menopause. Adequate protein intake, along with resistance exercise, can help preserve muscle mass and support long-term health.

While supplements can be useful to bridge gaps in the diet, a food-first approach is recommended. Supplements such as fish oil (for omega-3 fatty acids) can be beneficial if oily fish intake is low. Calcium and vitamin D supplements may also be necessary, especially as dietary requirements increase with age. However, it's essential to discuss supplement use with a healthcare provider or dietitian to ensure they are appropriate for individual needs.