Living Well Through the Menopause Transition
“Nothing in life is to be feared, it is to be understood. Now is the time to understand more, so that we may fear less.” Marie Curie
Menopause has a PR problem. There is fear attached to it. We hear about hot flashes and night sweats. Brain fog and body aches. Sleep disturbances and fatigue. We are faced with confusing messages about hormone therapy, nutrition, and exercise. However, the menopause transition can also be a time of increased freedom and exploration. A time of confidence and career advancement. The key to a positive menopause experience is understanding the process and finding the right combination of supports for you.
So, what is the menopause transition? There are 3 phases that describe the process: perimenopause, menopause, and post menopause.
Perimenopause is the 5-15 years prior to menopause. It is a time of variable sex hormone decline: progesterone declines steadily, while estradiol (a type of estrogen) fluctuates. As we progress through perimenopause, we may notice a change in our menstrual cycles: they may become shorter or longer, they may be heavier or lighter, and there may be more cramping. We will also progressively have more cycles where we do not ovulate. Ovulation is not only important for conception–it is an essential process to produce and release progesterone. Ovulation leads to the production of the corpus luteum—a transient endocrine gland responsible for producing progesterone. When we don’t ovulate (aka have an anovulatory cycle), we don’t produce the corpus luteum; thus, there is less overall progesterone in the body—during a phase in the menstrual cycle where progesterone is usually at its highest. It is thought that these variable changes in our sex hormones is what leads to the challenging symptoms that some people report in perimenopause.
Menopause is a snapshot in time. It is the moment your period stops. The trick is you won’t know that your period has permanently ceased until 12 months have passed without it. The normal age of your final menstrual period is between 45 to 55 years old, with 51 being the average.
Post menopause is the rest of your life after menopause. Estradiol and progesterone settle into a lower, consistent level. The consistent low levels can help alleviate some of the symptoms that were present during the more tumultuous perimenopause phase. However, the lower sex hormone levels affect many body systems including the musculoskeletal, cardiac, metabolic, endocrine, and immune systems. It may also affect brain health.
Musculoskeletal changes during the menopause transition
All skeletal muscles, tendons, connective tissues, and bones have estrogen receptors. Estrogen is anabolic (helps build muscle mass and strength) and anti-inflammatory (helps recover from injuries). Estrogen increases muscle power (improves efficacy of the actin-myosin coupling needed for muscle contraction) and the collagen content of connective tissues. Estrogen decreases tendon stiffness, which improves tendon performance and decreases injury rates. Estrogen inhibits bone resorption and helps maintain bone mineral density.
With decreased estrogen availability in the menopause transition, it is harder to put on muscle mass, power declines, connective tissues become weaker, and tendons become more stiff. Sarcopenia, the age-related progressive loss of muscle mass and strength, starts as early as perimenopause when estrogen starts to decline. With these changes, we see an increase in reports of hip pain due to gluteal tendinopathy, shoulder pain due to rotator cuff tendinopathy, foot pain due to tibialis posterior tendinopathy, and pelvic health concerns.
The decline in estrogen also leads to increased bone resorption, causing a decrease in bone mineral density. In fact, the 3-5 years after menopause marks the highest rate of bone loss of our life, losing ~10% of bone mineral density on average in that short period of time.
Thriving Through Menopause
So, what can we do to thrive during the menopause transition?
“When women take care of their health, they become their own best friend.” Dr. Maya Angelou
There is hope! There are things you can do to lessen the symptoms of menopause and protect your health.
Perimenopause is definitely a good time to take a look at your lifestyle. Disrupted sleep, increased stress, a diet high in sugar, alcohol and/or processed foods, and low physical activity levels are not a good fit if your goal is to thrive through midlife and beyond. That is the definition of an inflammatory lifestyle. This lifestyle can stimulate a pro-inflammatory state throughout the body, which may perpetuate menopause symptoms, increase pain, and negatively affect your health. On the other hand, embracing an anti-inflammatory lifestyle can improve your health, decrease troublesome menopause symptoms, and prevent the declines associated with the decrease in sex hormones.
An Evidence-Based Anti-Inflammatory Lifestyle includes:
- Getting adequate sleep: 7-9 hours/night for adults aged 18-65
- Developing effective stress management strategies: self compassion is vital; mindfulness and breathing practices are effective as well.
- Optimizing nutrition: the research supporting a whole food, mediterranean style diet is compelling
- Regular exercise: strength training 3x/wk (that alone can decrease hot flashes by 44%!) and 150 min of moderate to vigorous aerobic activity spread throughout the week. Don’t forget to stretch after exercise, too!
It is also a good idea to talk to your health care provider–Family Doctor, Gynecologist, or Naturopathic doctor–about menopause hormone therapy. Find out if systemic and/or local hormone therapy is right for you.