The Facts About Menopause: How Lifestyle Can Support Your Health

Information about the menopause has flooded the media and social media in recent years, from celebrities to lifestyle guru’s - but how do you know what is accurate, trustworthy information? The supplement industry is big business – but how do you know which products being sold to you, often at high cost, are necessary or effective? Which diet or exercise programme should I follow? There are a bewildering amount of options available leaving women struggling to know what they should do and what is right for them.

Here our GP Dr Lucy Joslin cuts through the noise, sharing evidence-based insights from the recent British Menopause Society conference on how lifestyle, nutrition and exercise can make a real difference to symptoms and long-term health.

With more people than ever turning to social media for their menopause information, my aim is to present the latest unbiased, accurate information to you without hidden agendas or drug industry influence. The patient website of The British Menopause Society has evidence based, up to date fact sheets, videos, a wellness hub, book recommendations and information for the work place.

Let me start by giving you some history behind the current drivers of information. Back in 2002, when I was a GP trainee in the UK, the Women’s Health Initiative study was published. This was closely followed in 2003 by the Million Women Study. These studies created a culture of fear regarding HRT (hormone replacement therapy) presenting data showing increased death rates from breast cancer, heart disease and stroke risk. Almost overnight, GP’s changed from regularly prescribing HRT to hardly every prescribing it, leaving a whole generation of women to struggle on with their sometimes disabling menopause symptoms. It wasn’t until the first set of NICE (National Institute of Clinical Evidence) menopause guidelines, published in 2015, that this started to change, with a reevaluation of this data and new safer prescribing guidance. Recent years have seen the advent of greater visibility for ‘The Menopause Movement’ with increased understanding of the impact on women, at home and in the workplace, creating a sense of community and anti ageism however this has come with a reliance on celebrity to bring a spotlight on the issue.

So, what does the current research about lifestyle in menopause suggest?

There is really positive news about the benefits of diet, exercise and lifestyle changes for managing menopause symptoms and longer term health issues such as osteoporosis, heart disease and dementia. Switching from a poor diet to a healthy diet at any age, even in your 70’s, can potentially give a lifespan gain of 10 years presented Professor Sarah Berry, from her BMS funded research at Kings. She also commented that increasing your sleep from just 6 hours to 7 hours can reduce risk of death by 15%. These are average figures as the effectiveness of a lifestyle change differs between people in response and adherence highlighting the need for personalised approaches. We all have differences in our genetics and biology along with different goals and motivations, situations and environments. The data generally presents the average response however some people receive no benefit from a lifestyle change and others may be super responders. Menopause is one of the factors that influences our response to food. Before menopause, eating regular meals and snacks leads to more time with higher blood sugars and fats (lipids) but the body can cope with this in normal physiological responses. During (peri) and after (post) menopause, the body’s metabolic response to food is less favourable leading to higher circulating levels of sugars and fats which leads to higher levels of inflammation, oxidative stress and disease risk.

What can we do about this? What we eat, how we eat and how we live can have a major impact on this.

What we eat

• Reducing refined carbohydrates reduces the blood sugar levels,

• Adding fibre/protein/healthy fats to a meal delays gastric emptying and reduces the glycaemic response. Aim for 1.2-1.5 mg/kg/day of protein intake

• A healthy diet that is high in unprocessed foods, plant based, high in polyphenols and low in unhealthy fats can significantly reduce most menopause symptoms including sweats and flushes, physical and brain symptoms. Research is still ongoing however women eating a Mediterranean diet have significantly fewer menopausal symptoms than those eating a typical western diet

  
  

How we eat

• Time of day – we are more insulin sensitive in the mornings leading to lower glucose peaks and this effect is even more pronounced in peri and post menopause

• Meal ordering – eating fibre and protein before carbohydrates slows down digestion giving better glucose regulation and increased satiety

• Snacking – late night snacking (after 8pm) leads to increased hunger and poorer health outcomes

• Fasting/time restricted eating – this can lift mood and energy levels and reduce hunger and weight. Time restricted eating is an exciting area making weight loss easier as calorie intake tends to be lower without having to scrutinise foods and count calories. This is an easy technique to adopt and it can be made to work for your lifestyle. A 10 hour window e.g. 10am-8pm, can be beneficial with the most benefits seen with an early window and avoiding eating after 8pm

• Eating rate – fast eating tends to increase calorie intake with a poorer metabolic response leading to an increased risk of obesity, diabetes and heart disease. Studies show that by slowing eating rates by just 20% (10-12 mins) can reduce calorie intake by 15%

  
  

  

How we live

• Sleep – 85% of women in the menopause notice sleep disturbances. Poor sleep leads to increased reward cravings and bad diet choices such as carb cravings and an increased metabolic response. Hunger hormones are increased leading to an increased calorie intake e.g. approx additional 400 kcal per day per loss of 1 hour sleep. This effect if worsened in menopause

• Activity – an increase in moderate physical activity can reduce menopausal symptoms. Symptoms are increased in those with longer sedentary/sitting hours

• Consistency – lack of consistency and ‘social jet lag’ have an impact on health

  
  

I can’t talk about diet and lifestyle without mentioning the microbiome which is another hot topic undergoing much research. It is becoming increasingly recognised that there is a relationship between sex hormones and the gut microbiome which has an impact on health and the risk of disease. The premenopausal microbiome supports a wide variety of beneficial bacteria which support hormone production and function. This becomes much less diverse post menopause with an increase in types of bacteria associated with high blood pressure, high cholesterol and inflammation. Researchers can now analyse the microbiome and predict the number and severity of symptoms. In the future, it may be possible to personalise menopause supplements depending on your microbiome and genetic makeup.

Exercise and activity is important to consider in the menopause. Some women find this easy and others find it incredibly daunting. Even before menopause, women start to lose muscle and then with declining oestrogen levels comes loss of bone density. Muscle accounts for 20-30% of resting energy expenditure. Young adults have approximately 30-50kg of muscle which burns an average of 485 calories per day while older women have on average 13kg of muscle burning only 120 calories per day. Loss of muscle mass and strength leads to more severe menopause symptoms and is associated with increased risk of chronic disease, osteoporosis and fracture risk and reduced quality of life. There is also an increased risk of developing dementia. Fitness is one of the strongest predictors of longevity, more so than blood pressure, cholesterol, smoking, diabetes and cardiovascular disease.

What can we do about this?

The World Health Organisation recommends 150mins of moderate exercise per week this can seem unachievable for many people. The good news is that research is showing that short bouts of accumulated exercise (less than 10mins) can be as effective. Ideally a combination of aerobic and resistance exercise at a moderate to vigorous intensity several times a week will increase VO2max, which is a measure of fitness. Breaking up sedentary time with short bursts of activity such as climbing the stairs or a lunchtime walk, is manageable and effective in promoting health and preventing disease. Just changing from unfit to a low level of fitness reduces the risk of death by 31%. There is a dose response and people with a moderate level of fitness have a 49% reduced risk, 60% in fit people and up to a 67% reduced risk in the very fit.

Short bouts of exercise, such as HIIT (high intensity interval training) shows the strongest evidence for cardiovascular health improvement but there is also evidence of improvement in blood sugar levels and liver lipid metabolism.

Weight gain is a common problem around the time of the menopause with an increase in unhealthy visceral fat and fat in the muscles and a loss of lean muscle. This particularly affects the legs which is important as leg muscles are longevity muscles and as these deteriorate women become slower in movement and more likely to fall. There is little actual data regarding muscle and menopause. What we do know is that mobility reduces Ice pre and peri menopause stages then plateaus and reduces again in later life. Strength and power start to decline age 30-40 years, losing around 10% of muscle strength. Power reduces by 11% affecting balance and stair climbing for example.

So, the aim is to maintain fitness, reduce muscle loss and reduce weight gain. An analysis of currently available data shows that a combination of aerobic exercise, resistance training and calorie restriction is the most effective method of reducing weight and fat while maintaining lean muscle. This is also shown to improve cognition.

Resistance training – ideally this should be performed twice weekly, using resistance bands or weights and step heights doing 6-10 exercises with 1-3 sets of 6-12 repetitions at moderate to hard intensity (70-85% of maximum). The higher the weight/resistance, the more the benefit. Benefits are seen at all stages of menopause with the greatest response in pre and perimenopause. Exercises can be incorporated into daily activities such as carrying shopping, lifting it into cupboards and getting up and down from chairs.

Bones need a variety of exercise including some high impact exercise, resistance training and balance exercises. The Royal Osteoporosis Society has excellent information regarding diet, exercise and bone health.

What are the take home messages from this lifestyle advice in relation to menopause?

• Muscles and fitness matter- ‘Exercise is medicine’

• Find an activity plan that suits you

• Food first approach- no single nutrient or nutrition is effective, aim for whole foods with adequate protein and calorie restriction such as the Mediterranean diet

• Stick with it – aim for progress not perfection and remember that every movement counts

To book into our Menopause Clinic call 01481 237757