What is menopause?

What is menopause? Menopause is a term used to describe the one day which is marked by the absence of the menstrual cycle for a period of 12 months and can only be established after this point.

What is menopause?

What is menopause?

Menopause is a term used to describe the one day which is marked by the absence of the menstrual cycle for a period of 12 months and can only be established after this point. However, many people describe the period leading up to this point, technically called the perimenopause, by the same name. Anything after this point is post-menopause and symptoms can also continue for several years after the menopause has occurred. Menopause generally occurs between the ages of 45–55, with the average age in the UK being 51.1 Changes in hormone levels and the post-menopause period can also be associated with several longer term and chronic conditions. These can include osteoporosis and heart issues.2

There are many factors which determine the age at which menopause occurs. Genetics (such as your mother’s age at menopause), age at which you had your first period, number of pregnancies and use of oral contraceptives all have a role in determining menopause age.3 Lifestyle can also have an effect; smoking, heavy exercise and low sun exposure can all accelerate menopause, whilst alcohol intake, moderate exercise, high BMI and a diet high in protein and fruit and vegetables are all associated with a later menopause. Ethnicity can also play a role as black women have a longer menopause transition than white or Asian counterparts.4 Symptoms and their severity in these ethnic minorities may also be different to those experienced by Caucasian women, and this may be due to differences in perception of the process of menopause as well as societal factors.

Unfortunately, women are still under-informed and under-prepared for the menopause: 94% of women had not been taught about the menopause and 49% felt uninformed about it.5 Unsurprisingly this has led to nearly 16% of women dreading this period of their lives and 63% finding it hard to cope with. Given that this is a process that just over half of the population will experience, the lack of knowledge and available information seems unbelievable, and most women are forced to do their own research about how to cope more easily with the symptoms they experience. However, menopause is being discussed much more openly than in previous generations, when many women suffered silently. Women can research treatments and lifestyle changes independently and new options for symptom management are discovered and are being used more widely.

Symptoms

Symptoms of menopause are often considered to be limited to hot flushes and night sweats, and this can sometimes be all that is expected by women as they approach perimenopause. However, there are a huge range of symptoms and not knowing what to expect can make the process much harder for women, and those around them at home and work, to deal with them effectively.

As women reach, on average, their mid-forties, the level of eggs naturally decreases leading to changes in hormones. Oestrogen levels fluctuate and then decline, and it is this hormone which is responsible for many of the effects most associated with perimenopause.

Two of the most common symptoms of perimenopause are hot flushes/flashes and night sweats, with more than 80% of women experiencing hot flushes and night sweats,6 with many women also reporting sleep disturbances.7 These are thought to be linked to changes in female hormones affecting the production of other hormones, triggering increased heat loss. These symptoms can be embarrassing and uncomfortable, and in the most severe cases can make sleeping and working difficult or impossible and have a significant effect on quality of life.

There are also many less common symptoms experienced during menopause, including vaginal dryness, insomnia, mood swings and weight gain. Fatigue, depression, loss of libido, brain fog, hair loss and anxiety are also noted in many surveys into menopausal changes.

Most of these symptoms are caused either directly or indirectly by the drop in oestrogen; for example, decreases in oestrogen can cause lower serotonin, which is linked to depression and anxiety as well as poor sleep. This in turn can cause low mood and ‘brain fog’ and it is often difficult to establish which symptoms are related directly to changes in oestrogen and which are caused by other symptoms.

Lifestyle and diet

The most common treatment for these symptoms is hormone replacement therapy (HRT),8 with the addition of antidepressant or anti-anxiety medications if required. However, this is not always a suitable option, and some women choose not to use it – only around 15% of women between 45–64 are currently using HRT.9

There are several alternative options which may be useful for menopausal issues. Hypnotherapy has been shown to reduce the frequency and severity of hot flushes and night sweats, as well as improving sleep quality and sexual function.10,11 Mindfulness has also been shown to improve sleep quality,12,13 and inhalation of lavender oil also improves sleep and reduces the frequency of hot flushes.14,15 Several studies have also shown reflexology16 and acupuncture17 to be useful.

Nutrition can also be useful both for symptom management as well as reducing the risk of health issues such as heart disease and osteoporosis in post-menopausal women. Following a Mediterranean style diet is probably one of the most useful steps.18 This diet focuses on polyphenol, potassium and magnesium rich fruits and vegetables, foods such as nuts and seeds which contain both omega 3 and 6 fatty acids, olive oil and lean meats and oily fish, such as herring, mackerel, salmon, and sardines which are also rich in omega 3 fats. Processed foods are avoided, and the emphasis is on the consumption of fresh, unprocessed, or minimally processed foods which are naturally much lower in sugar, salt and trans and hydrogenated fats. A recent study found that consuming this type of diet could reduce some symptoms by 20% and it has also been found to be associated with health benefits relating to heart health, mood, glucose control, bone health and cognitive function.19

Hot flushes and night sweats

As hot flushes and night sweats are the most common menopausal issues, then many of the recommendations are aimed at them. Soya and especially compounds called isoflavones are widely recommended. Studies suggest that they may reduce hot flushes20 and they have been linked to bone and heart health. An intake of 50mg is useful for hot flushes and this should be increased to 90–100mg a day for bone health concerns. A review has also shown that soya isoflavones can improve cognitive function in menopausal women.21

Sage also appears to be able to reduce hot flushes,22 and is often recommended for brain health and memory.23 Like many plants, it contains a range of antioxidants, which appear to give sage a wide range of benefits for brain health.

Vitamin E is a nutrient which may also be useful for some menopausal issues, with some small trials suggesting that it can reduce both the severity and duration of hot flushes.24,25 Using vitamin E topically may also offer some relief from what are known as genitourinary symptoms (vaginal dryness, irritation and itching and urinary tract issues).26 Sea Buckthorn Berry Oil, which is rich in omega 7 fatty acids, may also be useful in this area.27

Brain fog

Around half of perimenopausal women mention ‘brain fog’ or cognitive issues as a major symptom28,29 and this seems to be linked to changes in female hormones, affecting mood hormones.30 This may influence many areas including memory, mood and sleep.

One of the most important nutrients for brain function is the omega 3 fatty acid docosahexaenoic acid (DHA),31 which can be found in algae and oily fish. This is almost impossible to make from dietary intakes in the body, and it is the main fat found in brain tissue.32 It has a range of different roles to play in improving brain function and cognition including supporting the growth and health of brain cells and supporting communication between brain cells.33

It is recommended to take at least 250mg of DHA per day for the health of the brain, a level which is only easily found in the diet from eating oily fish such as mackerel, salmon, sardines and pilchards. Both DHA, and the other omega 3 fat, EPA are recommended for mood, as lower intakes are associated with depression and anxiety scores.34

Consuming foods rich in B vitamins, such as eggs, fortified and wholegrain cereals, lean meat, dairy produce and nuts and seeds, may also be useful for menopausal women. Vitamin B6, which is often used for symptoms of PMS, can also be relevant for similar symptoms experienced during the perimenopause. B6 is involved in the production of brain chemicals which control mood, memory and sleep and may be useful for issues such as low mood, mood swings, and sleep.35

Bone health

Another area of concern for menopausal and post-menopausal women is bone health. Bone mass decreases sharply after menopause, due to the drop in oestrogen which occurs at this time.36 Maintenance of bone mass will be limited by dietary factors such as intake of bone building nutrients. Calcium is perhaps the most familiar of these and an adequate calcium intake is essential for the composition of bone, along with collagen. Bone is not a static tissue however, and bone turnover is an important factor in building and maintaining density and this is where other nutrients and dietary factors will play a significant role.

Vitamin D intake and status is closely linked to calcium, and low vitamin D impairs the absorption of dietary calcium. Low calcium in the blood triggers the release of calcium from the bones, leading to a decrease in bone density over time.37 Studies of vitamin D, both alone38 and in combination with calcium,39 have shown that it is associated with a higher bone mineral density (BMD) and a lower risk of fracture.

Vitamin K intake is also vital for bone, as it is required for the deposition of calcium in the bones. Vitamin K2, in the MK-7 form, is the preferable form as K1 is excreted too quickly and only has time to affect the liver.40 K2 as MK4 has a negligible effect on K2 levels in the body.41 However, vitamin K2 as MK7 is not generally widely consumed in the diet, as the main sources are fermented foods, particularly natto. Whilst the bacteria in the gut are known to produce some K2, this may not be enough. Therefore, supplementation with a good K2/MK-7 product is likely to be useful for most adults, particularly those concerned about bone health.

Magnesium is particularly relevant for bone health, and studies have shown that around 70% of women and 50% of men in the UK do not consume a sufficient level of this mineral from their diets. Low magnesium has been shown to soften bone and increase inflammation. It is also required for vitamin D to work correctly in the body, which then supports magnesium absorption.42 Several studies have shown a link between low magnesium and osteoporosis.43,44

Consuming an adequate level of protein can also be useful for maintaining bone health.45,46,47 Protein intake seems to be linked to higher bone mineral density in various bones, including the femur, neck and spine, and these findings are particularly relevant to post-menopausal women.45,46 Protein also has a better effect on bones when calcium intake is sufficient.47

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