Menopause can feel scary – you may no longer be in control of all aspects of your body’s health that you enjoyed in your 20s and 30s. But there are ways to prepare for this transition and offset the risk of the worst health consequences.
A balanced diet can slow down natural weight gain and thus reduce the risk of obesity and diabetes. And regular exercise to strengthen muscles and bones strengthens the body against osteoporosis and unbalanced body composition.
“Where you are health-wise in menopause is a really important predictor of what menopause will be like and what your health will be like on the other side of menopause,” said Carrie Karvonen-Gutierrez, PhD, MPH. assistant professor of epidemiology at the University of Michigan and an expert on women’s health and aging.
Menopause seems to “take a moment” these days, Karvonen-Gutierrez said. Media reports are sparking renewed interest in HRT, and medical educators have begun calling for more menopause training for providers. The market for menopause-related products could exceed $5 billion this year by 2020, according to a report by the Female Founders Fund.
With discussions about menopausal health, more and more young adults want to better prepare their bodies for the transition to middle age.
Do you need to “balance” your hormones?
Hormonal changes are a hallmark of the menopause transition. Most importantly, estrogen fluctuates and then declines.
Social media influencers are increasingly touting supplements for diet, good night’s sleep, and hormonal “imbalances.” Their recommendations range from taking hormone-altering pills to reducing bloating to consuming certain seeds and herbal teas during perimenopause.
Hormones change throughout a person’s life, such as during puberty or pregnancy, during periods of stress, or as a result of taking certain medications. In these cases, focusing on sleep, diet and exercise can naturally correct the imbalance. Many supplements marketed as hormone balancing use ingredients found in food.
“A lot of people prey on women by telling them they need to fix something or balance something or take extra hormones to correct that imbalance,” said Stephanie Faubion, MD, FACP, director of Northern Medicine. American Menopause Society. “It’s just money making that has no scientific basis.
Patients concerned about their hormone levels can ask their healthcare provider to order a lab test, Karvonen-Gutierrez said. A follicle-stimulating hormone (FSH) test or anti-Müllerian hormone (AMH) test can help confirm whether their symptoms are related to menopause and can predict their last period up to five years in advance.
Hormone testing is often not useful for premenopausal or perimenopausal people because hormone levels fluctuate daily and the use of hormonal birth control can skew the results, according to Faubion. In addition, direct-to-consumer tests can be expensive, and insurance companies do not cover hormone panels for non-medical reasons.
In some cases, tumors, autoimmune diseases, and endocrine glands can cause medically significant imbalances. Then it’s best to talk to your healthcare provider about hormone supplements.
Once a person has entered perimenopause, they may seek hormone treatments to increase estrogen or testosterone levels, depending on their symptoms. But until then, most healthy individuals don’t need to try to change their hormonal makeup, Faubion said.
Stephanie Faubion, MD, FACP
Many women feel a sense of freedom during menopause. They are no longer worried about their periods. They are not worried about getting pregnant… it can be an empowering transition.
– Stephanie Faubion, MD, FACP
Does birth control speed up menopause?
According to Mary Jane Mink, MD, a menopausal gynecologist and clinical professor at Yale School of Medicine, long-term hormonal birth control does not appear to delay or accelerate menopause.
“If you’re on the pill, your ovaries will poop like they would without the pill,” Minkin said.
Karvonen-Gutierrez is a researcher in the 30-year-long SWAN study, which examines the middle age transition. She agrees that “there is not enough evidence” to show that using hormonal birth control at a young age affects menopausal outcomes.
But figuring out how hormonal contraceptives can alter the menopause process is challenging.
“We have studies that could look at this question hypothetically, but the types of hormones that women going through menopause now may have taken in their late teens and 20s are very different than the types of hormones in their 20s today might take,” Karvonen- Gutierrez said.
Can a certain type of diet help with menopause?
Maintaining a healthy lifestyle in the decades leading up to the transition can significantly shape the peri- and postmenopausal experience. For example, poor cardiovascular health during the reproductive years and smoking are associated with an earlier onset of menopause, according to the American Heart Association.
“[Women] It’s really important to understand what’s causing their heart health and make sure they know what their lipids, sugars and blood pressure are, because menopause increases that risk for everyone,” Faubion said.
When estrogen decreases, cholesterol levels rise and the risk of obesity and diabetes increases. At the same time, aging into middle age is often associated with increased body weight and fat accumulation in the midsection.
There is “no magic” to premenopausal diets, Karvonen-Gutierrez said. A balanced diet with plenty of fruits and vegetables, lean protein, healthy fats and whole grains is just as important in the years leading up to menopause as it is throughout life.
Calcium is often considered important for pre- and postmenopausal women because it can keep osteoporosis at bay. The National Institutes of Health recommends that premenopausal women get 1,000 milligrams of calcium per day, preferably from dietary sources such as dairy products and green leafy vegetables. The recommended dose is 1,200 milligrams per day for women 51 years of age or older.
Getting enough vitamin D by spending time outside helps the body absorb calcium.
What kind of exercises should you do?
Menopause is accompanied by a significant decrease in bone density, and the most significant changes occur in the early years of menopause.
Weight-bearing exercises can help maintain bone health. Sports and activities that apply force to the skeleton, such as dancing and running, keep bones strong.
“Walking is better than biking is better than swimming for bone health,” Faubion said.
Muscle loss is also an important issue for people going through menopause. Although both men and women gain weight as they age, people who have gone through menopause tend to lose muscle mass faster due to hormonal changes. So while a peri- or post-menopausal person may stay the same weight, their fat-to-muscle ratio may increase significantly.
According to Karvonen-Gutierrez, it is more important to focus on achieving a healthy body composition than a certain weight. Resistance training, such as lifting weights and using resistance bands, is particularly effective in helping people build and maintain muscle.
“People throughout their lives, but especially women during middle age and menopause, can benefit from strength training and resistance training activities to both maintain muscle mass and improve bone health,” Karvonen-Gutierrez said.
How can you mentally prepare for menopause?
It is unrealistic that most people will be in pristine condition by menopause. But taking care of your overall health and wellness and getting regular checkups with a menopause-savvy clinician can make a big difference, said Donna Klassen, LCSW, founder of the nonprofit Let’s Talk Menopause.
“You have to put on a life jacket for yourself before you can help others,” Klassen said.
Faubion said people need not fear their middle and postmenopausal years. Menopauses don’t need to run for fear that the transition will “just slow you down.”
“A lot of women feel a sense of freedom during menopause. They don’t worry about periods anymore. They don’t worry about getting pregnant,” Faubion said. “It can be an empowering transition.”
Scientists still don’t know much about menopause, including how it affects people with certain conditions such as autoimmune diseases, how socioeconomic differences affect menopause outcomes, and how environmental toxins alter hormones.
“Given the changes in population and environment over the past 30 years, does menopause look the same today as it did 20 or 30 years ago? I would argue that it probably doesn’t,” Karvonen-Gutierrez said.
For those approaching middle age, meeting with a provider knowledgeable about menopause can be key to wading through the noise and finding treatment options that work for them.
“This is an important lifestyle for more than half of our population, and it’s really important that we give it the space and attention it deserves to help people know how to manage menopause and understand what’s going on,” Karvonen-Gutierrez said.
What does this mean for you?
If you are entering perimenopause or are experiencing menopause symptoms, it may be helpful to see a provider trained in menopause care to walk you through your options. You can find a certified menopause doctor or NAMS member in this directory.