As sure as the sun sets each day, every woman who enters her fifth decade will experience menopause, if she hasn’t hit it already. For this new life stage, the ovaries run out of eggs and no longer need to produce the hormones that prepare our bodies for making babies. But the effects reach far beyond reproduction.
“We call them sex hormones: our oestrogen, our testosterone and progesterone,” says Dr Peta Wright, a gynaecologist, “but it’s kind of crazy that we call them that because they actually have an effect everywhere in the body, which every woman who has gone through menopause, or in fact has a menstrual cycle, will be able to tell you about”.
The myriad symptoms that go with the transition to menopause (or perimenopause) can range from hot flushes, night sweats, mood swings and weight gain to poor sleep, brain fog, lower sex drive and dry skin. The hormonal changes also increase vulnerability to developing diabetes, heart disease, and osteoporosis, and may contribute to dementia.
This smorgasbord of symptoms, which can impact careers, relationships and quality of life, affects three out of four women. For some it can be particularly severe, which could be partly due to genetics, while others seem to sail through it. But Dee Murray, the founder of Menopause Experts, says it’s important to recognise what the body needs long term and not ignore the changes if they occur.
It’s useful to remember that menopause is not a disease and even a difficult transition will eventually settle down. “Perimenopause may be rocky or tumultuous because it’s a time of change,” says Wright. “But on the other side most studies report that women who’ve gone through that change in the hormones are now not on that crazy up-and-down rollercoaster ride. Most women’s symptoms will go away, and they see the light at the end of the tunnel.”
Meanwhile, several lifestyle factors can help mitigate the physical and psychological impacts of menopause and even empower women to embrace this inevitable life change. As highlighted by a recent paper in the Lancet that declares it’s time for attitudes to change, we need to start recognising menopause as a natural part of life and an opportunity to “reinvent one’s life, relationships, and future goals with renewed vigour”.
Women can also optimise their health earlier. “If you arrive at menopause at that transition time and you’re healthy, you’ve got a good diet, you don’t get too stressed, you’re probably going to have less symptoms,” says Wright. But it’s never too late to start turning things around.
Working out
Of the many lifestyle factors that can help deal with menopause and protect against long-term health problems, Dr Elina Safro, board member of the Australasian Menopause Society, says exercise is fundamental. Falling oestrogen levels impact bone density, making bones more vulnerable to fracture.
Added to that, muscle mass and strength decline with age, which can slow metabolism and cause muscle tissue to be replaced by fat. The hormonal changes during menopause also shift fat distribution from the hips to the stomach area, bringing greater risk of heart disease and diabetes.
The best way to strengthen bones and maintain muscle mass is through weight-bearing exercises, such as resistance or strength training. “But you don’t need fancy gym equipment,” says Dr Vanita Rahman from the Barnard Medical Centre in the US. “Walking, running and hiking are also weight-bearing exercises because our skeleton has to support our body weight while doing them.”
And while exercises like yoga and tai chi don’t necessarily have a direct impact on bone density, they can improve balance, which can mitigate the risk of falls and injury. They might also help manage stress and improve mood and sleep.
Ideally, a range of different exercises is best. Importantly, you need to find physical activities that work for you and can be sustained on a regular basis long-term, says Safro. “There’s no point doing something for a day and then not doing it for a month.”
Diet and nutrition
Ageing itself can increase weight unless lifestyle factors are addressed. On top of that, oestrogen helps with insulin sensitivity, so declining levels can bring greater risk of diabetes. Considering this, it’s more important than ever to be mindful of eating a healthy diet that is low in sugar and refined carbohydrates.
To mitigate weight gain and diabetes risk, Safro stresses the importance of eating less carbs and more protein. This was recently highlighted by researchers from the University of Sydney, who say that menopausal women would benefit by avoiding sugar and processed food and propose that eating more protein will help with appetite control.
Falling oestrogen levels can also increase blood pressure and unhealthy cholesterol levels. Ultimately, increased exercise and nutritious diet together are vital to tip the scales in favour of maintaining a healthy weight and avoiding chronic disease – at this life stage more than ever.
Other considerations include extra calcium and vitamin D to support bone health, and if necessary, reducing alcohol intake to ease hot flushes and promote better sleep. There is also increasing evidence that avoiding processed foods, sugar, alcohol and caffeine can reduce symptoms like hot flushes or night sweats – even menopause migraines – says Murray.
Hormone replacement therapy
Hormone replacement therapy (or menopause replacement therapy (MRT) as it’s now known) with bio-identical hormones is not a stand-alone treatment, but it can help. “It’s there for them and it can make a really big difference to their lives,” says Wright. “It generally has more benefits than it has risks.”
This doesn’t mean trying to achieve pre-menopausal hormone levels; it is most useful for relieving the more severe symptoms. “The aim of the treatment is never to replace the hormones to the level that they were when you were 25 years old,” says Safro.
Some women aren’t eligible for MHT, for instance, those who have had breast cancer, smoke or are overweight. It’s most important for women to have an individualised treatment plan with a health professional to weigh up the risks and benefits.
“Women must not feel that HRT is a magic bullet and that it will relieve all symptoms,” says Murray. “A holistic approach is required to properly manage menopause long term.”
Skincare
Our skin doesn’t escape the impacts of falling hormone levels, compounding the effects of ageing. For some, it’s just dry skin; for others, it can be worse.
“During perimenopause my skin really started to change,” says Murray. “It became blotchy and sometimes I would get rashes that would appear just before my period … My hair also started to fall out, and this continued for more than five years.”
Decreased oestrogen can also impact the skin’s collagen levels, contributing to ageing skin and wrinkling. Rahman notes that avoiding tobacco, limiting sun exposure and adequate sleep all play a role in skin health, as well as keeping it moisturised and eating a healthy diet.
Managing mental health
“Stress, stress, stress is a major factor,” says Murray. “Our modern days are so full – we are looking after families, often caring for aged relatives and trying to earn a living.”
It doesn’t help that changing hormones can affect sleep quality, which is also disrupted by night sweats. Good sleep habits or “sleep hygiene” can help, such as going to bed and getting up at a regular time, relaxing away from screens and avoiding caffeine or a full stomach before bedtime.
Fluctuating hormones, along with poor sleep, can contribute to depression and anxiety in some women. Exercise, healthy diet and calming activities such as yoga and meditation can help manage these issues. It’s also a good time to nurture friendships and take time out to care for yourself, seeking help when it’s all too much.
Step into your power
Above all, we can use menopause as a time for reflection and reclaim this as a powerful life stage when women can eventually feel liberated and empowered, says Wright, letting go of things we once thought were important or gave us value. “There’s help out there from the physical/medical perspective, but … I would love to see women being embraced and revered at this time of their lives.”
For her clients she likes sharing a traditional North American Indian saying. “At her first bleeding a woman meets her power. During her bleeding years she practices it. At menopause she becomes it.”
• Natalie Parletta is a freelance science writer based in Australia
