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Proactive Menopause

Proactive Menopause

Proactive Menopause

Menopause (medically defined as one year after your last menstrual cycle) is often labelled as a negative health event. We hear about the problematic symptoms, such as hot flashes and insomnia, and the negative consequences of decreased estrogen and progesterone. In North America, the cultural valuation of youth fosters negative attitudes towards menopause. An emphasis is placed on suppressing symptoms, rather than viewing this life transition as an opportunity to make proactive health changes.

Menopause is a natural event, and as Dr. Jennifer Prior, MD from CEMCOR said, ”it is a graduation from 30- 40 years of the ovary’s cyclic hormonal demands.”1 While menopause is associated with a number of bothersome symptoms and certain increased health risks, it is also a period where lifestyle, diet and a proactive approach can make a big difference.

In naturopathic and functional medicine, we tend to look at the whole picture, and focus on addressing symptoms as well as prevention. Here’s what you need to know about taking a proactive approach to menopause:

STRESS

Menopausal hot flashes are caused by a change in the body’s ability to regulate temperature (thermoregulation). A decrease in estrogen causes the body to be more reactive to shifts in core body temperature, and elicits an inappropriate response – a hot flash. Figure 1. Illustrates how in menopause, a women’s “thermoneutral” zone is narrowed.2

 

Figure 1. Menopausal thermoregulation

 

Now while estrogen may be responsible for narrowing the zone of “temperature tolerance”, it is often stress (elevated sympathetic activation) that elicits a spike in our core temperature.2 Norepinephrine (a stress hormone/ neurotransmitter) affects the frequency and intensity of hot flashes, and often disrupts sleep.

Avoiding stressful situations is one tactic to help reduce hot flashes.2 However, since this is not always realistic, mindfulness based stress reduction (MSBR) is one technique that has been shown to reduce the intensity of hot flashes and to improve sleep quality.3

MSBR helps to calm your mind, by being present with your thoughts, your body and the current moment. Mindfulness teachings focus on how to increase your awareness, without judgement.

This is a practice that takes time and guidance. Some great mindfulness resources include:

  • Headspace
    • This App provides amazing guided meditations and sessions focused on stress reduction, sleep and anxiety. The beauty of this app, is that you can choose the length of the meditation, which allows you to incorporate it in your busy schedule.
  • CALM
    • Another fabulous app that provides guided meditations and mindfulness video lessons. You can also choose nature scenes and sounds to enjoy while working, sleeping or relaxing.
  • Yoga
    • Yoga is a practice that fosters mindfulness and a concentration on your breath, your body and the current moment.

BREAST HEALTH

Breast cancer is the most common type of cancer in women in British Columbia. While menopause itself does not increase the risk of breast cancer, breast cancer incidence does rise with age. Therefore, it’s important to be proactive with breast health. This includes:

Understanding Your Risk Factors.
  • Factors that are used to determine a women’s risk include a personal history of breast cancer, a family history of breast cancer, your ancestry, a previous high-risk breast lesion and previous exposure to chest radiation. This is an important conversation to have with your health care provider, which will influence the frequency of screening.
Screening
  • Mammograms – Screening mammograms are the gold standard for detecting breast cancer early. Research has shown a 25 per cent reduction in deaths from breast cancer among women who regularly screen.4 A screening mammogram is available to women 40 years and older. For women between 50 to 74 years of age, without a family history of breast cancer, it is currently recommended to get a mammogram every two years.4
Physical Activity
  • Physical activity reduces your risk of breast cancer, and it is one of the risk factors amendable to change. A 2016 review of studies estimates that the risk of breast cancer is reduced the most among women that are the most physically active.5 Adopting a physical lifestyle means at least 150 minutes of weekly moderate-intensity activity and 75 minutes of vigorous- intensity activity.
Diet
  • Phytoestrogens. Phytoestrogens are naturally occurring plant substances with a chemical structure that resembles estrogen. These phytoestrogens are composed mostly of isoflavones, and are found in high concentrations in soybeans. They are weaker than the estrogen found in our body. There is evidence that soy-rich diets have a protective effect against breast cancer.6
  • Alcohol. Alcohol consumption is associated with an increased risk of breast cancer. The risk appears to be dose dependent, beginning with intakes as low as three drinks per week, and as high as six drinks per week.7

BONE HEALTH

Osteoporosis is characterized by low bone density and skeletal fragility. The incidence of osteoporosis increases after menopause, because of estrogen deficiency and age. Estrogen is protective for bones; estrogen affects bone remodeling, and the production of growth factors from bone marrow.8 With a decrease in estrogen, bones are prone to becoming weaker. Here are some tips to maintain strong bones:

Screening
  • One of the best ways to be proactive about your bone health is to be evaluated for bone loss. If your healthcare provider sees it as fit, they will order a DXA test to quantify your bone mineral density. For women who have a low bone mineral density (BMD), it is worthwhile testing vitamin D and a biochemistry panel (including calcium and phosphorus).
Diet
  • Optimal Calcium and Vitamin D – Calcium and Vitamin D are essential for building and maintain strong bones. Calcium provides the building blocks for bones, and vitamin D ensures that you are able to absorb calcium from your gut. Postmenopausal women who are getting adequate calcium from their diet (1200 mg/ per day) do not need to take calcium supplementation.
  • Calcium rich foods include: seeds, cheese, canned salmon and sardines, beans and lentils, yogurt, almonds, and dark leafy greens. If a woman is not getting enough calcium in her diet, then it is generally recommended to supplement (500 to 1000 mg/day) in divided doses with mealtime, such that her total intake equals 1200 mg.9
  • In Canada, most people do not get enough vitamin D from food only. Osteoporosis Canada recommends that individuals with either osteoporosis or an increased risk for fractures “receive adequate vitamin D, as recommended at 800-2,000 IU per day.”10 The best supplement to purchase is vitamin D3 (cholecalciferol). If you aren’t sure about interactions between vitamin D and any other medications you are taking, consult your healthcare provider or pharmacist.
Physical Activity
  • Exercise is prudent for maintaining bone density and improving balance. Most experts recommend exercising for at least 30 minutes, three times per week. There are four types of exercise that are recommended: strength training (2 days/week), balance training (every day), aerobic physical activity (150 mins/ week) and posture awareness (every day). Osteoporosis Canada has a series of great videos that outline safe and effective exercises. If exercising is new to you, consult with your healthcare provider or physical therapist about what exercises are right for you.

CARDIOVASCULAR HEALTH

In Canada, cardiovascular disease (CVD) is the second leading cause of death among women. While menopause does not cause cardiovascular disease, the number of cases of CVD increases significantly after menopause and with increasing age. This has been hypothesized to be due in part to lower estrogen, higher androgens and an increase in risk factors with age.11

Menopause is associated with adverse effects on blood lipids, changes in blood pressure, body composition, clotting factors and glucose metabolism.12 Taking a proactive stance with cardiovascular disease should focus on identifying and reducing risk factors.

Understanding Your Risk Factors
  • Prevention starts with knowing your risk; almost 80% of premature heart disease and stroke can be prevented through healthy behaviors.13 The traditional risk factors for cardiovascular disease include:
    • Hypertension
    • Cigarette smoking
    • Diabetes mellitus
    • Family history of premature cardiovascular disease
    • Chronic Kidney disease
    • Obesity

In addition to knowing your risk factors, it is recommended to get a baseline lipid profile. There are a number of cardiovascular risk calculators (i.e. Framingham, MyHealthCheckup, CardioRisk Calculator, etc) that your healthcare provider may use to evaluate your unique cardiovascular risk. A number of these calculators utilize your unique risk factors and cholesterol levels to estimate your risk.

There are other laboratory tests, such as the PULS Cardiac test, which looks beyond cholesterol levels, and detects unstable cardiac lesions. These unstable lesions cause seventy-five percent of heart attacks; detecting their presence can be an indicator of overall heart health and provide further information regarding your risk.14

Having a discussion with your healthcare provider about cardiovascular risk is paramount to being proactive and optimizing your heart health.

Diet
  • Vegetables –Observational studies have shown that individuals who consume diets high in vegetables and fruit (such as the Mediterranean diet) have a lower risk for cardiovascular disease. In my clinical practice, I work a lot with patients on optimizing their diets, increasing the antioxidant rich vegetables and choosing lean sources of protein. Make the emphasis of your plate colourful vegetables.
  • Fibre – Diets high in fibre, particularly insoluble sources of fibre, are associated with a lower risk of cardiovascular disease. Fibre helps to balance blood sugars, slows gastric emptying and is needed for the production of short chain fatty acids in the gut, which reduce circulating cholesterol.15 It is recommended to obtain your fibre through whole foods, rather than “enriched cereals”. The recommended amount of fibre per day is at least 25 grams for women and 38 grams for men per day. Great sources of fibre include:
    • Legumes – beans and lentils
    • Ground and whole flaxseeds
    • Nuts
    • Whole grains – i.e. whole wheat, brown rice
    • Rolled oats
    • Vegetables
  • Omega 3 Fatty Acids – Fish oils have been shown to provide benefit in cardiovascular disease and lower triglycerides. While the available studies have mixed results in regards to benefits16, cardiovascular guidelines so recommended a diet high in omega 3-fatty acids. This means including at least 2-3 servings of “high omega 3 foods” per week. Foods high in omega 3 fatty acids include:
    • Oily fish (such as salmon)
    • Sardines
    • Mackerel
    • Chia seeds
    • Flaxseeds/ flaxseed oil
    • Nuts – walnuts, pecan nuts
Physical activity
  • Regular exercise is essential for promoting heart health. The recommendations include moderate intensity exercise for 150 minutes a week and vigorous-intensity exercise for 75 minutes a week. Moderate intensity includes brisk walking and bike riding, whereas vigorous-intensity exercise includes jogging, swimming or cross-country skiing.17 If you have a health condition that limits exercise, or you are unsure about the types and amounts of physical activity most appropriate for you, consult your healthcare provider.

MENOPAUSAL SYMPTOMS

Many women experience menopausal symptoms, including hot flashes, vaginal atrophy and insomnia. It is important that you find a healthcare provider in which you can discuss your specific symptoms, goals and health history.

I utilize both conventional and alternative therapies when addressing menopausal symptoms. The decision to use herbal supplements, acupuncture vs. bioidentical hormones is based on the women’s unique symptoms, preferences, goals, risk factors and health history. This needs to be a conversation, where your concerns are heard, and you are provided with the risks and benefits of different options.

Don’t let your symptoms go unaddressed. Your sleep, your sex life, your energy and your quality of life is important, and there are a lot of options (natural and conventional) that can help you manage symptoms, and feel more resilient and empowered.

NEXT STEPS

I have created a Proactive Menopause Plan, to help assist women navigate their menopausal symptoms and risk factors, and to focus on prevention and longevity. The plan is based on the referenced information above and on current guidelines. To receive a copy of the proactive menopause plan, you can visit my website here.

Proactive menopause plan

Fill out your Proactive Menopause Plan, and have a conversation with your health care provider about assessing your risks, and the options for managing menopausal symptoms. Now’s the opportunity to take a preventative approach!

If you are interested in digging deeper into your health, hormones, risk factors and what you can do to be proactive, you can book a complimentary “Meet and Greet” appointment with one of our practitioners at Hawthorne Naturopathic Centre. Stay tuned for more information!

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References
  1. Estrogen Deficiency: The Wrong Idea About Menopause. (2014, August 7). Retrieved from https://www.cemcor.ca/resources/estrogen-deficiency-wrong-idea-about-menopause.
  2. Freedman, R. R. (2005). Hot flashes: behavioral treatments, mechanisms, and relation to sleep. The American journal of medicine, 118(12), 124-130.
  3. Carmody, J., Crawford, S., Salmoirago-Blotcher, E., Leung, K., Churchill, L., & Olendzki, N. (2011). Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause (New York, NY), 18(6), 611.
  4. Why are Mammograms Important? (n.d.). Retrieved November 10, 2019, from http://www.bccancer.bc.ca/screening/breast/get-a-mammogram/why-are-mammograms-important.
  5. Pizot, C., Boniol, M., Mullie, P., Koechlin, A., Boniol, M., Boyle, P., & Autier, P. (2016). Physical activity, hormone replacement therapy and breast cancer risk: A meta-analysis of prospective studies. European Journal of Cancer, 52, 138-154.
  6. Wu, A. H., Yu, M. C., Tseng, C. C., & Pike, M. C. (2008). Epidemiology of soy exposures and breast cancer risk. British journal of cancer, 98(1), 9-14.
  7. Cao, Y., Willett, W. C., Rimm, E. B., Stampfer, M. J., & Giovannucci, E. L. (2015). Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. Bmj, 351, h4238.
  8. Pacifici, R. (1996). Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. Journal of Bone and Mineral Research, 11(8), 1043-1051.
  9. Rosen, H. and Drezner. M. Overview of the management of osteoporosis in postmenopausal women. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2019.
  10. Vitamin D and Effects on Fractures, Falls and Bone Mineral Density. (2018, October 16). Retrieved from https://osteoporosis.ca/vitamin-d-and-effects-on-fractures-falls-and-bone-mineral-density/.
  11. Zhao, D., Guallar, E., Ouyang, P., Subramanya, V., Vaidya, D., Ndumele, C. E., … & Budoff, M. J. (2018). Endogenous sex hormones and incident cardiovascular disease in post-menopausal women. Journal of the American College of Cardiology, 71(22), 2555-2566.
  12. Abramson, B., Derzko , C., Lalonde, A., Reid, R., Turek, M., & Wielg, A. (2002, October). Hormone replacement therapy and cardiovascular disease. Retrieved from https://www.ccs.ca/images/Guidelines/Guidelines_POS_Library/HRT_PS_2002.pdf.
  13. Heart Risk & prevention. (2018). Retrieved November 20, 2019, from https://www.heartandstroke.ca/heart/risk-and-prevention.
  14. LifeLabs. (2019). PULS (Protein Unstable Lesion Signature Test) Cardiac Test. Retrieved from https://www.lifelabs.com/test/puls-protein-unstable-lesion-signature-test/.
  15. Threapleton, D. E., Greenwood, D. C., Evans, C. E., Cleghorn, C. L., Nykjaer, C., Woodhead, C., … & Burley, V. J. (2013). Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. Bmj, 347, f6879.
  16. Manson, J. E., Cook, N. R., Lee, I. M., Christen, W., Bassuk, S. S., Mora, S., … & D’Agostino, D. (2019). Marine n− 3 fatty acids and prevention of cardiovascular disease and cancer. New England Journal of Medicine, 380(1), 23-32.
  17. Lewis, S. F., & Hennekens, C. H. (2016). Regular physical activity: forgotten benefits. The American journal of medicine, 129(2), 137-138.

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