Nutrition And Hormonal Therapy For Menopause 

Nutrition and hormonal therapy for menopause – (exploring dietary strategies and hormonal treatments to alleviate menopause symptoms)

Overview of menopause

Menopause is the cessation of menstrual periods for at least twelve consecutive months, marking the conclusion of a person's reproductive phase. It's a natural aspect of ageing, typically occurring around the age of 51.

Importance of nutrition and hormonal therapy during menopause

As oestrogen levels decline during menopause, the likelihood and prevalence of various chronic diseases rise. Hence, dietary therapy should be a fundamental aspect of treatment, with nutritional intervention crucial in preventing these chronic conditions.¹ 

Understanding menopause

Stages of menopause

The process of menopause is gradual and occurs in three stages:

1. Perimenopause

During perimenopause, ovaries produce less oestrogen. It begins 8-10 years before menopause. In the last year of perimenopause, oestrogen levels drop quickly. Sometimes, this stage is accompanied by menopause symptoms. But, there exists a chance to get pregnant because you are still having menstrual cycles.

2. Menopause

Menopause is characterised by the absence of menstrual periods. Ovaries completely stop producing oestrogen. This prevents the production of eggs. Menopause is diagnosed when you are not having menstrual periods for 12 consecutive months. The following symptoms characterise this stage.

• Irregular periods
• Vaginal dryness
• Hot flashes
• Night sweats
• Sleep problems
• Chills
• Mood changes
• Weight gain
• Thin hair and dry skin

3. Postmenopause

The period beyond menopause is known as postmenopause. Simply, the rest of your life after menopause is classified as postmenopause. Menopausal symptoms may get better, but not necessarily. As the oestrogen level declines further, the risk of having specific health problems, such as osteoporosis and heart disease, increases.

Common symptoms

• Changes in periods

This is recognised as the first symptom you notice after menopause. You might experience heavy or light bleeding or a more significant cycle gap. But these are regular changes.

• Hot flashes

Many women experience hot flashes due to changing oestrogen levels, which may last for several years. A hot flash refers to a sudden sensation of warmth in the upper part or all of your body. Red blotches may appear on your chest, back, and upper limbs. Heavy sweating and cold shivering occur. Night sweats may be strong enough to wake you up. The duration of the hot flashes may vary from 30 seconds to 10 minutes. They can happen several times an hour or a few times a day.

• Bladder control

A loss of bladder control is referred to as incontinence, and it is characterised by a sudden urge to urinate. Urine may leak during exercise, sneezing, laughing, or heavy work, leading to bladder infection.

• Sleep

Sleep disturbances include difficulty falling asleep or waking too early, and night sweats might wake you up. 

• Vaginal health and sexuality

Following menopause, the vagina may become drier. It can make sexual intercourse uncomfortable. These changes are prone to sexually transmitted diseases (STDs), such as gonorrhoea.

• Mood changes

Menopause may alter emotional stability and make you moody and irritable. There is no clear consensus on why it happens. However,  possible causes include stress, a history of depression, or feeling tired. 

• Your body seems different

Your waistline may expand, muscle mass could decrease while fat accumulates, and your skin might thin out. Memory issues could arise, along with stiffness and discomfort in your joints and muscles. Researchers are studying these changes to understand their connection with hormonal fluctuations.

• Additional symptoms

Furthermore, some women may experience additional symptoms such as body aches, headaches, and heart palpitations. It's essential to consult with a doctor for proper evaluation and guidance. Since fluctuating hormone levels influence menopausal symptoms, it's difficult to predict the frequency and severity of symptoms for each individual.

Hormonal changes during menopause

During menopause, the body goes through hormonal changes. As a result, ovaries produce less oestrogen and progesterone. In such situations, hormone therapy helps to restore normal hormonal levels. 

Nutritional therapy

Eating a healthy and balanced diet can help support a healthy weight and relieve some menopausal symptoms. Supplements cannot replace the nutritional benefits of a healthy and balanced diet. Healthy, balanced diets are not only essential for physical well-being but also for mental health. Mood changes, anxiety and problems with concentration can be some of the mental health consequences of menopause.

Here are the essential nutrients to help manage postmenopausal symptoms:²

Calcium and vitamin D

Appropriate calcium intake and vitamin D have been shown to prevent bone loss and improve overall bone health. It reduces the risk of fracture in peri- and postmenopausal women. Adequate calcium intake for peri- and postmenopausal women is necessary to prevent osteoporosis. Per-day requirements of calcium intake vary according to different guidelines. However, a consensus exists that at least 1200 mg/day of calcium is required for most women.^2,3 

A daily intake of 400-600 IU of vitamin D is also recommended to facilitate effective calcium absorption through sun exposure diet or supplementation. There is also an increased risk of cardiovascular disease, diabetes, and hyperlipidemia due to a decline in oestrogen levels. Vitamin D regulates the growth of vaginal epithelial cells and decreases the chance of genitourinary tract problems in menopausal women.

Omega-3 fatty acids

Omega-3 fatty acids are polyunsaturated fatty acids. They are an essential dietary component because the human body does not make them.⁴

Omega-3 fatty acids help treat a range of menopausal symptoms, such as:

• Hypertriglyceridemia: Omega-3 offers a triglyceride-lowering effect for postmenopausal women. Menopausal women must take at least 1g/day of omega-3 fatty acids as provided by diet or supplementation.
• Joint pain: Omega-3 fatty acids work similarly to non-steroidal anti-inflammatory drugs (NSAIDs) and can reduce inflammation, which may help relieve joint pain
• Menstrual pain: During perimenopause, many women experience menstrual pain and cramping. This discomfort typically arises due to prostaglandins, both beneficial and harmful compounds. Menopause tends to favour the latter, while omega-3 fatty acids support the beneficial type, offering relief from menstrual pain and cramping
• Osteoporosis: Intake of omega-3 fatty acids increases bone mineral content and makes bones strong
• Hot flashes: Omega-3 fatty acids reduce the frequency of hot flashes when used in the right dosage
• Vaginal dryness: Lubricating properties of omega-3 fatty acids help with dryness of the vagina, a common symptom of menopause 

Sources of omega-3 fatty acids include:

• Oily fish
• Flaxseed
• Canola oil
• Walnuts
• Chia seeds
• Spinach
• Soybeans
• Eggs

Phytoestrogens

Phytoestrogens are plant-based products with oestrogen-like properties. Phytoestrogens effectively reduce the frequency of hot flashes in menopausal women. Furthermore, phytoestrogens are effective in improving the urogenital symptoms associated with menopause.^5,6

Antioxidants

Hormonal therapy has some adverse effects and sometimes cannot be tolerated by women. There is a risk of developing oestrogen-dependent breast cancer. In such cases, it is advantageous to use dietary antioxidants to manage the symptoms of menopause. Antioxidants improve the quality of life of menopausal women by reversing the oxidative stress chain.⁷

Antioxidants with proven beneficial effects include:

• Vitamin C
• Vitamin E
• Melatonin
• Grape polyphenols
• Lycopene
• Vitamin C and E can control the onset of menopausal symptoms associated with decreased estrogen levels. These vitamins' antioxidant properties help neutralise oxidative stress through their free radical scavenging effect

Hormonal therapy 

Hormone replacement therapy refers to medications that help to restore normal levels of female hormones and to manage common menopausal symptoms like hot flashes and vaginal discomfort. It is also helpful to prevent bone loss and reduce fracture risk in postmenopausal women.^8,9

However, there are certain risks associated with hormone therapy depending upon the type, the dose, and the duration of treatment. For this reason, hormone therapy should be tailored to each person’s medicine-related needs.

Types of hormone therapy

Oestrogen therapy (ET)

The therapy contains only oestrogen. Treatment usually begins at lower doses. Oestrogen therapy may be taken in many forms, like patches, pills, creams, vaginal rings, gels, or sprays. 

Oestrogen progesterone/progestin hormone therapy (EPT)

This therapy combines both oestrogen and progesterone so, referred to as combination therapy. Progesterone is a natural form, while progestin is a synthetic form of progesterone. This type of hormone therapy is for people who still have a uterus.

Selective oestrogen receptor modulators (SERMs)

These are hormone therapies that modulate how estrogen works in your body. Tamoxifen and raloxifene are examples of such types of modulators. They slow bone loss and reduce the risk of fractures in women with osteoporosis.

Bioidentical hormone therapy

These plant-based processed hormones mimic the function of hormones made by the body’s glands. They can help people manage symptoms associated with low or unbalanced hormone levels. 

Frequently asked questions

What is menopause?

Menopause is the cessation of menstrual periods for at least twelve consecutive months, marking the conclusion of a person's reproductive phase. It's a natural aspect of ageing, typically occurring around age 51.

What are the common symptoms of menopause?

Common symptoms of menopause include hot flashes, night sweats, irregular periods, vaginal dryness, mood swings, difficulty sleeping, and changes in libido.

Can menopause be treated?

While menopause is a natural process and cannot be prevented, its symptoms can be managed through lifestyle changes, dietary interventions, and hormone therapy, if necessary.

What is hormone replacement therapy (HRT)?

Hormone replacement therapy involves supplementing the body with estrogen, progesterone, or both to alleviate symptoms of menopause, such as hot flashes and vaginal dryness.

How can diet and nutrition help manage menopausal symptoms?

Eating a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help alleviate symptoms of menopause and reduce the risk of chronic diseases associated with this life stage. Certain nutrients, such as calcium, vitamin D, omega-3 fatty acids, and phytoestrogens, are particularly beneficial.

Summary

In conclusion, managing menopause involves understanding its stages, symptoms, and hormonal changes. With the onset of menopause, the decline in oestrogen levels brings about various challenges and health risks. However, by combining nutritional interventions and hormonal therapies, individuals can effectively manage symptoms and reduce the likelihood of chronic diseases. This approach can significantly improve the quality of life during menopause.