Managing Menopause: Symptom management in menopause


Following on from her ‘Managing Menopause’ article in December’s Fitness Journal, Wendy Sweet describes the symptoms of menopause and how a change in lifestyle might reduce the impact menopausal-symptoms might be having on the quality of a woman’s daily life.

Although some women heading into their mid-life years hardly notice menopause at all, for some, this stage heralds the onset of a number of symptoms which impact on the quality of their daily life.
As reproductive hormones start to nose-dive, the first thing a woman might notice is the start of hot flushes. It’s the most commonly reported symptom in menopause. Some women have a few, but studies show that some can experience up to 40 or more a day. Now that’s a lot of heat! For these women, their daily life might be impacted if they can’t keep cool. Coupled with these of course, are a number of other symptoms that women experience. These include:

•     Night sweats
•     Poor or interrupted sleep
•     Dry skin and vaginal dryness
•     Low energy and unresolved fatigue
•     Mood swings and/ or irritability
•     Depression
•     Sore joints and muscle pain
•     Loss of muscle (sarcopenia)

While these are the most common symptoms, others include, heart palpitations, bloating and the dreaded diaphragmatic weight gain. But of greater importance are the ones that are only detected through blood work. These ‘invisible’ symptoms include:

•     High blood pressure (hypertension)
•     High blood fats (high triglycerides)
•     High low-density cholesterol (LDL-C)
•     High inflammatory markers (C-Reactive Protein)
•     Low ferritin (stored iron)
•     Low Vitamin-D (25-hydroxy Vitamin D)
•     Altered thyroid and ddrenal hormones

Women experience their symptoms in different ways depending on how quickly oestrogen/estrogen and progesterone levels are changing and how their lifestyle is being managed. Menopause itself is not the issue. All women go through it.

The concern is whether symptoms are impacting on the quality of their daily life as well as other aspects of their health. And the severity of symptoms are influenced by a woman’s genetic risk, her family history, her body-weight going into menopause years, her stress levels, too much or too little exercise, diet, nutritional imbalances, hormonal imbalances and increasing age.

Hot flushes and night sweats

Known in many countries as ‘hot flashes’ these are clinically defined as an instability of the vaso-motor system. This is the name given to the system that is driven by the adrenal glands through the sympathetic nervous system (SNS).

The SNS controls blood pressure including the dilation and constriction of blood vessels. Hot flushes and night sweats are the hallmark of menopause for many women. Reddening of the face, a sensation of heat and sometimes, profuse sweating, drive many to despair and because these occur mostly at night, hot flushes can be the main cause of sleeplessness and restless leg syndrome.

Hot flushes are how the body responds to an excess of heat. The ‘flush’ is the body trying to get-rid of the heat. What precedes the feeling of the ‘flush’ is an interaction of hormones, including the stress and thyroid hormones. Remember, all hormones interact in the body.

Although hot flushes are officially seen as being caused by low oestrogen production, they may also be brought on by stress (the adrenal glands control your stress levels) and…wait for it, hyper-glycemia (high levels of blood glucose).

This is why the right nutrition, stress management and the amount and type of exercise women do, have an impact on the reduction of the symptoms of menopause.

Women suffering moderate to severe symptoms need to change their diet. Getting off sugar, white starch and processed food helps enormously as well as cutting back on alcohol.

This is because these types of food cause a surge in blood sugar and insulin production in the body, exacerbating inflammation. Because hot flushes are inflammatory to the body’s internal cells, high production of insulin ‘triggers’ more hot flushes.

High stress levels are also inflammatory as a hormone called cortisol, starts to accumulate. High insulin production, coupled with poor sleep and high cortisol levels are the culprits in the increased distribution of high-risk belly fat or what doctors call ‘central adiposity.

Once women understand this connection, then their nutritional choices become clearer. Success comes when mid-life women manage their food choices and portion sizes as well as other aspects of their lifestyle. Foods which do not spike insulin production are those carbohydrates which nutritionists call low-glycemic foods.

Protein choice and amount is also important. Too much emphasis is put on proteins these days and causes confusion. If women are overweight, then the liver struggles to ‘turn over’ protein, so those who are not exercising do not need as much as some popular diets advocate.

For a woman who is not exercising in the form of cardio and resistance training and is overweight, then her priority is to only have around 1.0 – 1.2 gms of protein per day, per kilogram of body weight. The priority lies in cleaning out the liver, so that she can manage to turn over proteins. If a liver is ‘fatty’ (steatosis), then her diet at best, needs to reduce saturated fats as well as high sugar and starch foods.

Good quality fats are still important for menopausal women. But the type of fats depends on her heart risk and weight status. Once again, there is a ‘one-size-fits-all’ approach to nutrition by some popular chefs and authors. This is not the case for women transitioning through menopause.

Fats should be sourced from avocadoes, salmon, fish, nuts and other Omega 3-rich sources. If the risk of heart disease is present, then organic olive oil is still favoured over coconut fats and oils, which do turn into a saturated fat in the body. While coconut oils are popular as being anti-inflammatory for athletes, there is still debate as to the effectiveness of these for some people.

In the latest New Zealand Health Survey from the Ministry of Health, (Update of Key Results, 2015), the news for mid-life women is not great. More than 50 percent of women in New Zealand (age 45 – 60 years) do not do enough exercise to mitigate the risk of heart disease and Type 2 diabetes. Added to this, is the report that 32 percent of New Zealand women in this age group are now obese.

High blood cholesterol is on the increase in women as is arthritis, asthma and high blood pressure. For those that are already overweight or obese going into their menopause years, the risk of developing heart disease and diabetes is higher. This is why for many, the best diet is the Mediterranean-style diet (without the pasta or too much bread). This includes a high intake of vegetables (not too much fruit), proteins and fats derived from mainly fish and nuts/ seeds and legumes.

It is not high in red-meat and dairy products which makes the Mediterranean diet less inflammatory to the body’s internal cells than the typical New Zealand diet.

Drinking water is also important in menopause. At least two litres daily is recommended especially if you are overweight. If you adopt this type of diet in menopause and improve sleep quality and quantity, you will be well on your way to managing the severity of the symptoms.

Next month we take a look at Hormone Replacement Therapy as well as the latest information about the role of phytoestrogens and isoflavones (secondary vegetable substances which can act as oestrogens in the body), and whether these are suitable for all women.

Wendy Sweet (RGN/ M.SpLS/ PhD Student, Waikato University)
An award-winning fitness and wellness educator in New Zealand and Australia, Wendy brings her personal experience as well as her research interest in women’s mid-life ageing and lifestyle behaviour-change to the relatively unspoken topic of ‘menopause’. Coming in early 2016, is ‘My Menopause Transformation’ (MyMT™) – an evidenced 12-Step Program of Lifestyle Change, just for women transitioning into and through menopause.


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