Nourishing Menopause Q&A
Menopause comes with a lot of myths, questions and concerns for many women. On May 1, 2024, Y@HOME partnered with Emily Opthof, RD, to dispel some of these myths, answer your questions, and delve into how nutrition can play an important role during this new life stage.
Y@HOME+ members can replay the webinar here. Read on below for answers to questions we ran out of time to answer!
General Menopause questions
As a Fitness Professional, what should I keep in mind when I work with women in peri-menopause and menopause?
Women in perimenopause and menopause have lots of life experience and are valuable sources of information around movement that is enjoyable and supportive to them! Ask not only about how they like to move their bodies, but what makes movement a priority for them and the different barriers they experience when trying to incorporate movement. Get creative as a team and prioritize feeling stronger and being mobile and functional with aging versus exercising only to lose weight or body fat. Weight-focused goals can start as motivating, but quickly become frustrating and overwhelming, often leading to reduced activity and feelings of low self-confidence.
How long does menopause last? Not for life, right?
The symptoms of menopause will not last the rest of your life, and typically end four to five years after your period stops. However, every woman is different, and symptoms may last longer. As time progresses, symptoms should reduce in severity and frequency.
What is the early and late age of menopause? What is the normal age?
Perimenopause often begins between the ages of 40 and 44 (but may happen earlier). The average age menopause begins is 51, but may occur in a woman’s 40s or 60s.
Does this same information apply to premature ovarian failure? Or do you have any extra information that would apply?
Primary ovarian insufficiency (the more accurate term for premature ovarian failure!) is when periods and ovulation stop before age 40, and it is sometimes missed or ignored unless a person is actively trying to become pregnant. It is different than menopause! We don’t know exactly why it happens, but factors such as genetics, autoimmune conditions and some other health issues can be involved. This is a situation where hormone replacement therapy can be used to support symptom reduction until anticipated menopause around age 50. For those trying to become pregnant, fertility-focused nutrition strategies and specialist medical care is helpful.
Do you have any recommendations when there are sudden life changes that can affect menopause like a partial hysterectomy? Would the advice for menopause also be the same as for a partial hysterectomy?
A partial hysterectomy is when the uterus is removed from the body, leaving behind the cervix, fallopian tubes and ovaries. A total hysterectomy is when the uterus and cervix are removed; when both fallopian tubes and ovaries are removed, this is called a bilateral salpingo-oophorectomy. Those who have their ovaries removed will likely experience symptoms of menopause, and hormone therapy can be helpful in managing symptoms such as hot flashes. A person without a uterus will stop having periods even if they still have their ovaries, so while they may not need period products or hormone therapy, they can still benefit from nutrition care that supports cycle-related symptoms such as food cravings, bowel movement changes, bloating and fatigue. This often looks like making sure blood sugar levels are stable, enjoyable foods are included with other meals and snacks, and fibre intake is modified to support digestion.
Any suggestions for anxiety?
There are many techniques that can help with anxiety and relaxation. Deep breathing, CBT and DBT therapies, meditation or mindfulness, or even gentle movement such as yoga can all be beneficial. We encourage you to try many different techniques and styles to find what works best for you. Y@HOME has a wide selection on their wellness page.
I’m concerned about my sexual health changing but want to continue with my partner. Is there any helpful information?
As estrogen falls, it’s common to experience changing emotions, as well as physicality (e.g., pain) regarding your sexual health and partnership. Emily suggests reading the book “Come As You Are” by Emily Nagoski for helpful information and tips on how to navigate this change. If you’re experiencing pain, visiting a pelvic floor physical therapist can be helpful, as well as using a personal lubricant. Seeing a therapist who specializes in sexual health can also teach you a variety of relaxation techniques.
When I have hot flashes, it starts with a burning feeling on the inside of my leg and makes its way up my chest - is this normal?
The experience of hot flashes can be unique to every individual! Triggers such as stress, alcohol, caffeine and even weather can change how a hot flash is experienced. Keep a journal of your hot flashes, including any additional negative symptoms such as shortness of breath, dizziness or loss of consciousness or pain that may indicate the need for further assessment.
I just turned 50 and am not yet experiencing menopause. Is there anything we can do to prevent and ease the symptoms of menopause when it happens?
Hormone therapy focuses on reducing the symptoms of menopause and can be something to consider. There are many delivery methods, and Emily suggests taking a look at the book “The Menopause Manifesto” which details the different methods and is a good starting point when having a conversation with your doctor about these therapies.
What do you recommend as a focus for post menopause...supplements, food, and/or lifestyle?
Ensuring a healthy lifestyle and habits is the most important focus to have. Practice good sleep hygiene, eat for nutrient density and variety, and make sure you’re moving and getting physical activity in.
Can you share any information about menopause/hormonal changes and symptoms that seem to cause ADHD symptoms (typical female symptoms vs typical male symptoms). Can hormonal treatment improve ADHD-type symptoms (better or the same as ADHD meds/stimulants)
Mood changes and brain fog in menopause can present very similarly to the typical female symptoms of ADHD, including difficulties with communication, anxiety symptoms, lower executive functioning and difficulties with time management. If a person has experienced these symptoms in the past but managed them well, it’s possible they may notice a period of time where they are more challenging and extra support is needed! Hormone therapy doesn’t stop the temporary brain fog of menopause, but it may provide some benefit for women who experience mild depression alongside other symptoms; hormone therapy for menopause hasn’t yet been studied as a treatment for ADHD! Like hormone therapy, ADHD medications can vary for each person and you can trial different types along with your provider’s support to find the one that is right for you.
Nutrition
What is your view on the idea of eating 3 times per day vs. 4-5 times with smaller portions (meals plus snacks)?
The main takeaway is to eat regularly and enough, and try to prioritize nutrient density and variety. Intuitive eating is a framework that's designed to support eating in the pursuit of individualized health without the influence of diet, culture or unnecessary restriction. Some individuals may feel their best eating 3 times a day, others may feel better eating more often.
In terms of intuitive eating, we see eating – a meal or snack or otherwise - as a time to add nutrients, and this can be a much more valuable approach. Adding a variety of nutrients will benefit our health in the long term.
Do Asian women have less menopause symptoms? What are they eating?
Asian women do not have less menopause symptoms than other women. Menopause will affect each woman differently, regardless of ethnicity. Traditionally, many Asian diets are richer in soy, which contain phytoestrogens, alongside a good balance of macronutrients (carbohydrates, fats and protein).
Is there a magical micronutrient balance we should follow in menopause?
Nothing magical! Incorporating a combination of carbohydrates, proteins and fats at each meal and snacks supports nutrient density and adequate energy. It can be helpful to look for higher fibre carbohydrates, from whole grains, fruits and vegetables and legumes as these benefit digestive and metabolic health. Protein options that are lower in saturated fat, such as poultry (chicken and turkey), rabbit, fish, tofu, eggs, and nuts and seeds, support muscle health while managing cholesterol levels. And a variety of unsaturated fat options provide the heart and brain-healthy fuel we need, from oils and non-hydrogenated margarines, avocados, nut butters and seeds.
Supplements
Do you have any recommendations on brands when it comes to supplements?
The best supplement brand is the one that offers the correct dose of the nutrient at an accessible price and format for you. Many supplements are not regulated and this means the product you are taking could have too much or not any of the nutrient it says it does. It can be helpful to look for supplements that are third-party tested, such as those on the NSF Certified for Sport Registry, to reduce the risk of consuming contaminated products or those that may be harmful to health. Avoid supplements that contain proprietary blends, as these do not specify how much of each nutrient or compound you are taking and this could pose issues for possible reactions or interactions.
What’s your opinion about ashwagandha supplements?
Ashwagandha is commonly taken for relaxation and stress management, and while anecdotally it may be helpful, we still need more research to determine if it is both safe and effective to use long-term. If a person is taking no other medications, or there are no possible medication interactions, the dose of the supplement is low, and the person has the means to afford and trial the supplement, this may be when they choose to take it. It can be important to consider other factors that affect energy levels and stress, including if we are eating enough, our sleep hygiene, and non-diet support systems like partners, friends and family!
Hormonal Therapies
What is your opinion on estrogen gel & progesterone therapy?
In terms of menopause transition, hormone therapy can provide support in terms of hot flashes and other symptoms. It’s important to have a conversation with your healthcare provider around dosages, and the types of estrogen therapy and duration.
When it came to estrogen therapy, estrogen's job is to promote tissue growth and that involves the uterus and the endometrium or the lining of the uterus and breast tissue. It’s important to keep that in mind as a potential risk, and look at the family history and personal medical health history, often in the context of history of breast cancer and endometrial cancer. It’s important to talk to a gynecologist or your doctors about different forms of estrogen that might provide symptom relief with a much lower risk profile.
You can also find more information on hormonal therapies and the various options in the book the “The Menopause Manifesto” by Dr. Jen Gunter. This book is a good resource to peruse as an individual and in preparation for appointments with providers to talk about hormone therapy.
I'm on progesterone for 12 days a month + a low dose estradiol patch. We eat a fairly clean diet and exercise daily and I'm having a heck of a time losing weight.
Weight is influenced by many more factors than just food and exercise, and changes in weight don't necessarily indicate whether a person is healthy or not, because health and weight are both spectrums that depend on each person and the context. Intuitive eating can be a helpful framework during this time.
Emily encourages folks to consider shifting their mindset away from intentional weight loss and to prioritize health-promoting behaviors such as eating regularly during the day and increasing nutrient density, using hunger and fullness cues to guide eating volume, and considering specific nutrients that might be of value for the individual person.
Prioritizing nutrient density and variety is a great way to promote health while our bodies change, and feel more confident throughout this important body transition.
We have a family history of strokes, and our healthcare practitioner is hesitant to try hormonal/estrogen therapy. What is the true benefit/risk?
As with any medication or therapy, the benefits and risks are highly individualized. It’s recommended to arm yourself with knowledge about the different treatments to take with you to your medical practitioner, ask them about your options and collaborate to develop a care plan that will work for you.
It’s important to talk to a gynecologist or your doctors about different forms of estrogen that might provide symptom relief with a much lower risk profile. The book “The Menopause Manifesto” by Dr. Jen Gunter is a good source of information about the different treatment options available.
Should we be taking external hormones such as estrogen to keep up our bone health and improve sleep?
Estrogen therapy in menopause has demonstrated high effectiveness at preventing menopause-related bone loss, but family history and other risk factors such as alcohol intake, fitness level and smoking should be considered when deciding if estrogen therapy is right for you and the form to use.
Evidence to use menopause hormone therapy for sleep is limited, but may be helpful if hot flashes and night sweats are negatively impacting sleep. Women who take hormone therapy appear to be equally likely to report sleep issues than those who don’t, so having a conversation around sleep hygiene, menopause symptoms and treatment options with a provider can be helpful. Other medications and treatments may be more appropriate depending on the person and their symptoms.
Suggested Resources
Come as you are – Emily Nagoski
The Menopause Manifesto - Dr. Jen Gunter
Why We Sleep – Matthew Walker, PhD