#70 Managing Menopause

Menopause occurs around the age of 50. Perimenopause (defined as around the time of menopause) starts sometime in the early 40s or with some women, can occur even sooner. Some women do not have menopause until they’re 55 or 60 years old. While some women have a lot of irregular bleeding for years, there are also those who just suddenly stop having periods.

There’s a lot of conflicting advice about what to eat during menopause. Certainly, as we age, mitochondria become less efficient as providing energy to our cells and our metabolism decreases. It’s very important to remember that for most women, bone building continues until about the age of 30 or 35 and then begins to decrease. After menopause, when you have less estradiol, the bone building cells (osteoblasts) decrease so there is a net bone loss after age 30 to 35 years. Once you hit menopause, that bone loss accelerates with the loss of estradiol (estrogen).

While there are many options for calcium replacement, 500 mg of calcium carbonate twice daily with vitamin D is considered important. Since you are not able to absorb more than 500 mg of calcium at a time, I’d recommend 500 mg twice a day in addition to what you can get in your diet. Vitamin D is very important for the absorption of calcium and also for other health benefits, including prevention and management of viral illnesses, including Covid.

There are many recommendations for low fat foods, including skim milk, low fat, yogurt, and low-fat cheese. But remember, when fat in removed from these products, carbohydrates increase, so you’re actually better off with more fat and a little less carbohydrate because the extra carbohydrates will increase your weight and your blood sugar, and the increased blood sugar leads the way to your likelihood of developing diabetes. The typical breakfast we see of dry toast, cold cereal with skim milk, and orange juice is loaded with carbohydrates. These will turn into blood sugar that will turn into fat and other inflammatory products. If you must eat cold cereal, orange juice and dry toast, have an egg with it to balance fat, protein, and carbohydrates. This will moderate the carbohydrate surge and will balance your blood sugar. Too much blood sugar will simply turn to fat.

Turkey breast contains the highest amount of meat protein with the lowest level of fat. Chicken breast is a close second. Fatty fish contains omega-3 fats, which are good for our brains and fish is high in protein. Aerobic exercise is a good way to keep your metabolic rate as high as possible. But you don’t have to go to the gym every day. Walking a mile or two a couple of days a week is good exercise and will help maintain a favorable metabolic rate.

After the Women’s Health Initiative (WHI) study about 20 years ago, providers and patients alike have become afraid of estrogen and HRT (hormone replacement therapy). Before the WHI study, we had 60 years of extoling the benefits of hormone replacement. The WHI study stopped much of HRT cold. There were, however, shortcomings to the WHI study as well as with all previous studies. A problem with the WHI study was the fact that there was little or no control as to how many years lapsed between menopause and starting HRT. We know HRT needs to be started immediately with menopause. It is ineffective if started several years after menopause.

Another major flaw in the WHI study was the lack of differentiation between Premarin, estrogen from horse urine, and estradiol, which is the natural circulating hormone. HRT consisting of real hormones given at the right time should not be dismissed because the net result is improved life expectancy for all causes of death. HRT, started at the right time, is especially useful for the treatment of painful intercourse and hot flashes.

And finally, exercise is important, but you don’t need to be a female Arnold Schwarzenegger. Walking one or two miles three days a week will help your physical and your mental health and slow down advancing dementia.

I have a blog post “How to Preserve Bone Health Over Time” which contains additional information about menopause.