Menopause is when you’ve had no ovulations for 12 months, usually between 45 and 55yo. This is usually signalled by a loss of periods for 12 months, unless your periods had already stopped due to a hysterectomy or hormonal contraceptives like the Mirena IUD. The hormonal fluctuations of perimenopause (and the associated symptoms) can start many years before you actually reach menopause.
Due to the changes in hormones during perimenopause, especially oestrogen, our bodies change.
One of the changes you may notice is an increase in belly fat (known as central adiposity) and more total body fat. Besides just not feeling great about how our shape is changing, the increased body fat more importantly impacts on our overall health and wellbeing, putting us at higher risk of chronic disease. Research has shown that if your waist is >90cm and/or your waist to hip ratio is > than 0.85, this places you into this higher risk category for health issues – like hypertension, cardiovascular disease and metabolic diseases like diabetes.
In addition, if your Body Mass Index is less than 30 the severity of your menopause symptoms, like hot flashes, unexplained mood swings and sleep disturbances can be less.
Other physiological changes in menopause include
Very few Australians eat in accordance with recommended nutritional guidelines. If we did there would be hugely reduced rates of diabetes, heart disease, obesity, cancers, and other chronic diseases.
As we age we require less calories because of overall reduction in activity levels and reduced lean muscle mass (which burns calories 24/7). Our bodies are also less efficient at absorbing nutrients as we age, but we still require the same amount of nutrients so what we eat has to be more nutritionally dense and less calorie dense.
Eating this way also lets you eat bigger portions of food for the same amount of calories, so you feel fuller with less calories. It also helps in losing weight or preventing weight gain.
Mental health issues are incredibly common around perimenopause, with women 3x more likely to have depression at menopause than pre-menopausally. The Jean Hailes article “Foods for your future” quotes studies demonstrating that a Mediterranean diet is linked to higher psychological resilience, ie. coping better with stress.
“The Mediterranean diet is rich is natural wholefoods, with a particular focus on vegetables, as well as olive oil, fruits, legumes and wholegrains,” …”In this study, consuming high amounts of antioxidants present in these foods and including a large variety of fruits and vegetables was associated with higher mental resilience and stress-coping ability.”
A Mediterranean diet has also been shown to reduce risk of heart disease, type 2 diabetes and some cancers. That leads us to…
Heart disease and dementia are the equal highest killers of Australian women. CVD was responsible for 1/3 of all female deaths in 2016 (around 28000 women). A Mediterranean diet is not only protective of your mental health, it also is protective against heart disease.
Other key strategies to improving heart health are:
Bone density drops sharply with the estrogen decline at menopause. Calcium intake is important for bone health. Good sources include dairy (such as milk, yoghurt and cheese), sardines or salmon (with the bones in). Calcium is also found in vegetarian/vegan-friendly food such as calcium-enriched tofu, soy, almonds and broccoli. Vitamin D helps uptake of calcium; if you are dark skinned, vit D deficient or don’t get much sunlight a vit D supplement might be helpful.
Perimenopause often brings frequent or heavy periods (menorrhagia), which can lead to iron deficiency. If you have menorrhagia ask your doctor about getting your iron level tested. Ways to improve your iron levels include lean red meat, or eating green leafy vegetables with a carbohydrate and some vitamin C to boost its absorption. Avoid eating your iron-rich foods or taking iron supplements with tea or calcium-rich foods such as dairy, as they inhibit iron absorption in the gut.
About one-third of women may get some improvement in their menopausal symptoms from eating soy- these are the women with the right type of gut bacteria to process it into the required molecules.
Quality lean proteins help you build and retain lean muscle mass, and can help you feel full at meals. Protein also contains zinc which is protective against mood disorders and is important for brain functions like memory, learning and concentration.
Take the Healthy Eating Quiz to compare your nutritional intake to the Australian healthy eating guidelines.
The quiz is linked to the “No money, No time” recipe planning site, which ties in with quiz’s recommendations.
Scientific studies show that central weight gain is associated with increasing Body Mass Index (BMI) rather than menopause itself.
BMI increases in response to lifestyle changes, many of which are exacerbated by hormonal changes however. For example, it’s harder to exercise and make good food choices when you’re exhausted from lack of sleep caused by hot flushes. As previously mentioned, the women who changed what they were doing managed to avoid weight gain.
Importantly, evidence confirms that reduced estrogen levels lead to more centrally-located fat deposition, so whatever weight you do gain tends to go on around the middle. This is yet another risk factor for heart disease.
The key to avoiding tummy fat accumulation then is to maintain a healthy weight during the menopausal transition through physical activity and healthy eating… It can be done!
Reduced estrogen levels also led to a reduction in incidental movement in animal studies, so there may be hormonal triggers contributing to reduced activity levels. It really does take extra effort to remain active after menopause
Lauren Williams from Griffith University found that the average weight gain during menopausal transition is 2.5kg. Contributors include hormonal changes amplified by life changes: physical work reduces, alcohol intake increases for many women, busier at work, more disposable income and eating out more.
Importantly, ALL women are prone to weight gain during menopausal transition, regardless of having a lifetime of good fitness habits. NONE OF US ARE IMMUNE!
BUT here is the really exciting thing: Lauren’s research shows that women who changed something at perimenopause DID NOT GAIN WEIGHT.
Basically, the key to not gaining weight at menopause is to not do the same things you’ve been doing pre-menopausally. Increase your activity levels, decrease your portion sizes, cut out snacks, cut out alcohol, increase the proportion of non-starchy vegetables on your plate… just do something differently to shift the balance between calories in and calories out.
Bloating can be caused by many things, not all of them dietary. Hormones and fluid retention are big culprits. Think not just of estrogen and progesterone but also stress hormones if you’re very stressed or anxious.
Medical causes can include a variety of gut disorders like infections, inflammatory bowel diseases, coeliac disease, abdominal fluid (from some serious disorders including cancer), eating disorders and reflux. Significant or persistent pain associated with bloating should always be investigated by your GP.
Kate Freeman and her team at the Healthy Eating Clinic offer a free Telehealth Nutrition Assessment with a gut health dietitian. What have you got to lose?
***NEXT WEEK: Kate’s top tips to lose weight and keep it off***
The good news is that with lifestyle changes like improved diet and increased exercise we can change our shape and body composition ie. increase muscle and reduce fat. It can also help reduce the impact of the severity of peri-menopausal symptoms.
The other benefits of exercise that you may be aware or unaware of include:
Try to achieve the following each week:
To know if you are working at the right level:
Start looking at perimenopause as an opportunity rather than a burden; an opportunity to remind us to take care of ourselves. Take stock of where you are up to in regard to your health and well being and ask yourself the following questions:
If you can answer yes to all the above, you’re well set up for good long-term ageing and an independent healthy life well into your 80s and 90s.
If you’re finding it hard to to get started with exercise Gillian will send you her activity planner and tracker and to help you on your way. Email her at email@example.com
Heavily discounted consultations are also available for women in regional, rural and remote areas who agree to complete short questionnaires for WellFemme’s Pilot Study.
Not sure if Telehealth is for you? Free trial consultations are available to find out how WellFemme can help with your menopausal symptoms.