Beyond hot flushes – how to transition through the menopause to protect your long term health
Oestrogen is one of our key sex hormones, essential for reproduction and survival and we have receptors for oestrogen in nearly every organ in our bodies. Levels of oestrogen fluctuate and decline at perimenopause causing a significant impact on our health beyond hot flushes. Supporting oestrogen early in perimenopause (which can start at mid-forties) can help both our transition through the menopause and our longer term health.
The reason oestrogen has such a profound effect at this time is that in addition to reproduction Oestogen has a number of other diverse roles in our bodies which influence
- Brain health
- Bone health
- Heart health
- Circadian rhythm
By understanding more about these different functions of oestrogen and what is happening to our bodies during this time when oestrogen is declining, we will be able to manage the impact and protect our long term health through diet, lifestyle and nutritional interventions.
So instead of putting up with feeling exhausted, worried about our new tummy and the fact our bottom has disappeared, feeling like our brain has gone to mush, struggling to fall asleep or stay asleep, let’s look at each at each of the functions of oestrogen and how we can best support ourselves at this time.
Menopause, Oestrogen & Weight Gain
Oestrogen is involved in our metabolism and our insulin function because it influences how we use glucose (sugar) in our bodies and turns it into energy in the Krebs cycle. At menopause, as oestrogen declines our ability to utilise glucose changes and as a result our metabolism slows down. We are not able to convert sugar into energy as efficiently and as oestrogen affects where fat is distributed, we will see more fat deposited around our middle and we develop more subcutaneous fat.
An additional impact of lower oestrogen levels on our weight at this time is that oestrogen influences our appetite and as this lowers at perimenopause, we are less able to control how much we are eating (think cravings) or recognise when we are full. The end result is that we may find ourselves eating more, not utilising glucose as well, decreased insulin sensitivity, more fatigue (see below) and therefore put on weight.
Weight loss interventions should always be tailored to a client’s concerns as well as what is driving their particular weight gain as these will vary. For example, is it fat mass, appetite control, glucose support, thyroid health or other mechanisms? However, eating sufficient protein, lowering carbohydrate foods by replacing them with starchy vegetables, ensuring sufficient healthy Omega 3 fats and including resistance training are likely to be beneficial for all women at this life stage.
Menopause, Oestrogen and Fatigue
Fatigue is a significant issue at perimenopause when women may find themselves struggling both mentally and physically, unable to concentrate for very long and feeling tired all the time. The reason for this is that oestrogen is involved in energy production in our mitochondria (mitochondria are cells in our body which generate most of our body’s energy in form of ATP) and oestrogen also acts as an anti-oxidant protecting these mitochondria from damage. So – less oestrogen results in less energy.
Supporting women at this time so that they feel they can function is crucial. A detailed assessment of dietary intake, and ensuring there are sufficient macro and micro nutrients to optimise mitochondrial function, together with optimising adrenal and thyroid health (which impact energy levels) as well as paying attention to sleep and exercise regimes will all be useful interventions to restoring energy and allowing women to get their lives back on track.
Menopause, Oestrogen and Brain Health
Oestrogen is crucial for brain health, and oestrogen receptors in our brain regulate our cognition, mood and emotions as well as provide anti-oxidant protection for our brain (i.e it is neuroprotective). It is not surprising therefore that as oestrogen levels decline we may feel like our brain has turned to mush, experience significant mood swings / low mood and find it hard to relax and stay calm.
In addition, when we are exposed to endocrine disruptors like plastics, BPA, till receipts (which are ubiquitous in our daily environment), this will also affect our brain health as endocrine disruptors block oestrogen receptors in our brain thus further lowering oestrogen levels in the brain, independent of naturally falling levels. Research has actually shown that higher levels of endocrine disruptors in our bodies can contribute to an earlier menopause.
So interventions to protect brain health will include looking at detoxification of women’s lifestyles, reviewing household and beauty products that are used on a daily basis as well as dietary intake to ensure maximum anti-oxidant intake.
In addition, there is one particular nutrient called Choline which supports memory and as oestrogen is involved in the production of choline when oestrogen declines at perimenopause, so will our choline status and ability to retain information. Increasing our dietary intake of foods high in choline can be very supportive at this time and includes foods like eggs, liver, chicken, fish, soya, and broccoli. To meet the daily requirement of 500mg it may be necessary to supplement if you are following a vegan diet.
Menopause Oestrogen and Bone Health
Oestrogen (and testosterone) are crucial for bone health and muscle mass and whilst total bone mass starts to decline after the age of 35, at menopause this will fall more sharply. Oestrogen is directly responsible for bone building and bone breakdown (bone is in fact a living organ!).
What will impact bone health at this time is therefore oestrogen levels and critical to this is a protein called Sex Hormone Binding Globulin (SHBG) which is a protein produced in the liver. SHBG binds to oestrogen and reduces the amount of free circulating oestrogen resulting in bone loss and poorer bone health. Our levels of this protein naturally increase as we age so in order to support bone health, interventions to lower levels of SHBG are important as well as looking at bone supporting nutrients including Vitamin K2, Vitamin D, Calcium, Magnesium, Colostrum and Boron. Performing weight bearing exercise at least 3 times a week to promote muscle mass and bone health is also wise.
Menopause, Oestrogen and Cardiovascular Health
Perhaps less known is the role that oestrogen plays in supporting women’s heart health and preventing us from cardiovascular disease. This is because it is anti-inflammatory and protects the lining in our arteries and muscles, our heart cell receptors as well as keeping our lipid levels in check (cholesterol levels and triglycerides).
Fortunately there are an abundance of heart healthy foods which can be recommended at this stage, as well as lifestyle interventions such as infrared saunas which can help elimination of toxins and heavy metals to lower inflammation and therefore reduce cardiovascular risk. Additionally there are a number of targeted supplements which can be recommended. For example – Garlic and Niacin to reduce high cholesterol levels, Quercitin, Fish Oils, CoQ10 and Magnesium to lower blood pressure.
Menopause, Oestrogen and our Circadian Rhythm
The role oestrogen plays in how well we fall asleep and stay asleep is perhaps the most easily understood, as changes in our sleep patterns at this time present as a major challenge for women transitioning through the menopause. Oestrogen is actually involved in controlling our master clock, it is the conductor of our circadian rhythm so when oestrogen levels change, our circadian rhythm can shift.
Focusing on sleep and stress management will therefore be important at this time and supporting this with nutritional interventions such as adequate protein and fats in the morning, consumption of carbohydrates such as resistant starches in the evening to promote better sleep, lifestyle recommendations such as getting sunlight in the mornings, cold showers (if tolerated) and exercising also in the mornings, as well as supporting with targeted supplementation.
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