Good nutrition and lifestyle changes can contribute to a healthy, contented menopause.
KEEPING healthy with a positive lifestyle has a significant impact on health. Women in their late 30s and 40s can make lifestyle changes that will lower their risk of health problems when they get older.
The menopausal years are a time of transition when fertility gradually ends. Every woman’s experience is unique. The decline or absence of oestrogen can lead to changes in bone, heart, urinary, sexual health, memory and energy levels.
Good nutrition and lifestyle changes can contribute to a healthy menopause. They can make a real difference to how you feel and can help to maintain health during and after the menopause.
The perimenopause is a good time to pay more attention to health if you have not been doing so.
Women at the menopause and beyond should be concerned about their diet as it influences cardiovascular disease and thinning of the bone (osteoporosis).
A balanced diet that is high in grains, fruits and vegetables, with adequate water, vitamins and minerals, but low in fat, contributes significantly to good health.
The intake of sweets and fatty food should be limited. Fat intake should be less than 30% of daily calories.
The recommended daily consumption of elemental calcium in premenopausal and postmenopausal women is 1,000mg and 1,500mg respectively. This can come from leafy green vegetables, calcium-rich dairy products (low fat or non-fat), as well as calcium-fortified foods and juices.
If this is not sufficient, calcium supplements may be used.
The body’s absorption of calcium is increased by vitamin D, which can be found with about 15 minutes of daily exposure to the sun without any sunscreen, certain fortified foods like milk, tuna and liver, or vitamin D supplements.
It is advisable to eat plenty of fresh fruits and vegetables, especially dark leafy vegetables, legumes, nuts and seeds; complex carbohydrates, like oats, wholegrain bread and brown rice; and essential fatty acids (good fats) from oily fish, like sardines and pilchards.
You should limit or reduce the intake of salt, saturated fat, stimulants like alcohol, coffee and tea, sugary food and junk food.
Supplemental vitamins and minerals may or may not be required, depending on whether the diet is balanced or not. A discussion with your doctor or nutritionist would be helpful.
Physical inactivity is a risk factor for many conditions.
Exercise is a remedy for many menopausal complaints and helps prevent future disease.
It can help a person lose weight and maintain it.
It protects against cardiovascular disease and prevents osteoporosis.
It gives a person more energy, helps with better sleep, and it stimulates the brain’s production of endomorphin, which gets rid of negativity and depression, thereby relieving stress.
It improves circulation, lowers blood pressure and increases muscle strength.
The benefits of exercise are well-documented. Colpani et al reported in the journal Menopause in May that: “Habitual physical activity, specifically walking 6,000 or more steps daily, was associated with a decreased risk of cardiovascular disease and diabetes in middle-aged women, independently of menopause status.”
There are three types of exercises: aerobic, weight-bearing, and flexibility. A moderate aerobic exercise regimen of at least 30 minutes each day, like a two-mile walk, has the greatest effect on heart and lung health.
Weight-bearing exercise, like fast walking or working with weights, can delay or prevent bone loss.
Flexibility exercises, like yoga and stretching, help maintain muscle function and joint flexibility, and may also improve balance, which can decrease the risk of fractures due to falls.
Each exercise session should start with a 10-minute warm-up, and at the end, a five- to 10-minute cool-down.
In a good workout, a person will need to exercise at the target heart rate for at least 30 minutes three times a week. Your doctor will be able to provide advice on the target heart rate, which is dependent on a person’s age.
If there is difficulty in fitting exercise into your schedule, there are things that can be done to be more active, for example, walking rather than driving, and/or wherever possible, taking the stairs instead of the lift.
If a person is not used to strenuous activity, it would be prudent to check with the doctor before commencing an exercise programme, especially if you are above 40 years or are overweight.
Pelvic floor exercises strengthen the pelvic floor, which is composed of layers of muscle that stretch like a hammock, from the pubic bone in front to the end of the back bone. If the pelvic floor muscles are weak, urine may leak when a person coughs, sneezes or laughs (incontinence).
The pelvic floor can be strengthened by closing up the back passage as if trying to prevent a bowel movement. At the same time, the urethra is drawn in, as if trying to stop the flow of urine, and the vagina is also drawn in, as if trying to grip a tampon.
This is held for five to 10 seconds. The exercise is repeated in sets of five about 10 times a day.
Weight gain is not due to the menopause. As one ages, the body’s metabolism slows down so that it takes a longer time to burn up food that has been consumed.
This means that taking the same amount of food (like when a person was younger) would increase the weight.
An overweight person is more likely to have cardiovascular disease, high blood pressure, raised cholesterol, diabetes, arthritis and back problems.
The most dangerous form of body fat for heart health is located around the waistline.
It would be wise for all menopausal women to reassess their dietary intake and exercise levels to reach a balance that maintains a healthy weight.
Being too thin is not healthy. Women who diet or exercise excessively can become so thin that their menstrual periods stop temporarily.
It would be best not to exceed the weight for one’s height. If you have to lose weight, a discussion with the doctor and dietitian would be helpful. A healthy rate of weight loss is 0.5 to 1kg per week. It is not advisable to go on crash diets.
Alcohol exerts a greater impact on women than men as their bodies contain less water to dilute the alcohol, and the enzyme that digests alcohol is less abundant in women.
Alcohol slows reflexes, and affects judgement and memory. It also interferes with calcium absorption and bone growth.
A drink or two a day is alright. Larger amounts have been associated with menstrual problems, early menopause, damage to heart muscles, high blood pressure and some cancers.
Prolonged excessive consumption results in liver cirrhosis, which can lead to liver failure, and eventually, death.
Tobacco causes and increases the risk of many diseases. It is the single most preventable cause of illness and premature death.
Women who smoke shorten their lives by five to eight years.
The risk of heart disease, osteoporosis, cancer of the cervix and vulva, and Alzheimer’s disease is doubled.
The risk of lung cancer is increased 12 times.
Smokers also reach the menopause up to two years before non-smokers do. Family members exposed to second-hand smoke also suffer.
Any time is the right time to stop smoking. The earlier smoking is stopped, the more benefits there are. The circulation improves, and breathing is easier within three months. The risk of a heart attack is decreased by 50% within a year. The risk of other serious smoking-related diseases drops to that of a non-smoker within a few years.
There are various smoking cessation techniques and aids – reducing and limiting the number of cigarettes smoked, nicotine gum or patch, antidepressants, hypnosis and support groups. If you are unable to stop smoking, seek help from your doctor.
A combination of behaviour modifications and medicines appear to be the most successful approach. Many smokers make more than one attempt to successfully cease smoking. As such, persistence and continuing to try is vital.
Prolonged stress impacts upon health. Although the menopause has not been shown to increase stress, many women at this age face life situations that may be stressful, thereby affecting health.
Exercise has been proven to reduce stress. Deep, slow, abdominal breathing can increase relaxation and may reduce hot flushes.
There are also reports of fewer hot flushes and just feeling better with meditation, yoga, massage, or even a bath. It is beneficial to spare some time to relax every day.
Prevention of falls
It is important to eliminate factors in the environment that can result in falls, thereby reducing the risk of fractures.
Measures to avoid falls indoors include keeping rooms free of clutter, keeping floors smooth but not slippery, installing grab bars and using a rubber bath mat in the tub or shower, avoiding obstacles that one might trip over, and switching on the lights if getting up at night.
Some measures to avoid falls outdoors include wearing rubber-soled shoes, avoid walking on slippery surfaces, and using a walker or cane if it is needed for added stability.
- Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail email@example.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.