My previous post described the cause of perimenopause, the hormonal changes that occur and how these impact some of our major body systems. Many of these effects – such as hot flashes, sleep disturbance, mood changes and vaginal symptoms – negatively affect a woman’s quality of life. These can vary from being mildly bothersome to severely disabling, and the level of impact can dictate whether women opt for relief.
However, it is also important to be aware that other changes occur, which are not obvious to women as they go through perimenopause. These changes can lead to negative health impacts down the line, such as an increased risk of osteoporosis and heart disease. These changes should also be taken into consideration as women go through perimenopause.
Fortunately, there are measures available that can aid in symptom relief as well as lessen some of the health impacts that may occur. These fall in the realm of lifestyle measures, hormone treatment and non-hormone medications. This and the following two blogs will focus on each of these topics respectively.
The first step is an assessment of your health
Once it appears that perimenopause is happening, it is advisable to take inventory of your health status. It is an important time to have your blood pressure, cholesterol and blood sugar checked as these values can increase during this transition. It is also a good time to make sure you are up to date on all of the recommended screening exams such as PAP smears, mammograms, and colon cancer screening tests.
Many women wonder if they should have a bone density test as they approach menopause. These are generally not recommended because the vast majority of women between the ages of 40 and 50 have normal bone densities. However, some women who are considered high risk for osteoporosis may benefit from a baseline exam. High-risk candidates are women who are extremely thin, have had previous fractures from non-traumatic injuries, have been on long-term steroid treatment, or have certain autoimmune disorders.
Specific lifestyle management measures
Weight loss and weight maintenance
During perimenopause the part of the brain that regulates energy expenditure is affected, and this subtly leads to a decrease in the way the body burns calories – to the tune of about 250 to 300 calories per day. This makes weight control difficult because suddenly you start gaining weight without changing your diet.
While the benefits of having a healthy weight are obvious, during perimenopause it is particularly important because a healthy weight helps avoid the elevation in cholesterol and blood pressure that occurs. The decline of estrogen during perimenopause also causes any weight that is gained to end up primarily around the middle, causing the undesirable and unhealthy consequence of increased belly fat.
Diet
To control weight, limiting calories is a major goal. The type of calories is also important. Avoiding products high in sugar and fat allows more intake of less concentrated caloric foods such as fresh fruits and vegetables, whole grains and lean meat. The Mediterranean diet incorporates these elements.
It is also important to get adequate protein because the decline in estrogen leads to an accelerated loss of bone and muscle mass. Getting adequate calcium is also important to prevent bone loss. Ideally the best form of calcium is from foods, primarily dairy products.
There really are no specific perimenopausal diets that have been proven to be particularly beneficial during this transition. Intermittent fasting has been promoted in the media, but studies so far haven’t shown this is a superior way to avoid weight gain or belly fat compared to calorie restriction.
Certain dietary measures help limit hot flashes. These include avoidance of alcohol, spicy foods, caffeine and hot beverages. Soy products contain estrogen-like compounds and studies have been mixed whether they help hot flashes or confer any additional benefits and risks. Eating or drinking soy products in moderation is likely very safe. Diets which incorporate fresh fruits and vegetables and other anti-oxidants are also believed to promote brain health. Dr. Lisa Mosconi’s books contain much information on this subject.
Exercise
Exercise burns calories and committing to exercising a minimum of 30 – 60 minutes a day is recommended. Aerobic exercise burns more calories than low level exercise such as walking, so consider a 60 minute goal daily if not doing aerobic activities. Weight bearing exercise that includes jumping or dance helps retard bone thinning. Adding in weight/resistance exercise has also been shown to help prevent osteopenia, as well as lessen the muscle weakening that develops.
Good sleep hygiene
The perimenopause affects sleep in a number of ways. The part of the brain that controls sleep and the circadian rhythm malfunctions with declining estrogen. Nighttime hot flashes and night sweats have been shown to prevent sustained and deep sleep. And finally women have an increased risk of sleep apnea during the menopause transition.
Besides the fact that inadequate sleep causes daytime fatigue, poor sleep is associated with a number of health problems, including an increased risk of heart disease, diabetes, dementia and even cancer.
There are a number of measures recommended to help restful sleep. These include having regular sleep hours, avoiding alcohol at night, limiting caffeine later in the day, turning off electronic devices at bedtime, maintaining a comfortable sleeping environment and others.
Stress management
Stress is another factor that compounds problems in perimenopause. Stress increases cortisol and adrenalin which are hormones that increase blood pressure, blood sugar, inflammation as well as cause other adverse health effects.
Strategies to decrease stress are plentiful and seeking the measures that are most effective for any given person is encouraged. These may include recreational sports, meditation, yoga, mindfulness, hobbies, engagement with friends, and community activities. Seeking help from a counselor should be considered if other measures don’t seem to be working.
Other general recommendations
Since hot flashes are triggered by tiny changes in the body temperature, clothing choices can be helpful. Measures would include layering and wearing breathable materials. Avoiding heavy blankets at night and keeping the ambient temperature slightly on the cool side are suggested.
Cognitive behavior therapy is a counseling style that has been shown to help many women in perimenopause. This type to intervention has been shown to help decrease problems with hot flashes and sleep disturbance, as well as help alleviate stress, anxiety and depression. Some women have had benefit from hypnosis.
In conclusion
My next two posts will review the options for non-hormonal and hormonal measures to deal with perimenopausal symptoms and health impacts. Regardless of whether a woman chooses one of these paths, following a healthy lifestyle should be a pursued.
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