Women’s Health Focus – Nutrition during Peri-Menopause and Menopause

The peri-menopause and menopause life stages can be times of significant and disabling physical and psychological change. The symptoms experienced are a consequence of the decline in estrogen, progesterone and testosterone levels compounded by the aging process. Some symptoms such as heavy menstrual bleeding are specific to the genital tract while others, including atrophic changes, can affect the genital tract as well as the urinary tract. The skin, hair and nails are also affected by aging and the decline in hormonal levels.

The decline in estrogen causes hot flushes, which at times can lead to sleep disturbance, while the decline in testosterone often leads to low libido. Other common symptoms frequently described by women include brain “fog” or impaired cognition, poor memory, emotional lability, anxiety, headaches, low energy, depression and fatigue.

If hormone replacement therapy is clinically indicated this can alleviate many of the symptoms. However, to gain maximum health benefit from this stage of life onward this must be combined with optimizing nutrition and supplementing with micronutrients.

For peri-menopausal and menopausal women there are significant health benefits to maintaining optimum levels of vitamins and nutrients such as vitamin K2, vitamin D, calcium, omega-3, B vitamins, zinc, magnesium and iron. Supplementing with phyto-estrogens might also plan an important role in balancing the decline in endogenous estrogen.

Vitamin K2

Vitamin K2 is essential for supporting bone and heart health¹. New studies show that vitamin K2 also has significant health benefits for its ability to facilitate the action of vitamin D. The two vitamins work synergistically so you should consider taking these two nutrients together². Vitamin K2 is also beneficial in regulating elevated calcium levels and can be used as a solution to prevent arterial calcium accumulation (in patients with a high calcium intake) which in turn can reduce the risk of heart disease³ Western diets are often deficient in vitamin K2 which is only present in fermented foods such as sauerkraut and kefir. Menaquinone-7 (MK-7) is the type of vitamin K2 recommended in supplements.

Vitamin D/Calcium

Vitamin D, although actually classified as a hormone, is critical to maintaining bone and joint health. We gain it from sun exposure and our body can store it for up to a month. During the peri-menopausal and menopausal stages of life bone density deteriorates and to preserve optimal bone health daily supplementation of 800 IU of vitamin D and 1200mg of calcium is advised⁴. Combining this with regular physical activity of 2.5 hours per week can have significant benefits in maintaining bone strength⁵. The primary factors that lead to bone deterioration are declining estrogen, limited physical activity, poor nutrition and lack of Vitamin D⁶. The role that nutrition and supplementing key vitamins, such as vitamin D, play in optimizing health during menopause is therefore vital.

Omega-3

DHA Omega-3, also know as docosahexaenoic acid, is a vital nutrient for maintaining cardiovascular health, brain function, skin health, mental wellbeing, bowel function and bone and joint health. A diet high in oily fish such as salmon, sardines and mackerel, is a good way to increase levels of omega-3 in the diet. In developed countries excess consumption of omega-6 is more prevalent. The ideal ratio of omega-6 to omega-3 is 2:1 but in developed countries the ratio is up to 20:1. This can lead to chronic disease and can cause inflammation and a number of other health issues⁷. Research suggests that a high omega-6/omega-3 ratio is a major factor contributing to weight gain and obesity⁸.  Priority should be placed not just on increasing omega-3 intake but on limiting omega-6 intake in peri-menopausal and post menopausal women who are already prone to weight gain due to the decline in endogenous estrogen and progesterone. 

A study conducted on 54 post-menopausal women by the American Association for Cancer Research showed that increasing the intake of omega-3 fatty acids was feasible as a primary step for breast cancer prevention⁹. Other research studies support this theory and suggest that maintaining the balance between omega-6 and omega-3 should be the focus when looking for effective ways to reduce breast cancer risk factors through nutrition¹⁰. The peri-menopausal and menopausal eras are when breast cancer typically presents, so increasing omega-3 intake during this period is advisable.

B Vitamins

Research studies have shown that B vitamins can support cognitive health and reduce brain and cerebral atrophy¹¹. In old age we experience an increase in cognitive decline so increasing our intake of vitamins and mineral, such as B Vitamins, that can support mental health and brain function is advisable. Research shows that optimizing levels of B12, B6 and folate (B9) intake could support cognitive function¹². 

Iron

With the prevalence of heavy menstrual bleeding in the peri-menopausal stage it is essential to exclude acute or chronic anaemia, which would cause iron deficiency. Supplementation with iron is essential in this situation.

Phyto-estrogens

Naturally occurring phyto-estogens are a useful first step in addressing the symptoms caused by declining estrogen levels. Good sources include nuts, soya beans and legumes.

References

In the peri-menopausal and menopausal stages of life it is essential to focus on nutrition and supplementing micronutrients as well as reviewing and correcting the declining endogenous hormone levels. A proactive approach, including a balanced diet, will ensure optimal health benefits from this stage of life onwards.

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REFERENCES

1. Schwalfenberg, G.K., 2017. Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health. Journal of nutrition and metabolism, 2017.
2. (Reference to follow )
3. Maresz, K., 2015. Proper calcium use: vitamin K2 as a promoter of bone and cardiovascular health. Integrative Medicine: A Clinician's Journal, 14(1), p.34.
4. O'Connor, D.L., Blake, J., Bell, R., Bowen, A., Callum, J., Fenton, S., Gray-Donald, K., Rossiter, M., Adamo, K., Brett, K. and Khatri, N., 2016. Canadian consensus on female nutrition: adolescence, reproduction, menopause, and beyond. Journal of Obstetrics and Gynaecology Canada, 38(6), pp.508-554.
5. O'Connor, D.L., Blake, J., Bell, R., Bowen, A., Callum, J., Fenton, S., Gray-Donald, K., Rossiter, M., Adamo, K., Brett, K. and Khatri, N., 2016. Canadian consensus on female nutrition: adolescence, reproduction, menopause, and beyond. Journal of Obstetrics and Gynaecology Canada, 38(6), pp.508-554.
6. Wicks, S.M. and Mahady, G.B., 2015. Nutritional and Dietary Interventions for Menopause. Nutrition, Fertility, and Human Reproductive Function, p.165.
7. Simopoulos, A.P., 2002. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & pharmacotherapy, 56(8), pp.365-379.
8. Simopoulos, A.P., 2016. An increase in the omega-6/omega-3 fatty acid ratio increases the risk for obesity. Nutrients, 8(3), p.128.
9. Fabian, C.J., Kimler, B.F., Phillips, T.A., Nydegger, J.L., Kreutzjans, A.L., Carlson, S.E., Hidaka, B.H., Metheny, T., Zalles, C.M., Mills, G.B. and Powers, K.R., 2015. Modulation of breast cancer risk biomarkers by high dose omega-3 fatty acids: Phase II pilot study in post-menopausal women. Cancer Prevention Research, pp.canprevres-0336.
10. de Lorgeril, M. and Salen, P., 2014. Helping women to good health: breast cancer, omega-3/omega-6 lipids, and related lifestyle factors. BMC medicine, 12(1), p.54.
11. McGarel, C., Pentieva, K., Strain, J.J. and McNulty, H., 2015. Emerging roles for folate and related B-vitamins in brain health across the lifecycle. Proceedings of the Nutrition Society, 74(1), pp.46-55.
12. McGarel, C., Pentieva, K., Strain, J.J. and McNulty, H., 2015. Emerging roles for folate and related B-vitamins in brain health across the lifecycle. Proceedings of the Nutrition Society, 74(1), pp.46-55.