How to prepare for the transition to menopause?

The time leading up to menopause can seem daunting – you may no longer have complete control over aspects of your physical health that you valued in your 20s and 30s. But there are ways to prepare for this transition and offset the risk of worse health outcomes.

A balanced diet can slow natural weight gain, reducing the risk of obesity and diabetes. And regular exercise to strengthen muscles and bones fortifies the body against osteoporosis and imbalanced body composition.

“Where you stand health-wise before menopause is really a big predictor of what your menopausal experience will be like and what your health will be like coming out of the other side of menopause,” says Carrie Karvonen-Gutierrez, PhD, MPH, associate professor of epidemiology at the University of Michigan and expert in women’s health and aging.

Menopause seems to be “having a moment” these days, Karvonen-Gutierrez said. Media reports are sparking renewed interest in hormone replacement therapy, and medical educators are beginning to press for healthcare providers to receive more information about menopause. The market for menopause-related products could surpass $5 billion this year, according to a 2020 report from the Female Founders Fund.

With invigorated conversations about menopause health, more and more young adults are looking to better prepare their bodies for the transition into midlife.

Do you need to “balance” your hormones?

Hormonal changes are the hallmark of the menopausal transition. More importantly, estrogen fluctuates and then drops.

Social media influencers are increasingly touting the power of diet, a good night’s sleep and supplements to cure hormonal ‘imbalances’. Their recommendations range from taking hormonal pills to reduce bloating to consuming specific seeds and herbal teas during perimenopause.

Hormones will change throughout a person’s life, for example during puberty or pregnancy, during times of stress, or due to the use of certain medications. In these cases, focusing on sleep, diet, and exercise can naturally remedy the imbalance. Many supplements marketed as hormone balancers use ingredients that can be found in food.

“There are a lot of people who pick on women saying they need to fix something or balance something or take extra hormones to correct that imbalance,” said Stephanie Faubion, MD, FACP, Medical Director North. American Menopause Society. “It’s just a lucrative thing that has no scientific basis.

Patients concerned about their hormone levels could ask their healthcare provider to order a lab test, Karvonen-Gutierrez said. A follicle-stimulating hormone (FSH) test or anti-Mullerian hormone (AMH) test could help confirm if their symptoms are menopause-related and could predict their last period up to five years in advance .

Hormone tests are often not useful for premenopausal or perimenopausal people because hormone levels fluctuate daily and the use of hormonal contraceptives can skew results, according to Faubion. Also, direct-to-consumer testing can be expensive, and insurers won’t cover hormone panels for non-medical reasons.

In some cases, tumors, autoimmune diseases, and endocrine gland damage can cause medically significant imbalances. This is when it is best to consult a health care provider about hormonal supplements.

Once a person has entered perimenopause, they may seek hormone treatments to increase estrogen or testosterone levels, depending on their symptoms. But until then, most healthy individuals don’t need to try changing their hormone makeup, Faubion said.

Stephanie Faubion, MD, FACP

Many women feel a certain freedom during menopause. They don’t care about the rules anymore. They don’t worry about getting pregnant…it can be an exciting time of transition.

— Stephanie Faubion, MD, FACP

Will birth control speed up menopause?

Long-term use of hormonal contraceptives does not appear to delay or hasten menopause, according to Mary Jane Minkin, MD, a menopausal gynecologist and clinical professor at Yale School of Medicine.

“If you take the pill, your ovaries will poop like they would without the pill,” Minkin said.

Karvonen-Gutierrez is a researcher for the 30-year Study of Women’s Health Across the Country (SWAN) that explores the transition into midlife. She agrees that there is “not enough evidence” to indicate that the use of hormonal contraceptives in the younger years affects menopausal outcomes.

But it is difficult to determine how hormonal contraceptives can modify the process of menopause.

“We have studies that could look at this question, hypothetically, but the types of hormones that women currently going through menopause might have taken in their late teens and early twenties are very different from the types of hormones that 20-year-old women today might be taking,” Karvonen-Gutierrez said.

Can a certain type of diet help with menopause?

Maintaining a healthy lifestyle in the decades leading up to the transition can significantly shape the peri- and post-menopausal experience. For example, poor cardiovascular health during the childbearing years and a history of smoking are associated with early menopause, according to the American Heart Association.

“[Women] really need to understand what their heart health is all about and make sure they know what their lipids, sugar and blood pressure are because the menopause transition increases that risk for everyone,” Faubion said. .

As estrogen decreases, cholesterol levels increase, along with the risk of developing obesity and diabetes. Meanwhile, aging in your midlife is often accompanied by an increase in body mass and the accumulation of fat in the midsection.

There’s “no magic formula” when it comes to premenopausal diets, Karvonen-Gutierrez said. Sticking to a balanced diet rich in fruits and vegetables, lean proteins, healthy fats and whole grains is as important in the years leading up to menopause as it is throughout life.

Calcium is often considered important for pre- and post-menopausal women because it can ward off osteoporosis. The National Institutes of Health recommend that premenopausal women get 1,000 milligrams of calcium daily, preferably through food sources such as dairy products and green leafy vegetables. The recommended dose is 1,200 milligrams per day for women 51 years of age or older.

Getting enough vitamin D by spending time outdoors helps the body absorb this calcium.

What types of exercises should you do?

Menopause is accompanied by a marked decrease in bone density, with the greatest changes occurring during the first years of menopause.

Weight-bearing exercises can help maintain bone health. Sports and activities that exert force on the skeleton, such as dancing and running, keep bones strong.

“Walking is better than biking is better than swimming in terms of bone health,” Faubion said.

Muscle loss is also a significant issue for people transitioning through menopause. Although body weight tends to increase in both men and women as they age, people who go through menopause tend to see a faster decrease in muscle mass due to their hormonal changes. So while a peri- or post-menopausal person may maintain the same weight, their fat to muscle ratio may increase significantly.

It’s more important, Karvonen-Gutierrez said, to focus on achieving a healthy body composition rather than a certain weight. Resistance training, such as lifting weights and using resistance bands, is particularly effective in helping people gain and maintain muscle.

“People throughout their lives, but women especially during the midlife and menopause transition, can benefit from engaging in activities related to strength training and resistance training, both to maintain skeletal muscle mass but also to improve bone health,” Karvonen-Gutierrez said.

How do you mentally prepare for menopause?

It’s unrealistic for most people to be in top shape before menopause. But looking after your overall health and well-being and getting regular checkups from a clinician knowledgeable about menopause can make a big difference, said Donna Klassen, LCSW, co-founder of the nonprofit Let’s Talk Menopause.

“You have to put on the life jacket before you can help others,” Klassen said.

Faubion said people don’t have to dread their middle and post-menopausal years. There’s no need to race through menopause lest the transition “slow you down”.

“A lot of women feel a certain freedom during menopause. They don’t worry about periods anymore. They don’t worry about getting pregnant,” Faubion said. “It can be an empowering time of transition.”

There’s still a lot scientists don’t yet know about menopause, including how it affects people with certain conditions like autoimmune diseases, how socioeconomic disparities shape menopausal outcomes, and how environmental toxins alter hormones.

“Given how people and the environment have changed over the past 30 years, is menopause today like it was 20 or 30 years ago? I would say that’s probably not the case,” Karvonen-Gutierrez said.

For those approaching their 40s, meeting with a provider familiar with menopause can be key to getting through the noise and finding care options that work for them.

“This is a life-changing event for more than half of our population and it’s really important that we give it the space and attention it deserves to help educate individuals on how manage their menopause and understand what’s going on,” Karvonen-Gutierrez said.

What this means for you

If you are entering perimenopause or experiencing menopausal symptoms, it may be helpful to see a provider trained in menopause care to guide you through your options. You can find a certified menopause practitioner or NAMS member on this directory.

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