by Jennifer Novakovich
Menopause is an inevitable part of a woman’s life and has several consequences on the quality of life following its commencement. Symptoms of menopause include hot flashes, insomnia, night sweats, mood disturbances, pain, depression, and very importantly, bone mass reductions. The bone loss during menopause puts women at a significantly greater risk for osteoporosis—something that many people do not know and therefore do not take the necessary steps for prevention. Whether you’re menopausal or not, this article will give you or someone you love information on how to manage menopausal symptoms and reduce risks for osteoporosis.
As a normal part of female life, ovarian function decreases over time and ultimately leads to a large reduction in estrogen; the lack of estrogen is the underlying mechanism for menopause. Menopause is characterized by the end of menstruation, which is usually seen in women between 45 to 55 years of age. Women are considered postmenopausal when menstruation has stopped for 6-12 months. Estrogens have many important roles including development, gene regulation, cognitive function, heart and brain health, and cell growth. The decline of estrogen is the underlying cause for the symptoms associated with menopause, including bone loss.
According to the World Health Organization, in the United States, Europe, and Japan about 75 million people are affected with osteoporosis, which occurs due to a reduction in bone density. Decreased bone mineral mass is a major concern for menopausal women since the rate of bone loss is accelerated to 2–5% per year during early menopause (decreasing later on in menopause). Bones are in part regulated by estrogen, seen through the estrogen receptors that are present on osteoblastic cells. This is why women have a much greater risk for osteoporosis. In the USA, osteoporosis is three times more common in 45–64 year old women than in men.
Replacing estrogen through hormone therapy has been demonstrated to be the most effective practice in the management of menopausal symptoms, including the reduction of bone mineral density. However, many women have become leery of the side effects and enhanced cancer risks associated with hormone therapy. Hormone therapy may be either unopposed estrogen or a combination of estrogen and progesterone. Unopposed estrogen has been seen to cause endometrial damage and significantly increase risks for endometrial cancer. The risks for endometrial damage and cancer increases with higher doses and longer durations of unopposed estrogen treatment. Furthermore, hormone therapy also increases risks for breast cancer and heart disease. The addition of progestogen significantly reduces these risks, and it is generally advised that women start with the lowest effective dose to minimize risks. While hormone therapy is very effective, women should also be aware of some of the lower risk natural options for managing menopause.
Phytoestrogens, which are non-steroidal plant derived compounds that resemble estrogen, may be a good alternative to hormonal therapy. Many foods contain phytoestrogens but most belong to isoflavones (in soy), lignans (particularly high in flax), and coumestans (particularly high in alfalfa and clover sprouts). Following the consumption of these phytoestrogens, they are metabolized in the gut to form bioactive breakdown products. Isoflavones are metabolized to aglycones, genistein, and daidzein; lignans are metabolized to secoisolariciresinol-diglucoside (SDG); and coumestans to coumestrol. These breakdown products compete for estrogen receptors and have weak estrogenic activity and therefore have a similar, lower risk mechanism as hormone replacement therapy.
Phytoestrogens have shown an ability to reduce hot flashes, decrease atrophy, reduce risks for breast cancer, and improve cognitive function, sleep, and bone density (by binding the estrogen receptors on osteoblasts). The most significant outcomes seem to come from a mix of lignans and isoflavones, but that may be due only to the lack of research on coumestans. Phytoestrogens may provide a safe and effective way to manage menopause, but more research is definitely needed. Research should include the risks for long term phytoestrogen supplementation, which would provide much greater levels of phytoestrogens than what we could achieve through our diets. Also more research is needed to determine the optimal timing and doses.
What are some other dietary considerations to manage menopause? A higher intake of calcium as well as either more sunshine or a good vitamin D supplement is important to maintain bone density. Exercise is another consideration as it decreases rates of depression, sleep apnea, pain, obesity, risks for chronic diseases, and bone loss. A higher DHA omega 3 intake would also be a good idea. Omega-3 supplements have well known anti-inflammatory properties and since inflammation also contributes to osteoporosis, omega-3 has been proposed to protect against bone loss. There has been promising research, although there is still a long way to go to gain sufficiency and significance, on the improvement of bone turnover and bone mineral density with higher omega-3 intakes. Either way, omega-3s are an important addition to your diet since they offer protection from many other chronic diseases including heart disease and cancer.
How can you add these components to your day-to-day life? Phytoestrogens can either be supplemented using natural health products—which may still need research—or for now, taken in through our diet. Soy, although typically genetically modified and a bit controversial among consumers, comes in many convenient forms that can be easily used, including cheese, milk, tofu, and protein powders. Flax provides the most lignan when it is freshly ground, though air sealed bags of flax will also be a good source for lignan. Flax can be thrown into just about anything, from pizza crusts to smoothies, and makes an excellent vegan egg replacer. Ground flax should be stored in a fridge and lasts about 6 weeks (whole seeds last a bit longer). Something to note about alfalfa and clover sprout is they contain trace amounts of a toxin called canavanine. As a result, it would be advisable to stick to a single serving per day or less. These sprouts can be tossed into salads or sandwiches to give it a bit of a kick.
Calcium is found in many foods and beverages including almond milk, beans, nuts, and many soy products. Vitamin D can be derived from the sun, but that is usually problematic during the winter time and as a result, many people have vitamin D deficiencies. A good vitamin D supplement may be necessary, or even a good vitamin K2, vitamin D, and calcium supplement, to prevent bone loss during menopause. DHA omega 3 is derived from algae and can be taken in through fish (which should be limited per week due to potential environmental contamination, e.g. Mercury), algae, or fish or algae DHA omega 3 supplements. Finally, exercise can be an easy and fun incorporation into your day to day life. Find an activity that you love so that you'll stick to it. Exercise can involve anything including dance class, running, aquafit, or maybe even rock climbing.
Whether you’re menopausal or not, this article has hopefully given you (in the present or future) or someone you love, the information to take the right steps to managing menopause and preventing bone loss.
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