The run-up to menopause can feel daunting — you may no longer have full control over aspects of your physical health that you enjoyed in your 20s and 30s. But there are ways to prepare for that transition and offset the risk of the worst health outcomes.
Eating a balanced diet can slow natural weight gain, decreasing the risk of obesity and diabetes. And regular exercise to strengthen muscles and bones strengthens the body against osteoporosis and imbalanced body composition.
“Where you go in menopause health-wise is really a major predictor of what your menopause experience will be like and what your health will be like when you get to the other side of menopause,” says Carrie Karvonen-Gutierrez, PhD , MPH, an associate professor of epidemiology at the University of Michigan and an expert on women’s health and aging.
Menopause seems to be “having a moment” these days, Karvonen-Gutierrez said. Media reports are fueling a renewed interest in hormone replacement therapy, and medical educators are beginning to push for more menopause education for healthcare providers. According to a 2020 Female Founders Fund report, the market for products related to menopause could exceed $5 billion this year.
With conversations about menopausal health amplified, more young adults are trying to better prepare their bodies for the midlife transition.
Do you need to ‘balance’ your hormones?
Hormonal changes are the hallmark of the menopausal transition. Most importantly, estrogen fluctuates and then drops.
Social media influencers are increasingly touting the power of diet, a good night’s sleep and supplements to heal hormonal ‘imbalances’. Their recommendations range from taking hormone-altering pills to reduce bloating to consuming specific seeds and herbal teas during perimenopause.
Hormones change throughout life, for example during puberty or pregnancy, during periods of stress or due to the use of certain medications. In these cases, focusing on sleep, diet, and exercise can naturally correct the imbalance. Many supplements marketed as hormone balancing use ingredients found in food.
“There are a lot of people who prey on women by telling them to correct something or balance something or take some extra hormones to correct this imbalance,” says Stephanie Faubion, MD, FACP, medical director of the North. American Menopause Society. “It’s just making money that has no scientific basis.
Patients who are concerned about their hormone levels can ask their healthcare provider to order a lab test, Karvonen-Gutierrez said. A follicle-stimulating hormone (FSH) test or an anti-Müller hormone (AMH) test can help confirm whether their symptoms are related to menopause and can predict their last period up to five years in advance.
Hormone tests are often not helpful for premenopausal or perimenopausal people, because hormone levels fluctuate daily and using hormonal birth control can affect results, Faubion said. In addition, direct-to-consumer testing can be expensive and insurance companies will not cover hormone panels for non-medical reasons.
In some cases, tumors, autoimmune disorders, and damage to endocrine glands can cause medically significant imbalances. That’s when it’s best to consult a health care professional about hormone supplements.
Once a person has entered perimenopause, they may seek hormone therapies to increase estrogen or testosterone levels, depending on their symptoms. But until then, most healthy individuals don’t need to try to change their hormone composition, Faubion said.
Stephanie Faubion, Physician, FACP
Many women feel some freedom as they go through menopause. They no longer worry about menstruation. They don’t worry about getting pregnant… it can be a stimulating transition time.
– Stephanie Faubion, MD, FACP
Will Birth Control Speed Up Menopause?
Long-term use of hormonal birth control does not appear to delay or speed up menopause, according to Mary Jane Minkin, MD, a gynecologist who specializes in menopause and a clinical professor at the Yale School of Medicine.
“When you’re on the pill, your ovaries poop out like they would have done without the pill,” Minkin said.
Karvonen-Gutierrez is a researcher for the 30-year Study of Women’s Health Across the Nation (SWAN) that examines the midlife transition. She agrees that there is “not enough evidence” to indicate that hormonal birth control use in a person’s younger years affects menopause.
But it is challenging to determine how hormonal contraceptives can change the menopause process.
“We have studies that could hypothetically look at that question, but the kinds of hormones that women now going through menopause might have taken in their late teens and early 20s are very different from the kinds of hormones 20-year-olds might be taking today. last,” said Karvonen-Gutierrez.
Can a certain type of diet help with menopause?
Maintaining a healthy lifestyle in the decades before menopause can significantly influence a person’s peri- and post-menopausal experience. For example, according to the American Heart Association, poor cardiovascular health in a person’s reproductive years and a history of smoking are associated with an earlier onset of menopause.
“[Women] really need to understand what their heart health is doing to it and make sure they know what their lipids, sugar and blood pressure are because the menopause transition increases that risk for everyone,” said Faubion.
As estrogen decreases, cholesterol levels increase along with the risk of developing obesity and diabetes. Meanwhile, aging into middle age is often associated with increased body mass and an accumulation of fat in the abdomen.
There is “no magic bullet” when it comes to premenopausal diets, Karvonen-Gutierrez said. Sticking to a balanced diet high in fruits and vegetables, lean protein, healthy fats and whole grains is just as important in the years before menopause as it is throughout one’s lifetime.
Calcium is often cited as important for pre- and postmenopausal women as it can keep osteoporosis at bay. The National Institutes of Health recommends premenopausal women get 1,000 milligrams of calcium per day, preferably through dietary sources such as dairy and leafy green vegetables. The recommended dose is 1,200 milligrams per day for women age 51 or older.
Getting enough vitamin D by spending time outdoors helps the body absorb that calcium.
What types of exercises should you do?
Menopause is accompanied by a marked decrease in bone density, with the main changes occurring in the first years of menopause.
Weight-bearing exercise can help maintain bone health. Sports and activities that exert stress on the skeleton, such as dancing and running, keep the bones strong.
“Walking is better than cycling is better than swimming in terms of bone health,” Faubion said.
Muscle loss is also a major problem for menopausal people. While body weight tends to increase for both men and women as they age, people going through menopause see muscle mass decline more quickly due to their hormonal changes. So while a person in peri- or post-menopause may maintain the same weight, their ratio of fat to muscle 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 especially women during midlife and menopause, can benefit from activities associated with strength training and resistance training, both to maintain skeletal muscle mass and to improve bone health,” said Karvonen- Gutierrez.
How can you mentally prepare for menopause?
It is unrealistic for most people to enter menopause in pristine shape. But taking care of one’s general health and well-being and getting regular checkups with a doctor who knows about menopause can make a big difference, said Donna Klassen, LCSW, cofounder of the nonprofit Let’s Talk Menopause.
“You have to put the life jacket on yourself before you can help others,” Klassen said.
Faubion said people shouldn’t be afraid of their middle and postmenopausal years. There’s no need to run into menopause for fear that the transition will “just slow you down.”
“Many women feel some freedom as they go through menopause. They no longer worry about menstruation. They’re not worried about getting pregnant,” Faubion said. “It can be a powerful transition time.”
There’s still a lot scientists don’t know about menopause, including how it affects people with certain conditions like autoimmune diseases, how socioeconomic inequalities shape menopause outcomes, and how environmental toxins alter hormones.
“Given the changes in population and the environment over the last 30 years, does menopause today look like it did 20 or 30 years ago? I would say that’s probably not the case,” said Karvonen-Gutierrez.
For those approaching middle age, meeting with a home care provider in menopause can be key to wading through the noise and finding care options that work for them.
“This is a groundbreaking life 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 to manage their menopause and understand what’s happening,” Karvonen -Gutierrez said.
What this means for you
If you are entering perimenopause or are experiencing menopausal symptoms, it may help to consult a healthcare provider trained in menopause care to guide you through your options. You can find a certified menopause practitioner or member of NAMS in this directory.