There are some topics considered sacred, but that doesn’t mean they don’t need and deserve to be voiced. Today we’re talking about menopause and we’re doing it out loud, not a hush among friends or silently within. A menstruating woman who lives to 80 might manage menopause symptoms and outcomes for 40+ years, so…yes, let’s talk more about that halfof our life!
It’s way past time to normalize discussions around menstruation, from our first period all the way to our last and life after. Many people still feel that periods are unsanitary. Many are still trying to remove or reduce the ‘dreaded monthly visit’ from routine. Embracing our nature and dispelling completely unnecessary shame and discomfort starts with having honest and open conversations about women’s health. Ignite the quest and join us as we dive into the topic of menopause.
First we’ll go over the basics like what menopause is, the stages of menopause, and the symptoms associated with menopause vs normal aging. Then, we’ll dive into a less frequently acknowledged element of this topic involving the sociocultural factors that impact the onset of menopause, dissecting the scientific literature to shed light on the health inequities affecting premature menopause and menopause management. And finally, we’ll leave you with practical guidance on how to best manage throughout this life transition, based on your individual needs.
What is Menopause? Stages and Symptoms
Menopause is a natural event in a menstruating person’s life occurring at an average age of 51.1 It is retrospectively characterized by the cessation of menstrual activity for at least 12 consecutive months. The ovaries stop releasing eggs, marking the end of reproductive life and ovarian follicular activity. Menopause is a transition (called menopausal transition) comprising of three (3) stages:
Perimenopause (1st stage)
Menopause (2nd stage)
Postmenopause (3rd stage)
The scientific literature reports chronological and ovarian ageing as two processes influencing the pace and duration of the menopausal transition process.2 In the 1st phase of menopause onset, perimenopause occurs.3 This could begin 7 to 10 years (when a menstruating person is in their 40s) prior to menopause, where a woman experiences irregular periods prior to the final menstrual period (FMP). Significant to this stage, is an increase in follicle stimulating hormone (FSH), to help maintain estrogen secretion amidst ongoing ovarian function loss that is marked by decreased levels of inhibin B and anti-mullerian hormone (AMH).4 In other situations, a fluctuation in ovarian hormone secretion occurs at this stage, where FSH levels increase during some menstrual cycles and return to premenopausal levels in other cycles. With climacteric shifts, many, but not all, people in the menopausal transition begin to report symptoms such as:
Hot flashes
Sleep disruptions
Mood changes
Palpitations
Night sweat
Vaginal dryness
Following the perimenopause stage, marked after 12 months of amenorrhea (no period), is menopause.5 In addition to existing perimenopausal symptoms described above, additional symptoms may be observed in menopause including6:
Weight gain
Body composition shifts
Skin dryness
Hair thinning
Urine leak during exercise, sneezing or laughing
In the last stage, postmenopause occurs. Postmenopause is the 24 to 36 months after the final menstrual period, when most symptoms of menopause typically subside. However, possibilities to experience mild menopausal symptoms could continue in this stage. While we are often presented with the effects of aging and menopause on potential adverse health outcomes, it is essential to emphasize that:
“Menopause is not a disease; it is a natural transition.” – Maya Feller
To officially diagnose menopause, visit your health care provider and discuss any of the aforementioned symptoms you are experiencing or if your period has been absent for 1 year.
Menopausal symptoms often overlap with natural signs of aging, making diagnosis and management complex. Hormonal changes during menopause can increase risks for health concerns such as metabolic disorders, cardiovascular disease, osteoporosis, and urinary incontinence. Understanding the relationship between aging and menopause can help us better prepare for this stage of life.
Overlapping Impacts of Aging and Menopause on Health
Brain fog, bones creaking, and foods you love now upset your stomach are phrases echoed in circles of “grown” folks. Diagnosing menopausal symptoms is complicated by the fact that symptoms that occur during the menopausal transition are also related to aging.7 Moderating factors like current health status, lifestyle, cellular senescence (cell deterioration) and hormonal changes impact symptoms management, severity or recovery post-menopause. For example, a cross-sectional study found moderate to vigorous physical activity (MVPA) as a protective factor against metabolic disorders in postmenopausal women aged 59 years and above.8 During the menopause transition, women experience a decline in estrogen and progesterone production.
Navigating this natural stage of life can be overwhelming for any woman without adequate support and information. Seeking out a health provider who specializes in women’s health, specifically menopausal transition, can greatly support this phase of life and how it’s experienced. Moreover, hormonal fluctuations occurring in menopause could accelerate the onset of non-communicable disorders and diseases, like dyslipidemia or impaired glucose tolerance/type 2 diabetes, increasing the risk for cardiovascular disease in women.9 Additionally, the presence of visceral adiposity (fat) common during menopause perpetuates the onset of the aforementioned metabolic disorders.
Osteoporosis and urinary incontinence are also common conditions present during menopausal transition, influenced by the loss of ovarian function on the female skeletal health. A prospective cohort of the Vietnam Osteoporosis study showed an occurrence of bone loss in the perimenopausal stage (45 – 50 years of age), with loss accelerating in the first 5 years post-menopause.10 Such findings suggest early screening of osteoporosis in women aged 45 years and above.
Many studies conducted around the world struggle to explain the reasons behind the metabolic changes seen during the menopausal years, particularly in menstruating women. However, there is growing evidence on the role of lifestyle modification including nutrition, physical activity, and stress management, in addition to hormonal replacement therapy (HRT) to alleviate the severity of these conditions. There isn’t one size that fits all strategies but rather recommendations for making adjustments to your lifestyle, eating pattern, and commitment to ongoing education and the practices that work for you. We provide more insights to consider below but highly recommend working with expert professionals like a Registered Dietitian for nutrition, a physical trainer for exercise, a therapist for mental heath needs, and an Ob/Gyn specializing in menopause for HRT, to identify what solutions are effective in each unique case and presentation.
Every menopause journey is unique—but you don’t have to navigate it alone. Maya Feller Nutrition offers personalized, compassionate support to help you manage menopausal transitions through evidence-based nutrition and lifestyle strategies tailored to your needs. Work with Maya, a nationally recognized Medical Nutrition Therapy expert and Registered Dietitian Nutritionist, and her expert team of Registered Dietitians to create a plan that empowers you to feel your best during this stage of life.
Schedule a Free Consultation and connect with us today for individualized guidance on managing menopause with confidence and care.
Each woman experiences menopause differently as influenced by genetics, diet, lifestyle, cultural expectations and attitudes, and the duration/severity of symptoms. Many women report no physical changes during the perimenopausal years other than irregular menstrual periods. Some women experience some or all of the symptoms commonly associated with menopausal transition, such as hot flashes, sleep problems, body composition shifts, mental health effects such as increased anxiety or mood changes, vaginal dryness or changes in memory. Our hope is that heading into the menopausal years with information on treatments for managing this natural event will positively impact your perception and experience of the menopausal transition. Before fully diving into the management approaches and treatment for menopausal transition, insight into the effects of socio-cultural factors to influence unique experiences is worth discussing.
The Impact of Socio-Cultural Factors on Menopausal Transition
How a woman views or transits through menopause is a non-competitive sport where each person’s experience is unique. Several factors influence the intensity of menopausal symptoms and the onset of menopause. By race, African American women are more likely to experience earlier onset, or premature menopause, and more severe menopausal symptoms compared to their white counterparts.11 Additionally, the influence of social determinants of health (SDOH) on menopausal transition has been documented. Social determinants of health: These are conditions in the environment where people live, work, study, and play that can impact health outcomes. According to the CDC, these variables include, but are not limited to12:
Education access and quality
Health care and quality
Neighborhood and built environment
Social and community context
Economic stability/Socioeconomic status
For example, lower- income, higher perceived stress, and negative attitudes towards menopause are associated with increased psychological and physical symptoms including early onset of menopause prior to age 45.13 Additionally, attitude within the context of SDOH, is shaped by two determinants: 1) Neighborhood and built environment; 2) social and community context. In the existence of these determinants lies the role of culture to influence menopause perspectives across the world. A woman’s view on menopause and the symptoms she reports have been linked, in part, to the views her culture holds of aging and menopause. Watling et al. examined culture from three lenses and came to the conclusion that “culture resists a simple definition.”14 As we move across the globe and through regions, social norms vary widely. Cultural practices and customs, such as eating patterns, dieting views, lifestyle, medication and substance use, beauty standards, weight bias, as well as biological factors, influence how individuals experience the stages of menopause.
The Pre-Collegiate Global Health Review (PGHR) provides examples on how women from cultures that perceive menopause positively could experience fewer and less painful symptoms than women who view menopause otherwise.15 For example, Many Asian cultures, compared to Western cultures, view menopause as a time of freedom when women can show their sexuality. This celebratory perspective could allow for less distressing symptoms for Asian women, even when barriers to gaining proper treatment exist. This is also similar for women in countries such as Sweden, Denmark, and Norway who report menopausal experience better than expected. In western cultures like the USA, existing health inequities and disparities fabricate the resiliency of cultures to adapt and manage situations of health, including menopause.
During menopause, hormonal and body composition changes could lead to greater visceral/abdominal adiposity and further into the onset of obesity.16 However, this association remains unclear. A longitudinal study conducted in the population-based Penn Ovarian Aging Cohort (n = 436), found that obesity is an important factor influencing the hormonal changes observed during the menopausal transition.17 Weight accumulation further predisposes a woman to co-morbidities like glucose intolerance, type 2 diabetes, heart disease and cancer. Even in menopause-symptoms experienced, a higher BMI and waist circumference have been significantly associated with more hot flashes (vasomotor symptoms) in early menopause.18 Meaning that healthy weight maintenance in early menopause may help prevent or reduce the severity of vasomotor symptoms experienced. Lifestyle modification is strongly encouraged for sustainable weight management and improved well-being. This includes nutrition, physical activity, and reduced stress for mental stability.19
Aside from lifestyle approaches, there are medical treatments for managing this natural phase. These include hormone therapy, hormone replacement therapy (HRT) and non-hormonal treatments. Achieving successful lifestyle modification for all women requires the absence of health inequities. The presence of health inequities, defined as “avoidable, unfair differences in health status seen within and between populations” and driven by SDOH, compounds poorer health outcomes for menopause management among socially disadvantaged populations. This has existed for centuries, further complicating how women, especially in marginalized communities like the Black, brown and indigenous communities, including immigrants and refugees, successfully navigate this natural phase (menopause).
Marginalized communities routinely experience food apartheid. Women living in lower-income, underfunded areas are more likely to have to travel farther distances to a full-service grocery store to access nutritious foods like whole grains, fruits and vegetables. Moreover, threatened safety in high crime neighborhoods restricts the zeal to engage in physical activity for better metabolic functioning. In general, we all eat what is affordable, tastes good, and is readily available. This includes foods that are in close proximity to where we live (grocery stores and fast foods), impacting what we purchase and eat. Making space for equity to thrive in socio-cultural contexts affecting menopause will help more women begin to demystify menopause, lessen the shame, and manage symptoms better, which improves the overall experience. Remember, whether you begin or experience menopause in your forties or later, embrace it with pride and talk about it. It is a milestone in graceful aging.
We’ve discussed how society, culture, lifestyle, aging, current health status, and body composition can influence symptom severity. While some of these changes are a natural part of life, early screening and personalized strategies—such as nutrition, exercise, stress management, and hormone therapy—can help women manage this transitional period and reduce long-term health risks. To wrap up, we offer some specific, effective lifestyle changes and approaches for managing menopause and overall well-being.
Managing Menopausal Transitions
Managing menopause isn’t one-size-fits-all, but these practical lifestyle tips can help you navigate symptoms and support long-term health with confidence.
Be Carb Literate
A balanced eating pattern instead of a strict generalized diet, along with increasing carbohydrate literacy, is recommended. Being mindful of your carbohydrate consumption does not mean ditching the bread, rice, pasta, and other foods you may love. It means educating yourself, for instance, on the option of higher fiber, slow-release carbohydrates in place of refined grains. Carbs with higher fiber will better support the body’s response to glucose, preventing sudden blood sugar spikes.20 Examples of slow-release carbohydrates and low glycemic index carbohydrates are beans, nuts, seeds, ancient whole grains, and non-starchy vegetables. You might also opt to increase the protein-carbohydrate ratio in your pattern of eating. For example, consuming a piece of fruit with a source of protein (i.e. a green apple with a dollop of peanut butter) will slow the absorption of glucose into the bloodstream and reduce rapid increases in blood sugars. This approach encourages variety in the choice of foods you consume while making room for your cultural dietary preferences. For daily intake estimates, working with a Registered Dietitian can determine appropriate portions and flexibility to ensure satiety, eliminate starvation and ensure total body nourishment.
Want to learn more about eating to balance your blood sugar levels? Take our self-paced masterclass, The Blood Sugar Fix. Each module is 15 minutes long and includes a recorded video by nationally recognized nutrition expert Maya Feller MS, RD, CDN, a downloadable PDF, and a resources list.
Mind The Lipids
Altered blood lipid levels associated with metabolic disorders can lead to an increased risk for cardiovascular disease, such as heart attack and stroke, particularly in the postmenopausal stage. There is evidence to support that consuming fewer foods high in animal-rich fats, like butter, tallow and lard, trans fat/ hydrogenated fats, added sugars (less than 10% of total daily calories), and refined carbohydrates, can decrease lipid/ bad (LDL) cholesterol levels in the body.21 Foods rich in phytonutrients and antioxidants, like fruits, vegetables, legumes and whole grains, have the potential to improve altered lipid levels as well as increase HDL cholesterol (good cholesterol). As women move through the life cycle, energy intake needs decrease after menopause. Consistently embracing a nutrient-dense, lower-energy eating pattern helps balance and even decrease the bad cholesterol levels, including related unpleasant effects.
Take control of your metabolic health with The Cholesterol Solution, our self-paced masterclass led by Maya Feller, MS, RD, CDN. In this on-demand course, Maya offers clear, actionable strategies to support healthy cholesterol levels—especially during life transitions like menopause.
Your wellness journey deserves thoughtful, evidence-based guidance, and we’re here to provide just that. If you would like personalized support, Connect with our Team Today for compassionate, one-on-one nutrition care.
It can take about 3 – 6 months to see improvements in LDL cholesterol and triglyceride numbers through nutrition and physical activity. Consistency and patience are key to seeing results. Although some people may still require medication as part of the total management approach.
Manage Your Microbiome
Gut health is key. The right balance of microorganisms in your gut plays a role in reducing oxidative stress and inflammation. The gut is an integral part of the immune system, involved in endocrine function and cell signaling. An unfavorable microbiome, as seen in decreased diversity among gut bacteria, may contribute to the onset of metabolic dysfunction by triggering pro-inflammatory responses. Alternatively, a favorable microbiome where there is a plethora of diverse colonic bacteria may offer protection against metabolic diseases. A pattern of eating featuring nondigestible plant fibers (nuts, wheat, whole grain foods, oats, legumes) increases the diversification of gut bacteria, which may have a “protective” role against many diseases. Check in with your physician on probiotic supplements and with your dietitian on the vast variety of foods that your stomach may love.
Lowering Sodium Intake
Ideally, a sodium intake below 2,000 mg/day is recommended for decreasing the risk for the onset of hypertension or what is commonly known as high blood pressure. Particularly, the scientific literature outlines that Elderly people, African Americans and people with obesity are more sensitive to experiencing the blood pressure lowering effects of a decreased salt intake.22 As much as a reduction of systolic blood pressure by 4 to 8 mmHg can be observed with changes in sodium intake. High amounts of salts are added into our food production system. Think of cured meat, frozen lunch and dinners, pizzas, fast foods and sauces. These and many more are examples of high sodium foods that require mindfulness in consumption. Gently and intentionally reducing added salt intake can be an understandable challenge. It typically takes 6 to 8 weeks to slowly adjust taste preferences toward less salty foods. In the absence of impaired kidney function, loading up on potassium rich foods, from fruits to vegetables, is also beneficial for controlling high blood pressure. Other strategies such as increased intentional movement (30 minutes of moderate-vigorous exercise 5 days a week), smoking cessation, and limited alcohol intake ( about 1 daily) can all be part of a strategy to reduce the risk of hypertension and cardiovascular disease.23
Bone Health
Bone Health begins in the early years of a woman’s life (during puberty), when there is a high rate of bone mass accumulation. During adolescence, calcium can be retained in significant amounts to support peak bone mass. This sets the stage for bone health later in a woman’s life. So, a pattern of eating that promotes healthy, strong bones throughout a woman’s life cycle is essential in reducing the risk of developing osteoporosis and other osteo-related medical conditions. Bone health is often dismissed or disregarded relative to health imperatives, particularly in the reproductive years, given the length of time it takes for complications to manifest. Osteogenesis, or bone formation, is complete around age 18 in women. Bone strength peaks between the ages of 25 and 30, with a noticeable decline around age 40.24 Loss of bone mass begins after 30 years of age when the rate of bone formation declines and bone resorption increases. Before entering menopause, bone continuously undergoes balanced remodeling, resorption, and deposition of calcium into new bone. However, after menopause, bone breakdown exceeds formation, leading to bone loss and weakness. This inevitable decline is further accelerated by the decrease in estrogen levels during the menopause transition.
This may be sobering but it’s not a lost cause! Bones are primarily composed of calcium and collagen and include other minerals such as phosphorus and magnesium. The body builds bone with calcium obtained through foods and beverages, and is constantly replenishing bone calcium. If calcium intake is low or inadequate, the body may begin to leach nutrients from bone reserves in the teeth and bones for necessary body functions like vascular signaling, hormonal responses, nerve transmission and muscle function beyond bone formation. To absorb calcium into the bones, Vitamin D3 is needed. Magnesium is an additional nutrient essential for supporting bone density and overall bone homeostasis. Consuming foods rich in calcium and Vitamin D3 can help support optimal bone health. Examples of calcium-rich foods include dairy products (e.g., milk and cheese, or alternatively soy drinks with added calcium); fortified foods like fortified flour, orange juice with added calcium, fortified breakfast cereals; and fish where the bones are eaten (e.g., sardines, anchovies). Besides sun exposure, Vitamin D can be derived from foods like liver, egg yolks, fortified foods (e.g., orange juice, milk, soymilk, and other fortified milk substitutes, some fat spreads, and most fortified breakfast cereals), and coldwater fatty fish (e.g., salmon and trout and to a lesser extent tuna, sardines, herring, mackerel, halibut).
Physical activity
Physical movement is another primary component of a comprehensive intervention that supports metabolic health. Geography, home environment, ability, mobility, accessibility, and affordability all play a role in the type of exercise plan attainable by a person. Setting goals that are realistic, achievable, and sustainable based on your ability and mobility challenges encourages participation in consistent exercising.
For example, barriers to walking outside or joining a fitness center can be substituted with climbing the stairs versus the elevator whenever possible. Finding creative and joyful ways to walk daily or engage in other safe exercises, like holding dance parties with friends and loved ones, or using household items for weightlifting, are possible ideas to include. Body movement can take on a variety of forms focusing on flexibility, aerobic conditioning, strength training, and restorative moments. Finally, do not skip adequate hydration as part of the nutrition plan to support your physical activity and moisturized skin.
In conclusion, we re-emphasize that menopause is not a disease but a natural event that menstruating people will experience as part of their aging experience. Each woman’s menopausal experience is unique, influenced by genetics, diet, lifestyle, cultural expectations and attitudes, and other social determinants of health (socio-cultural factors). Heading into the menopausal years with habits that support overall optimal health, such as the 6 insights mentioned above, requires mindfulness and strategic tweaks. This could make the menopause transition much easier and support postmenopausal wellness.
What surprised you about menopausal transition from this article? Please share your comments below or meet me in the DMs on Instagram. If you’d like to connect with someone on our team today, schedule a free consultation.
References
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