Maya Minding Menopause IV: More Impact and Recommendations

Heart health and hypertension

Here are a few more recommendations as this is the last article in our menopause series. One adjustment that can be made while keeping socioeconomics and cultural factors in mind is reducing sodium intake. Lowering sodium intake, ideally below 2,000 mg/day, has been linked to decreasing hypertension (“Evidence Analysis Library”, 2020). Cured meat is a rich source of added salts so being mindful of your intake can help to reduce your overall sodium intake. High amounts of added salts are a mainstay in many foods. 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. Making intentional reductions of sodium in the pattern of eating is associated with a 17% decrease in the incidence of hypertension and a reduction in blood pressure across all demographics, especially older adults (Cannoletta, M., and Cagnacci, A., 2014). Strategies such as increased intentional movement, smoking cessation, and limited alcohol intake can all be part of a strategy to reduce the risk of hypertension and cardiovascular disease.

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 amounts significant enough 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 to 30 years with a noticeable decline around age 40 (Malabanan, A.O., and Hollick, M.F., 2003).

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 to new bone; however, after menopause bone breakdown exceeds formation leading to bone loss and weakness (“Office of Dietary Supplements”, 2020). This decline is inevitable and is 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 (Martinez, J.A., et al., 2017). The body builds bone with calcium obtained through the diet and is constantly replenishing bone calcium. If calcium intake is low or inadequate, however, the body may begin to leach nutrients from bone reserves and may utilize osteo-derived calcium for necessary functions and needs in the body. There’s also magnesium. Bone formation is largely influenced/supported by magnesium. In association with parathyroid hormone and vitamin D3 – –the active form of vitamin D–magnesium plays a significant role in supporting bone mineral density and overall bone homeostasis.

There are some foods with small amounts of vitamin D that, as part of a well-balanced pattern of eating, may mitigate reduced sun exposure. A few examples of such foods include 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).

As the most abundant mineral in the body, calcium supports nerve transmission, muscle function, vascular signaling, and hormonal responses. It is one of the only minerals that does not shift serum levels with inadequate dietary intake as it is found in abundance within bone tissue, supporting tightly regulated levels (“Office of Dietary Supplements”, 2020). Foods that are rich in calcium include dairy products (e.g., milk and cheese, or alternatively soy drinks with added calcium), green leafy vegetables (e.g., kale, chard, okra, spinach), foods made with made fortified flour (e.g., breads, cereals, pasta), and fish where the bones are eaten (e.g., sardines, anchovies).

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 recommended. Set goals that are realistic, achievable, and sustainable based on your ability and mobility challenges.

If you aren’t always comfortable walking outside or joining a fitness center, don’t sleep on taking the stairs whenever possible. Find creative and joyful ways to walk daily or engage in other safe exercises: 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. Lastly don’t forget to indulge in adequate hydration as part of the nutrition plan to support your physical activity.

While we have spent much of this series discussing the effects of aging and the menopause transition on potential adverse health outcomes, it is essential to emphasize that menopause is not a disease. Each womxn experiences menopause differently influenced by genetics, diet, lifestyle, cultural expectations and attitudes, and duration and severity of symptoms. Many report no physical changes during the perimenopausal years other than irregular menstrual periods whereas some experience some or all of the symptoms commonly associated with menopause, such as hot flashes, sleep disturbances, weight gain, increased anxiety or mood changes, vaginal dryness or memory problems. A few of these issues are unrelated to hormone changes and many, such as hot flashes and memory disturbances, usually go away after menopause. Heading into the menopausal years with habits that support overall optimal health as well as mindfulness and strategic tweaks might even make the menopause transition an easier one.