Nutrition
is a basic consideration in any discussion on menopause. It is particu1arly
important at this stage in your life as the body’s metabolism starts to slow
down. Middle-age is usually associated with some weight gain and with a
redistribution of the body’s fat. These
changes are contributed to by aging as well. More seriously, the risks of heart
disease, diabetes and osteoporosis increase.
To
overcome these risks, a diet low in cholesterol and high in calcium is
recommended. You may also have other specific dietary needs because of diseases
such as diabetes, hypertension which commonly occur in this age group.
Maintaining a good weight
It is important to have realistic
expectations about shedding kilograms:
believing
in yourself and having a positive self-image is important. The criteria for
maintaining your correct weight are based on eliminating bad eating habits such
as snacking between meals with food high in calories and controlling your
intake of fat, salt and sugar and partaking in some form of healthy exercise on
a daily basis. To assess your weight you take your height in centimeters minus
100, gives you your best weight in kilograms. Example: If you are 170cms in
height you subtract 100 from this and your best weight is 70 kilograms.
Abdominal circumference is important from the point of review of subsequent
medical problems, along with the BMI.
Eat sensibly
and moderately from these five food groups:
1.
Fruit and vegetables
2.
Meat, eggs, fish and soya beans
3.
Bread and cereals.
4.
Fat, however be mindful of
cholesterol rich food.
5.
Milk and milk products (600 ml
daily) — women after menopause, should use fat-reduced and calcium-enriched
milk products.
To stay
healthy, eat less fat, less salt and less sugar and reduce your alcohol
consumption. Drink plenty of water. Never allow yourself to be hungry as this
is a temptation to eat indiscriminately. It is a good idea to keep a food and
drink diary and to understand the following simple principles of behavior
modification which are the basis of many weight loss programs.
If you want to lose weight, there
are some simple changes you can make to your eating habits. Healthy food eaten
in smaller quantities, by using a smaller plate can make a big difference, have
one sandwich instead of two; cut down on refined carbohydrates (such as starch
and sugar), limit your intake of eggs,
fatty meals and deep fried foods; switch to skim milk and drink black tea or
coffee in moderation. Caffeine taken in any form has a negative effect on bone
density
Reduce your alcohol intake as it
adds calories, lowers bone density and weakens your dietary self-control. Some
drinks have more calories than others. For example, beer has many more calories
than whisky and soda; tonic water can be surprisingly high in calories. Be
careful when you choose low calorie drinks as they are often loaded with salt
which promotes fluid retention.
For lasting results, you should
maintain a weight-loss program over several months. The average recommended
weight loss should be half to one kilogram a week. Using fad diets to achieve
weight loss usually only gives short-term results.
Diet, in
your menopausal years, should be well balanced. If weight loss is not required,
then your daily intake should be about 2000 calories.
Smoking
More women die from lung cancer than
from any other cancer yet more and more women are smoking today. Smoking also
increases the risk of heart disease and osteoporosis as it adversely affects
deposition of cholesterol on the blood vessel walls and the changes in body
metabolism concerned with maintenance of bone thickness. Smoking always causes
early onset of menopause and more symptoms.
Calcium
An adequate calcium intake helps to
prevent osteoporosis; it helps to improve the muscle tone. It is very useful to transmit messages
between our body parts and brain by transmitting enzymes and hormones. Milk and
milk products are the richest source of calcium along with broccoli,
artichokes, brussel sprouts, cabbage, celery, cauliflower and mangoes. Nuts and
sesame seeds are also rich in calcium. Include some of these in your diet to
meet your recommended daily calcium intake of about 1000 mgm and if your daily
calcium intake is less than 400 mgm; you can take inexpensive calcium
supplements from your chemist or supermarket.
In the
menopausal years, calcium absorption can be impaired because of smoking, and
inadequate vitamin D and oestrogen, both of which are necessary for the
absorption and deposition of calcium in the bones. It is suggested that too
much calcium interferes with the body’s ability to absorb zinc and iron. It can
also cause constipation. Excess of supplemental calcium has been linked to the
increased risk of kidney stones. Some researchers have indicated that an excess
of calcium in the blood increases the risk of cardio vascular disease and
stroke.
Magnesium
Lack of
magnesium causes tiredness and fatigue, it can also cause muscle cramps.
Adequate magnesium helps to prevent high blood pressure, vascular disease,
muscle spasms, osteoporosis and migraine headaches. The daily magnesium
requirement is about 400mg. Dark green leafy vegetables, some fish like tuna
and mackerel, lentils and beans and many grains for example like quinoa,
burghal contain magnesium.
Zinc
The excretion of zinc is
increased during times of body stress such as surgery, burns, alcoholic liver
disease or starvation. It is also found to be high in women suffering from
osteoporosis. Recommended daily allowance for zinc is 15 mg. While there are no
current recommendations for zinc supplements to be taken by women with
osteoporosis, it may be a matter for further investigation. It seems that a
deficiency of zinc can cause retinal degeneration, night blindness and
cataracts. It can also cause repeated infections, and too much zinc can cause
abdominal pains, cramps and diarrhoea. The highest source of zinc is in oysters
however it is present in most of the vegetables, nuts and grains we generally
eat. It is not often necessary to take zinc supplements
Iron
During menopausal transition
years women often suffer from abnormal and often heavy periods, this can cause
anemia and make them very tired. So when you have your tests done at menopause
make sure you are not anemic. There are different types of anemia but bleeding
causes iron deficiency. Make sure that you are not deficient in iron, making
you tired; you can easily make this up by consuming green leafy vegetables and
red meat.
Vitamin D
Vitamin D is essential along with
calcium. The main source of vitamin D is cutaneious synthesis from exposure to
ultra violet light from the sun. Food such as fish, salmon, mushrooms and
fortified nibbles contain vitamin D. Vitamin D deficiency is caused by poor
exposure to sunshine, poor diet, some medical problems and finally at
menopause. Besides bone health, vitamin D is also supposed to prevent heart
disease, certain cancers, and maybe diabetes, however there is no consistent
proof for this. It is recommended that vitamin d levels should be 50nmol/L or
higher. It is important to take vitamin d until a satisfactory level is
reached. Take it under medical supervision, as high levels of Vitamin D can be
harmful.
Diuretics
Hormone
replacement therapy can cause fluid retention and your doctor may advise you to
take an occasional diuretic. A salt restricted diet also helps to decrease your
fluid retention. Many natural foods such as celery, parsley, cucumber and
asparagus have a diuretic effect. Try to include these foods in your daily
diet.
Low salt and salt-restricted
diets
A small
amount of salt intake is necessary for your body to function correctly. Normal, healthy individuals require 200 mg of
sodium daily. People with high blood pressure or heart disease should follow a
salt- restricted diet. Try to avoid foods with a high salt content such as
bacon, ham, salami, and all tinned food.
Sugar
There is
no harm in consuming a small amount of sugar daily. There are several natural
alternatives for sugar available such as apple juice and honey concentrates,
both of which can be used for food preparation.
Fiber
A high fiber
diet prevents constipation and is believed to prevent bowel cancer which is
prevalent in Western society. It is also valuable in reducing abdominal pain,
appendicitis, hiatus hernia, colitis, hemorrhoids and varicose veins. An
excellent intake of daily fiber is a breakfast of two heaped dessert spoons of
unprocessed bran and one heaped dessert spoon of wheat germ mixed with stewed
fruit, with or without sugar depending on your weight problem. Almonds are
another effective way of avoiding constipation. The daily requirement of fiber
is 25 mgm.
Cholesterol
Low cholesterol diets are
recommended for the menopausal years recent research has shown that adverse
changes in blood cholesterol take place within six months of menopause.
Cholesterol rich food is not the only
cause of high cholesterol in the blood. The human body can also make its own
cholesterol; the amount often depends upon your genetic make-up. It is not
necessary to starve yourself to lower your cholesterol level. You should seek
the advice of your doctor before making a major dietary change. Beware of the overly
simplistic view of cholesterol often reported in the media. These days there
are often comments about unsaturated fats, saturated fats and Trans fats. There
type depends on the chemical structure of the fat. It is best to know that the
fats that remain liquid at room temperature are the best fats to use: ie:-
Olive Oil, Flaxseed Oil, Peanut Oil and Rice Bran Oil. Please avoid trans oils
which are generally used for take away deep fried foods. They are made by hydrogenating
ordinary oils and can be used several times for frying and hence are cheap for
commercial cooking. They are harmful as they increase our LDL (Bad cholesterol
) and decrease our HDL (Good cholesterol).
Vegetarian diets
Vegetarian
diets are high in fiber content and dairy products and are low in fats. High fiber content protects against bowel
cancer, a low fat diet protects the heart and blood vessels.
Besides
all the important foods we eat, carbohydrates, fats, proteins, don’t forget the
herbs and spices which are equally good for our health. Some of the Indian
herbs, like Turmeric, Fenugreek and Cinnamon are very important to help us with
our dementia, cholesterol levels and blood sugar levels. Vegetarian and vegan
have to take special care that they some food fortified with vitamin B12 or
take supplements. Its lack can cause nervous system disorders, similarly
Vitamin D is important but that you can
get from sunlight and supplements are easily available. Some mushrooms are rich
in both B12 and Vitamin D.
Exercise
Exercise
plays a key role in our lifestyle particularly in the menopausal years. Lack of
daily exercise causes the body’s metabolic rate to decrease. It is important to
maintain an adequate exercise program as this can help reduce fat and stress as
well as improve posture, appearance, positive self-image, mood and concentration.
Useful exercises
•
Walking
•
Cycling
•
Jogging
• Swimming
• Skipping
The first group is aimed at keeping
fit and minimizing the risk of heart disease and osteoporosis. These exercises
are generally aerobic. They include walking, jogging, swimming, bicycling,
dancing and canoeing. Make sure that you are fit before starting any form of
exercise. A simple test to establish your fitness is the talking test: if you
are 50 or over, and run on the spot for two minutes and still carry on a
conversation; if you are fewer than 50, the recommended time is three minutes.
Another test is to watch your pulse rate before, during and after exercising.
Pulse rate indicates fitness.
Recommended training pulse
rate chart
Age (years) Beats per minute
40
120—150
45
115—145
50
110—140
55
105—135
60
110—130
Walking for at least 20 minutes a
day, four times a week, keeps the body metabolism in good condition. Move your
hands and arms at the time to get maximum benefit. An exercise bike is also
very useful with pressure adjustments to simulate a steep hill. This exercise
stimulates your metabolism, leg muscles and cardiovascular system. Golf, tennis
or gardening is also beneficial.
No one is ever too old to start
exercising. Well-conditioned muscles till help to prevent stiffening of joints
and will give you a sense of wellbeing. Swimming does not help prevent
osteoporosis, despite being excellent exercise for general fitness and
strengthening your cardiovascular system.
The second group of exercises is
useful for toning up your body face muscles. An excellent technique to tone up
your abdominal muscle is to lie on your back and raise your legs one or two
inches from the bed while counting to six. Do these exercises six times. Then,
lie on your back and raise your alternate leg at 90 degrees to the rest of your
body, and count up to six; slowly lower your leg. Again do this exercise six
times. Next, keep your body on the floor and lift both legs and stay in the
position for a count of six. Another exercise is to lie on your side, keeping
your leg straight and lift it up. Now raise and lower six times; change sides
and repeat.
Pelvic floor exercises
The third group of exercises tones
up the muscles of the pelvic floor and helps prevent problems such as stress
incontinence. Stand against a wall and lift your pelvic floor and contract your
buttocks. Do this six times and then cross your legs and do the same exercise a
few times again. The other way of supporting your pelvic floor is to contract
all your pelvic flood
muscles as if you suddenly have to stop passing urine. Do
this exercise 200 times a day to tone up your bladder. However you can now get
multiple devices to assist in pelvic floor exercises. I used a system called
Neotonus, which I found to be very successful in strengthening the pelvic floor
function.
Personal relationships
Personal relationships are important
in middle years. Sex can be even better with age. As the life expectancy for
women increases, almost third of a woman’s life is now spent after the
menopause. It would be a pity not to appreciate our sexuality at this time.
Many women enjoy sex after menopause more than ever before as the risk of an
unwanted pregnancy no longer exists, there are no more premenstrual tension, no
period pains, and life experiences allow them to enjoy a new freedom and open
communication with their partners.
There are two types of sexual
problems which commonly arise after menopause. Firstly, painful intercourse and
loss of sexual interest due to oestrogen deficiency and, secondly, problems
that are often due to partner’s declining sex drive or impotence inability to
sustain erection. At this age, a man’s sexual performance is often influenced
by stress and anxiety, diseases such as diabetes and arterial narrowing and the
effects of medication used for treating high blood pressure. Excessive
consumption of alcohol and cigarettes also effects sexual performance.
The best way to improve your sexual
enjoyment is to work at improving communication with your partner to find out
the real causes of any problems in your relationship whether they are physical,
psychological or both.
The treatment of any medical
problems for either partner is recommended, particularly with a caring doctor
who can do a careful assessment, including a physical examination with
appropriate treatment.
Hormonal changes, sexual
interest and intercourse
Loss of sex drive can occur at
any age so lack of oestrogen cannot be completely blamed for a waning interest
in love making. After menopause, a woman may lose her self-confidence if she
feels unwanted or physically unattractive. General feelings of emotional
instability and domestic stress seem to magnify frequent night sweats.
Where loss of sexual interest is a
problem, either from natural or surgical menopause, testosterone blood levels
are often found to be low. Benefit can be obtained from a testosterone implant
or injection. Although oestrogen replacement improves vaginal lubrication and
elasticity, its role in sexual desire is not yet fully understood.
It is,
however, generally believed that oestrogen does influence sexuality.
Age generally means a gradual
slowing of sexual response and arousal can take longer. However, sexual satisfaction
can often be achieved in other ways, and a mutual understanding of each other’s
needs and communication between two people are often the basis for a healthy
sex life, regardless of your age.
Embarrassment should never stand in
the way of good medical advice. If you want help, seek professional counseling
from your general practitioner or a clinical psychologist specializing in
psycho—sexual health for couples.
Commonsense, thoughtful communication
with your partner, counseling and HRT where appropriate can make your sex life
a happy one or perhaps better than you have experienced before. Currently laser
therapy for improving the vaginal health is greatly helpful. Urinary problems
are also improved by many new operative treatments. SERMS are a group of oestrogens
which act differently on different tissues. These will be discussed in a new additional chapter on Genitourinary
syndrome of menopause
How your family can help
A supportive family is important. Families
who can show understanding and consideration and make allowances for
irritability, forgetfulness and mood swings will make your menopause much
easier. You could encourage your partner to come to a menopause discussion
group, as understanding of why you are behaving differently from usual, can make
a tremendous difference to the smooth running of the family.
Key points
1.
Your diet should be sensible
with adequate calcium, reduced fat, and sugar content, and high in fiber. Have
realistic expectations about the weight you want to lose. Do it by sensible
eating and exercise and not by fad diets.
2.
The exercises recommended for
women in this chapter will keep you fit, minimize the risk of osteoporosis,
improve your urinary problems and help you to maintain your weight.
3.
Sexual difficulties at menopause
are often a combination of biological, psychological and social factors.
4.
Sexual problems can result from
your partner’s physical performance as much as from yours. A caring,
considerate attitude by your partner helps.
5.
Discuss your problems and seek
support from your family, friends and most of all your family doctor.
6.
Modify your lifestyle. Quit
smoking and decrease your alcohol, coffee and tea intake.
7.
Discuss with your care givers
the latest management of genitourinary syndrome of menopause .
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