Menopause is the stage in life where ovulation stops, resulting in the end of menstruation and decreased levels of oestrogen (1). Subsequently, this can have adverse effects on body composition, bone health and heart health. This reduction in oestrogen can also cause a range of menopause symptoms, of which 75% of menopausal women experience (2). This includes well known hot flushes, night sweats and brain fog, but also less spoken about symptoms, such as anxiety, itchy skin and vaginal dryness (3).
Why would someone in menopause visit a nutritionist?
Usually, the greatest concern shared amongst menopausal women is that of abdominal weight gain. It’s no surprise given that weight gain affects 50% of women at menopause, with the average person gaining 1.5kg/year during perimenopause (4).
Whilst weight gain is usually the client’s concern, from a professional perspective you must also consider that an increase in central fat deposition leads to an increased risk of cardiovascular disease. A reduction in oestrogen already increases the risk of cardiovascular disease – pair this with central weight gain, and it’s crucial that heart health is addressed (5).
Bone health should also be discussed, since reduced oestrogen levels increase the risk of developing osteoporosis (6).
How to address weight management
There’s a good chance that your client will have tried numerous diets by this point of their life, and will have created a narrative in their mind that they cannot lose weight. Not only this, but these women typically have many responsibilities in their lives, such as work or family commitments, meaning their own health is at the bottom of their priorities. This is why realistic, practical advice that they can easily implement into their lifestyle is crucial.
Keep your advice simple – start by checking how often and how much they’re eating. Sometimes, they’re eating too infrequently that it’s leading to over indulgence late in the evening. Consider the quality of their diet – are they eating a good source of fibrous complex carbohydrates, protein and plenty of fruits and vegetables at each meal? As nutrition professionals, you know the basics of weight management and the importance of creating an energy deficit… keep it simple, don’t overcomplicate it.
How to address heart health
As mentioned, many women won’t visit your clinic with the purpose to focus only on heart health. Regardless, it’s also important to ensure the advice you provide benefits their heart.
When considering heart health, it’s important to think about blood lipids and blood pressure. Total cholesterol typically increases with menopause, whilst HDL cholesterol starts to decline (4). Not only this, but central weight gain promotes increases in LDL cholesterol (7). Just like with weight management, don’t over complicate your advice.
Review their saturated fat and salt intake and see where simple swaps can be made. Perhaps it’s as simple as swapping salted butter for a plant-based vegetable spread. Don’t forget that fibre is good for heart health too (8). A good starting place is checking whether they’re getting their 5-a-day. If not, set this as a goal. Fruits and vegetables not only provide heart friendly fibre, but antioxidants, which are also beneficial for heart health.
How to address bone health
The rate of bone loss increases at menopause. It’s estimated that 1-3 years prior to menopause, bone mass density is lost at a rate of 2%, which can continue for up to 10 years (9). Subsequently, bone health must be taken into consideration to reduce the risk of osteoporosis. The recommendation for calcium is 700mg/day (10). However, the National Osteoporosis society suggest those at increased risk of osteoporosis should aim for 1000–1200mg/day instead (4,11). This can be achieved by ensuring your client consumes 3 good sources of calcium daily, such as dairy.
Where does exercise, emotional wellbeing and yoga come into menopause management?
A holistic approach to managing menopause symptoms ensures the best support possible for your client. Strength-based exercises will help to build and maintain muscle mass, which in turn will help increase your client’s metabolic rate and support their weight management. Aerobic exercise will also support their heart health. Yoga is a form of restorative exercise, helping your body to heal and repair.
With so many changes at this stage of life and the possibility of developing anxiety, depression or low self-esteem as symptoms of menopause, emotional wellbeing may be the most overlooked component of menopause management.
Knowing the importance of a holistic approach, alongside medical support, during menopause, was created. Harley Street at Home: Menopause provides exercise and yoga classes, open menopause clinics with British Menopause Society trained doctors, nutrition workshops, weight management programmes and emotional wellbeing courses, ensuring that everything a menopausal women could need is provided. You can access their for a free 30 day trial using code CPD30 to see how all these elements of menopause support come together to complete the puzzle.
4.Panay, N., Briggs, P. and Kovacs, G. (2020) Managing the Menopause, Second Edition, Cambridge University Press, Cambridge.