The Menopause Transition Rollercoaster–
Menopause transition can be like a roller coaster ride. Hormone levels can vary for several years until the ovaries slow down production of estrogen and progesterone to a new lower baseline level. It is when our hormones are changing that we experience symptoms. Think about the times our hormones are in flux, the first period, pregnancy and menopause. We associate mood changes, sleep disturbance, hot flashes, food cravings, acne, weight gain and more with these times of life. The transition to menopause does not need to be uncomfortable. Before getting on the amusement park roller coaster ride, you may not want to eat two hot dogs, and have your hat and sunglasses on. Before menopause, there are things you can do to prepare yourself for a easier experience.

Top Seven Lifestyle Interventions for Thriving:

#1 STABILIZE YOUR BLOOD SUGAR
Work to maintain an even blood sugar. We want to avoid high and low blood sugars as often these variations can trigger hot flashes as well as lead to weight gain. The foods that most likely cause your blood sugar to rise are grains that are ground up into flour followed a close second by actual dietary sugar. Choose for example oatmeal instead of oatmeal bread. The whole grain is slower to digest with added fiber and will cause less of a rapid rise (and then fall) in blood sugar. Balance your meals, each meal should include a protein, a fat and carbohydrate. Protein and fat also will slow down digestion and work to keep blood sugar levels more even. I recommend most carbohydrates to be non-starchy vegetables.
I have a patient who was getting hot flashes at 11 am on the dot every single day. We implemented a mid-morning snack, apple slices with nut butter and the hot flashes resolved. Refined carbohydrate and added sugars are the biggest drivers of weight gain during middle age. Eliminating these from your diet will help maintain weight during a time when many women gain weight.

#2 MOVE YOUR BODY
Yet another reason to exercise. Cardiovascular exercise in addition to reducing risk of ALL CAUSES OF DEATH, including reducing risk of cancer, exercise can also help with menopause. There is not a lot of direct evidence for hot flashes, but there is reduced weight gain, as well as reduced stress levels which influence mood. Exercise during the day can also help aid with sleep provided it is not done too late in the day. In a randomized controlled study of over 500 women, the women in the test group given nutrition and exercise program maintained their weight during the menopause transition while the others in the control group gained an average of 6 pounds. Strength training and weight bearing exercise can also help maintain bone density.

#3 GET YOUR Zzzzzs
Sleep is critical. Everything is worse the next day with a poor night’s sleep. Sleep disturbance during the menopause transition is often related to imbalance between hormones. That is the delicate balance between Progesterone and Estrogen. Sometimes testing and improving this balance can help. Low blood sugar in the middle of the night can often be a trigger of early morning awakening and disrupting sleep. Another biggie is stress hormone imbalances.
Prioritizing our bed time, is important. Aim for 7 hours of sleep. Try to avoid light and screens in the few hours before bed. Keep the room cool. A bedtime ritual, setting the intention for sleep can also be helpful.

#4 TAKE OUT YOUR TRASH
What would happen if you never took the trash out of your house, well, it would not be pretty. Our body is the same way in that our detoxification pathways (the mechanism by which our body removes harmful substances) is often bombarded and is unable to normally eliminate excess hormones as it should. We are exposed to hormone disrupting chemicals daily. Trying to reduce incoming toxins by evaluating what we are eating, putting on our skin and exposing ourselves to affects our hormone balance. Improving detoxification by drinking filtered water, eating plenty of fresh vegetables and fruits, organic when possible is a good start. Sweating regularly with exercise can also support detoxification and improve hormone balance.

#5 FEED THE MICROBIOME
The inner world of bacteria that populate the digestive tract called the microbiome is very important for hormone balance. There are bacteria that either enhance or prevent the elimination of excess estrogens that often can occur during the menopause transition. The bacterial balance can also influence our metabolism and affect weight. Eating “living foods” such as fermented foods (like sauerkraut, pickles and kimchi) as well as variety in the diet can support a healthy microbiome. Trying to avoid antibiotics if possible can also save our microbial friends in the digestive tract.

#6 MANAGE YOUR STRESS
No doubt that life is stressful. Our perception of events influences our hormones. When we are in fight or flight mode, high levels of stress hormone cause us to feel hot, and our heart to race very much like a hot flash. Often stress hormone rather than low levels of estrogen are the trigger for the hot flash. Low estrogen sets the stage, but adrenaline, stress hormone is the cue! Having healthy outlets for stress is important in evoking the relaxation response. Deep breathing, meditation as well as exercise can go a long way in improving menopause transition symptoms.

#7 EXPLORE YOUR PASSIONS
What did you love to do when you were 11 or 12 years old? Re-visit your younger pre-first-period self and explore what comes to mind. I think that embracing this stage of life as coming back to your true self is a great way to frame this transition time. Anticipating that there will be ups and downs but at the end of that is the opportunity to re-introduce yourself to your untethered soul. Find that joy and passion that perhaps you lost when life got in the way.

Wishing you the best of health and a comfortable menopause transition. If these lifestyle interventions are not enough, consider making an appointment to see if herbal/ botanical supplements, medications or bio-identical hormone replacement therapy is right for you.

References:
1.Annals Behavioral Medicine 2003 Dec;26(3):212-20. Lifestyle intervention can prevent weight gain during menopause: results from a 5-year randomized clinical trial.
2.A Randomized Controlled Trial Menopause. 2014 Apr: 21(4): 330-338
3.Menopause. Nelson HD. Lancet. 2008 Mar 1;371(9614):760-70. Review.
4.Hormone Changes Associated With the Menopause Transition. Su HI, Freeman EW. Minerva ginecologica. 2009 Dec; 61(6): 483-489
5.Hot flush severity during the menopausal transition and early postmenopause: beyond hormones. Mitchell ES, Woods NF. Climacteric. 2015;18(4):536-44.