Menopause and healthy living
| May 1, 2008
In-Depth Report
Menopause and healthy living
Healthy living choices won't cure the more severe symptoms of declining estrogen levels, such as hot flashes, but they can boost your overall physical health and improve mood. And they can maximize your chances for a more years of physical and mental well being. Menopause can be a time when women assess their health status and take steps to lower their risk of disease and improve their quality of life. In a 1998 survey by the North American Menopause Society, about 75% of women said they made lifestyle changes at the time of menopause or middle age, including changing diet, exercising, reducing their stress levels, and finding more time for themselves.
Diet
A healthy diet can help prevent obesity, heart disease, diabetes, osteoporosis, and some forms of cancer. The Dietary Guidelines for Americans 2005 puts a strong emphasis on eating fewer calories and getting more physical activity, in light of the fact that a growing number of Americans are overweight or obese.
Key recommendations in the Dietary Guidelines include these:
Watch calories. On average, a 134-pound woman needs 2,000 calories per day to maintain her weight; adjust accordingly for your needs.
Eat a wide variety of fruits and vegetables, including 2 cups of fruit and 2½ cups of vegetables daily.
Include at least three servings of whole-grain foods, such as brown rice, oatmeal, and whole-wheat bread, in your daily diet.
Consume 3 cups of fat-free or low-fat milk or equivalent milk products every day (1 cup of milk equals 1 cup of yogurt or 1½ ounces of natural cheese or 2 ounces of processed cheese).
Calories
The message here is to balance your calorie intake with your energy output. In other words, try not to eat more calories than you burn each day. It's a good idea to figure out how many calories you need to maintain your current weight, and determine whether your current weight is within a healthy range.
Obesity is an epidemic in the United States and other industrialized countries largely because of sedentary lifestyles and the wide availability of high-calorie convenience foods in large portions. Excess weight is linked to higher rates of heart disease, breast cancer, diabetes, and arthritis among other medical problems.
Fat
The 2005 guidelines suggest keeping total fat intake to between 20% and 35% of calories, and saturated fat to less than 10% of calories. On the other hand, Harvard nutrition experts say the best scientific evidence, including data from the Nurses' Health Study, shows that what's important is not how much total fat you eat but what kind of fat. Steer clear of saturated fats in meats and dairy products as much as possible. Avoid trans fatty acids (partially hydrogenated oils) found in stick margarine, vegetable shortening, and many commercially prepared baked goods. Instead, substitute lower-fat dairy products and vegetable oils. Choose polyunsaturated fats (liquid vegetable oil, fatty fish, soybean oil) and monounsaturated fats (olive oil, canola oil). The good news is that certain fatty snacks, particularly nuts and seeds, are healthful because they contain unsaturated fats — so long as you don't eat so much that you gain weight.
Water
Dehydration can exacerbate feelings of fatigue that some women experience during perimenopause and in the postmenopausal years. Keep in mind that caffeine and alcohol remove water from the body. Some of your daily water intake can be from decaffeinated tea or other drinks. Many herbal teas are caffeine-free, and therefore can help maintain hydration. But be aware that too much liquid can exacerbate incontinence problems. Incontinence is a growing problem for older women. So drink to quench your thirst and stay hydrated, but avoid drinking too much if you have any urinary incontinence problems.
What's your body mass index?The body mass index (BMI) is an index of weight by height. The definitions of normal, overweight, and obese were established after researchers examined the BMIs of millions of people and correlated them with rates of illness and death. These studies found that the BMI range associated with the lowest rate of illness and death is 19–24. |
||||||||||||||
Height |
Body weight in pounds |
|||||||||||||
4'10" |
91 |
96 |
100 |
105 |
110 |
115 |
119 |
124 |
129 |
134 |
138 |
143 |
167 |
191 |
4'11" |
94 |
99 |
104 |
109 |
114 |
119 |
124 |
128 |
133 |
138 |
143 |
148 |
173 |
198 |
5'0" |
97 |
102 |
107 |
112 |
118 |
123 |
128 |
133 |
138 |
143 |
148 |
153 |
179 |
204 |
5'1" |
100 |
106 |
111 |
116 |
122 |
127 |
132 |
137 |
143 |
148 |
153 |
158 |
185 |
211 |
5'2" |
104 |
109 |
115 |
120 |
126 |
131 |
136 |
142 |
147 |
153 |
158 |
164 |
191 |
218 |
5'3" |
107 |
113 |
118 |
124 |
130 |
135 |
141 |
146 |
152 |
158 |
163 |
169 |
197 |
225 |
5'4" |
110 |
116 |
122 |
128 |
134 |
140 |
145 |
151 |
157 |
163 |
169 |
174 |
204 |
232 |
5'5" |
114 |
120 |
126 |
132 |
138 |
144 |
150 |
156 |
162 |
168 |
174 |
180 |
210 |
240 |
5'6" |
118 |
124 |
130 |
136 |
142 |
148 |
155 |
161 |
167 |
173 |
179 |
186 |
216 |
247 |
5'7" |
121 |
127 |
134 |
140 |
146 |
153 |
159 |
166 |
172 |
178 |
185 |
191 |
223 |
255 |
5'8" |
125 |
131 |
138 |
144 |
151 |
158 |
164 |
171 |
177 |
184 |
190 |
197 |
230 |
262 |
5'9" |
128 |
135 |
142 |
149 |
155 |
162 |
169 |
176 |
182 |
189 |
196 |
203 |
236 |
270 |
5'10" |
132 |
139 |
146 |
153 |
160 |
167 |
174 |
181 |
188 |
195 |
202 |
209 |
243 |
278 |
5'11" |
136 |
143 |
150 |
157 |
165 |
172 |
179 |
186 |
193 |
200 |
208 |
215 |
250 |
286 |
6'0" |
140 |
147 |
154 |
162 |
169 |
177 |
184 |
191 |
199 |
206 |
213 |
221 |
258 |
294 |
6'1" |
144 |
151 |
159 |
166 |
174 |
182 |
189 |
197 |
204 |
212 |
219 |
227 |
265 |
302 |
6'2" |
148 |
155 |
163 |
171 |
179 |
186 |
194 |
202 |
210 |
218 |
225 |
233 |
272 |
311 |
6'3" |
152 |
160 |
168 |
176 |
184 |
192 |
200 |
208 |
216 |
224 |
232 |
240 |
279 |
319 |
6'4" |
156 |
164 |
172 |
180 |
189 |
197 |
205 |
213 |
221 |
230 |
238 |
246 |
287 |
328 |
BMI |
19 |
20 |
21 |
22 |
23 |
24 |
25 |
26 |
27 |
28 |
29 |
30 |
35 |
40 |
|
NORMAL |
OVERWEIGHT |
OBESE |
|||||||||||
Vitamins and minerals
Vitamins and minerals are important at all ages, and as you get older they may play a role in disease prevention. In midlife, women should start thinking of them as some added insurance against chronic diseases. Certain vitamin and mineral supplements — namely calcium, vitamin D, and the B vitamins — can help reduce the risk of various age-related chronic illnesses. There's some evidence that vitamin E may help ease hot flashes, but the data have been mixed. Taking a daily multivitamin will probably meet your vitamin needs, but to get sufficient calcium, you'll most likely need additional supplements.
Calcium
Calcium maintains proper functioning in the bones, heart, and nerves. If you don't consume enough to meet all of these physiological needs, your bones will pay the price. Your body will take what it needs from your bones, and the result could be osteoporosis. At midlife, women should consume more calcium than in previous years because calcium absorption declines with age. After menopause, it is recommended that you get 1,200 milligrams (mg) of calcium daily. Choose low-fat dairy options, such as skim or 1% milk and low-fat yogurt and cheese. Dried beans, dark green leafy vegetables, and nuts are other sources of calcium. Calcium supplements are also an excellent way to get the calcium you need. Your best bet for improving absorption (you cannot absorb more than 600 mg of calcium at once) is to take supplements in divided doses — that is, one pill in the morning and one later in the day. Many women find that drinking calcium-fortified orange juice or eating flavored calcium chews is an easy way to meet their daily requirement. Some calcium supplements must be taken with food to be absorbed so be sure you know if this applies to the one you use.
Vitamin D
Calcium and vitamin D work together to help maintain bone density. Without vitamin D, the body can't absorb calcium. Vitamin D production takes place in the body when ultraviolet light from the sun reacts with a form of cholesterol in the skin. A little bit of sunshine — about 15 minutes a day — can help boost your vitamin D production, but more than that can raise your risk of skin cancer. Vitamin D is also available in fortified milk. Women over 50 should get 400 international units (IU) of vitamin D daily; after age 71, the recommended amount is 600 IU. But many experts think that postmenopausal women should get at least 800 to 1,000 IU of vitamin D (along with 1,200 to 1,500 milligrams of calcium) per day to reduce their risk of developing osteoporosis. The Tolerable Upper Intake Level (UL) — the highest intake regarded as clearly safe — is 2,000 IU per day.
B vitamins
Maintaining appropriate levels of certain B vitamins can help midlife and older women ward off anemia, depression, insomnia, irritability, and possibly heart disease and breast cancer. Folic acid, or folate, is a B vitamin that has a variety of healthful properties. This vitamin can help prevent neural tube defects in developing fetuses. Also, a daily supplement of folic acid helps reduce cancer risk in people who drink alcohol. Folate is found in green leafy vegetables and oranges. Folic acid is the form of folate that's found in supplements and fortified cereals. The recommended daily dose is 400 micrograms (mcg) per day.
Vitamin B12 is necessary for red blood cell production and healthy nerve function. It is found in red meat, chicken, fish, dairy products, and fortified cereals. Deficiencies of this nutrient are rare in the United States but may occur in elderly people who do not have enough stomach acid to extract vitamin B12 from foods. Vitamin B12 deficiencies in the elderly can lead to a condition called pernicious anemia, which can cause nerve damage and sometimes dementia. Injections of B12 are needed for people with this deficiency because their digestive systems are often unable to absorb this vitamin. The recommended dose for adults is 2.4 mcg per day.
Vitamin B6 metabolizes fat and protein and aids in the development of red blood cells and the neurotransmitter serotonin. The primary sources are meat and legumes. B6 may help reduce your risk of heart disease; studies show that intake below the recommended 1.5 mg daily (for women) is linked with an increased risk of coronary artery disease. Low levels of vitamin B6 have also been linked with depression, insomnia, and irritability. It's important to know that if you reduce your consumption of red meat without increasing your consumption of legumes (beans and peas) you may lower your intake of this vitamin.
What about soy? Soy has been touted as a woman's health cure-all. Soy contains phytoestrogens, plant compounds that have weak estrogenic properties in some parts of the body and anti-estrogenic effects in others. There is some evidence that eating soy foods such as tofu may be helpful in reducing hot flashes and other menopausal symptoms, but the situation with soy has yet to be completely sorted out. It is possible that soy's estrogenic properties could compete with natural estrogen in the body instead of boosting estrogenic effects. Research shows different soy products are metabolized differently in different women. Studies looking at the effects of soy in the diet in relation to breast cancer, heart disease, and bone loss have not been consistent, just like those assessing the effect soy on hot flashes. If you choose to take soy, most experts think eating soy foods is safer than taking pills. |
Exercise
The Dietary Guidelines for Americans 2005 includes specific advice for exercising — not just to lose or maintain your weight, but also to promote physical and mental health. To lower your risk of chronic disease, you need at least 30 minutes of moderate activity per day, most days of the week. You can reap even more benefits with slightly longer or more intense workouts. For the greatest benefit and to help fend off the gradual weight gain that occurs in many people during midlife, strive for 60 minutes of moderate to vigorous activity on most days of the week.
Exercise has numerous physical benefits. It strengthens bones, tones muscles, burns fat, improves the cardiovascular system, and helps to prevent depression and fatigue. Studies show that regular physical activity can reduce the risk of heart disease in women by as much as 50%. Women who walk briskly for at least three hours a week and those who exercise vigorously for 90 minutes a week are 30%–40% less likely to develop heart disease than sedentary women. Active women tend to have higher levels of HDL, the "good" cholesterol. Physical activity can also cut a woman's risk of colon cancer in half and provide moderate protection against type 2 diabetes. Bones derive benefits from exercise, too. The mechanical stress from physical activity forces bones to absorb more calcium and become stronger. A large study of women past age 65 showed a 30% reduction in the risk of hip fracture in those who walked for exercise compared with those who did not. Regular physical activity also has been linked with reduced risk of breast cancer.
Studies have shown that exercise is good for mental as well as physical health. Physical activity can be as effective as psychotherapy, relaxation, and meditation in helping women cope with stress and depression. Exercise improves sleep, which can have a beneficial impact on mood. (Women who join health clubs or walking groups may improve their sense of well-being from the social interaction these groups provide as well.)
A good exercise program has three components: aerobic activity, strength training, and flexibility exercises. Each of these benefits your body in a different way. Aerobic activity improves your heart health, lowers your risk for numerous diseases, and can lengthen lifespan. Strength training (resistance exercise) strengthens your muscles and bones and improves your ratio of lean muscle mass to fat. Muscle tissue burns more calories than fat tissue does — and it looks better, too! Flexibility training keeps your muscles stretched and your joints limber and improves balance.
If you haven't exercised regularly for a while (or ever), start by putting some mental energy into a plan. For example, when will you exercise; what will you do (for the next 30 years); what can you do? Accept that you will have to give something up to exercise (some sleep in the morning, or some free time). It will be worth it. Start slowly and be patient — it takes time to see results. Walk around the block, garden, or go dancing. Try to do it on a regular basis, at least two or three times a week to start, and work your way up to more sustained activity. Choose activity you enjoy, so you'll stick with it. If you want something a little more structured, devise a plan that includes aerobic exercise and strength training. Remember to warm up and cool down before and after exercising to reduce the risk of injury. And if you can't fit in exercise six days a week, start with three. After a while you will want more!
Tipping the energy balance To tip the energy balance in your favor, start by determining how many calories you need each day to maintain your current weight. Doing this requires a few simple calculations. First, multiply your current weight by 15. That's roughly the number of calories per day needed to maintain your current weight if you are moderately active. Moderately active means getting at least 30 minutes of physical activity a day (walking at a brisk pace, climbing stairs, or active, physical gardening). If you are less active, you'll need to increase your activity to that level or reduce your calories further, or you will gain weight. Let's say you're a moderately active woman who is 5 feet, 2 inches tall and weighs 150 pounds. If you multiply 150 by 15, you will get 2,250, which is the number of calories per day that you need to maintain your current 150-pound weight. To lose weight, you will need to eat below that total each day. If your BMI shows that you are overweight, you can set a goal of losing one to two pounds a week — a rate that experts consider safe. To lose weight, your daily food consumption should provide 500–1,000 calories less than your total weight-maintenance calories. So in the example of the 150-pound woman, reducing calories to 1,250–1,750 a day will produce the desired weight loss. If you are sedentary, you will also need to build more activity into your day. In order to lose at least a pound a week, try to do at least 30 minutes of physical activity on most days, and reduce your daily calorie intake by at least 500 calories. However, calorie intake should not fall below 1,200 a day in women or 1,500 a day in men, except under the supervision of a health professional. Eating too few calories can endanger your health by depriving you of needed nutrients. |
Smoking
Tobacco is the number one cause of preventable illness and premature death in the United States and smoking is responsible for the deaths of more than 178,000 women every year. About a third of those deaths are from cancer (nearly all lung, but also pancreas, stomach, cervix, and others). Another third are the result of cardiovascular disease, and most of the rest are caused by respiratory diseases. Smoking has also been linked with early menopause and wrinkles. It fouls the air and is costly.
Smokers who quit reduce their excess risk of heart disease in two years. After 10–14 years, a former smoker can regain the risk profile of someone who never took up cigarettes. Many people try quitting more than once before they are successful. If you've tried to quit and haven't yet succeeded, try nicotine patches or gum, or the prescription drug bupropion (Zyban). In 2006, the FDA approved the prescription drug varenicline (Chantix) as an aid for cigarette smokers who want to quit. It works two ways. It partly imitates the effects of nicotine, thereby cutting down craving and withdrawal symptoms. It also partially blocks the effect of nicotine, causing a smoker to get less of a reward. It should not be taken with nicotine replacement products.
Alcohol
Not only can alcohol trigger hot flashes, but it also disrupts sleep on its own. For midlife women who already have sleep problems because of night sweats or other age-related factors, alcohol only compounds the problem.
Regular alcohol consumption is linked with a 10% to 15% increase in breast cancer risk. It also increases the chances of hip fractures, hemorrhagic stroke, and, at more than one drink a day, colon cancer. Heavy drinking increases the risk of liver disease, cancer, alcoholism, falls, and motor vehicle crashes.
How much is too much? Two or three drinks a week is probably safe; two or more a day is not. Even though alcohol consumption can reduce the risk of heart disease, experts do not recommend that women drink alcohol for this reason. Remember that alcohol also has lots of calories, so regular drinking can make it harder to lose or maintain weight. And not only do women metabolize alcohol less effectively than do men from the get go, but as they age their tolerance for alcohol decreases.
Review Date: 2008-05-01
Harvard Medical School does not endorse products or services.
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