Menopause Treatment Options

Menopause healthcare is not only relief of symptoms and improvement of quality of life, but also health screening to minimise risks of inflammation that drives future chronic disease such as heart disease, diabetes, stroke, osteoporosis, sarcopenia and Alzheimer's disease.

Integrative medicine supports women in perimenopause and menopause by supporting healthy habits that will hopefully last a lifetime and will reduce the risks of chronic disease. 

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Hormone replacement therapy (see below) is often then 1st line treatment both for symptom relief and also for long term disease prevention when started in the first 10 years of menopause. However lifestyle plays a massive role in disease prevention.

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1. Exercise

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At least 150 minutes per week of moderate intensity exercise is ideal, but any exercise is better and beneficial for health than none. Exercise in 30-60 min sessions at the gym, walking to work, cycling, running, dancing or swimming.

You can also do snack size exercises multiple times during the day by setting a timer on your phone to jog on the spot or jumping jacks. Using a Fitbit or other device can help motivate and remind you of your goals. It can take some-time to make exercise a habit, but most people once they get going with an activity that they love, find it a pleasure to move their body.

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Exercise during menopause and beyond should include these 3 important aspects:

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• Aerobic exercise that gets the heart rate increasing for heart, lung and brain health. 

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• Resistance exercise that increases muscle strength by making your muscles work against a weight or force. This is important to maintain muscle mass. Resistance exercises can be carried out with free weights, machines, resistance bands or using your own body weight.

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• Weight-bearing exercise - this is exercise that force you to work against gravity. This includes activities such as jogging, running, stair climbing and dancing. 

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2. Real Food 

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Fuelling the body and brain are important to support the phenomenal hormonal and metabolic changes occurring during menopause. To support hormones and metabolisms consider including in your diet:

• Brassicas (cauliflower, broccoli, cabbage, bok choi etc) which are high in indole-3-carbinol and diindolylmethane (DIM) that help regulate estrogen metabolism.

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• Phytoestrogens such as lignans and isoflavones are beneficial for health. Non-ultraprocessed soy products such as whole soybean milk, miso, tofu, contain isoflavones. Flaxseeds contain lignans. 

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• Diverse plant foods are beneficial as they contain a variety of fibres and acts as  including fruit, veg, of many colours, whole grains such as steel cut oats, quinoa, buckwheat, nuts, seeds, legumes, lentils, herbs and spices.

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• Protein is important for fuelling the moving body, synthesizing protein essential for happy brains and maintaining bone and muscle function. Legumes such as beans, peas, lentils, peanuts, chickpeas and nuts such as walnuts and almonds are great protein sources. Lean meats such as chicken and fish. 

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• Green tea contains antioxidants and epigallocatechin gallate (EGCG). EGCG supports metabolism, helping stabilise body composition and increase bone mineral density. 

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3. Sleep

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Vasomotor symptoms of menopause such as hot flushes and night sweats can interrupt sleep. Additionally variations in hormones can lead to early waking, and difficulty sleeping resulting in non-restorative sleep for many women during menopause. Exercise, particularly morning or afternoon exercise can aid with sleep. There are a number of mind-body therapies which can be useful for improving sleep including cognitive behavioural therapy and yoga. 

Some women find support for sleep from magnesium, tart cherry, micronised progesterone or melatonin. 

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Often the best treatment for impaired sleep is management of hormonal fluctuations with hormone replacement therapy (HRT).

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4. Stress Management

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Often menopause is occurring concurrently with a busy time in a woman's life. She may have children or older teens, or grandchildren to care for, she may be progressing in her career or making a mid-career shift. Some women are caring for aging parents and others are involved in relationship breakdown or discovering new relationships.

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It is important to have strategies in place to maintain balance and boundaries and to avoid becoming too overloaded so that you can avoid burnout.

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Stress management depends on adequate restorative sleep, and is aided by exercise. Additionally these are some strategies some people find useful in managing stress:

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• mindfulness, deep abdominal breathing or meditation

• yoga

• massage

• positive affirmation

• daily gratitude practice

• prayer

• journalling/creative activities

• down-time/leisure/fun/laughter

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5. Healthy Relationships

Perimenopausal and menopausal symptoms affect women in many different ways, for some, the mental and physical symptoms can be detrimental to relationships. Mood changes, brain fog and lack of sleep can compound to create irritability and unhappiness and difficulties in relaationships. Lower hormonal levels can also contribute to vaginal dryness, discomfort during sex, low libido and low sexual desire. 

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Good communication is essential for maintaining healthy relationships. Utilising lubricants can help with vaginal dryness. If mood changes and menopause symptoms are having a negative impact on your relationship, hormone replacement therapy may be useful. You may also benefit from talk therapy.

It is important to seek help if your relationships are being affected as it's important for your health and wellbeing to be surrounded by loving, supportive relationships. 

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Read more about Sexual Health Clinics Dunedin.

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6. Minimising substances that negatively influence hormone health

Some foods and substances can worsen symptoms during menopause so these are best avoided or minimised. 

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• Caffeine - coffee consumption exacerbates menopausal vasomotor symptoms--hot flashes and night sweats that occur due to the constriction or dilation of blood vessels. A cup a day is unlikely to have a detrimental effect, but several cups and especially coffee or caffeinated drinks later in the day are likely to contribute to symptoms and impair sleep.

• Alcohol - unfortunately alcohol is bad news for the menopausal woman. It is one of the largest risk factors for breast cancer, and breast cancer is the most common cancer caused by alcohol among women globally. The good news is that alcohol is a modifiable risk factor for breast cancer, meaning cutting down consumption reduces the risk.

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