Menopause

Peri-Menopause is the months and years prior to menopause. For some women the peri-menopause period may be short, only a year or two. For others it may be as long as seven to ten years. Some women in their late thirties and early forties may begin to show symptoms.  Menopause is defined one year after menstrual periods have ended.

Sign and symptoms

• Hot flashes, flushes, or power surges- sense of warmth that starts suddenly, usually over your face, neck, and chest
• Related to fluctuations in estrogen, occurs only during peri-menopause when estrogen levels are decreasing
• Fluctuating estrogen levels may cause an imbalance in the hypothalamus. The body is tricked into thinking it is too hot. To cool itself blood is rushed to the surface of the skin, therefore resulting in a flushed appearance
• Night sweats - when hot flashes interfere with sleep
• Vaginal dryness, itching, and irritation
• Thinning of the vaginal lining may cause painful intercourse
• Urinary tract infections, need to urinate frequently, burning on urination, itching in the urethra area
• Urinary incontinence if the uterus and bladder slip lower into the pelvis
• Osteoporosis – or bone density loss occurs when estrogen diminishes to a low level. The most rapid bone loss occurs during the first 10 years of menopause.
• Heart rate rises after menopause. Estrogen helped to dilate the arteries. Menopausal women are at greater risk of heart attacks.
• Skin changes with an increase in wrinkles. The decreasing estrogen levels makes the skin more elastic.

Major Depression in Menopause

Women who experience a Major Depression in the postpartum period may be at greater risk of experiencing a depression in menopause. If a woman’s body is sensitive to hormonal shifts in the past, it may be sensitive to shifts in the future. However, not all women who experience a Major Depression in the postpartum period will experience a Major Depression during peri-menopause or menopause.

Women who experience Major Depression during menopause can be successfully treated with anti-depressants alone or in conjunction with hormone replacement therapy.

Menopause & Nutrition

Will menopause affect my bones?

Women achieve their peak bone mass by age 25 to 30. There is some slow loss of bone after this, particularly after the age of 40. As women approach menopause, estrogen production slows. This drop in estrogen leads to a period of rapid bone loss for about 5 years.

Osteoporosis is a condition of the skeleton where there is decreased bone mineral causing decreased bone strength leading to an increased risk of breaking bones.

At menopause, women should talk with their family doctor to see if there are factors, including Osteoporosis in a parent, which increase their chance of getting Osteoporosis and indicate that a bone density test should be done.

Adequate calcium and vitamin D intakes have a role in slowing bone loss.

How much calcium do I need?

Women 50 and over need 1200 mg calcium a day.  Some recent research suggests that calcium supplements may be associated with an increase in heart attacks, but other research has not found this. Based on what we know at this time, it is best to get as much of your calcium intake as possible through food, avoiding large doses of calcium supplement.

How do I make sure I’m getting enough calcium?

Dairy products and fortified or enriched soy beverages are rich sources of calcium. Three choices from the list below gives you 900mg calcium. Eating a varied diet based on Canada’s Food Guide gives you an added 200-300mg calcium per day.

• 250ml (1 cup) milk or soy, rice or almond beverage labeled as fortified or enriched; choose skim, 1% or 2% unless doctor or dietitian tells you otherwise

• 175ml (3/4cup) plain or vanilla yoghurt or 250ml (1 cup) fruit flavoured yoghurt; choose low fat unless doctor or dietitian tells you otherwise

• 1 ½ ounces of hard cheese such as cheddar or edam
• 2 ounces of soft cheese such as mozzarella or brie (2 times size of this diagram)

Note: Discuss your cholesterol level with your doctor or dietitian before choosing cheese as a calcium source

Note: If you are not able to include 3 of these choices, look at:

• The Calcium Calculator www.bcdairyfoundation.ca, 604 294-3775 or 1-800-242-6455

• HealthLinkBC File #68e: Food Sources of Calcium and Vitamin D www.healthlinkbc.ca/dietitian - Nutrition & your Medical Condition – Bone Health
• Subtract the amount of calcium you get daily in food from the amount recommended for your age. You will need to increase your intake through food and/or supplement by this amount.

How much vitamin D do I need ?

Osteoporosis Canada recommends that women over 50 get 800-2000 IU a day.

How do I make sure I am getting enough?

In most of Canada the skin makes vitamin D when it is exposed to sunlight from April through September (if sunscreen is not worn). Vitamin D is in very few foods and the amount from sunlight is usually too little. So, people need a supplement all year long.

Menopause and Hormone Replacement

Only consider hormone replacement therapy after looking at your psychological and physical risks, your personal history, and your family history.

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