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Should There Be A Change in Attitude Towards Menopause?

With the baby boomer population becoming or already of age for the onset of menopause, it becomes an important topic of discussion. The average duration of menopause is about one year, but perimenopause can be present for three to four years. Symptoms of menopause can persist for a year or two after menopause as well, making the progression of menopause last for up to six years!

The perception and experience of menopause varies from woman to woman and also cultures.  Education and helping to shape a woman’s experience of menopause is just as important as the supplemental support provided.  Research has shown that menopause is perceived as a negative experience when women view it as a medical issue as opposed to an expected life change. 

As primary care providers and supporters for women experiencing menopause, we need to educate and support the notion that this experience is an expected and normal life change. Working with patients to better shape their perception of menopause can be treatment in itself.

Heart health, cancer and bone density are major concerns for post-menopausal women.  A recent research article showed that women in menopause do not consider themselves at risk for conditions such as heart disease and osteoporosis.  This is disturbing, considering coronary heart disease is the number one killer of women and after the age of 60, a woman’s risk of dying from heart disease is very close to that of men. By age 65, 30% of women have osteoporosis, and one in three women over the age of 50 will experience an osteoporotic fracture.

There is a huge need for primary care providers to educate patients on preventative measures for these conditions that become extremely prevalent and deadly post-menopause. We need to place emphasis on informing our patients that with this natural progression in life, more attention is needed towards preventative measures for these concerns. 

In women, breast cancer rates hover around one in nine for lifetime risk, and hip fractures around one in six.  Changing the perceptions of our post-menopausal patients, peri-menopause and menopausal patients, of their risk is important in preventing the occurrence of these potentially debilitating and deadly health conditions.

Looking at supplemental support for menopause is also something where education and perception becomes important. Probably one of the most controversial questions in menopausal treatment is the safety and use of soy for menopausal symptoms of hot flashes. Typical Japanese diets consume about 24 lbs of soy per year, the majority of this fermented. The typical American diet provides about 3 lbs of soy per year, with most of the dietary soy being soy protein added to processed food. Natural fermented sources of soy are most healthful to include in the diet. However, it is important for women to work with their medical doctor in order to assess their hormone levels and determine if they are estrogen dominant, in which case a woman may not react favorably to soy. There are several phytoestrogenic components of soy, including isoflavones, which have the ability to influence hormone levels in the body. Phytoestrogens are weak estrogens that attach to estrogen receptors and exert a weaker effect than estrogen. This effect may be beneficial when estrogen is either too high or too low. For some women, soy can exert beneficial effects such as reducing hot flashes.

Rates of reported hot flashes vary amongst culture and may be partially attributed to dietary choices such as using healthful forms of soy:

  •         China – 10% report hot flashes
  •         Singapore – 17.5% report hot flashes
  •         Japan – 22.1% report hot flashes
  •         US – 75% report hot flashes

Soy has quite significant evidence in menopause.  A meta-analysis looked at 19 trials and found consumption for six weeks to 12 months significantly reduced the frequency of hot flashes by more than 20% and reduced the severity by more than 26%.  Soy may also play a role in the prevention of bone loss and aid in cardiovascular health – two important post-menopausal concerns.

For information regarding soy safety in cancer and cancer risk, please see the following references:

Consumption of soy is not the only causal effect of these lower reported rates of hot flashes, but it certainly plays a part.  Looking more macroscopically, diet and weight management play an important part as well.  A Mediterranean-ish diet can cut risk of hot flashes and night sweats by 20%. Menopausal women who eat diets higher in sugar, saturated fats and trans fat increase their risk by 23%.  One study showed that menopausal women who lost weight eating a low-fat diet rich in fruits and vegetables reduced or eliminated their hot flashes and night sweats.

Weight management is also an important aspect of menopause. Weight gain can become common in middle-aged women, especially 50-59 years old. Abdominal weight gain is a risk factor for heart disease, diabetes and other issues. Higher BMI is also associated with an increased risk for more frequent and severe hot flashes.

Looking at global obesity rates by the countries listed above for reported hot flashes (not 2013 data) show:

  • China – 5.7%
  • Singapore – 7.1%
  • Japan – 5%
  • US – 33%

Changing and influencing our perception of menopause can significantly improve our patients’ outcomes, independent of therapeutic treatment.  Therapeutic treatment should revolve around diet, lifestyle and research based supplemental support.

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