Real Health in Focus: Menopause Series – Part 1

An Introduction to Menopause

Women experience natural and notable changes in hormone levels in midlife as they reach the end of their reproductive years, signaling the beginning of menopause. While all women will experience menopause—typically after the age of 40—the facts about what it is and about women ought to expect receives less attention than would be expected for a shared biological process at such an important time in adult life. At its most basic level, menopause is the cessation of production of reproductive hormones in the ovaries, or as OBGYN Dr. Jen Gunter puts it succinctly, it is simply “puberty in reverse.” Like puberty, there is a wide range of varying experiences women have during this stage when a whole host of changes begin to take place all at once. However, unlike puberty, there is less public education about menopause and fewer communities for women to learn about and discuss the experience of undergoing menopause. Because understanding what is happening in our bodies is vital, we have created this two-part series on menopause to help bring the basics into the light, mitigate fears about entering this natural phase of life, and to empower you on your health journey.

Stages of Menopause

Let’s start by clarifying some basic terminology. The word menopause is comprised of two Greek root words: mēn meaning “month” and pausis “to stop or pause,” that is, it is the cessation of our regular menstruation cycles. After our reproductive years, we first enter perimenopause (peri-, meaning “near”). A common first symptom is irregular periods that vary in duration and heaviness (most commonly shorter, lighter, and less frequent periods). Unfortunately, this symptom alone does not tell us exactly how near menopause you are. In fact, it could be anywhere from a few months to 10 years before you enter menopause. Menopause itself is officially diagnosed after you have gone an entire year without a menstrual period. Receiving this diagnosis at this point can be especially frustrating: “Oh, after all those changes in my body for the last few years I have a confirmation finally that I am undergoing menopause.” While a blood test (FSH) is sometimes used to guide the diagnosis of menopause, its utility is limited. As with puberty, your experience, and not a test, provides the strongest indication of a menopause diagnosis. Any time after the first year without a menstrual period is considered post-menopause.

when does menopause happen and what happens?

Menopause can occur within a broad range of our lifespan, typically between the ages of 40 and 58.  The average age of menopause is age 51. Most women follow a pattern similar to their mothers or sisters, so it can be helpful to discuss their experiences with them, if you can. Given that the average life expectancy for a woman in the US is 81 years, it’s important to keep in mind that you have a third of your life remaining and that by understanding changes that occur during menopause you can help yourself continue to stay healthy for years to come.

So, what happens during perimenopause and menopause? Let’s start by discussing changes in muscle, fat, and bone (don’t worry, we will cover other important things like hot flashes in the next blog post on this topic with the help of my new colleague at SHIFT – Dr. Jess Benjamin).

muscle changes

As we age, our metabolism slows. After age 20, our body’s energy demands slow by about 2% each decade. This is commonly due to a loss of muscle mass as a part of the aging process. Protein is the building block for muscles, so having an appropriate amount in your diet helps to preserve current muscle tissue and build new lean muscle tissue. This is important for many reasons, including maintaining your physical strength but also preserving your bone strength. With strong muscles, there is a constant amount of tension on the bones, this helps trigger the body’s natural bone strengthening processes and will help to prevent bone loss in the future. Here at SHIFT, our registered dietitians determine your individual body’s nutrition needs, including making sure you are including adequate protein in your diet.

Bone Changes

Another change that happens with aging but also accelerates during the menopause transition is a decrease in bones strength. After 40, Bone Mineral Density (BMD), or the strength of our bones, progressively declines by 0.5% per year or more. Post menopause, this process quickens, placing women at greater risk for osteoporosis (low bone strength). According to the American College of Lifestyle Medicine, nationwide hospitalization rates and costs for women 55 and older were higher for osteoporotic fractures than for heart attacks, strokes, or breast cancer. Once again, lifestyle changes (primarily in diet and exercise) help prevent osteoporosis and even help to preserve or strengthen your bone mineral density. Getting sufficient calcium and vitamin D through your diet can also help prevent bone density loss. In fact, one meta-analysis study even showed consuming fortified dairy products can increase bone mineral density (BMD) by about 0.7-1.8% at the lumbar spine, total body, total hip, and femoral neck after two years. Another way to help decrease bone loss is through strength training. Studies have shown that strength training preserves the bone mineral density, even in the setting of accelerated bone loss in postmenopausal women. Every day our fitness classes incorporate a strength training portion. (For me, strength training is something that before starting at SHIFT I had not incorporated into my weekly routine. I am reminded that I still have room for improvement in my own lifestyle choices and more to learn from my colleagues in physical therapy and fitness instruction.)

fat changes

Hormone changes in the perimenopausal period trigger a change in where we store fat and this, in addition to age-related changes, can cause weight gain. On average, a woman will gain anywhere from 3-6 lbs. over the course of these hormone changes (typically at a rate of 0.8 lb. per year). Studies have shown that this weight gain usually takes the form of visceral fat. Remember that this is the particularly nefarious variety of fat that accumulates around your organs and can decrease your sensitivity to insulin and increase inflammation in the body. The good news is that studies have also shown that by exercising at least 120 minutes per week during perimenopause can prevent this visceral fat gain. Another change you may also notice is a change in the distribution of fat on your body. Studies show women lose fat from their hips during this time, which may translate to your clothes sitting differently on your body.

If you would like to learn more about menopause – “The Menopause Manifesto” by OBGYN Dr. Jen Gunter or “Wellness: Fact vs Fiction” podcast by Cardiologist Dr. Danielle Belardo featuring Dr. Jen Gunter are great resources. Watch out for the second and final part of this series on menopause!

In Real Health,

Dr. Sierra Vanderkelen & the SHIFT Physician Team

Reference List

1. Gunter, Jen. The Menopause Manifesto: Own Your Health with Facts and Feminism. Random House Canada, 2021.
2. Crandall, C. (2019). In Menopause practice: A clinician’s guide (6th ed.). essay, North American Menopause Society.
3. Van den Heuvel E., Steijns J. (2018). Dairy products and bone health: How strong is the scientific evidence? Nutrition Research Reviews. 31(2), 164-178. Doi: 10.1017/S095442241800001X
4. Geyer C, McHugh J, Tollefson M. Lifestyle Medicine for Women: The Time Is Now! American Journal of Lifestyle Medicine. 2021;15(4):366-371. doi:10.1177/15598276211004233
5. Calatayud, Joaquin MSc, NSCA-CPT¹; Borreani, Sebastien MSc¹; Moya, Diego MSc¹; Colado, Juan C. PhD¹; Triplett, N. Travis PhD, CSCS*D². Exercise to Improve Bone Mineral Density. Strength and Conditioning Journal: October 2013 – Volume 35 – Issue 5 – p 70-74 doi: 10.1519/SSC.0b013e3182980d57
6. Bocalini DS, Serra AJ, dos Santos L, Murad N, Levy RF. Strength training preserves the bone mineral density of postmenopausal women without hormone replacement therapy. J Aging Health. 2009 Jun;21(3):519-27. doi: 10.1177/0898264309332839. Epub 2009 Feb 27. PMID: 19252142.
7. National Research Council (US) Committee on Diet and Health. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington (DC): National Academies Press (US); 1989. 6, Calories: Total Macronutrient Intake, Energy Expenditure, and Net Energy Stores. Available from: https://www.ncbi.nlm.nih.gov/books/NBK218769/