Ladies, menopausal transition begins between ages 45 to 55 years old and can last as long as 14 years. The point at which you have not had a cycle for 12 consecutive months is biological menopause. The time leading up to that point is perimenopause, which typically lasts 4 to 6 years, but can last up to 10 years. The duration and variance seen in estrogen and progesterone affect each woman differently depending on family history, age of onset, smoker versus non-smoker, race, and ethnicity. Menopause can come with an array of symptoms such as:
Abnormal menstrual cycle. This may show up as longer or shorter cycles, heavier or lighter cycles, and/or spotting between cycles.
Hot flashes. Estrogen is a primary regulator of body temperature. As it begins to fluctuate, so does your ability to regulate your temperature.
Decreased sleep which can be from difficulty falling asleep or staying asleep. Hot flashes may also play a role in sleep disruption. Here are some helpful tips.
Joint stiffness, aches, and pains
Changes in distribution of body fat around your midsection
Decreased lean mass and strength
Mood disturbances. You may feel more irritable, have increased anxiety, and/or depressive symptoms. Talk with your primary physician or a mental health professional to walk you through changes occurring and treatments available.
Decreased cognition and memory, which you may know as ‘brain fog’.
These symptoms stem from the variance in the body’s production of progesterone and estradiol (primary estrogen) as shown below:
You may also experience medical menopause if you have a hysterectomy or surgical removal of the ovaries. Surgical removal of the uterus or ovaries will cause symptoms of menopause to start abruptly. With medical menopause, progesterone and estrogen do not go through the five plus years of changes seen in the perimenopause section above. Symptoms may feel more drastic in this scenario.
In comparison, in your pre-menopausal years as shown below, you will see estrogen, progesterone, follicle-stimulating hormones (FSH), and luteinizing hormone (LH) rise and fall throughout the menstrual cycle accordingly from follicular to luteal phase. This is why as you enter perimenopause and hormones start to shift things can just feel “off”.
I want to remind you, entering menopause is not doomsday! There are lifestyle, nutrition, and fitness changes you can make to optimize your health and performance during this transition. Heck, you still have half of your life to live!!
Concerns I have as a sports dietitian for active women in menopause:
“Eat less, move more” rhetoric
Estrogen plays a key role in bone health, metabolism, cognition and mood, body temperature regulation, and muscle development. As estrogen declines in perimenopause and eventually flatlines in post-menopause, you see a shift in all the above. Low energy availability (LEA), aka calorie restriction, can lead to relative energy deficiency in sport (RED-S). The symptoms seen in LEA and RED-S mirrors those of menopause.
In years when you are menstruating, you have an “in your face” warning sign of delayed or skipped menstrual cycles. As cycles become more irregular in perimenopause and eventually stop with menopause, LEA and RED-S can be difficult to catch. That does not mean you are off the hook. RED-S affects numerous physiologic systems and may show up in your performance as:
Decreased endurance performance
Decreased training response/ plateau or decrease in performance
Increased risk of bone stress injury
Decreased glycogen stores
Gut issues - impaired nutrient absorption, constipation, diarrhea
Decreased neuromuscular coordination - more injury-prone
Mood disturbances - irritability, depression
Muscle loss and decreased strength
You can learn more about RED-S, warning signs, and prevention here. Support your body fiercely at all costs.
We will also be holding a master class on RED-S March 14th at 6pm mountain time!
Low carb diets
As mentioned above, as hormones shift, your physiology begins to shift. Physiologically, females are already very efficient at utilizing fat as an energy resource. In peri- and post-menopause, females become more glycogen-sparing, meaning their body wants to use fat as an energy source. In theory, this sounds great! The challenge: if you do not support your body with carbohydrates, you will struggle to hit the intensity necessary to have variable training zones and see performance gains (more on training in Bulletproof Menopause), go the distance, and recover from the activity you worked so hard doing.
Research indicates that intermittent fasting (IF) is problematic in women. This is a popular weight loss trend, but it causes unnecessary stress, decreases insulin sensitivity, and has the potential to cause hormonal disruption because of inadequate total calorie intake in women.
Additionally, IF can pose a concern in maintaining muscle. In fact, research shows that individuals lost more than sixty percent of weight from muscle compared to thirty percent lost from muscle in other weight loss strategies. No thank you!! As you age, you are already up against declining muscle mass at a rate of 3-8% every decade after 30 years old; this rate accelerates with age. Fuel fiercely, ladies.
ONLY relying on hunger cues
As an athlete or active individual, there are times when eating intuitively is appropriate and times when you need to be intentional (ie. around a workout or training session). This may sound contradictory, but the two can coexist. Continue to tune into what and how much you would like to eat in your day to day, but also be timely with what you are eating before, during (when appropriate), and after your training sessions.
Hard or long training sessions can suppress normal hunger cues. If you are only being intuitive, you are missing an opportunity to replenish glycogen stores and provide your muscles with protein to repair your muscles. This will also prevent the ravenous kitchen raid in a couple hours.
Eating before early morning sessions may not be your favorite, but providing your body with the resources (carbs, a little protein, hydration) it needs to do the work you are setting out to do is an absolute must!
As you enter the menopause transition, there is an opportunity to make a shift in your nutrition, training, and lifestyle to optimize your new biological age! You deserve to be happy. You deserve to understand how to enhance body composition, health, and performance. Stop working against your body and start supporting it!
DDN’s Bulletproof Menopause course takes a deep dive into all things menopause and the changes you can make to live a high-quality life! It starts the week of February 5th for a 6-week period where you will have access to registered dietitians, Dana and Jane, as well as a virtual community where you can take conversation from the course further with your peers. We can’t wait to see you there!