Probiotics & Menopause

Probiotic, Prebiotic, Synbiotic, Antibiotic, Psychobiotic?

If you think this is the title to a new Sci-Fi flick, you’re not alone. How confusing can things get? We hear about them in the news and on ads but does anyone ever really explain what they mean and why you should care to know? Well, I’m breaking it all down for you into small digestible bites. 

Crazy Chemist Woman With Chemical Glassware Flask IsolatedMenopause is marked by a plethora of symptoms ranging from hot flashes, weight gain, and memory loss, to depression and anxiety, just to name a few. With probiotics being the new hot topic on the supplement market with its adds promising infinite health benefits, the question arises if they can be beneficial with menopausal symptoms as well. Is there truth to any of those claims? What are probiotics? Would you benefit from consuming them? The last question is one you will have to answer for yourself but after reading this blog you’ll be well-equipped to make an informed decision:

Probiotics:

Probiotics come from the Greek word “pro bios” which means “for life”. The internationally endorsed definition of probiotics is “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” The key word here is “live”.

Prebiotics:

Dietary substances that nurture a selected group of microorganisms living in the gut. Example: Polyphenols in chocolate act as prebiotics, enhancing beneficial bacteria that are already in the gut. They favor the growth of beneficial bacteria over that of harmful ones. (1)

Synbiotics:

Appropriate combinations of prebiotics and probiotics.

Antibiotics:

A substance that inhibits the growth of or destroys microorganisms.

Psychobiotics:

Probiotics that have a specific health benefit in regards to mental health. This is not a scientific term but rather a term coined by a scientist that was researching the mental health benefits of probiotics. (2) It’s very catchy so I thought I’d share 🙂

There are over 100 trillion bacteria, most of them in the intestines. These bacteria are our own intestinal medicine cabinet, which is capable of protecting us from damaging organisms.

They produce neurotransmitters that relay messages from the intestines to the brain via the vagus nerve, which causes the body to react in many different ways:

Gut bacteria work in the body through different modes of action supporting essential functions:

  • Digestion
  • Immunity
  • Metabolism
  • Mental Health
  • Nervous system

and helping with a variety of diseases. A few are mentioned below:

  • Lactose intolerance
  • Stress
  • Hypertension
  • Cholesterol reduction
  • Irritable bowel syndrome
  • Crohn’s disease

A lot of the now marketed probiotics don’t have any benefits as they don’t make it passed the stomach acid. There are however, some that have great benefits:

Warning: No legal definition of probiotics currently exists, which allows companies to label their products “probiotic” even if they don’t meet the scientific definition of the term. No probiotic has of yet been approved for therapeutic purposes by the FDA. So when purchasing probiotic supplements, do your research. As with any other nutrient, always try to get as much in your daily fresh food (yogurt, kefir, fermented foods, sauerkraut, kimchi) instead of supplementing with pills or powders.

Due to their specific benefit, some of the strains of bacteria that may be beneficial for menopausal symptoms are listed below:

Combination of Lactobacillus helveticus & Bifidobacterium longum 

    • Reduced cortisol and inflammation
    • Cortisol is a big player in menopausal belly fat
    • Inflammation is a big player in musculoskeletal pain

Lactobacillus and Bifodobacterium

  • Secrete GABA, a neurotransmitter, who’s deficiency has been linked to depression. Polyphenols in dark chocolate act as prebiotics increasing both bacterial families

Lactobacillus rhamnosus

  • Reduces anxiety and depression by increasing GABA receptors in the brain

Bifidobacterium 

  • Alters levels of serotonin (similar to Prozac)

Lactobacillus reuteri 

  • Improves mood, appearance, and general health by increasing levels of the feel-good-hormone oxytocin

Lactobacillus acidophilus 

    • Influences canabinoid receptors, which are critical to regulating pain

B. infantis, L. reuteri 

    • Decrease inflammation

Active agents in yogurt 

    • Reduce anxiety and fear

Note: I was not able to find any specific studies that evaluated the benefit of probiotics for menopausal symptoms. This article, although based on information from peer-reviewed sources, is my own opinion on the possible benefits that probiotics can have on menopausal symptoms. It is intended to provide you with information but should not be taken as medical advice. Each situation is different. Contact your health care provider if you have other health conditions and are interested in exploring probiotics, as there may be interactions with medications that were not explored in this article.

Stay happy & healthy – Dr. Maria

References:

(1) Jain, D. & Chaudhary, H.S. (2014). Clinical significance of probiotics in human. International Journal of Nutrition, Pharmacology, Neurological Diseases, 4(1), 11-22.

(2) Davidson, J. (2014). The Psychobiotic Revolution. Psychology Today March/April, 40-41.

(3) Sanders, M.E. (2008). Probiotics: Definition, Sources, Selection, and Uses. Clinical Infectious Diseases, 46:S58-61.

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Physical Activity and Menopause

Diverse Hands Holding The Word Exercise 

Menopause is bad.

Exercise is good. 

More exercise is the solution!

Is that it?

It’s not quite that simple, although most things you will read will tell you that any form of physical activity is helpful. There is a lot of truth to it. Physical activity at any age is beneficial and for women during mid-life exercising carries additional substantial health benefits. The menopausal transition is associated with many health risk factors such as increased risk for cardiovascular disease, osteoporosis, decreased bone mineral density, metabolic syndrome, and musculoskeletal symptoms. Exercise prescriptions for those health risks are the same as for non-menopausal women.

However, according to my research, not all forms of physical activity are of equal benefit in helping with menopause symptoms. In fact, some forms of exercise can exacerbate certain types of symptoms such as hot flashes and insomnia.

I believe that it is important to pick the type of exercise depending on your symptoms rather than just exercise to exercise.

So how do you know which exercise is best for you? You start by reading this blog 🙂 To help you find your way through the labyrinth of research that is out there, I’ve consolidated the findings of the last 20 years of research on this topic so you don’t have to.

First I want to highlight the overall benefits of exercising regardless of symptoms:

Increases:

  • Benefits brain function and functional capacity
  • Increases beta endorphins
  • Quality of Life
  • Strength and balance
  • Increased Bone Mineral Density
  • Increase in quality and length of sleep
  • Maintenance of healthy BMI
  • Self-perceived physical condition
  • Sport competence
  • Body image & physical self-worth

Decreases

  • Vasomotor Symptoms
  • Somatic & psychological symptoms
  • Depression (1 exercise session/week = 22% reduction)
  • Osteoporosis
  • Body Mass Index
  • Musculoskeletal symptoms
  • Cardiovascular Disease (50% reduction)
  • Overall mortality (20% reduction)

Exercise has many benefits but can also be stressful on the body

Too much exercise and/or intensity can:

    • Decrease sleep quality and length, which in turn is correlated with adverse physiological and psychological outcomes
    • Increase circulating cortisol levels, which can lead to increased abdominal fat (read last week’s post for more info on this)
    • Have negative effects on thermoregulation as it causes substantial increases in metabolic heat production and core temperature (during exercise, metabolic heat production can increase by ten to twenty-fold and recent studies suggest that hot flashes are triggered by small elevations in core body temperature)
  • Moderate intensity appears to have the most benefits
    • Highest menopause-specific quality of life
    • Lowest number of symptoms
    • Increased sleep, energy, confidence, mood

The following exercise guidelines are specific to helping you with menopause symptoms as well as increased quality of life throughout the menopausal transition. These recommendations do not apply to overall physical health.

Type of Exercise 

Female running athlete. Woman trail runner sprinting for successEndurance/aerobic training best for increased sleep

Woman Exercise With Kettle Bell - Crossfit WorkoutStrength training for body image, strength, body aches

young yoga female doing yogatic exericiseYoga for vasomotor (VMS) symptoms and overall menopause-specific quality of life (Hatha yoga for cognitive function (memory, concentration)

walking womanWalking at ~3-3.5 mph for anxiety and depression

Duration & Intensity

  • Moderate Intensity (60-70% Target HR)
  • Min. 3 x week (more days = decreased severity of symptoms)
  • Programs lasting at least 12 weeks

Special Considerations

  • Keep body core temperature at comfort level to avoid increases in VMS
  • Focus on activities that are enjoyable to you. Forcing yourself through workout regimens that you dislike can have negative effects on quality of life. I hear too many people say: “I think I should run more” and my question to them is “Why? Do you like running?”. “No, but it’s good for you”. Really? Is it? I don’t believe in doing things just because someone said they’re good, especially in regards to exercise. If you don’t like it, you won’t stick to it. It’s as simple as that. And when it comes to working out, consistency is the key. So find activities that you truly enjoy. Not only will you continue doing them and reap the physical and mental benefits but doing things you love will help you reduce stress and keep off that unwanted meno-pod (if you don’t know what a meno-pod is, you have to read last week’s post).

Have a comment or question? Leave me a note on the blog or tweet me @doctorluque

Stay happy and healthy

– Dr. Maria

All information is based on peer-reviewed research. I usually add a reference list of all the articles I read to put together an article but this one would be way too long. If you’re interested in finding out more about specific research articles used for this blog, contact me.

The Dreaded Menopod – Menopausal Belly Fat

The most common concern I hear from women in their 40’s and 50’s is increased belly fat. It isn’t weight gain that they are mostly upset about but where it’s deposited…right around the belly button.

Fat Woman Give Up Wearing Her Tight Jeans

Even women that don’t gain weight, see changes in where the fat is deposited. Is it an evil magic trick? I’ve heard it being called the belly bagel, spare tire, jelly center, and my favorite the menopod. Regardless of its name, it’s unwanted and you want to know how to get rid of it. Can you get rid of it or are you doomed to everlasting belly fat increases? Well, let’s break down why it happens and I’ll give you some ideas on what you can do.

Aging 

As we age, it is normal to see some weight gain. This is not something unique to women but women do see a larger increase in abdominal fat. In fact,  the prevalence of abdominal obesity in women in 2008 was 65.5% for women aged 40-59 years. So you’re not alone in this experience. Many different factors play a role in this. Changing hormone levels, loss in muscle mass, decreased activity level, and increased caloric intake, are just a few.

Estrogen

This is the queen bee of all hormones and sadly, this is the one that you’re being robbed off during menopause. Why is this such a big deal? Because she controls everything!! Estrogen plays a role in endocrine, immune, and neurologic systems. That’s why when it’s taken away, many women feel symptoms ranging from hot flashes to forgetfulness, depression and insomnia. One of the biggest connections of estrogen on increased belly fat is its relationship to cortisol. Ahhh, there it is, one of the biggest baddest buzz words in the health industry right now.

Hand with pen drawing the chemical formula of cortisol

If you believe what you read in headlines, this is the one to blame for everything. If it’s out of control, you lose, but to control it seems impossible. Is it? How is estrogen related to it and how does it play a role in belly fat?

Cortisol deserves an entire article by itself (which will come soon) so here is the condensed version on why cortisol is so important to your menopod.

Cortisol is:

  • “ Cortisol regulates energy by selecting the right type and amount of substrate (carbohydrate, fat or protein) that is needed by the body to meet the physiological demands that is placed upon it.” (5)
    • Energy production, exercising, eating, and under stress
    • This chronic stress can cause excess fat storage deep in the abdomen (visceral fat)
      • Deep abdominal fat has greater blood flow and four times more cortisol receptors. That’s why when there is too much cortisol in your body, it goes right to your belly.
    • It naturally is higher in the morning when you wake up and tapers down as the day goes on
    • When the body remains under constant stress, cortisol levels remain high regardless of time of day

Estrogen – Cortisol Connection 

Estrogen has anti-cortisol properties, which helps the body counteract some of the negative effects of cortisol. So as estrogen starts disappearing, so do its cortisol-fighting superpowers. This means that if your body was able to handle some of the excess day-to-day stress before, it may not be able to handle it quite as well now, which translates into excess belly fat.

What can you do?

  • Chill out!!
    • This is the most important thing you can do
    • Eliminate little, unimportant things that drive you crazy. This is unnecessary stress.
      • In my case, every time I feel like getting stressed out over some inconsiderate driver on the road, I say to myself “menopod alert, menopod alert…not worth it!!”. It helps :)Female Hands Balancing Life And Stress 3D Words Conceptual Image
    • Stress will always be a part of life. Learning how to cope with it, is essential to controlling weight gain, belly fat, and overall health and well-being.

Diverse Hands Holding The Word Exercise

    • Resistance training
      • Don’t wait!
        • It is easier to maintain than to try and lose weight during menopause
        • Nobody knows exactly when menopause starts. It can be as early as mid-30’s to late 50’s.
        • Being active before midlife has advantages as it can contribute to entering menopause with lower BMI, higher bone density, lower fat mass, higher lean body mass.
      • Muscle mass decreases with age for every person, not just women. However, this decrease is accelerated in women as they transition through menopause.
    • Mindful exercises such as yoga, Tai Chi, meditation
      • it can help with stress reduction as well as other psychological symptoms, such as anxiety and depression

Diet Decision

    • Eat healthy and adjust your caloric intake to your energy output
      • if you’re not working out as much as you did before, you can’t eat like you did

As we age, we are faced with many physical changes that affect us not only physically but also psychologically and emotionally. As women, those changes are exacerbated during menopause. Understanding these changes is a key factor in being able to overcome these challenges and transition happily through menopause. In regards to increased belly fat, you must remember that weight gain doesn’t happen overnight and it doesn’t start with menopause.

Don’t wait until you’re unhappy with your body…live healthy now!

Exercise, eat well, find a good balance between work and personal life, and enjoy the smaller things in life. Most importantly, don’t let inconsiderate drivers give you a menopod! 🙂

Stay tuned for next week’s blog post when I will cover cortisol and other hormones in a bit more detail.

Stay happy & healthy

 – Dr. Maria

References:

  1. Davis, et al. (2012) Understanding weight gain at menopause. Climacteric 15;419-429. doi: 10.3109/13697137.2012.707385
  2. Sammel, et al (2003). Weight gain among women in the late reproductive years. Family Practice, 20: 401-409. doi: 10.1093/fampra/cmg411
  3. Lovejoy, J. C., Champagne, C. M., De Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949-58. doi:http://dx.doi.org/10.1038/ijo.2008.25
  4. Epel, E. S. (1997). Can stress shape your body? stress and cortisol reactivity among women with central body fat distribution. (Order No. 9930948, Yale University). ProQuest Dissertations and Theses, , 96-96 p. Retrieved from http://search.proquest.com/docview/304388219?accountid=28844. (304388219).
  5. Maglione-Graves, C., Kravitz, L., Schneider, S. (no date). Cortisol Connection: Tips on Managing Stress and Weight. http://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html

Menopause Treatments

The “M”-Word – Let’s Talk Menopause

Most Common Treatments

Crazy Chemist Woman With Chemical Glassware Flask Isolated

During the last installment of this series, I introduced you into the basics of what menopause is. But I know that what you want is solutions. How can I make these hotflashes stop? Is there something I can take to help with the insomnia? Help me with these mood swings before I kill someone!

So I dug into the research and found lots of great information. It is important to note that thousands of studies have been published on this topic and of course I haven’t read all of them but I tried my best to consolidate the most recent results so you can make a more informed decision. This article is designed to give you unbiased and factual information obtained from peer-reviewed articles and reviews published in reputable journals. It is not meant to provide clinical advice on which treatments are better or which to choose. Talk to a menopause specialist if you have specific questions about any treatments.

Hormone Replacement Therapy Concept.

The big kahuna – the mother of all menopause treatments

To date, HRT is both the most common and most controversial form of treatment for menopausal symptoms. After the results of the Women’s Health Initiative (WHI) were published, the use of HRT dropped significantly because they showed an association of HRT use with greater breast cancer incidence and heart disease1. But there is much more to the story. The results were oversimplified and overgeneralized. Without going into too much medical detail, you should know that the study had two components: the estrogen plus progestin (E+P) trial for women with an intact uterus and the estrogen only (ET) trial for women with a history of hysterectomy. The published results that caused such a big backlash where only for the E+P trial but generalized to the entire study population. According to a recent study published in the American Journal of Public Health, “Over a 10-year span, starting in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy”2. In 2011, the post-intervention data of the ET were published indicating a reduced risk of mortality due to cardiovascular disease and invasive breast cancer.

The moral of the story: get clear and accurate information about HRT that is dependent on your own situation. One size does not fit all.

Here is HRT at a glance based on both types of HRT:

Benefits:

  • Relieves vasomotor symptoms (hot flashes, night sweats)
  • Relieves vaginal dryness
  • Risk of bone fracture
  • Improved Cholesterol
  • Reduces risk of colon cancer
  • Reduced risk of cardiovascular mortality (ET)
  • Reduction in mortality because of invasive breast cancer (ET)

Does not cause significant changes in:

  • Depression
  • Overall cognitive function

Risks:

  • Increased risk of stroke
  • Increased risk of serious blood clots
  • Increased risk of breast cancer (E+P)
  • Unpleasant side effects such as bloating
  • Increased risk of heart disease

Note: It is very important to mention that the risks associated with HRT are heavily dependent on personal factors, family history, as well as type of HRT and time of initiation of HRT.

Alternative TherapiesBioidentical Hormone Therapy (BHT)

Bioidentical hormones explained:

  • Endocrine society defines bioidentical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.”3
  • FDA approved BHT are available in pills, patches, creams, gels, and vaginal tablets.
    • These are controlled and regulated preparations that are manufactured under strict standards3
    • Various studies have documented their beneficial effects on hot flashes
  • Compounded bioidentical hormones are not FDA approved4
    • They are specifically compounded for an individual patient by a pharmacist
    • There is no scientific evidence to support the claim that they are superior to conventional HRT
    • They are not required to provide information about risks, contraindications, dosage, purity and potency
    • They carry some of the same benefits and risks as HRT

Phytoestrogens 

Phytoestrogens are plant-derived chemicals that exhibit weak estrogen-like effects.

Isoflavones, originated from soy, are the most common form of phytoestrogens and have received a lot of scientific attention because of the possible benefits it may have in treating menopausal symptoms as well as the concern that they might stimulate the growth of existing estrogen-sensitive breast tumors7. The majority of studies researching the association between soy consumption and breast cancer risk, have found an inverse relationship between the two. Studies show that the soy intake during early life may both reduce breast cancer risk and risk of recurrence and that a diet rich in isoflavones from soy products also reduces the risk of postmenopausal breast cancer5-6. Promising research studies also show the potential benefit of increased soy consumption on bone health especially for postmenopausal women but more research is needed.

I was not able to find any credible evidence to suggest that consumption of traditional soy products high in isoflavones has adverse effects in healthy individuals. The latter (healthy individuals) is very important. You should always consult a health professional before increasing your soy consumption considerably as it may have adverse affects depending on your particular health condition. As with everything, moderation is key. Don’t replace every protein source with soy and when consuming soy products, be sure they are quality products. Beware of many commercial soy products as they have little or no isoflavones but are high in sugars and fillers. Another factor to take into account is that a large number of soy crops in the United States are genetically modified and therefore can have significantly different effects.

Here is a list of foods that contain phytoestrogens. These items are also high in other nutrients and make a great addition to any diet.

Alfalfa Beets Carrots Apples Chickpeas Licorice
Eggplant Fennel Garlic Potatoes Soy foods (tempeh, tofu, edamame) Eggs
Dairy foods Flax seed Pomegranates Red beans Sunflower seeds Tomatoes
Cherries Celery Cinnamon Citrus fruits Black-eyed peas Broccoli
Brussel sprouts Cabbage Leeks Kale Artichoke Peppers

Botanical Alternatives

In addition to bioidentical hormones, botanical alternatives have received a lot of attention in regards to their potential benefits in helping with menopausal symptoms.

Although there is a lot of research in regards to botanical alternatives, there is not much consensus on what works. Black Cohosh seems to be the most effective but more research is needed for conclusive evidence8. Below is a list of botanical alternatives that have been mentioned in the scientific literature as possible treatments for menopausal symptoms.

Botanical Supplement Possible symptoms relief for Notes/Possible side-effects/Words of caution
Black Cohosh (Actaea racemosa or Cimicifuga racemosa) Insomnia, anxiety, hot flashes Does not act like estrogen (hormone-sensitive tissue such as uterus and breasts are not negatively affected).
Studies are still out on possible liver problems; do not take if you have known liver problems
Red clover (Trifolium pratense) hot flashes Contains phytoestrogens and might therefore negatively affect hormone-senstive tissue
Dong Quai (Angelica sinensis) heart palpitations, anxiety, night sweats, Possible effect on blood clotting; women with fibroids, blood-clotting problems or taking medications that affect clotting, should not take Don Quai
Ginseng root (Panax ginseng or Panax quinquefolius) Mood and sleep disturbances, headaches, gastrointestinal disorders Some types of ginseng may affect blood sugar. Use caution if diabetes is of concern
Agnus castus stimulates pituitary gland, general well-being
Milk Thistle mood swings, depression
St. Johns worth mood swings, depression
Kava (Piper methysticum) anxiety Potential damage to liver

Note: studies on all botanical alternatives listed in this table (besides Black Cohosh) were inconclusive or inconsistent. This table merely describes those mostly listed in scientific studies.

As mentioned before, the menopausal transition is a highly subjective and individual experience and there is not a one-size-fits-all answer. I wrote this article to give you unbiased information about treatments that may help with menopause symptoms. It is meant to be a guide and by no means do I advocate the use of any of them. Always consult your health care provider before experimenting with any of these supplements. In the next installment of this series, I will talk about the dreaded menopausal belly fat. Why does it happen? What can help?

Stay happy and healthy – Dr. Maria

Note: If you are interested in finding a health care provider that specializes in menopause, here is a great starting point – The North American Menopause Society: http://www.menopause.org/for-women/find-a-menopause-practitioner

References:

1 Yang, X.P., & Reckelhoff, J.F. (2011). Estrogen, hormonal replacement therapy and cardiovascular disease. Current Opinion in Nephrology and Hypertension, 20(2), 133-8.

2 Sarrel, P.M., Njike, V.Y., Vinante, V., Katz, D.L. (2013). The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years. American Journal of Public Health, 103(9), 1583 – 1588. doi:10.2105/AJPH.2013.301295

3 Files, J., Ko, M., Pruthi, S. (2011). Bioidentical Hormone Therapy. Mayo Clinic Proceedings, 86(7):673-680. Doi10.4065/mcp.2010.0714

4 Pfeifer, S., Goldber, J., Lobo, R., McClure, RD, Thomas, M., Widra, E, et. al. Compounded bioidentical hormone therapy. Fertility and Sterility, 98(2):308-12.

5Goodman MT, Shvetsov YB, Wilkens LR, Franke AA, Le Marchand L, Kakazu KK, Nomura AM, Henderson BE, Kolonel LN. (2009). Urinary phytoestrogen excretion and postmenopausal breast cancer risk: the multiethnic cohort study. Cancer Prev Res., 2(10):887-94.

6 Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. (2009). Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life  After Cancer Epidemiology study. Breast Cancer Res Treat., 118(2):395-405

7 Song WO, Chun OK, Hwang I, Shin HS, Kim BG, Kim KS, Lee SY, Shin D, Lee SG. (2007). Soy isoflavones as safe functional ingredients. Journal of Med. Food;10(4):571-80.

8 Mohammad-Alizadeh-Charandabi, S., Shahnazi, M., Nahaee, J., & Bayatipayan, S. (2013). Efficacy of black cohosh (cimicifuga racemosa L.) in treating early symptoms of menopause: A randomized clinical trial. Chinese Medicine, 8 doi:http://dx.doi.org/10.1186/1749-8546-8-20

The “M” Word – Let’s Talk Menopause

We’ve all heard about menopause, but what really is it? When does it start? How long does it last? How will I know if I’m in menopause? What are the symptoms? Does everyone have the same symptoms? These are just a few of the many common questions that I’m asked on a regular basis. This natural phase in every woman’s life is still a big mystery surrounded by misinformation, confusion, and yes, quite a bit of secrecy. In the next few installments of this series, I will address hormone replacement therapy, alternative therapies, the role of nutrition & physical activity, and any questions you may have. Let’s blow the top off this taboo topic – let’s talk menopause!

Menopause has morphed from an experience that only a small percentage of women lived through to a natural part of every woman’s life today. At the turn of the 20th century, women were not expected to live past 50. Now life expectancy for women is 78 years of age. If you’re a woman in your 20’s or 30’s, you might ask yourself: why should I care? I’m way to young for this. Well, I hate to be the bearer of truth but the reality is that you will eventually go through it; so you might as well be educated.

The fact is that 75% of all women will experience hot flashes and night sweats, and many experience insomnia, weight gain, and irritability. Menopause symptoms can be debilitating for many women, often appearing before they realize hormonal changes have begun to take place. Women don’t expect to experience these symptoms in their mid-thirties, but it happens all the time. Yet an alarming number of women still think they don’t have to “worry” about menopause until their 50s. Don’t wait! Educate yourself early. So let’s start with the basics: what is menopause?

The Menopausal Transition Defined
Menopause is not a singular event but rather a transition lasting on average 3.8 years. It is often described in three phases: premenopause, which is the time when menstruation is normal, to perimenopause, which is the time when menstruation becomes more infrequent and also includes the one year after the final period, after which postmenopause begins, which is defined as the time in a women’s life when the ovaries stop functioning and menstruation has ceased for at least 12 consecutive months. You’re also considered postmenopausal if the ovaries were surgically removed or were damaged during chemotherapy. (Note: a hysterectomy, where only your uterus is removed, does not affect your ovaries or menopause). For a more detailed breakdown of the adult female reproductive life , the most recent Stages of Reproductive Ages Workshop (STRAW) is a great resource (Harlow, et al., 2012). It provides guidance on the different stages, their lengths, characteristics, and signs. Although there is no exact test to determine perimenopause, STRAW also provides guidelines for hormone levels that play a role in determining the stages in the menopausal transition. The most common hormone used for determination of perimenopause is the Follicle Stimulating Hormone (FSH), with levels greater than 25 IU/L indicating decline in ovarian function and beginning of perimenopause. As estrogen drops, FSH climbs to kickstart the follicle cycle and make up for the lack in estrogen.

Symptoms – oh no!
Menopausal symptoms are often summed up to hot flashes and night sweats although that couldn’t be further from the truth. Both hot flashes and night sweats are symptoms of menopause but there are many more, often subtle symptoms, that are not commonly attributed to the menopausal transition but are indeed symptoms linked to declines in ovarian function.
Menopausal symptoms fall into four categories to include vasomotor, psychosocial, physical, and sexual.

Vasomotor symptoms (VMS)
About 75% of women experience VMS
Hot flushes, night sweats, sweating

Psychosocial
Anxiety, impatience, poor memory, depression (prior depression is the highest risk factor for subsequent depression)

Physical
Body aches, fatigue, insomnia, weight gain, changes in skin appearance, migraines

Sexual
Vaginal dryness, painful intercourse, avoiding intimacy, lack of sexual desire

In addition, reduced levels of neurotransmitters (serotonin, dopamine, oxytocin) can cause changes in brain function and behavior, and declines in cognitive function, mood, and memory.

I know, I know, this all sounds very scary and depressing but this article is not designed to scare you into expecting the worst. Its purpose is to inform you of changes that will happen and that can come in all forms and intensities. Every woman is different; some women experience all symptoms to the extreme but there are also women that don’t experience any symptoms at all. It is impossible to predict what your experience will be. My goal is to equip you with the knowledge to be able to identify changes that are attributable to the menopausal transition and how to successfully and hopefully happily transition through this time in your life. Let’s start this conversation.

Have a comment or question? Leave me a note on the blog or tweet me @doctorluque

Stay happy and healthy
– Dr. Maria Luque

The Soy Controversy – Is There A Dark Side to Soy?

Since the 90’s, more than 10,000 studies have been conducted on evaluating different soy products, their nutritional and metabolic benefits, and their function in disease prevention and reduction.

But, as with all studies, the more you know, the more confusing and contradicting information seems to get. It is difficult and time-consuming to weed through all the information that is thrown at us and it is even more difficult to find credible and peer-reviewed research that has actual scientific backing. Loads of information that is being put out by “experts” is nothing but clever marketing ploys to sell a product without any research to back it up.

Always question information, 

especially if it is supposed to be “good” or “bad” for you. 

Don’t just take somebody else’s opinion; ask them to tell you what they are basing their “expertise” on.

What makes the soy bean so special and controversial is its unique source of isoflavones, called phytoestrogens. These phytoestrogens exhibit weak estrogen-like  effects and have received a lot of scientific attention because of the concern that they might stimulate the growth of existing estrogen-sensitive breast tumors. However, the majority of  of studies researching the association between soy consumption and breast cancer risk, have found an inverse relationship between the two. Studies show that the soy intake during early life may both reduce breast cancer risk and risk of recurrence and that a diet rich in isoflavones from soy products also reduces the risk of postmenopausal breast cancer.

Results from several studies also suggests that soy consumption might reduce the risk of prostate cancer and coronary heart disease. Clinical studies of soy-based diets revealed that soy consumption significantly decreased total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels.  Promising research studies also show the potential benefit of increased soy consumption on bone health especially for postmenopausal women but more research is needed.

I was not able to find any credible evidence to suggest that consumption of traditional soy products high in isoflavones has adverse effects in healthy individuals. The latter (healthy individuals) is very important. You should always consult a health professional before increasing your soy consumption considerably as it may have adverse affects depending on your particular health condition. As with everything, moderation is key. Don’t replace every protein source with soy and when consuming soy products, be sure they are quality products. Beware of many commercial soy products as they have little or no isoflavones but are high in sugars and fillers. Another factor to take into account is that a large number of soy crops in the United States are genetically modified and therefore can have significantly different effects.

Be informed about what you put in your body!

My little disclaimer: as mentioned above, thousands of studies have been done on soy and of course I have not read every single one of them. I chose about 20 peer-reviewed articles and reviews published in well-known and reputable magazines. This article is designed to give you unbiased and factual information obtained from those articles so you can make a more informed decision when consuming soy products.

References:

Dai Q, Franke AA, Yu H, Shu XO, Jin F, Hebert JR, Custer LJ, Gao YT, Zheng W. (2003). Urinary phytoestrogen excretion and breast cancer risk: evaluating potential effect modifiers endogenous estrogens and anthropometrics. Cancer Epidemiol Biomarkers Prev. 12(6):497-502.

Goodman MT, Shvetsov YB, Wilkens LR, Franke AA, Le Marchand L, Kakazu KK, Nomura AM, Henderson BE, Kolonel LN. (2009). Urinary phytoestrogen excretion and postmenopausal breast cancer risk: the multiethnic cohort study. Cancer Prev Res., 2(10):887-94.

Guha N, Kwan ML, Quesenberry CP Jr, Weltzien EK, Castillo AL, Caan BJ. (2009). Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life  After Cancer Epidemiology study. Breast Cancer Res Treat., 118(2):395-405

Harkness, L. (2004) Soy and bone. Where do we stand?  Orthop Nurs. 23(1):12-7

Hilakivi-Clarke, L., Andrade, J.E., Helferich, W. (2010). Is soy consumption good or bad for the breast? Journal of Nutrition

Messina, M. (2010). Insights Gained from 20 Years of Soy Research. Journal of Nutrition

Song WO, Chun OK, Hwang I, Shin HS, Kim BG, Kim KS, Lee SY, Shin D, Lee SG. (2007). Soy isoflavones as safe functional ingredients. Journal of Med. Food;10(4):571-80.