There are Many Ways to Manage your Midlife

Decisions about therapies depend on your current symptoms and their severity, your current health status, your long term health risks and your personal life expectations. Research shows that a healthy lifestyle increases the chances that women at midlife will have fewer problems with heart disease, diabetes type 2, weight management, osteoporosis and symptoms of menopause.

Nutrition 

The evidence of the health benefits of eating a variety of foods is getting stronger and stronger. Studies about health at midlife suggest that eating less salt, sugar and saturated fat may help to reduce hot flushes. Importantly, it also appears that a healthy diet helps to lower the chances of developing heart disease, the most common killer of women in Australia. 

Healthy eating 

Diet has many roles apart from the nutritional value. The foods we eat and perhaps more importantly, the foods we avoid, have a far reaching impact on our health and wellbeing. The ideal nutritional intake for a woman at midlife should be low in saturated fat (as found in animal fat), sugar and salt (as found in many fast foods), high in fibre (cereals, grains, rice, fruit and vegetables) and rich in calcium. Drinking less alcohol may also help to reduce some of the symptoms associated with menopause.

Phytoestrogens 

Phytoestrogens are compounds found in plants and herbs. When eaten they bind to oestrogen receptors and may act in a similar way to oestrogen. However, phytoestrogens are much weaker, so their effects are different from those of hormones found in Hormone Therapy (HT). 

Phytoestrogens have been found to have a 

• heart disease prevention action 

• possible anti-cancer properties (but more research is needed) 

• possible role in the prevention of osteoporosis (more research is needed). 

Soy products are the most reliable source of phytoestrogens and are the most researched among the plants containing these compounds. Legumes generally are also a good source of phytoestrogens. 

Phytoestrogens in dietary form are largely considered to be safe. Here are some suggestions for incorporating phytoestrogens in your diet: 

• Eat tofu at least twice a week: marinate and add to stir fry meals, or on grilled kebabs; bake in oven with vegetables; cook in soups and then puree; order tofu if eating Asian style cuisine. 

• Cook soybeans or buy tinned soybeans and add to salads and casseroles - they have a nutty texture. For added flavour when cooking soybeans, add an onion chopped in half, 1-2 bay leaves, 1-2 celery sticks and black peppercorns to the water. 

• Use breads that have soy flour as a major ingredient with linseed (watch the fat content in the bread). 

• Sprinkle soy grits onto cereals, yoghurt, fruit etc. 

• Add 1-2 dessertspoons of linseed to breakfast cereal, on yoghurt, smoothies or fruit. o Use soymilk that lists whole soybeans in the ingredients (need calcium enriched, low fat). 

• Use legumes, such as lentils, chickpeas and kidney beans - canned are fine. 

• Use sprouts - these are even higher in phytoestrogens than the legumes from which they are sprouted. 

• Soy sauce is not a good source of phytoestrogens. 

Isolated phytoestrogen supplements do not have the same cholesterol lowering or blood pressure benefits as diets rich in phytoestrogens and less is known about their safety profile, therefore currently dietary sources are the most ideal way to obtain phytoestrogens. 

Nutritional supplements 

Vitamins and mineral supplements can be used low dose as part of a healthy lifestyle, but they should never replace a good varied diet. Multivitamin preparations are recommended rather than high dose select vitamin preparations that may cause an imbalance of nutrients. Remember that all of the vitamins and minerals that you might need at midlife are in fact found in a wide range of foods including fruits, whole grains and vegetables. 

The literature shows reduced incidence of disease is linked to diets rich in Vitamins E, C and Pro Vitamin A. However these effects do not appear to be associated with using supplements of these vitamins. More emphasis needs to be placed on a diet low in saturated fat, with more breads, cereals, fruits and vegetables, and more calcium-rich foods, as well as maintaining a healthy body weight by balancing food intake and regular physical activity. 

To better inform yourself about using supplements speak to your health practitioner or a dietician.

Important nutrients 

Calcium 

Eating foods rich in calcium is particularly important for you at midlife. It is not only important for your bones but is also used by other parts of the body, such as the heart and muscles. 

The total dietary calcium intake, including calcium supplements, for a menopausal or postmenopausal woman should be at least 1200 mg - 1500mg a day. 

Some dairy foods that are rich in calcium include: 

• Milk 

• Yoghurt 

• Cheese - cheddar and cottage 

Some non-dairy foods that are rich in calcium include: 

• Tinned fish with bones 

• Broccoli, spinach and silverbeet 

• Soy products o Grains and cereals 

• Sesame seeds especially unhulled (about 9 times richer in calcium) and tahini o Chickpeas and hommus 

• Fruit including dried figs and lemons 

The consumption of diverse and balanced meals rich in nutrients, including antioxidants and phytoestrogens, is recommended for the prevention of cardiovascular disease and cancer. 

Vitamin B6 

Vitamin B6 (pyridoxine) can be very useful for the relief of fluid retention and sore and swollen breasts. It needs to be taken with a good source of Vitamin B complex, particularly if taken long term (more than four weeks). This facilitates its absorption and protects against the possibility of depletion of other B group vitamins. Excessive consumption of vitamin B6 can cause nerve damage. 

Vitamin B complex may be useful for some women as part of the treatment for depressed feelings.

Evening Primrose Oil 

Evening Primrose Oil is an essential fatty acid and is usually recommended for the treatment of breast pain, fluid retention, aching joints and premenstrual tension. It does not appear to improve menopausal symptoms. It is expensive and effective alternatives include cold pressed linseed oil or safflower oil (10-20mL daily). 

Lifestyle 

During perimenopause and menopause there are many ways that you can nurture yourself and maintain your health. Along with regular Pap tests and breast care (mammograms) you may find that improved lifestyle habits including attention to healthy nutrition and exercise may well help with the maintenance of long term good health and the prevention of disease. For many women this may be all that is required. Research shows that a healthy lifestyle increases the chances that women at midlife will have fewer problems with heart disease, diabetes type 2, weight management, osteoporosis and symptoms of menopause. 

Exercise 

Physical exercise needs to be accessible, affordable and easily incorporated into daily life. Appropriate weight bearing exercise (where bone and muscle are challenged) of long duration (about 30 minutes) at least three times a week is beneficial. Some examples of this kind of exercise could include: 

• walking briskly for 30 minutes 

• appropriate weights (including leg and arm lifts with weights) 

• progressive resistance strength training 

• riding a bike 

• playing tennis 

• skipping using a rope 

• aerobic exercises 

• dancing

Swimming is a great non-weight bearing exercise for the back and heart and overall muscle workout even though it is not weight bearing. Sexual activity is also a good form of exercise.

Regular exercise also helps to prevent cardiovascular disease, high blood pressure and reduces the severity of noninsulin dependent diabetes and can contribute to the management of these conditions. Exercise can also contribute to the development of muscle mass and in turn, stability, leading to a reduction in falls. 

The feeling of relaxation and well being that comes with exercise helps us to cope better with stress in our everyday lives. Exercise is also six times more likely to continue if it is undertaken with friends when it can become an enjoyable pastime rather than a chore. Please note: next issue we will feature further information and practical tips on how to keep active. 

Herbal remedies 

Herbal remedies are used around the world and many have been used for centuries. These herbs or herb mixtures can be dried and combined with boiling water to make teas and infusions, concentrated in alcohol, water or vinegar to make tinctures or extracts, or made into tablets and powders. 

Herbal remedies are a valuable and viable option for many women in the management of perimenopausal symptoms, such as hot flushes, night sweats and vaginal changes. Not all the symptoms experienced by women in midlife are the result of declining oestrogen levels. Herbal therapies may manage mood changes such as anxious thoughts and depressed feelings, as well as fatigue and low energy. 

Buying herbal products over the counter It is important for women using herbal remedies to remember: 

• Many of the herbal products available over the counter are not what a traditional herbalist would prescribe. 

• Some of the herbal products may contain herbs which should not be used in conjunction with pharmaceutical hormone therapies but do not carry such a warning. 

• Experimenting with 'over the counter' preparations may be more costly than seeing a trained herbalist/naturopath. 

The best way to use herbal remedies for the treatment of symptoms of menopause is under the guidance and advice of trained natural therapists.

It is important to seek the advice of a qualified natural therapist if you are using natural therapies. While natural medicines and therapies generally do not suppress symptoms or cause side effects if they are used properly, not all natural medicines are free from potentially harmful effects. 

Along with the other therapies outlined above, women at midlife may have a variety of practitioners and methods to choose from. The following are some examples you might find useful: 

• Keeping a diary and writing down your thoughts and concerns. 

• Yoga which includes postures that help stretch the muscles, and breathing exercises that will increase the flow of oxygen and meditation. 

• Massaging your ears can give your head and ears a relaxed feeling. 

• Visualisation calls on the imagination to find images to heal the mind and the body. 

• Therapy and counselling give a woman an opportunity to understand how her behaviour can affect her health. 

Meditation can be particularly helpful for relaxing and finding peace of mind. It can involve a variety of techniques such as taped voice or music, chanting and concentration on breathing. 

Conclusion 

Making informed decisions about menopause 

While menopause is a normal biological event that affects every woman, there is enormous variation in how each woman experiences and views this transition, both in physical and psychological terms. Your experience may well be influenced by your health and wellbeing, as well as the environment and culture in which you reside.

Your Emotional Health and Relationships at Midlife and Menopause 

Much has been written about menopause - in books, in the media, in information pamphlets. It is a subject that has attracted considerable attention. In the past, menopause was often viewed negatively and women going through menopause were portrayed as irrational, neurotic and even psychotic. 

Today, our understanding is more balanced and more positive and is based not only on the women who come to health practitioners, but also on large community studies across the full spectrum of women, many of whom do not need to seek specialist help during menopause. One woman's experience of menopause may not be the same as another's. 

Wellbeing 

Hot flushes, sleep disturbances, vaginal changes, irritability, anxiety and depression are all commonly reported symptoms of menopause. However, while menopause can be directly linked to hot flushes and vaginal changes, there is debate among researchers about its role in depression and anxiety. Menopause does not happen in isolation in a woman's life, but at a time when many other things are happening that may affect her emotional wellbeing.

INFLUENCES ON HER EMOTIONAL HEALTH AND WELL BEING MAY INCLUDE: 

• ageing and midlife 

• life events (such as partner retiring or parents dying) 

• age and stage of children 

• children leaving and coming home (the revolving door) 

• marital status and relationship satisfaction 

• psychological state, including history of emotional/psychological health 

• socio-economic status 

• social role 

• employment 

• health status 

• cultural background 

• diet 

• substance use (including caffeine and alcohol) 

Mood Changes 

Depressed Feelings 

Many theories have debated the link between hormones and depression. When all of the research is summarised it appears that oestrogen and testosterone are likely to account for a small percentage of the depressed mood women experience around the time they become menopausal. Women who have had a hysterectomy are more likely to experience depression than women who have had a natural menopause. It may also be that physiological changes such as hot flushes and night sweats have a secondary or roll-on effect on the feelings and thoughts of women at this time. It is important to remember that depression at this time of life is also influenced by previous episodes of depression, stress, relationship satisfaction, self esteem, body image, social and cultural factors.

Anxious Thoughts 

Anxious thoughts involve extreme feelings of fear and worry. When intense anxiety is experienced over a length of time and interferes with daily life, then anxiety can be perceived as a problem that may require both medical and psychological treatment. Symptoms of anxiety may include a racing heart, rapid breathing, sweating and dizziness. There are many different kinds of anxiety such as panic attacks, phobias, social and generalised anxiety. Some menopausal symptoms are similar to anxiety-type symptoms such as hot flushes, sweating, awareness of breathing and 'crawling skin'. If a woman is worried, it is important for her to discuss the symptoms with a health practitioner or psychologist to seek clarification. 

Self Esteem 

Self esteem is what we believe and feel about ourselves and the way we evaluate ourselves. It may be built on our roles and relationships, our body image, and our feelings about health. Self esteem can be based on the perceptions that other people have of us, as well as our own view of ourselves. It is learned and comes from childhood, friends, family, as well as our comparisons with others and life experiences. People who have high self esteem focus on their achievements and successes, while people who have low self esteem tend to focus more on their failures. If women going through menopause have low self esteem they are often more vulnerable to depressed feelings, anxious thoughts and increased health problems. WHAT YOU CAN DO Ways to improve self esteem can include: o Challenging unreasonable expectations you may have of yourself o Taking time to do something you really want to do just for you, that is, to be SELF-ish o Participating in lifestyle courses o Reviewing your lifestyle and relationships. (Abusive relationships - physical, emotional, financial, mental and/or social can lead to loss of self esteem)

Stress 

Stress occurs when we feel threatened or cannot cope with a situation. Life is busy and it is important to take time out to deal with influences that may be causing the stress. Some things that make people feel stressed include traffic, crowds, technology, relationships, children, family, mobile phones, work deadlines, poor health and events such as Christmas. While a little stress is beneficial, too much stress can impact on health and wellbeing. Some women may perceive menopause and midlife as stressful experiences. There may be a sense that the person a woman knew herself to be before menopause has changed, and now she is not so sure of what to expect from either her body or her emotions. What seemed to be a body that was controllable and reliable is now breaking out in a sweat at the most inconvenient times, or periods are irregular and unpredictable. It is important to identify what makes you feel stressed and try to make changes to lessen the feelings of stress. 

Body Image 

Body image refers to the way we think, feel and picture our body. At menopause there is often a shift in fat deposits from the lower (buttocks and thighs) to the central body (stomach region). Negative body image may appear to be a problem for some women going through menopause, particularly their distress at a perceived increase in weight. 

These negative feelings can also influence self esteem and sexuality. Further, society's negative views of ageing women can be very undermining. Changes to the body associated with menopause, such as hot flushes, have the potential to make women feel differently about their body image. 

Some women going through menopause report that they do not know their body any more: "I used to know what to expect from my body, now it is like my body is not under my control."

Relationships 

It is hard to know if menopause influences relationships, or relationships influence the experience of menopause. Talking to family and friends When you experience changes associated with menopause it can be confusing and challenging for family members as well as for you. The best thing you can do is talk to your family about these changes. 

Changing family relationships with a partner, with children, parents and friends may occur around midlife. For some women, these changing relationships may cause disruption, anxiety and feelings of loss. Other women may embrace their freedom and take up new roles and interests.

Relationships with children 

When a woman becomes menopausal the role of mother often undergoes a transition. Menopause means that a woman can no longer physically have children, but it also occurs at a time when grown up children are becoming independent and leaving home. For some women, this change in role is perceived as a terrible loss, while others have new roles to occupy and look forward to. For some women, this change/loss in role can be quite devastating and may lead to depressed feelings and anxious thoughts, while others are happy to move forward. 

If you have young children you may also find this time challenging as you learn to manage some of the physical and emotional changes associated with menopause and cope with the ongoing demands of raising young children. Relationship with self A woman's experience of menopause can be influenced by the role she plays during this life stage. Attitudes of Western society to ageing often lead a woman to believe she no longer has a role to fulfil after menopause. Having many roles to fulfil can increase positive well being and a woman experiences better health, especially if these roles are considered by her to be important. Ultimately it depends how you feel about your role and how important you believe it is to have a purpose in life. 

Culture

The culture in which you live may impact on your experience of menopause just as it may determine your lifestyle to a large extent. In some cultures a woman's life is likely to involve much more physical activity and/or will traditionally have a diet that contains more plant oestrogens which may decrease the frequency of hot flushes. 

In Australia in the 1990's the average life expectancy for women was about 80 years. As a result, a large proportion of women will live almost a third of their lives after menopause. For indigenous women however, the picture is unfortunately very different. In the 1996 Australian Bureau of Statistics Census, the projection for 1999-2000 showed the life expectancy for indigenous women in Victoria to be 63.5 years. For these women health issues are related to the problems of heart disease, diabetes and respiratory diseases and menopause may have less relevance.

However, perhaps the most important influence a culture has on a woman's experience of menopause is in the way the culture views women and the importance of their fertility and its attitude in general to ageing. In Asian cultures, menopause is regarded as a natural event and women are not apprehensive of its onset. 

Occasionally, in some cultures, this time of life can bring an almost mystical status, as postmenopausal women are thought to possess healing and supernatural powers. Alternatively, in a youth orientated society, it may be seen only in terms of losses.

The Jean Hailes Foundation magazine is designed to be informative and educational. It is not intended that The Jean Hailes Foundation magazine provide specific medical advice or replace advice from your health professional. The Jean Hailes Foundation does not accept any liability to any person for the information or advice (or the use of information or advice) which is provided in this magazine or incorporated into it by reference. Information is provided on the basis that all persons reading the magazine undertake responsibility for assessing the relevance and accuracy of its content. 

© The Jean Hailes Foundation. Apart from fair dealing for the purposes of private study, research, criticism or review, as permitted under copyright legislation, no part may be reproduced or reused for any commercial purposes.

Note: This article is an archive. Whilst the Jean Hailes Foundation for Women’s Health has made every effort to ensure this information was accurate at the time of publication, the article content has not been updated since the date listed below.

Content December 07, 2002