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Long Term Effects of Menopause

 

Cognition and brain health

Like the rest of the body, the brain is full of oestrogen receptors. This tells us that brain tissue is influenced by the presence (or absence) of oestrogen! The brain regions that control mood, memory, sleep and body temperature are particularly sensitive to oestrogen levels, which is why declining oestrogen can disrupt these domains throughout peri-menopause.

Pioneering research has also revealed the role that oestrogen plays in the brain’s ability to defend itself against long term damage and ageing, while other studies have linked peri-menopause symptoms like hot flushes to microscopic changes consistent with Alzheimer’s dementia.

While this all sounds rather bleak, there are definitely some simple measures that can be taken to protect our brain. Regular exercise, weight control, mental and physical stimulation, stress control, and control of risk factors of vascular disease (like diabetes, hypertension and high cholesterol) are suggested to prevent cognitive decline. 

 

Muscle health 

The reduction of skeletal muscle is one of the most important causes of functional decline and loss of independence into older age. Maintaining healthy muscle mass is associated with better metabolic health, increased functionality and strength.

Recent studies have helped us better understand why women tend to lose muscle at a faster rate post-menopause. The combination of a loss of oestrogen, and the general changes associated with ageing leads to faster muscle breakdown, and a greater resistance to building muscle from the protein we eat.

 

Research suggests that women post-menopause should aim for > 1.2g of protein per kg of body weight per day to reduce risk of frailty. For a 70kg woman, this is 84g of protein per day (equivalent to 13 eggs!). Unfortunately, the standard Australian diet is much higher in carbohydrates and fats than in protein. Without proper education, many women are not meeting their required protein intake to maintain or build muscle.

 

It is important to remember that no matter how much protein we consume, this will not translate to stronger muscles unless combined with resistance training. Resistance training uses weights, resistance bands or body weight to strengthen muscles. By gradually increasing the weight or resistance used, muscles adapt and grow stronger. Consistency is required for optimal results. Experts suggest training three times per week, focusing on different muscle groups each session.

For those going through menopause, research shows that Menopause Hormone Therapy (oestrogen replacement) can also have beneficial effects on muscle mass and function, particularly when combined with lifestyle changes. It's important to discuss this with your doctor, to determine whether it is right for you.

 

Cardiovascular disease 

Cardiovascular disease refers to diseases of the heart and blood vessels. This includes conditions like coronary heart disease, cerebrovascular disease, rheumatic heart disease, arterial disease, peripheral arterial disease, congenital heart disease, deep vein thrombosis and pulmonary embolism.

Menopause has long been considered a risk factor for cardiovascular disease, due to the protective effect that oestrogen has on the heart and vessels.

Midlife is a good time to check in with your doctor about your own cardiovascular risk. Diet, exercise, smoking cessation and reduction of alcohol intake are the foundations of preventing or managing cardiovascular disease, and for some people, medications such as MHT (menopause hormone therapy) and/or others may be appropriate.

 

Urogenital health 

Oestrogen is the hormone responsible for maintaining the integrity, elasticity, and lubrication of your vaginal tissue. As oestrogen levels drop through peri-menopause, it can result in symptoms of vaginal irritation, recurrent UTIs, increased urinary frequency, persistent malodorous discharge and pain during sex. These symptoms affect up to 50% of women and can significantly impact self-confidence, relationships and comfort. Over time, decreased oestrogen can decrease the integrity of the vaginal tissue and supporting structures so much so that pelvic organ prolapse can result. When this occurs, the first symptom is often a bulging sensation in the vagina, or difficulty passing urine or stool. 

To help alleviate these symptoms and prevent pelvic organ prolapse, local oestrogen can be prescribed by your GP. It comes in the form of a suppository, cream, gel or ring that is inserted into the vagina. The oestrogen in this form does not travel beyond the vagina, and is therefore deemed safe for most women. Menopause Hormone Therapy (oestrogen replacement through a patch, pill or gel) can also help if deemed safe by your doctor. Talk to your doctor if you would like to explore oestrogen options.

 

Things you can do to optimise your urogenital health:

  • Limit time spent in tight, synthetic underwear, or pants that will increase sweating. Go underwear free overnight!
  • Wash underwear in hypoallergenic detergent, rinse well
  • Use a vaginal lubricant for sex
  • Avoid feminine douching, scented sprays, pads etc.
  • Gently wash the area with water only.
  • Do not shave or wax the area if irritation is present.
  • Pelvic floor exercises may help urinary frequency or and help to prevent or manage pelvic organ prolapse - ask your GP or physiotherapist about these!

 

Sexual health 

A common result of the hormonal changes associated with menopause is a decrease in sexual desire or libido. This, coupled with changes to the vagina can make penetrative sex painful and frustrating. Other common things that women report as contributing to a reduction in sexual desire after menopause include sleep issues, changes in body image, external pressure such as work demands, caring for family members and challenging relationship dynamics.

At Acro, we believe that there is no room for shame in this conversation. You deserve to feel confident and satisfied with your sexual health, and there are ways to improve things if that is not how you currently feel.

 

Bone health

According to research, 20% of bone loss occurs during menopause, which contributes to 1 in 10 women over 60 years of age having a condition called osteoporosis. Osteoporosis is the term used to describe weaker, brittle bones that are prone to fracture. Osteopenia is a milder reduction in bone density that can precede osteoporosis.

All women should be made aware of the risk of osteoporosis following menopause so they can adjust their lifestyle to prevent it.

These measures include:

  • Increasing Vitamin D (through safe sun exposure, or supplementation)
  • Increasing calcium levels (through diet or supplementation)
  • Weight bearing exercises - to encourage bone turnover
  • Reducing alcohol consumption
  • Smoking cessation

There are medications that can prevent further bone density loss after menopause, Menopause Hormone Therapy being one option. These should be discussed with your GP.

Read more from our article: Menopause and bone health

 

    Metabolism and fat distribution 

    Many women  experience changes to body composition at menopause, with a decrease in lean muscle and an increase in fat deposition.

    ‘Stubborn, mid-section fat’ is often reported as one of the most frustrating symptoms of menopause. It is also a sign of increased visceral fat (fat that lines the organs) which increases the risk of cardiovascular and metabolic disease. Read more from our article: changes to body composition following menopause. 

    Pioneering research suggests that the solution to this problem may lie in our protein consumption.

    When we lose muscle due to menopause, our bodies respond by craving more protein. If women are not educated about this, and don't eat enough protein to meet this greater need, they can end up eating more calories from other sources, often carbohydrates and fats, to feel full. Increasing protein, as a percentage of our daily energy intake, can help with weight loss, fat reduction, and muscle maintenance.

     

    References: 
    Cognition and brain health - 

    Muscle health - 

    Cardiovascular disease - 

    • Ryczkowska K, Adach W, Janikowski K, Banach M, Bielecka-Dabrowa A. Menopause and women's cardiovascular health: is it really an obvious relationship? Arch Med Sci. 2022 Dec 10;19(2):458-466. doi: 10.5114/aoms/157308. PMID: 37034510; PMCID: PMC10074318.
    • https://www.cvdcheck.org.au/identifying-people-for-assessment

    Urogenital and sexual health - 

    Bone health - 

    Metabolism and fat distribution -