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No longer simply an obstetric and gynecologic concern, menopause has been linked to risk of several chronic diseases.1,2 Early menopause is tied to increased cardiometabolic risks,3 as well as other conditions like rheumatoid arthritis and chronic fatigue syndrome.4, 5 The timing of menopause has also been linked to risks for diabetes and gastroenteritis.6 More broadly, hormonal changes in aging patients have been associated with greater risk of frailty and disability,7 likely due to disruptions along several hormonal axes rather than deficiency of a single hormone.8 Altering lifestyle habits can reverse or lower the risk for these issues.

Obesity, cancer, endometriosis, cardiovascular disease (CVD), and poor cognitive function are all marked by gut dysbiosis and can be considered estrogen-modulated conditions.9 Evidence continues to grow demonstrating that lifestyle changes can modulate hormonal function to increase health.

Board-certified OB/GYN for 23 years, Margaret Christensen, MD, shares her Functional Medicine approach to menopause.

Nutrition is an important pillar of lifestyle interventions that can impact hormonal balance. At the most basic level, consumption of anti-inflammatory foods—specifically fruits and vegetables—can help alleviate symptoms of many chronic conditions associated with increased inflammation. Additionally, cruciferous vegetables like broccoli and cauliflower contain glucosinolates, which help the body send estrogen metabolites down the pathway that helps prevent and suppress the development of hormone-modulated female cancers.10 In a survey that followed premenopausal women over nearly 13 years, women who reported regularly consuming the carotenoid ?-cryptoxanthin (a precursor to retinol) and fruit entered menopause later than those who did not.10 ?-carotene, lycopene, lutein, curcumin, and other carotenoids are being studied to identify their mechanisms of action, including stimulation of B- and T-lymphocytes.11

Reduced estrogen also increases cardiometabolic risks for women entering menopause.12, 13 For this population, nutrition can make a difference. For example, researchers found that women in perimenopause who followed a Mediterranean diet rich in fruits, vegetables, whole grains, and nuts displayed a significantly lower index of preclinical atherosclerosis and lower weight than their noncompliant counterparts.15 The degree to which women adhered to the diet was also important.14 In another study, women who were fully adherent to a Mediterranean diet enjoyed lower total cholesterol, resting heart rate, LDL-C, triglycerides, C-reactive protein, and clustered cardiometabolic risk.15

This may be partly due to changes in fat intake. In a double-blind study on the impact of marine-derived omega-3 polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid) on dyslipidemia in women entering menopause, total and LDL-C cholesterol levels dropped dramatically, along with levels of anti-LDL-autoantibodies, over a three-month supplementation with fish oil and vitamin E.16 Clearly, nutrition has a number of impacts for women experiencing changes in hormones that occur during menopause.

References

  1. Appt SE, Ethun KF. Reproductive aging and risk for chronic disease: insights from studies of nonhuman Maturitas. 2010;67(1):7-14. doi:10.1016/j.maturitas.2010.03.028.
  2. Innes KE, Selfe TK, Taylor AG. Menopause, the metabolic syndrome, and mind-body therapies. Menopause. 2008;15(5):1005-1013. doi:1097/01.gme.0b013e318166904e.
  3. Appiah D, Schreiner PJ, Demerath EW, Loehr LR, Chang PP, Folsom AR. Association of age at menopause with incident heart failure: a prospective cohort study and meta?analysis. J Am Heart Assoc. 2016;5(8):e003769. doi:1161/JAHA.116.003769.
  4. Pikwer M, Bergström U, Nilsson JÅ, Jacobsson L, Turesson C. Early menopause is an independent predictor of rheumatoid arthritis. Ann Rheum Dis. 2012;71(3):378-381. doi:1136/ard.2011.200059.
  5. Russell L, Broderick G, Taylor R, et al. Illness progression in chronic fatigue syndrome: a shifting immune baseline. BMC Immunol. 2016;17:3. doi:1186/s12865-016-0142-3.
  6. Fu Y, Yu Y, Wang S, et al. Menopausal age and chronic diseases in elderly women: a cross-sectional study in Northeast China. Int J Environ Res Public Health. 2016;13(10):E936. doi:3390/ijerph13100936.
  7. Fabbri E, An Y, Zoli M, et al. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. J Gerontol A Biol Sci Med Sci. 2015;70(1):63-70. doi:1093/gerona/glu127.
  8. Maggio M, Cattabiani C, Lauretani F, et al. The concept of multiple hormonal dysregulation. Acta Biomed. 2010;81(Suppl 1):19-29.
  9. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. 2017;103:45-53. doi:10.1016/j.maturitas.2017.06.025.
  10. Pearce K, Tremellen K. Influence of nutrition on the decline of ovarian reserve and subsequent onset of natural menopause. Hum Fertil (Camb). 2016;19(3):173-179. doi:1080/14647273.2016.1205759.
  11. Milani A, Basirnejad M, Shahbazi S, Bolhassani A. Carotenoids: biochemistry, pharmacology and Br J Pharmacol. 2017;174(11):1290-1324. doi:10.1111/bph.13625.
  12. Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. 2007;10(Suppl 1):19-24. doi:10.1080/13697130601114917.
  13. Park JK, Lim YH, Kim KS, et al. Body fat distribution after menopause and cardiovascular disease risk factors: Korean National Health and Nutrition Examination Survey 2010. J Womens Health (Larchmt). 2013;22(7):587-594. doi:1089/jwh.2012.4035.
  14. Mattioli AV, Coppi F, Migaldi M, Scicchitano P, Ciccone MM, Farinetti A. Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women. Nutr Metab Cardiovasc Dis. 2017;27(11):985-990. doi:1016/j.numecd.2017.09.011.
  15. Ruiz-Cabello P, Coll-Risco I, Acosta-Manzano P, et al. Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project. Nutr Metab Cardiovasc Dis. 2017;27(3):217-224. doi:1016/j.numecd.2016.10.008.
  16. Alves Luzia L, Mendes Aldrighi J, Teixeira Damasceno NR, et al. Fish oil and vitamin E change lipid profiles and anti-LDL-antibodies in two different ethnic groups of women transitioning through menopause. Nutr Hosp.2015;32(1):165-174. doi:3305/nh.2015.32.1.9079.