Ep #10: Menopause Treatment Part II: Non-Hormonal Options (June 10, 2019)

Dr Jessica Stefanski discusses your treatment options for menopause in this 2 part series. In Part II, she discusses: 

✅What symptoms and health concerns are common after menopause

✅What can make hot flashes worse

✅Whether soy is safe and effective for menopausal symptoms

✅The foods you should be adding to your diet and the foods you should avoid

✅The 3 best types of exercise for women who are menopausal

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**Episode Transcript**

Hi there, this is Dr Jessica Stefanski with the Let’s Talk Hormones! podcast. This is episode #10 and part II of a 2 part series on treatments for menopause. In part I we talked about the main hormone-based treatments for menopause. this episode we’re going to talk about non-hormonal options. 

Now the first thing I’d like to say is that this is not about choosing hormonal versus non-hormonal. You can do both. And even if you choose hormone replacement, it’s a great idea to also use some of the tools I’ll discuss in this podcast episode. 

What are we going to talk about today? 

  • The main symptoms and health concerns that occur after menopause

  • Diet and the best foods to eat if you’re in menopause

  • Botanical medicine

  • Specific nutrients that you may want to incorporate

  • Acupuncture

  • The best types of exercise 

As we talked about in part I of this 2 part series, there are many symptoms and health concerns that can be a problem after menopause. I want to stress that menopause is not a disease that needs to be cured. But it can be a time of uncomfortable symptoms and as you get older, the hormonal shifts can put you at risk of certain diseases. So we want to be proactive and this is a good time to re-assess our health and institute some good practices that will keep us vibrant and healthy for the long term. 

Now if you have not gone through menopause and you’re wondering why should I care about this stuff, one thing I’d like to remind you of is that the better your health is going into menopause, the better your experience will be. SO you can really be proactive and set yourself up for smoother sailing through this time of life. 

What are the common symptoms and health concerns?

Hot flashes, also known as flushing, Night sweats and Sleep issues, Changes to your mood like anxiety and depression, Brain fog, memory loss. Cognitive changes are common. Greater risk of dementia, Alzheimer’s after menopause, Changes to the skin and hair, Bone loss, Lose muscle mass, weight gain around the middle, You become more Insulin-resistant in menopause, potential for blood sugar problems, weight gain, pre-diabetes, diabetes, Increased risk of cardiovascular disease, Changes to the vagina and pelvic floor. When the vagina becomes very atrophied, this can make intercourse and Pap smears very painful or impossible. Changes to the pelvic floor put you at greater risk of prolapse. 

So treatment-wise, let’s start by talking about diet and nutrition which is always a foundation of good health: 

Diet and Nutrition

As we go through perimenopause and menopause, we naturally become more insulin-resistant. What does that mean, we have a harder time processing sugar and we do better on a low sugar, lower carbohydrate diet. That doesn’t mean a zero carbohydrate diet. And it’s been shown that there is an association between blood sugar problems and hot flashes. So if you are really struggling with hot flashes, it’s really important to get your blood sugar and insulin in check.  The very first thing to do is to cut out the processed foods out of your diet. That means anything that comes in a box or has an ingredient label with more than 1 or 2 items on it. This includes things you might think of as healthy like most protein bars, cereal, energy drinks, protein shakes. 

You need real food.  You need protein like meat, poultry, beans, fish, nuts, eggs. You need healthy fats like avocado, extra virgin olive oil, wild caught salmon or other fatty fish, walnuts.  You need lots of organic vegetables. You need fruit. Fruit has sort of gotten a bad rap because it is high in fructose but it is also high in fiber and all sorts of nutrients and plant-based chemicals that are amazing for your health as well as being very hydrating.

So some things to think about when it comes to fruit: Avoid fruit juice. All the fiber has been stripped away and it’s really high in sugar and easy to drink a lot of juice when given the chance. And in general, try not to drink your fruit such as in a fruit-based smoothie. It’s really easy to overdo it. If you want to add a 1/4 or 1/2 cup of berries, that’s usually fine. Berries are one of my favorite fruits for women, they are so nutritious and won’t spike your blood sugar. Fruit shouldn’t replace protein and fat in a meal. 

Fasting: You may want to incorporate some intermittent fasting if that is appropriate in your case. This can be a great tool for balancing blood sugar and insulin. You can go back and listen to my episode on IF to learn more about it. 
Now let’s move on and talk about a few things that are plant-based that may be helpful to address symptoms. 

Soy: Soy contains phytoestrogens, plant-derived estrogens that can help ease the menopausal transition, reduce hot flashes, can benefit your bones and can help reduce cardiovascular disease. You can get soy into your diet through whole foods or extracts or supplements. There is also something called soy protein isolate which will work but it’s not my favorite, it’s used in a lot of processed foods to increase the protein content. 

Soy milk and tofu are 2 products you are probably aware of. There are also foods like tempeh and miso which are fermented soy foods. It’s important that the soy is organic, conventional soy can be heavily sprayed and really is not fit for human consumption, so make sure you are getting good quality organic soy. 

I wouldn’t go crazy on the soy, I recently saw a woman who was post-menopausal and started having vaginal bleeding which is a bad thing, it usually means that the lining of the uterus has become thickened and can put you at risk of uterine cancer. Well, we figured out that the bleeding began after she had started a new diet which had her eating protein bars that were loaded with soy protein isolate. If taken at high enough doses, you can get a pretty high dose of what is an estrogen and estrogen stimulated the lining of the uterus. 

Red clover which is found most often in supplemental form is another source of phytoestrogens.

Other plants foods like flaxseed, grapes have very small amounts of phytoestrogens, they may or may not be enough to make a difference in menopausal symptoms although if you’re eating a whole foods diet, this may be enough to provide a benefit along with balancing blood sugar. 

Black cohosh is a commonly used botanical particularly commonly used for hot flashes. And research studies have shown that it can be very effective. It does not contain plant estrogens and it has been suggested that it works on the nervous system and reduces inflammation among other things. 

Other herbs that are commonly used like dong gui or dongquai and I like to always include the adaptogenic herbs like eleuthero, rhodiola, holy basil/tulsi, ashwaghanda depending on the collection of symptoms and everything else that is going on. 

Maca: Maca is a root vegetable that is traditionally grown at high altitudes in the Peruvian Andes, it’s a member of the brassica family and most often we see it in gelatinized powdered form.  Maca root works differently than soy, in that it doesn’t contain any plant-based estrogens. But it has been shown to raise estrogen levels. It seems to work on the parts of the brain that signal the body to make and release hormones, so it can indirectly raise levels of all the key hormones. Now there is a lot of maca on the market, some of it is not great quality, so you’ve got to be an educated consumer. It has to be prepared and stored correctly. If we’re really trying to see if maca will make a difference, I will use a standardized extract of maca given once or twice daily and then we can track symptoms and hormone levels to see if it is having a good effect. 

Other Nutrients

1.Fish Oil; the key pieces here are DHA and EPA, you might call these the active parts of the fish oil. The we want for it’s anti-inflammatory benefits. And these need to get up into the range of 2000mg or more of a combination of DHA and EPA, depending on your health status. I wouldn’t skimp here, it’s really important to get a good quality fish oil because it is an unstable oil and can go rancid. So buy in smaller quantities, keep in the fridge or freezer which also makes it a bit easier to digest. 

2. Magnesium drives hundreds of biochemical processes in your body and many of us are deficient. There are many kinds of magnesium, I would avoid magnesium oxide and try something like magnesium glycinate. 

3.B Vitamins; A good quality B Complex in the morning. 

Acupuncture has been shown to reduce hot flashes and improve sleep. It is great for the nervous system so if you are stressed and on the go, it can be very helpful. I would give it at least 6 sessions to see how you feel and also know there are different styles of acupuncture so you have to find the right practitioner and style that will be a good fit for you. 

The best types of exercise: The overwhelming consensus from research is that exercise is beneficial for everyone, regardless of health status.  Even if you are sick or in pain, there are types of movement that you can do. It’s generally never a good idea to stop moving. When we stop moving and stop using our musculoskeletal system, our muscles, bones and connective tissue don’t get the blood flow and stimulation to grow and stay healthy. 

Women who exercise are less likely to experience hot flashes than women who live a more sedentary lifestyle. Exercise will help you keep blood sugar and insulin levels balanced.  It’s good for your cardiovascular system.  So what are the best exercise tools? I want to highlight three areas of focus for exercise: 

1.Walking is a foundational exercise that everyone can do. It has been shown to improve all sorts of health parameters, it’s good for your brain and it’s easy to do. You need no equipment or trainer. 

2.Weight training or resistance training. This type of exercise stimulates the growth of muscle fibers and bone and is great for keeping blood sugar balanced. It is also one of the few things that can truly change your shape and help you stay lean. Which is no easy task after menopause, because the rate of muscle loss can accelerate and unless you take action, the body composition will continue to go in the wrong direction. And what I mean by that is that you will gain more fat tissue and lose bone and muscle mass. 

3.The other elements I would like to discuss here is maintaining balance and coordination. We know that as people get older, they are more at risk of falls and broken bones from those falls. If you maintain your balance and coordination over time, you won’t have to worry about this. It’s much easier to maintain balance and coordination than it is to build from scratch. So things like yoga, pilates, and gyrotonics are some of my favorite tools for this. These also help you maintain the health of your connective tissue so that it doesn’t contract and harden. You want your tissues to remain open and pliable and flexible but also have good structure. This will help you in all aspects of your life. It will prevent injury and allow you to move through life more gracefully. 

So those are some of the best non-hormonal options for menopausal symptoms. I hope you have enjoyed this episode and I hope to see you next time. Bye now!