Menopause

Peri and post menopause are easier if you teetotal and aren't fat

Published 6.14.2017
Despite the tagline for this site, my trip through menopause ended years ago. I've written about it a bit, and will again in the future. My bottom line when it comes to menopause: aging is not a disease, and menopause is part of aging. I still follow news about the menopause process, and what follows are interesting items I've come across recently.

Drinking alcohol increases muscle wasting post-menopause. I enjoy having an adult beverage (or two) in the evenings with my dinner, hence my focus on research suggesting health effect of imbibing. Most often those effects are said to be positive, the Blue Zone populations, for example are known to enjoy moderate alcohol intake associated with meals. However, that is not the case here.

Led by Yu-Jin Kwon, MD, of Yonsei University College of Medicine in Seoul, prevalence of sarcopenia among post-menopausal women rose as alcohol-drinking patterns increased (7.6% low-risk, 11.0% intermediate-risk, 22.7% high-risk; P=0.003), published in Menopause, The Journal of The North American Menopause Society (NAMS).

In a fully adjusted model, postmenopausal women who consumed the highest levels of alcohol had over four-fold increased odds of developing sarcopenia compared to those who drank the least (OR 4.29, 95% CI 1.87-9.82). Similar findings were reported in an age-adjusted only model (OR 3.97, 95% CI 1.78-8.88).

Sarcopenia is loss of muscle mass due to aging. Post menopausal women should limit their alcohol intake. They should lift heavy things and do yoga, both of which have been shown to mitigate muscle loss and increase bone mass.

There are a number of weaknesses to this study: Women who drink a lot have other health issues because heavy drinkers have a tendency to have other risky habits. This was a study of Koreans, so it might not translate uniformly.

Get your vitamin D and calcium from food, not supplements. However, vitamin D isn’t in many foods, unless they have been fortified. On the other hand, going outside in the sun allows the skin to make vitamin D. Supplements should be unnecessary, and calcium supplements are downright dangerous.

In this case, women taking supplements had a higher association with early menopause. Low dietary vitamin D and high calcium supplementation were also associated with early menopause.

Surprisingly, women who took the recommended daily allowance of calcium (1,000 mg) or more had a significantly increased risk of early menopause compared with those who did not take calcium supplements (odds ratio 1.60; 95% CI 1.19-2.17; P=0.02). The researchers speculated that many of these women may have been taking calcium supplements prescribed by a doctor for conditions that affect sex-steroid hormones, such as autoimmune diseases or a family history of osteoporosis.

I don’t find this results surprising, but I’ve already admitted my bias is anti-supplement. Save your money and eat more plants or dairy to achieve your calcium levels. Could the effect of dairy be related to steroid hormones in the milk?

When the investigators examined the effect of dietary vitamin D and calcium obtained from dairy and non-dairy sources, they found significant risk reductions only for the vitamins that came from dairy. "We think that our findings for dietary vitamin D may be driven, at least in part, by dairy foods themselves," Purdue-Smithe told MedPage Today via email.

"Dairy foods are a rich source of steroid hormones, such as progesterone. Higher intake of progesterone from dairy may influence levels of circulating sex hormones, which in turn may influence ovarian function during the reproductive years." Ongoing research is exploring this possibility, she said.

Not sure I understand that quote, and I’ve read it three times now.

Obesity makes menopause symptoms worse. The body's ability to compensate for levels of abuse shifts during menopause as hormones shift. Note: I use the word abuse in its broadest sense. Smoking is bodily abuse, excess alcohol intake is bodily abuse, extremes in physical training are abuse and weight in excess of the body's ability to compensate is abuse. I realize that not everyone will appreciate the use of the word abuse, but that is what you are doing to your body if you are overly stressing it. All of the examples listed— by no means an exhaustive list— abuse the body and force it to compensate and heal the damaging effects.

As a body ages, hormonal effects occur and the compensation process, as well as other processes, change. That is simply a fact of life. What the body could tolerate and compensate for when it was younger is different than what it can as it ages. Menopause is a huge hormonal shift is a women's life. The body's function changes in response.

On a 4-point symptom severity scale, obese women scored a mean of 1.4 for hot flashes, compared with 1.2 for overweight women and 1.1 for women of normal weight (P=0.034 for comparison), said senior investigator Lucia Costa-Paiva, MD, PhD, of the State University of Campinas in São Paulo, Brazil, and colleagues.

Obese and overweight women also suffered more severe consequences of hot flashes compared with normal-weight women, including interruptions in sleep (P<0.0001), work activity (P<0.0001), sexual activity (P<0.0001), and leisure time activities (P=0.0002), Costa-Paiva and colleagues reported online in Menopause: The Journal of The North American Menopause Society.

Fatter women had more hot flashes, joint pain and urinary problems. However, there was no difference related to body mass index (BMI) for psychological symptoms. Fatter women in the survey tended to exercise less, and exercise is known to be one way to mitigate menopausal symptoms. Another reason that movement is essential.

Thyroid function is not well understood, and can be over treated. This to me, falls into the “aging is not a disease” category. All drugs have side effects, but the thyroid touches so many bodily functions, the bias should be for doing less, not more.

We think, however, that this case highlights a problem of critical importance: the overuse of thyroid replacement, particularly among older patients. In our experience, patients with nonspecific symptoms like fatigue, low energy, or constipation receive a TSH check as part of the work up. If the level is elevated (or even on the high end of normal), the treating clinician will frequently start levothyroxine.

Hypothyroid has numerous side effects, including weight gain, but could it be that what’s diagnosed as hypothyroid might just be a natural again process of thyroid function? Hyperthyroid is a different situation because it can affect heart function. But trying to “speed up” the thyroid strikes me as the same kind of thinking that lead to hormone replacement therapy to “correct” the body’s natural aging process… otherwise known as menopause.

Yes, many thing change after menopause, but most of the shifts are simply a woman’s body getting older. I realize that many people (not just women) don’t like to acknowledge the effect of the passage of time, but too many of the efforts to reverse time’s effects are worse than the original. The article was an example of “Slow medicine,” and I think I like the sound of that. The concept seems to be to as little as possible for as long as possible.