Q: I’m approaching the menopause and am extremely worried about the risk of osteoporosis associated with it because my mother and grandmother both suffered from it. What can I do to prevent it?

A: A greater cause of immobility than strokes or heart attacks, osteoporosis (also known as brittle bone disease, when your bones become weak and fracture easily) results in disability, pain, loss of independence and even death. The risk of osteoporosis increases with age, especially after the menopause when oestrogen levels decline. Other risk factors are a slight build, family history of the disease, early menopause and chronic bowel problems like irritable bowel syndrome and diverticulitis. Some of these risks, like your family history, can’t be changed – but there are plenty of ways you can defend yourself against the onset of this disease. It’s never too late to start because diet and lifestyle changes can slow and reverse the symptoms at any age. In addition to eating a healthy diet, rich in phytoestrogens (naturally occurring forms of oestrogen) found in soybeans, wholegrains, flaxseeds and legumes, the recommendations that follow can help reduce your risk of osteoporosis:

Change your lifestyle: Women who sit for more than nine hours a day are twice as likely to have hip fractures as those who sit for less than six hours a day. So if you have a sedentary job or lifestyle you should build more exercise into your life. Activity is crucial because it helps build strong bones and muscles, so make sure you follow the menopause diet exercise guidelines. Don’t become a gym junkie though. Excessive exercising, as well as dieting and overeating, can increase the likelihood of developing the condition.

 

Avoid faddy diets: Without enough vitamin D, calcium and other valuable nutrients your body cannot defend itself against osteoporosis. So don’t follow faddy diets or crash diet as it deprives your body of the nutrients it needs to keep your bones healthy.

 

Stop smoking and drink in moderation: Women smokers generally have lower bone density and after the age of 40 they lose bone faster than non smokers. Excessive alcohol consumption interferes with the way your body handles calcium, increasing the amount you get rid of and decreasing the amount you absorb.

 

Eat for strong bones: Calcium is your vital mineral for the formation and continuing strength of your bones and teeth and a diet rich in it is your first step in protecting yourself against osteoporosis. Some women increase their intake of dairy foods to boost calcium intake, but this can be counter productive. Although these foods do provide us with calcium, the acidic nature of some dairy foods, particularly cheese, can in fact encourage our bones to release calcium rather than conserve it. Therefore, it’s important to look at other food sources. Calcium-rich foods include tinned sardines and salmon (with bones), seaweed, eggs, sesame seeds (tahini), figs, almonds, hazelnuts, walnuts, amaranth, spring greens, cabbage, broccoli, parsley, watercress, sunflower seeds, soya, chickpeas, black beans, pinto beans, buckwheat, brown rice and quinoa.

 

In addition to calcium you also need to get plenty of vitamin D, as without it your body can’t put calcium into your bones. Your body manufactures its own vitamin D when your skin is exposed to ultraviolet light from the sun, and 10 to 15 minutes daily exposure without sunscreen is perfectly safe in the early morning or late afternoon. The best dietary source of vitamin D is oily fish, although there are small amounts in egg yolks. If you don’t go out into the sunlight at all you should take vitamin D supplements. A strong skeleton also needs omega-3 fatty acids from flaxseeds and fish oil and vitamin K from green vegetables, which is vital for hardening calcium in your bones. Magnesium, found in nuts, seeds and peanut butter, is another vital mineral because it helps your body absorb calcium and vitamin D. And don’t forget to get enough vitamin B. A new study in the Journal of Clinical Endocrinology has found that elderly people with low levels of B vitamins are more likely to have hip fractures. Cereals, beans, fish and pulses are all good sources of the B vitamins.

 

Lose excess weight: But don’t get too thin or exercise too much. Your body needs some fat to produce oestrogen, which is produced in fat cells; thin women, especially those who diet and over exercise, are more likely to suffer from osteoporosis.

 

Watch your stress levels: When you are anxious your adrenal glands pump out a number of hormones including cortisol, which can increase the risk of fractures, so find ways to manage stress. I recommend yoga, breathing exercises and meditation – but find what works best for you.

Your risk of osteoporosis will be higher because of your family history, but it is not inevitable that you will have it too, so put into place preventative measures to protect yourself. For more detailed information on what to eat and what supplements to take, see my book ‘Osteoporosis – the silent epidemic’.

A new study (by Japanese scientists in the British Journal of Sports Medicine) suggests that playing ball games like tennis and netball in your teens can make women’s bones stronger forty years later. The scientists interviewed post menopausal women about the kind of exercise they took in their teens and it appears that the more weight bearing exercise a girl takes between the ages of 12 and 18 the more her bone density is likely to be protected after the menopause. High impact sports like sprinting can also be beneficial.

Every woman will go through the menopause, but despite being such a universal experience there are a lot of myths and misunderstanding out there about this important life stage. Read on to sort out the myths from the facts:

Myth: All women have unpleasant symptoms around the menopause.

Fact: A minority of women have difficulties. A large US survey reported 66 percent of women managing the menopause easily. The majority of women have one, or a small number, of menopause related symptoms. Five to 15 percent notice no symptoms at all.

 

Myth: Middle aged spread goes hand in hand with the menopause.

Fact: A number of pesky factors – such as a slowing metabolism, stress and decreasing oestrogen levels – all seem to increase the likelihood of weight gain with the menopause. But, although it is harder to stay in shape, it is not impossible. Regular exercise, stress management and a healthy diet rich in whole grains, fruit, vegetables, soya, nuts, seeds and legumes will help you stay in shape – and in some cases feel fitter and slimmer than ever before. (If you are struggling with extra weight around your waist then see my ‘Fat around the Middle’ book.)

 

Myth: Every woman gets hot flushes with the menopause.

Fact: Up to two thirds of women get hot flushes and these range in severity from mild to intense. This means that up to a third of women have no hot flushes. And as only about 20 per cent of women ask their GP for help, this indicates that many women who get hot flushes are not troubled by them.

 

Myth: Many women get depressed and moody because of the menopause.

Fact: There are many problems that often coincide with the years around the menopause: troublesome teens, elderly parents and work overload; and all these can cause stress and depression. Although women with a history of depression were more likely to report mood swings and hot flushes, researchers have found that menopause symptoms do not cause depression.

 

Myth: Menopause means your best years are behind you.

Fact: In past centuries, age inevitably meant ailments – but medical advances have changed all that. In fact, 21^st century women who exercise every day, eat healthily and keep stress levels under control, can enjoy their life in a way previously thought possible only for young people. In some ways you could say that there are a number of bonuses with the menopause, including freedom from menstruation and contraception.  Don’t forget – you can now live 30 to 50 years past the menopause. 

 

Myth: Loss of libido is common around menopause.

Fact: As they enter the prime of their life, many women gain a new sense of self and feel sexier than ever before. While it is true that declining levels of oestrogen around the menopause can cause a dry vagina, making intercourse less pleasurable, it is important to understand that many other factors can cause a loss of libido. Common factors include too much alcohol, poor diet, stress, fatigue, illness and medical conditions. Some of these common factors can be worked on to great effect with healthy diet and lifestyle changes – and a determined effort to put love making higher on your list of priorities. Kegel exercises can help strengthen your pelvic muscles and make sex more enjoyable and motherwort tincture, or 1 -3 tablespoons daily of flaxseed oil taken orally, can increase vaginal lubrication within a month of use. You can also use a natural lubricant (not the chemical based ones you buy from the chemist), the one I would recommend is an organic lubricant called Yes (see the Resources Page).

 

Myth: If your periods started early, your menopause will be late.

Fact: This is another old wives tale as research into the age of menopause has found no strong connection. What has been established though is that the menopause may occur several years earlier if you smoke. The average age of the menopause is 51, and women who don’t smoke will be in the age range 48-55 when they go through the menopause. It is even thought that smoking can cause not just a few years difference, but can cause premature menopause where a women goes through the menopause before the age of 40.

 

Myth: There is no alternative to HRT.

Fact: You do not have to take HRT at the menopause to combat the hot flushes and night sweats that are associated with fluctuating levels of oestrogen. In fact, it is preferable to take oestrogens, which occur naturally in plants, to supplement declining oestrogen levels after the menopause. Include more phytoestrogens in your diet in the form of soya products, whole grains and legumes. Eating healthily, managing stress and exercising regularly can keep the symptoms and risks of menopause at bay, naturally. You can also add in some herbs, like black cohosh, agnus castus and dong quai, if the symptoms are bothering you (see Black Cohosh Plus on the Resources Page).  Remember this is only a transition, so the symptoms do not last forever – and the sooner you do something about them the easier this stage in your life will be.