by The hormonal changes that we start in perimenopause affect every important organ system in our body. Understanding these biological changes is not only important for the treatment of symptoms-it is crucial for your long-term health. We have entered Rajita Patil, MD, MSCP and director of the UCLA comprehensive menopause program to tell how these changes affect our health, as well as tips on expanding your health span in this next phase of life.
Bone health
Ostrogen plays a protective role in bone health. An estrogen loss is associated with a decline in bone mineral density, which can increase the risk of osteoporosis (if bones become weak and brittle) and fractures. The fastest bone loss typically begins in late perimenopause, about two years before the final menstrual period, and remains for four to five years after its existence.
Tip: Exercise exercises and at least three days a week with weight exercises; Eat foods that are rich in calcium (at least 1200 mg/day) and vitamin D (at least 800 IE per day) and if necessary; Avoid smoking and limit alcohol recording. Consider hormone therapy, which has been shown that you reduce the risk of osteoporosis and fractures.
Muscle mass
Sinking of estrogen, testosterone and progesterone in menopause are associated with sarcopenia – a loss of muscle mass and strength.
Tip: Some studies show that a longer use of hormone therapy (estrogen and progesterone) is associated with higher muscle mass and a lower prevalence of sarcopenia, but these effects are not consistently observed in all populations or study structures. Check out the tips under “bone health” to get the muscle mass and make sure that you eat a gram of protein per ideal weight every day.
Heart health
Low estrogen levels are associated with an increase in cardiovascular risk in women, especially after menopause. This accelerates the cardiovascular disease (CVD) by promoting negative effects on cholesterol, body fat distribution (central separation associated with insulin resistance) and blood pressure. Interestingly, a low testosterone is associated with a cheaper cardiovascular risk profile.
Tip: Hormone therapy is not recommended for CVD prevention in women after menopause. However, it can be an advantage for women who are younger and further away from this period. They also eliminate smoking; Prioritize regular physical activity (at least 150 minutes a week with aerobic exercises with medium intensity); Eat a heart -healthy diet like the Mediterranean diet; Perform regular screenings to monitor blood pressure, cholesterol and glucose. Minimize stress; Address changes in the mood; And aim at good quality and duration of sleep.
Mental health
During the transition of menopause, there is a well -documented increase in the risk of new depressive, anxiety symptoms and deterioration of existing mood disorders due to estrogen fluctuations and to a lesser extent progesterone.
Tip: Studies show that transdermal estradiol (with or without intermittent micronized progesterone) is effective in the prevention and treatment of depressive symptoms in perimenopaus women. Consider hormone therapy, cognitive behavioral therapy (CBT) or SSRI/SNRI for new mood changes. It is just as important to focus on physical activity and movement. Optimize sleep; Reduce stress; Stick to the behavior of lifestyle (right nutrition, regular social commitment; avoid smoking and substance consumption).
Brain health
Fluctuations or declines in estrogen cause changed neural connectivity and reduced the activation of the hippocampus and the prefrontal cortex regions that are of crucial importance for memory and attention. While the brain fog is temporary most of the time and people do not develop Alzheimer’s disease, there are some progressive long-term neurodegenerative changes that expose them to a higher risk of developing cognitive impairments and finally Alzheimer’s disease.
Earlier menopause with a longer duration of the estrogen deficiency and a strong family history of Alzheimer’s disease are associated with a higher risk of Alzheimer’s risk. The role of testosterone and progesterone in cognitive function is less clear.
Tip: Current findings do not recommend hormone therapy for the treatment of brain fog or the prevention of Alzheimer’s disease. However, there is some data that indicate that hormone therapy can only be associated in perimenopause with hormone therapy with a reduced risk of Alzheimer’s disease. The mind (Mediterranean confusion between neurodegenerative delays), Mediterranean and DASH (dietary approaches to terminate hypertension) are associated with a slower cognitive decline and a lower risk of dementia. What is good for the heart is good for the brain (and vice versa). See lifestyle tips under “Heart Health” and remain in connection and socialize.
Intestinal health
The intestinal microbioma and estrogen have a cozy relationship. Gearmicrobes regulate the estrogen metabolism and estrogen influences the microbial composition and function. A decline in the estrogen is associated with a shift in the intestinal microbiome and an increased intestinal barrier permeability. This can cause inflammation and contribute to metabolic disorders. The connection between progesterone and testosterone to intestinal health is less well investigated, although the testosterone levels are associated with specific microbioma changes.
Tip: For optimal intestinal health, eat the Mediterranean diet (it is strongly supported for its ability to increase the diversity of intestines, reduce intestinal permeability and reduce systemic inflammation), the fiber absorption from sources such as whole grain products, legumes, fruit and vegetables, the regular physical activity, potentially supplement, with a pre- or probiotic and probiotic and probiotic Prediotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and probiotic and tried, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes.
metabolism
A lack of estrogen affects the energy high -homöostasis (the balance between food intake and food expenditure), which leads to an increased fat accumulation and reduced metabolic flexibility.
Tip: Hormone therapy is not only recommended to improve metabolic health or weight loss, but if they are initiated in perimenopause, it is associated with a reduced central obesity, improved insulin sensitivity, lower sober glucose and a reduced risk for the development of type -2 diabetes. See lifestyle modifications in the above sections to also be implemented.
Sleep
Several studies show that decreasing estrogen and progesterone both by effects on the sleep regulation of the central nervous system – and indirectly contribute to a sleep disorder by aggravating vasomotor symptoms such as hot flashes that can disturb sleep.
Tip: Hormone therapy can help improve sleep (both estrogen and combined estrogen-professional regime are effective, with progesterone showing greater benefits for sleep disorders than estrogen alone). On the other hand, CBT is the most effective non -pharmacological intervention to improve sleep in women in menopause. Also focus on physical exercise, mindfulness and relaxation techniques. Address vasomotor symptoms; keep a regular sleeping plan; And see a sleep specialist who excludes a sleep disorder for continuing problems.
Genitary Health
A lack of estrogen can lead to vaginal drought, combustion, irritation, dyspareunia (recurring or persistent pain during gender), urgency, frequency, dysuria (pain, burning or symptoms during urination) and recurring urinary tract infections. The decline in testosterone in old age contributes to the severity and persistence of these symptoms.
Tip: Local estrog therapy is the first treatment for the genitarian syndrome of menopause (GSM). Clinical studies show that intravaginal DHEA (prasterone) also improves the GSM symptoms. Prasterone converts both in local estrogen and testosterone, which is an additional advantage because there is androgenic receptors in this area. Use lubricant on an oil -based or silicone basis and avoid irritants (e.g. perfumed soaps, douches) that aggravate the vulvovaginal irritation and dryness; The physiotherapy of the pelvic floor can improve the symptoms of urine, vulvovaginal and pelvic floor function.
Sexual health
Low estrogen levels are strongly associated with negative effects on sexual health, in particular through the development of vulvovaginal atrophy (the thinning, drying and inflammation of the vaginal walls), which leads to vaginal dryness, reduced lubricant, dyspare unusity and reduced excitement and orgasmic capacity. A lack of estrogen also contributes to reduced vaginal blood flow and elasticity, which further affects sexual function. Low testosterone levels can contribute to a reduced sexual desire and excitement.
Tip: See section “Genitourary Health” above. Structured programs – including CBT and mindfulness techniques – have shown significant improvements in the overall supply function as well as in certain areas such as desires, arousal, lubricant, orgasm, satisfaction and pain. Combating communication, sexual myths and partner dynamics is of essential importance for optimizing the results. Testosterone therapy can also be taken into account in selected cases of hypoactive sexual desire.
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