How the 4 Pillars of Health can influence Menopause

Menopause will affect every woman’s life, and while it is a normal part of ageing, it can occur early in some women for many reasons, including premature ovarian insufficiency (POI) or surgical/medical menopause. Whether you have experienced menopause or are currently experiencing perimenopause, premature menopause, POI, or surgical/medical menopause, they all come with a variety of physical, emotional, and mental challenges. There are over 32 commonly reported symptoms; these can include difficulty concentrating, itchy skin, sleep disturbances, and joint pain. However, regardless of personal symptoms, many women may not realise that the 4 pillars of health—nutrition, exercise, sleep, and mental well-being—can significantly impact how they experience menopause.

The 4 pillars of health represent the foundational elements that support overall well-being. By focusing on these areas, you can not only manage the symptoms of menopause but also improve your quality of life during this time. Let’s explore what each of these pillars involves and how they can work together to make menopause a smoother, more manageable voyage.

The 4 Pillars of Health: What Are They?

1. Nutrition: Fuelling Your Body Through Menopause

Nutrition is one of the most important tools for managing menopause symptoms. The foods we eat provide the fuel and nutrients our body needs to function. A well-balanced diet can support healthy hormone levels, reduce inflammation, and maintain energy levels. As hormone levels fluctuate, it can affect everything from metabolism to bone health. Here’s how:

Hormonal Balance and Symptom Management

The decline in oestrogen during menopause can lead to various symptoms, such as hot flushes, night sweats, and mood swings. While nutrition cannot replace the body's natural hormone production, certain foods can support the body’s hormonal balance and alleviate some of these symptoms.

• Phytoestrogens: These are plant compounds found in certain foods that mimic the effects of oestrogen in the body. Phytoestrogens can help reduce hot flushes, Japanese woman in particular report a lower frequency of hot flushes than western woman. This has been partially attributed to the higher consumption of phytoestrogens in Japan. Good sources include:

  • Soy products (tofu, tempeh, edamame)

  • Flaxseeds

  • Sesame seeds

  • Chickpeas and lentils

• Omega-3 Fatty Acids: Omega-3s, found in fatty fish (like salmon, mackerel, and sardines), flaxseeds, and walnuts, have anti-inflammatory properties and can help alleviate symptoms. Omega-3s support brain health, which is important as menopause can affect memory and cognitive function causing brain fog.

• Vitamin E: Known for its antioxidant properties can also alleviate commonly reported menopause symptoms. You can get vitamin E from foods like almonds, sunflower seeds, spinach, and avocados.

Bone Health

One of the significant health concerns during menopause, especially when experienced at a younger age due to POI or surgical/medical menopause, is the risk of osteoporosis. Oestrogen helps maintain bone density, so as oestrogen declines, so can bone density. Proper nutrition is key to preserving bone health during and after menopause.

• Calcium: Adequate calcium intake is essential for maintaining bone density. Calcium-rich foods include:

  • Dairy products (milk, yoghurt, cheese)

  • Leafy greens (kale, bok choy, collard greens)

  • Fortified plant-based milks (almond, soy, or oat milk)

  • Tofu and sesame seeds

• Vitamin D: Vitamin D helps the body absorb calcium. Vitamin D is primarily synthesised from sunlight. However, the NHS recommends everyone in the UK take a vitamin D supplement between October and March and those high at risk of vitamin D deficiency take a supplement year-round. Nutritional sources of vitamin D include:

  • Fatty fish (salmon, mackerel)

  • Egg yolks

  • Fortified foods (such as fortified cereals, plant-based milks, or orange juice)

• Magnesium: Magnesium helps with bone health and muscle function. It can also help reduce the risk of osteoporosis. Foods high in magnesium include:

  • Nuts and seeds (almonds, pumpkin seeds)

  • Whole grains (brown rice, quinoa)

  • Leafy green vegetables (spinach, Swiss chard)

  • Legumes (black beans, lentils)

Weight Management

Many women experience changes in metabolism during menopause, and often report weight gain, especially around the abdomen. While diet alone can't prevent weight gain, it can do a lot to manage it.

• Protein: Adequate protein intake is essential during menopause to help maintain lean muscle mass, which naturally declines with age. Protein can also help regulate appetite and prevent overeating. It is recommended that during menopause women aim for 1g-1.2g of protein per kg of body weight daily. That is roughly 25-30g of protein per meal. Lean sources of protein include:

  • Chicken, turkey, and fish

  • Beans and legumes

  • Tofu and tempeh

  • Eggs

• Fibre: A diet high in fibre helps regulate blood sugar levels, promotes satiety (feeling full), and supports digestion. It also aids in weight management and helps prevent constipation, which can become more common during menopause. Foods rich in fibre include:

  • Whole grains (oats, quinoa, barley)

  • Fruits (berries, apples, pears)

  • Vegetables (broccoli, carrots, sweet potatoes)

  • Legumes (lentils, chickpeas, beans)

• Healthy Fats: Monounsaturated and polyunsaturated fats can help reduce the risk of heart disease, which becomes a greater concern after menopause. These fats also contribute to a feeling of fullness. Sources of healthy fats include:

  • Avocados

  • Olive oil

  • Nuts and seeds

  • Fatty fish (salmon, mackerel, sardines)

• Limit Processed Sugars: High sugar intake can contribute to weight gain and metabolic issues. It’s important to reduce refined sugars found in processed foods, sugary beverages, and snacks.

Mood and Mental Health

Hormonal changes during menopause can affect mood, leading to irritability, anxiety, and even depression. Nutrition can play a key role in stabilising mood and improving mental well-being.

• B Vitamins: B vitamins, particularly B6, B12, and folate, are important for brain function and mood regulation. Deficiencies in these vitamins can lead to mood swings, fatigue, and cognitive decline. Foods rich in B vitamins include:

  • Leafy greens (spinach, kale)

  • Whole grains (brown rice, oats, barley)

  • Eggs

  • Poultry and fish

  • Legumes (beans, lentils)

• Magnesium: Magnesium plays a role in regulating the nervous system and can help reduce symptoms of anxiety and depression. It also promotes better sleep. Sources of magnesium include:

  • Dark leafy greens (spinach, swiss chard)

  • Nuts and seeds (almonds, sunflower seeds)

  • Whole grains (brown rice, quinoa)

• Antioxidant-rich Foods: Antioxidants help reduce inflammation, which can have a positive effect on mood. They also protect brain health as we age. Sources of antioxidants include:

  • Berries (blueberries, strawberries, raspberries)

  • Dark chocolate (in moderation)

  • Nuts (almonds, walnuts)

  • Green tea (in moderation)

2. Exercise: Staying Active for a Smooth Transition

Regular physical activity is vital for maintaining strength, flexibility, and overall health. Exercise helps control weight, improve bone health, reduce stress, and alleviate many symptoms of menopause, like mood swings and sleep problems. Here's how:

Helps Manage Weight Gain

One of the more common concerns during menopause is weight gain, particularly around the abdomen. This is due to a combination of hormonal changes, a slowing metabolism, and lifestyle factors. Regular physical activity can help:

• Increase Calorie Burn: Exercise, especially cardiovascular exercise like walking, jogging, swimming, or cycling, helps burn calories, which can help with weight management.

• Boost Metabolism: Strength training exercises (like lifting weights or bodyweight exercises) can increase lean muscle mass, which in turn boosts metabolism. More muscle means the body burns more calories even at rest.

• Reduce Belly Fat: Studies show that women tend to accumulate more visceral fat (fat around the abdomen) during menopause. Exercise can help reduce this fat, which in turn lowers the risk of heart disease, type 2 diabetes, and other metabolic conditions.

Improves Bone Health

During menopause, the decline in oestrogen levels can accelerate bone loss, leading to a higher risk of osteoporosis and fractures. Exercise, especially weight-bearing activities, is one of the most effective ways to maintain bone density and reduce the risk of osteoporosis.

• Weight-Bearing Exercise: Activities like walking, running, hiking, dancing, and weightlifting are excellent for stimulating bone growth and preventing bone loss.

• Strength Training: Lifting weights or using resistance bands can improve bone density and encourage them to become stronger and denser.

• Balance and Flexibility: Exercises like yoga and Pilates help improve balance and flexibility, reducing the risk of falls and fractures.

Reduces Hot Flushes and Night Sweats

Hot flushes and night sweats are among the most well-known symptoms of menopause. While they are primarily linked to hormonal changes, regular exercise has been shown to help alleviate these symptoms.

• Endorphin Release: Exercise triggers the release of endorphins, the body's natural "feel-good" hormones, which can help regulate temperature and reduce the intensity of hot flushes.

• Improved Circulation: Cardiovascular exercise enhances blood flow and circulation, which may help your body better regulate temperature and reduce the severity of hot flushes.

• Reduced Stress: Exercise is an excellent stress-reliever, and stress can exacerbate hot flushes and night sweats. Reducing stress through regular physical activity can help keep symptoms under control.

Improves Sleep Quality

Sleep disturbances, including insomnia and waking up frequently at night, are common during menopause. Hormonal fluctuations and symptoms like night sweats can interfere with restful sleep. Regular exercise can improve sleep quality in several ways:

• Regulates Sleep Patterns: Moderate-intensity exercise during the day can help reset your internal body clock, promoting deeper and more restful sleep at night.

• Relieves Stress: Exercise helps reduce anxiety and stress levels, which can otherwise keep you awake at night.

  
  

Tip: Aim to finish your exercise routine at least 2-3 hours before bedtime to avoid overstimulation that may affect your sleep.

Enhances Mental Health and Mood

Menopause can bring about emotional changes due to fluctuating hormone levels, leading to mood swings, anxiety, irritability, and even depression. Exercise has significant mental health benefits and can help improve mood and overall well-being.

• Endorphins and Serotonin: Exercise stimulates the release of endorphins and serotonin, neurotransmitters that improve mood and reduce symptoms of depression and anxiety.

• Stress Reduction: Physical activity helps lower levels of cortisol (the stress hormone), promoting relaxation and a sense of calm.

• Improved Cognitive Function: Regular exercise, especially aerobic exercise, has been shown to improve cognitive function and memory, which can sometimes be affected during menopause.

• Self-Esteem: Exercise can help women feel more confident about their bodies, reduce feelings of stress, and foster a sense of accomplishment, which can improve overall mental well-being.

Promotes Cardiovascular Health

The risk of cardiovascular disease increases after menopause, primarily due to the loss of oestrogen, which has a protective effect on the heart. Exercise plays a key role in reducing this risk by:

• Improving Heart Health: Regular aerobic exercise, like walking, cycling, or swimming, helps strengthen the heart, improve circulation, and reduce the risk of heart disease.

• Lowering Blood Pressure: Regular exercise can help reduce high blood pressure, a risk factor for heart disease.

• Regulating Cholesterol: Exercise can help lower "bad" LDL cholesterol and raise "good" HDL cholesterol, reducing the risk of plaque buildup in the arteries.

Alleviates Joint Pain and Stiffness

Many women experience joint pain, stiffness, and discomfort during menopause due to the decline in oestrogen. Exercise can help reduce these symptoms and improve joint mobility.

• Strengthening Muscles: Strengthening the muscles around the joints can provide more support and reduce pain. Exercises like strength training and Pilates are particularly helpful.

• Improved Flexibility: Regular stretching exercises, yoga, or tai chi can improve flexibility, reduce stiffness, and relieve tension in the joints.

• Weight Management: By maintaining a healthy weight through exercise, you reduce the strain on your joints, which can alleviate pain, particularly in weight-bearing joints like the knees and hips.

Increases Energy Levels

Fatigue is a common symptom during menopause, partly due to disrupted sleep patterns, hormonal fluctuations, and lifestyle changes. Regular physical activity boosts energy levels and combats fatigue.

• Improved Circulation: Exercise improves blood flow and oxygen delivery to tissues, which helps to increase overall energy levels.

• Enhanced Endurance: Regular physical activity improves cardiovascular fitness, making daily tasks feel less taxing and helps you feel more energised throughout the day.

Supports Healthy Skin and Ageing

The skin can become thinner and less elastic during menopause due to decreased collagen production. Regular exercise increases blood flow to the skin, promoting a healthy, youthful complexion.

• Collagen Production: Exercise stimulates collagen production in the skin, which may help combat sagging and dryness that often accompanies menopause.

• Reduced Inflammation: Regular physical activity helps reduce chronic inflammation in the body, which is linked to skin ageing and other health issues.

Types of Exercise to Include:

To maximise the benefits of exercise during menopause, a well-rounded routine that includes a combination of the following is ideal:

• Aerobic Exercise: Walking, swimming, cycling, or jogging—great for heart health, weight management, and improving mood.

• Strength Training: Weight lifting or bodyweight exercises—important for maintaining muscle mass, bone density, and metabolism.

• Flexibility and Balance: Yoga, Pilates, or Tai Chi—excellent for improving flexibility, reducing stress, and enhancing balance and coordination.

• Stretching: Regular stretching can reduce muscle tension and improve joint flexibility.

3. Sleep: An Essential Pillar of Menopausal Health

Restful, restorative sleep is essential for emotional and physical well-being. During menopause, sleep disturbances such as insomnia and night sweats can be common, but establishing healthy sleep habits can help combat these issues and improve overall health. Here’s how sleep can influence menopause:

Sleep and Mental and Emotional Health

Chronic sleep deprivation during menopause can exacerbate emotional symptoms such as mood swings, irritability, anxiety, and depression. Lack of sleep affects the brain’s regulation of stress hormones (like cortisol), making it harder to manage stress and emotions.

• Increased Stress: Poor sleep can elevate levels of the stress hormone cortisol, which can cause a vicious cycle—stress can worsen sleep, and poor sleep can increase stress. This can lead to more mood swings, anxiety, and feelings of overwhelm.

• Cognitive Function: Sleep is critical for cognitive processes like memory, concentration, and problem-solving. During menopause, cognitive decline, often referred to as "brain fog," can occur, and poor sleep can make it worse. Lack of restorative sleep hampers mental clarity, focus, and memory retention, making it harder to manage daily tasks.

Sleep and Menopause-Related Health Risks

Heart Health

Sleep plays an important role in heart health, and menopause increases the risk of cardiovascular disease. Sleep deprivation and poor sleep quality can further increase the risk of heart disease.

• Increased Blood Pressure: Chronic sleep deprivation has been linked to high blood pressure, which is a risk factor for heart disease and stroke. It can also increase the risk of developing other conditions like diabetes and obesity.

• Inflammation: Sleep deprivation can lead to chronic low-grade inflammation, which is linked to various health problems, including cardiovascular disease. Proper, restful sleep helps regulate inflammation in the body and supports heart health.

Bone Health

Sleep is important for bone health because:

• Bone Remodeling: Sleep is when your body engages in the process of bone remodeling—breaking down old bone tissue and forming new bone. Lack of sleep may disrupt this process.

• Growth Hormone Release: Deep sleep is essential for the release of growth hormones, which help stimulate bone growth and repair. Without adequate sleep, this process may be impaired, making it more difficult to maintain strong, healthy bones.

Improving Sleep During Menopause: Practical Tips

Since sleep plays such a significant role in managing menopause symptoms and supporting overall health, it’s essential to adopt strategies that promote better sleep quality. Here are some tips for improving sleep during menopause:

1. Create a Sleep-Friendly Environment

• Cool the Room: Since hot flushes and night sweats are common during menopause, keep your bedroom cool and well-ventilated. A cool room (around 60-67°F or 15-19°C) promotes better sleep.

• Comfortable Bedding: Invest in moisture-wicking sheets and lightweight blankets to ensure you are comfortable during the night.

• Dark and Quiet: Limit exposure to light and noise. Use blackout curtains, an eye mask, or earplugs.

2. Establish a Bedtime Routine

• Regular Sleep Schedule: Try to go to bed and wake up at the same time every day, even on weekends. Consistency helps regulate your internal body clock.

• Relax Before Bed: Engage in relaxing activities such as reading, meditating, or taking a warm bath. Avoid screens (phones, computers, TVs) at least 30 minutes before bed, as the blue light can interfere with your sleep cycle.

3. Manage Hot Flushes and Night Sweats

• Stay Hydrated: Dehydration can worsen hot flushes and night sweats. Drink plenty of water throughout the day, but avoid large amounts right before bed to prevent waking up to use the bathroom.

• Dress in Layers: Wear breathable, moisture-wicking fabrics to bed, and keep a light blanket nearby so you can adjust your warmth as needed.

4. Focus on Relaxation Techniques

• Mindfulness and Meditation: Mindfulness practices like deep breathing, progressive muscle relaxation, or guided meditation can help calm the mind and reduce stress, which is essential for sleep.

• Journaling: If racing thoughts keep you awake, consider journaling before bed to clear your mind. Writing down your thoughts can help reduce anxiety and make it easier to relax.

5. Exercise Regularly

• Physical Activity: Regular exercise, such as walking, yoga, swimming, or strength training, can improve sleep quality by helping to regulate your circadian rhythm and reduce stress.

• Avoid Intense Exercise Late at Night: While exercise is beneficial for sleep, avoid intense physical activity right before bed, as it can be stimulating and make it harder to wind down.

6. Watch Your Diet

• Avoid Caffeine and Alcohol: Both caffeine and alcohol can interfere with sleep. Caffeine is a stimulant, and alcohol, while initially sedating, can disrupt your sleep cycle and make it harder to stay asleep.

• Limit Heavy Meals Before Bed: Avoid large, rich meals right before bedtime, as they can cause discomfort or indigestion, making it difficult to fall asleep.

7. Consider Natural Sleep Aids

• Herbal Teas: Certain herbal teas, like chamomile or valerian root, have calming effects and may promote relaxation before bedtime.

When to Seek Professional Help

If sleep disturbances are severe or persistent, and these strategies aren’t enough to improve sleep quality, it may be time to consult with a healthcare provider. 

• Cognitive Behavioural Therapy for Insomnia (CBT-I): This evidence-based therapy helps individuals manage insomnia by addressing the thoughts and behaviours that disrupt sleep. It can be highly effective for women going through menopause.

4. Mental Well-Being: Nurturing Your Mind During Menopause

Mental health is often overlooked when discussing menopause, but it’s just as critical as physical health. The hormonal changes that occur during menopause can lead to an increase in anxiety, depression, and stress. Taking care of your mental well-being is essential for managing menopause symptoms and maintaining a positive outlook.

Mood Swings and Anxiety: Regular exercise, mindfulness practices, and meditation can reduce the severity of mood swings and anxiety. These activities help to regulate cortisol (the stress hormone) and support emotional balance.

Cognitive Health: Mental exercises, social engagement, and stress management techniques (like deep breathing and journaling) can help maintain mental clarity and improve mood.

Self-Care: Taking time to relax, engage in hobbies, or spend time with loved ones can boost feelings of well-being and reduce feelings of isolation.

Tip: Mindfulness practices, such as yoga and meditation, are particularly beneficial in reducing stress and promoting emotional resilience during menopause.

A Holistic Approach to Menopause

By focusing on these 4 pillars, you can significantly ease the physical and emotional challenges associated with menopause. A balanced approach to these pillars not only helps manage symptoms but also enhances overall quality of life, making menopause a time of empowerment and well-being regardless of your age.

Please remember, menopause is not the end of vitality but rather an opportunity to embrace self-care, health, and a new chapter of life with confidence!