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What you do now can make you happier and healthier after the menopause (GUEST ARTICLE)

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Published on: 17 June 2021

When we’re experiencing mind-melting or life-bending symptoms, it’s easy to get tunnel vision; only focusing on doing what you can to feel better in the here and now.

But what other action can we take that will future-proof our health and happiness for when all the hormonal hoo-haa has died down?

We asked Dr Angela Sharma, GP and Menopause Expert, for some advice. She has daily insight into how self-care during the change influences not just the quality of mid-life, but how well women feel post-menopause.

Want to find out how you can ensure your long-term fitness and peace of mind? Read what Angela has to say...

Living longer than ever

It’s well-documented these days that women live much longer than previous generations.

In fact, women spend a third of their life in their later years, which incorporate stages of the menopause, post-menopause and then older age. So it’s vital to have good health to enjoy all the benefits that can pop up as you journey through midlife and beyond.

I find myself spending a lot of time with women in this latter stage of life as an NHS GP in London running menopause clinics, as well as doing care planning for patients over 65.

During these clinics, I have the luxury of spending an hour with these lovely ladies and getting to know them, their lifestyle habits, their beliefs, their past medical history, stories about their lives and what they did.

Observations from the other side

One thing that has always struck me is the vast difference between women with good health in old age and those with poor health. It makes me wonder why some women get to that stage of life and do so well, or do poorly when it comes to health.

After five years of doing detailed reviews, I’ve come to realise that the women in good health had certain traits, habits and outlook on life or had made certain choices earlier in life. These findings were consistent across all the women I met who were doing well.

Mental and physical fitness

They were the women who had a positive outlook on life, who always saw the glass as half full.

They were conscious about their food intake and ate moderately with little snacking; well-balanced diets with the occasional treats and not the other way round. They were the women who’d incorporated exercise into their life, or were active walkers, who enjoyed the exercise they did.

They were also socially active with good connections. They were either still working, or had joined groups, or met regularly with friends or family – even embracing zoom calls in lockdown.

They were the obvious non-smokers or people that drank very little (not every day) and always had their annual flu jabs.

But what really made the difference?

Of course, these are all things we already know lead to good health or good mood.

But the most important observation for me was that amongst this group of women a large number had chosen to have HRT or, if not, had made conscious efforts to keep their bones strong.

These ladies stood up straighter and didn’t have that curved spine that’s so common as we get older due to osteoporosis (the condition where thin, fragile bones are more likely to crumble or break).

They also seemed to have more energy and a zest for life and so were more likely to be active and exercise, and take better care of themselves.

Strong bones = good health

So yes. Good bone health is one of the most important determinants for good health in older age. And the most common sufferers of poor bone health and osteoporosis are post-menopausal women.

One in three women will suffer from an osteoporotic fracture in their lifetime, which at an older age can be devastating for their long-term health.

It can lead to a period of hospitalisation, permanent disability or reduce their long-term mobility and autonomy – which in turn can make them depressed and affect their mental health.

They can then feel too anxious to go out for fear of further falls, reducing their activity further – which can reduce their lifespan.

Our bone life cycle

Our peak bone age, when our bones are the strongest, occurs as the bones grow during the teenage years up until their highest levels of density in our 30s.

Our bones then stay strong for some years until their strength starts to decline around our mid-40s.

As women enter the menopause, the loss of oestrogen causes bones to get thinner at a faster rate of 2% per year. It then slows down a few years after the menopause to 1-1.5% annually and then continues at a slightly slower rate.

Some women with a very early menopause (either naturally or after certain gynaecological surgery or chemotherapy) will be at a higher risk of osteoporosis. So they need to place even greater importance on their bone health.

So what can you do?

All women need to be informed about the accelerated loss of bone during the menopause and be proactive to counteract it and keep themselves healthy and mobile in their older years.

The good news is that you can do the following seven things to keep your bones strong:

  • 1. Stop smoking
    Smoking puts you at risk of osteoporosis, as well as a host of other conditions that can affect your long-term health.
  • 2. Avoid excessive alcohol
    More than three units per day ramps up your risk of bone loss, as well as increasing the incidence of other issues like breast cancer.
  • 3. Include adequate calcium in your diet
    This is the basic building block of bones. This will be fine for women who eat dairy products daily, but vegans can get it from other sources such as green leafy vegetables like broccoli and spinach, dried fruit, baked beans, nuts and soya beans.

    For those that are not on a vegan diet, salmon and sardines are also a good source. 700mg daily is the usual dose but this rises to 1000-1500mg per day for those at higher risk of osteoporosis. The British Dietetic Association is a good resource for checking the amount of calcium in foods you can search on www.bda.uk.com/resource/calcium.html
  • 4. Up your Vitamin D
    This is essential for turning calcium into strong bones. There are three sources of this vital vitamin: sunshine, supplements and a few foods.

    Spending 15-20 mins a day in the sun after midday, from May to October. Exposing a reasonably-sized body area such as arms, face or legs, is all you need for the skin to make vitamin D. Make sure you go outside – the sun doesn’t have the same effect through a window. Take care not to burn.

    You can also find Vitamin D in egg yolks, mushrooms, oily fish like salmon and sardines, cod liver oil and some foods like cereals and margarines that have been fortified with Vitamin D.

    There are numerous vitamin D supplements you can buy from any pharmacy too. 400 units daily is the usual recommended dose. 
  • 5. Do regular weight bearing exercise
    Supporting the weight of your body can help stimulate the growth and strength of bones.

    High impact exercises like running, aerobics, skipping and tennis and low impact walking, dancing and stair climbing help too.

    The type of exercise you can do depends on your fitness level and other health issues, so take it slow and build up gradually.

    Aim for 30 mins a day. Any strengthening exercises will also help to keep muscles around the bones strong and keep your joints working well, which will help prevent falls in later life.
  • 6. Consider Hormone Replacement Therapy (HRT)
    HRT replaces oestrogen lost during menopause that causes the bones to thin.

    It’s been shown to preserve bone strength and reduce the risk of osteoporotic fractures in women over the age of 50. Most bone benefits are seen after taking it for more than two years.

    Many women are not keen on taking HRT, but it often carries a much lower risk than you realise and has other pluses too. Don’t dismiss it until you’ve understood the full facts around it (take a look at HRT explained on this site).

    Women going into an early menopause are also generally encouraged to replace their hormones with HRT until their fifties (this forms part of the NICE guidelines around preventing osteoporosis in these women).

    Of course, it’s vital you have a discussion with a doctor with a specialist interest in menopause before taking any form of HRT. You should talk about family history and individual health concerns/risks as it’s not appropriate for some women.
  • 7. Take bisphosphonates and other drugs
    These drugs can help strengthen your bones and reduce your risk of fractures – but are usually only prescribed when you’ve been diagnosed with osteoporosis via a DEXA (Dual Energy X-ray Absorptiometry) scan.

    Most women who can’t take HRT, or have had cancer and have osteoporosis, can be treated with these medications. There are different drugs and different ways to take them so talk to your doctor to get more information. 

Talk and take stock

Far too many older women have told me they wished someone had talked to them about menopause. They were never given the chance to discuss anything about it, and had to suffer it silently.

Don’t become one of these women.

Make sure you do talk about your experience. It really is a great time to take stock of your general health, lifestyle, exercise and diet and revolutionise how you look after yourself.

It’s up to you

Sadly, there are no routine checks for women in the NHS at this crucial stage in life, despite the enormous benefits it would bring for them.

I would therefore encourage all women to get educated about the menopause, to take charge and go discuss these issues with your doctor.

If they don’t listen – find a doctor that does. There are lots of menopause specialists out there that want this area to improve.

Having a good informed discussion with your doctor at this stage, and talking through all the options you have to improve your general health and manage your menopause symptoms is vital.

Decide how you want to be

Start thinking about how you want to be at an older age.

Actively planning long-term will allow you to enjoy your latter years and be much more likely to stay in good health.

I am sure every woman on the post-menopausal side would look back and tell her younger self to start early and look after her bones and general health.

Angela is the Co-Founder and Director of Spiced Pear Health. This new service aims to put women in charge of their menopause by talking women through information and options and then creating personalised treatment plans. Visit www.spicedpearhealth.co.uk

GEN M is on a mission to make sure every woman is clued up on what happens from the perimenopause, to the menopause and beyond. If you haven’t already, take a trip around our symptoms pages to see what could change for you mentally and physically as you age… and what you can do about it. Knowledge is power!

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