When you begin the transition to menopause, your first thoughts are likely to be about how to handle the symptoms, especially hot flashes and their nocturnal cousin, night sweats. But you’ll also want to consider your long-term health now. While the menopausal transition (and its unwelcome symptoms) doesn’t last forever—it averages three to five years—its effects can have lasting repercussions on your health.
Menopause increases your risk of chronic conditions such as heart disease, stroke and osteoporosis, and simply getting older bumps up the risk of breast cancer. And while hormone replacement therapy is the most effective treatment for menopause symptoms, it may also increase the risk of heart disease, stroke, blood clots and breast cancer.
While this may all sound a bit scary, it’s actually an opportunity to reevaluate your lifestyle and make changes that may be long overdue. “Your symptoms may be getting all your attention, but the menopause transition can be the perfect time to take a look at your overall health,” says Cynthia Geyer, M.D., medical director of Canyon Ranch in Lenox, Mass. “You can make choices now that will help keep you healthy for the next 40 or 50 years.”
Here’s how to protect your health as you begin the next stage of your journey:
The estrogen your ovaries produce before menopause affects nearly every tissue in your body, and it’s especially protective of your heart. Estrogen increases HDL cholesterol (the good kind), lowers LDL cholesterol (the bad kind) and relaxes, smooths and dilates blood vessels so that blood flow increases. The hormone helps keep the lining of your arteries—the endothelium—elastic and responsive. A healthy endothelium protects you from developing high blood pressure (a major cause of stroke) and cholesterol-laden plaque, which can lead to coronary heart disease. Although your ovaries can still produce small amounts of estrogen after menopause, the marked reduction means that your risk of heart disease climbs then. Simply getting older also plays a role, in part because type 2 diabetes—a major risk factor for heart disease—becomes more common with age. Here’s what you can do to offset these changes:
- Maintain a waist-to-hip ratio of less than 0.8. To calculate this, divide the circumference of your waist by the circumference of your hips at their widest. For example, if your waist is 33 inches and your hips are 42 inches, your ratio is 0.78, which is within the healthy range.
- If you smoke, work on quitting.
- Exercise regularly—at least 30 minutes five days or more a week.
- If you consume alcohol, drink in moderation: up to five drinks spread out over the course of a week. (One drink equals 5 ounces of wine, 12 ounces of beer or 1½ ounces of liquor.) Alcohol may protect the heart by increasing small amounts of HDL, reducing blood clots and fighting cell-damaging free radicals with antioxidants. But too many drinks can raise your level of triglycerides (a type of fat found in the blood) and blood pressure, not to mention pack extra disease-causing pounds onto your waist. (If you don’t drink, don’t start.)
- Eat a Mediterranean-style diet rich in olive oil, fish, nuts and seeds and low in saturated fat and high-glycemic foods.
This may sound like a lot to pay attention to, we know, but it’s worth it: In one study, women who adhered to all five of these habits were 80 percent less likely to have a heart attack and 90 percent less likely to develop diabetes than women who didn’t. “No drug on the planet can lower your risk to that degree,” Dr. Geyer says.
Other ways to improve the elasticity of your arteries include deep breathing, biofeedback therapy and a diet that includes plenty of foods rich in magnesium, folate, omega-3 fatty acids and phenolic compounds (found in deeply pigmented foods such as blueberries and pomegranates, as well as in green tea and dark chocolate).
Estrogen helps maintain bone density. During the five- to eight-year window around menopause, bone loss is accelerated, which can lead to osteoporosis and a higher risk of fracture.
To protect your bones:
- Aim for a calcium-rich diet that supplies about 1,200 mg of the mineral per day (1,000 mg if you’re younger than 51), preferably through foods. In addition to dairy foods, dark green leafy vegetables, fish, nuts and seeds are good sources. Greens are also rich in other nutrients your bones need, such as vitamin K, B vitamins and magnesium.
- Make sure you’re getting enough vitamin D, which helps your body absorb calcium. Sunshine, fortified dairy foods and oily fish like salmon all increase vitamin D levels, but many women still need supplements (1,000 to 2,000 IU daily) to get enough.
- Limit sodium, which mostly arrives on our plates in processed foods. “The more sodium you eat, the more calcium you lose in your urine,” Dr. Geyer explains.
- Incorporate weight-bearing exercises like walking, jogging and strength-training into your routine. In addition to bulking up your bones, exercise will help you control your weight, improve your heart health and mood, keep your brain sharp and reduce your breast cancer risk (more about that below). “It’s the closest thing we have to a magic bullet,” Dr. Geyer says.
Menopause itself doesn’t increase your risk of developing breast cancer, but simply having more birthdays does. A 30-year-old woman’s chance of developing breast cancer over the next 10 years is 1 in 227, but it jumps to 1 in 28 by age 60. A healthy lifestyle can lower your risk, though. Here’s what makes a difference:
- Getting your body mass index below 25 with diet and exercise. “The biggest factor for breast cancer that you can reverse is weight gain after menopause,” Dr. Geyer says. Fat tissue takes over estrogen production from the ovaries after menopause. Extra body fat from the weight we put on in middle age and beyond produces too much of the hormone, which promotes certain types of breast cancer. Those pounds also increase insulin levels, which may factor into whether some women develop breast cancer. The American Cancer Society recommends getting 150 minutes of moderate intensity exercise every week to reduce the risk of all cancers. A diet that includes more inflammation-fighting foods, like fish, healthy oils and antioxidants, may help protect your breasts while also keeping your weight in check.
- Eating folate-rich foods if you drink. “Alcohol is tricky, because moderate alcohol protects the heart but may increase breast cancer risk,” Dr. Geyer explains. This is especially true for women who are already at high risk, such as those with a family history. There’s evidence that folate, a B vitamin, reduces alcohol’s contribution to breast cancer risk. You can get dietary folate from leafy green vegetables and enriched grain products, as well as beans and legumes, dairy products, poultry, meat, eggs and seafood. You might also want to talk to your doctor about whether folate supplements could help you.