Navigating Your New Normal in Post-Menopause

Written by: Victoria Biddick

• NZ Associate Registered Nutritionist (ARNutr)
• BAppSc (Human Nutrition), BAppSc (Food Science)

The advice below is general advice. For any specific tailored advice relevant to any health conditions, please talk to your health professional.

Twelve months since your last period?

Congratulations, you made it! It's time to get off the rollercoaster of perimenopause and arrive at the more stable destination of post-menopause. No more periods and, fingers crossed, an easing up on symptoms such as brain fog, mood swings, and extreme tiredness.

Some of the changes you experienced during peri-menopause will remain and become your new normal. If you've made some lifestyle adjustments along the way to accommodate these, keep maintaining them. If not, it's time to get started on changes to support your health and wellbeing so you can age awesomely and live your best midlife and beyond.

“Menopause is not the end of life. It’s the beginning of a new one.” – Jane Fonda, actress and activist.

What’s different in post-menopause?

In the first one to two years after your last period, hormonal fluctuations of Oestrogen continue. You might still experience hot flushes, or they could start during this time (1). If this sounds familiar, you can read more here: Feeling Flushed: Understanding and Managing Hot Flushes.

By the third year, Oestrogen and other female sex hormones stabilise, returning to pre-puberty levels. This often leads to a reduction in symptom unpredictability, and you may feel more settled.

As you transition into late-stage post-menopause (year six and beyond), body changes experienced during the menopause transition may become your new normal. In this stage, you might develop vaginal dryness and urogenital atrophy, affecting the bladder, urethra, and vagina (1). Kate Hines, Pelvic Physio, delves into pelvic health in this great article here: Pelvic Health and Perimenopause.

We’re also a little bit older, and the process of aging continues to have an impact on our bodies. Our cells have some general wear, tear, and damage, the immune system starts to slow down, and we begin to experience chronic low-grade inflammation, known as inflammaging (2).

Our metabolic hormones such as thyroxine and insulin, which are responsible for converting nutrients into energy and regulation of energy levels, also decline (2).

Post-menopause impact on health and wellbeing

During post-menopause, the loss of oestrogen's protective benefits can significantly impact health and wellbeing. Oestrogen, which played a crucial role during childbearing years, influences many bodily processes beyond just reproductive organs.

While each woman faces unique risks based on genetics and other factors, it's important to be aware of and take steps to protect against common health conditions that may become more prevalent after menopause. By staying informed and proactive, you can navigate post-menopause with vitality and strength.

Osteoporosis

One in three women over 50 will develop osteoporosis, a condition where bones become thin, weak, and more prone to fractures (3). Oestrogen helps prevent bone loss, but in the year before and about three years after the final menstrual period, bone loss accelerates. Often, osteoporosis symptoms are invisible and only detected after a fracture occurs.

What to do about it:
• Consult Your GP: If you have a family history of osteoporosis, discuss screening options like DEXA X-ray and preventative medications, including HRT, with your GP.
• Lifestyle Changes: Consider quitting smoking and limiting alcohol consumption.
• Dietary Calcium: Ensure you consume adequate dietary calcium (4 servings daily). Excellent sources include low-fat dairy products, chia and sesame seeds, almonds, leafy greens, broccoli, and fish with bones like salmon or sardines.
• Vitamin D Optimisation: Vitamin D helps your body absorb calcium. Get enough sunlight and include vitamin D-rich foods like fatty fish, egg yolks, and fortified foods in your diet. Consider supplementation during winter months when sun exposure is limited.
• Weight Bearing Exercise: Engage in exercises that require muscles and bones to work against gravity, such as walking, stair climbing, jogging, volleyball, tennis, dancing, or strength/resistance exercises like free weights. Kate Ivey Fitness offers great advice on midlife exercise and has a specific fitness programme for peri to post menopause women called Thrive.

Heart Health

Oestrogen keeps blood vessels healthy and dilated so blood can travel freely around the body. As oestrogen levels diminish, the risk of high blood pressure increases, which can damage blood vessels and increase the risk of heart disease, the number one cause of death in New Zealand women (4). Without oestrogen, low-density lipid cholesterol (LDL) or “bad cholesterol” increases. When you have too much LDL cholesterol, it builds up in the arteries and can cause a heart attack or stroke (4).

What to do about it:
• Consult Your GP: If you have concerns about your heart health or a family history of heart issues, speak with your GP. They can discuss risk factors, check your blood pressure, and may refer you for blood tests to check cholesterol levels.
• Adopt a Wholefood Diet: Focus on eating a diet rich in vegetables, fruits, quality proteins, whole grains, low-fat dairy, and healthy fats. For more information, you can read our articles on eating for health and wellbeing and smart food swaps for perimenopausal wellbeing here.
• Stay Active: The Heart Foundation of New Zealand advises us to sit less and move more every day to improve your heart health (4). Aim for at least 2.5 hours (150 minutes) of moderate-intensity physical activity each week. Moderate-intensity activity makes you breathe harder than normal but still able to talk. Or you can try to do 75 minutes of vigorous-intensity physical activity each week. Vigorous-intensity activity makes it hard to say more than a few words (4).
• Quit Smoking and Limit Alcohol: Consider giving up smoking and reducing alcohol intake, as this can significantly improve your heart health.

Type 2 Diabetes

During and after menopause, several physical changes can increase the risk of type 2 diabetes and other metabolic health issues. As we age, our metabolism slows down, meaning we burn energy from food at a slower rate. Declining oestrogen levels accelerate muscle loss, which is a natural part of aging. Since muscle mass burns energy faster than other cells, this reduction can impact our overall metabolism (2). Additionally, changes in insulin levels make it harder to break down and absorb carbohydrates, increasing the risk of type 2 diabetes. A slower metabolism can also lead to weight gain, and as oestrogen signals weaken, fat tends to redistribute to the belly area, which is associated with a higher risk of type 2 diabetes and heart disease (4).

What to do about it:
• Consult Your GP: If you experience increased thirst, frequent urination, tiredness, or rapid weight changes, check in with your GP. They can provide guidance and may refer you to a health coach, a registered nutritionist like Victoria Biddick Nutrition, or a dietitian for support and advice.
• Rebalance Your Diet: You may need to adjust your daily food intake. For more details, see our article on Rebalancing Energy Requirements in Perimenopause here.
• Incorporate Midlife-Specific Workouts: Include exercises that address midlife changes such as muscle loss and fat distribution. Prioritise lifting heavy weights and incorporate Short Intensity Interval Training (SIIT) and High Intensity Training (HIT) into your routine. For more details, see the Q&A session from our Embrace the Change webinar here.
• Consider Quitting Smoking and Limiting Alcohol.

Everee Women™ #4 Post-menopause Support is a new product being launched mid-March, designed specifically for women embracing their post-menopausal years. Featuring Ovitage® Collagen and boosted by the clinically proven cGP-PRo® extracted from New Zealand blackcurrant, this protein powder is rich in specific amino acids ideally suited to boost the body’s ability to deal with the challenges of post-menopause, from brain function through to metabolic health and muscle maintenance. More information can be found here plus you can pre-order yours for delivery mid-March: Everee #4 - Post Menopause.

Post-menopause is the perfect opportunity to make positive changes for the next chapter of life. As Susan Sarandon aptly put it,

“I think the key to understanding menopause is that it’s not an end, it’s a reset. You have to re-frame your approach to health and wellness to maintain your vitality.”

Embrace this reset with enthusiasm and determination. You have the power to shape your future, and every positive change you make now will pave the way for an awesome next chapter. You've got this! 🌟💪

References

1. Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., de Villiers, T. J., & STRAW + 10 Collaborative Group (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism, 97(4), 1159–1168. Link
2. Whitney, E., Rolfes, S., Crowe, T., & Walsh, A. (2019). Understanding Nutrition (4th ed.). Cengage Learning.
3. Australasian Menopause Society (2023). Osteoporosis. Link
4. Heart Foundation NZ (2023). Why does menopause increase the risk of heart disease? Link