The lead-up to menopause can feel daunting—you may no longer have full control over aspects of your bodily health that you enjoyed in your 20s and 30s. But there are ways to prepare for that transition and offset the risk of the worst health outcomes.
Eating a balanced diet can slow down natural weight gain, thereby reducing the risk of obesity and diabetes. And regularly exercising to strengthen muscles and bones fortifies the body against osteoporosis and imbalanced body composition.
“Where you are health-wise going into menopause is really an important predictor of what your menopausal experience will be like and what your health will be like coming out on the other side of menopause,” said Carrie Karvonen-Gutierrez, PhD, MPH, an associate professor of epidemiology at the University of Michigan and an expert on women’s health and aging.
Menopause appears to be “having a moment” these days, Karvonen-Gutierrez said. Media reports are stirring renewed interest in hormone replacement therapy and medical educators are starting to push for more menopause education for providers. The market for menopause-related products could top $5 billion this year, according to a 2020 Female Founders Fund report.
With invigorated conversations about menopausal health, more young adults are looking to better prepare their bodies for the midlife transition.
Do You Need to ‘Balance’ Your Hormones?
Hormonal changes are the hallmark of the menopause transition. Most crucially, estrogen fluctuates, then drops.
Social media influencers increasingly tout the power of diet, a good night’s sleep, and supplements to cure hormonal “imbalances.” Their recommendations range from taking hormone-altering pills to decrease bloating to consuming specific seeds and herbal teas during perimenopause.
Hormones will change throughout a person’s life, such as when they undergo puberty or pregnancy, during periods of stress, or due to the use of certain medications. In these cases, focusing on sleep, diet, and exercise can naturally remedy the imbalance. Many supplements marketed as hormone-balancing use ingredients that can be found in food.
“There are a lot of people that are preying on women in terms of telling them that they need to correct something or balance something or take some extra hormones to correct this imbalance,” said Stephanie Faubion, MD, FACP, medical director of the North American Menopause Society. “It’s just a money-making thing that has no basis in science.
Patients concerned about their hormone levels could ask their health provider to order a laboratory test, Karvonen-Gutierrez said. A follicle-stimulating hormone (FSH) test or an anti-Müllerian hormone (AMH) test could help confirm if their symptoms are related to menopause, and could predict their final period up to five years in advance.
Hormone testing often isn’t useful for either premenopausal or perimenopausal people, because hormone levels fluctuate daily and the use of hormonal birth control can skew the results, according to Faubion. Besides, direct-to-consumer tests can be expensive and insurance providers won’t cover hormone panels for non-medical reasons.
In some cases, tumors, autoimmune conditions, and damage to endocrine glands can cause medically significant imbalances. That’s when it’s best to consult with a health provider about hormone supplements.
Once a person has entered perimenopause, they may seek hormone therapies to boost estrogen or testosterone levels, depending on their symptoms. But until then, most healthy individuals don’t need to try and alter their hormone composition, Faubion said.
Stephanie Faubion, MD, FACP
Many women feel some freedom as they go through menopause. They’re not worried about periods anymore. They’re not worried about getting pregnant… it can be an empowering time of transition.
— Stephanie Faubion, MD, FACP
Will Birth Control Speed Up Menopause?
Long-term hormonal birth control use doesn’t appear to delay or speed up menopause, according to Mary Jane Minkin, MD, a gynecologist specializing in menopause and a clinical professor at Yale School of Medicine.
“If you are on the pill, your ovaries will poop out as they would have without the pill,” Minkin said.
Karvonen-Gutierrez is an investigator for the 30-year-long Study of Women’s Health Across the Nation (SWAN) that explores the midlife transition. She agrees that there’s “not enough evidence” to indicate that hormonal contraceptive use in one’s younger years affects menopausal outcomes.
But nailing down how hormonal contraceptives may alter the menopausal process is challenging.
“We have studies that could look at that question, hypothetically, but the types of hormones that women who are now going through menopause might have taken in their late teens and early 20s are very different than the types of hormones that 20-year-olds today might be taking,” Karvonen-Gutierrez said.
Can a Certain Type of Diet Help With Menopause?
Maintaining a healthy lifestyle in the decades before the transition can significantly shape one’s peri- and postmenopausal experience. For instance, poor cardiovascular health in one’s reproductive years and a history of smoking are associated with earlier onset of menopause, according to the American Heart Association.
“[Women] really need to understand what their heart health is going into it and making sure they know what their lipids, sugar, and blood pressure are because the menopause transition increases that risk for everybody,” Faubion said.
As estrogen declines, cholesterol levels increase along with the risk of developing obesity and diabetes. Meanwhile, aging into midlife often comes with increased body mass and an accumulation of fat in the midsection.
There’s “no magic bullet” when it comes to premenopausal diets, Karvonen-Gutierrez said. Sticking to a balanced diet high in fruits and vegetables, lean protein, healthy fats, and whole grains is as important in the years before menopause as throughout one’s entire life.
Calcium is often singled out as important for pre- and postmenopausal women, as it can keep osteoporosis at bay. The National Institutes of Health recommends premenopausal females get 1,000 milligrams of calcium per day, preferably through dietary sources like dairy and green leafy vegetables. The recommended dose is 1,200 milligrams daily for females 51 years or older.
Getting adequate vitamin D by spending time outdoors helps the body to absorb that calcium.
What Kinds of Exercises Should You Do?
Menopause comes with a marked decrease in bone density, with the most significant changes occurring in the early years of menopause.
Weight-bearing exercises can help maintain bone health. Sports and activities that exert force on the skeleton, like dancing and running, keep bones strong.
“Walking is better than biking is better than swimming in terms of bone health,” Faubion said.
Muscle loss is an important issue for people in their menopause transition, too. Though body weight tends to increase for both males and females as they age, people who undergo menopause tend to see a faster decline in muscle mass due to their hormonal changes. So, while a peri- or postmenopausal person may stay the same weight, their ratio of fat to muscle could increase substantially.
It’s more important, Karvonen-Gutierrez said, to focus on getting to a healthy body composition than a certain weight. Resistance training, like lifting weights and using resistance bands, is particularly effective at helping people gain and maintain muscle.
“People all throughout their life, but women in particular through midlife and menopausal transition, can benefit from engaging in activities related to strength training and resistance training, both to maintain skeletal muscle mass but also to improve bone health,” Karvonen-Gutierrez said.
How Can You Prepare for Menopause Mentally?
It’s unrealistic for most people to be in pristine shape going into menopause. But tending to one’s general health and well-being and getting regular check-ups with a menopause-informed clinician can make a big difference, said Donna Klassen, LCSW, co-founder of the nonprofit Let’s Talk Menopause.
“You have to put the life jacket on yourself before you can help others,” Klassen said.
Faubion said people need not dread their middle and post-menopausal years. It’s not necessary to go into menopause running for fear that the transition is “just going to slow you down.”
“Many women feel some freedom as they go through menopause. They’re not worried about periods anymore. They’re not worried about getting pregnant,” Faubion said. “It can be an empowering time of transition.”
There’s still a lot that scientists don’t yet know about menopause, including how it affects people with certain conditions like autoimmune disorders, how socioeconomic disparities shape menopausal outcomes, and how environmental toxins alter hormones.
“Given changes in the population and the environment over the last 30 years, does menopause today look like it did 20 or 30 years ago? I would argue that that’s probably not the case,” Karvonen-Gutierrez said.
For those approaching midlife, meeting with a provider who is versed in menopause can be key for wading through the noise and finding care options that work for them.
“This is a seminal life event for more than half of our population and it’s really important that we give it the space and the attention that it deserves to help inform individuals about how to manage their menopause and understand what is happening,” Karvonen-Gutierrez said.
What This Means For You
If you are entering perimenopause or are feeling symptoms of menopause, it can help to see a provider who is trained in menopause care to walk you through your options. You can find a certified menopause practitioner or a member of NAMS on this directory.