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Lifestyle advice for healthy ageing

Menopause is a normal part of ageing. With increasing age the risk of many common illnesses increases. Optimising health at menopause may help to improve healthy physical and emotional health into older age.

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The loss of oestrogen at menopause brings with it adverse changes in cardiovascular and osteoporosis risk as well as more immediately recognisable changes, such as hot flushes and genitourinary atrophy. (For advice on treating symptoms of menopause (Refer to AMS information sheets - Combined Menopausal Hormone Therapy (MHT), Menopause - Oestrogen Only Therapy, Vaginal Atrophy - a Change with Menopause, NonHormonal Treatments for Menopausal Symptoms).

Women can expect to spend about 40% of their lives after passing the menopause. Whether or not a woman decides to take hormone therapy for a short or a long time, menopause is an important and opportune time for re-assessment of the lifestyle factors which will have an impact on healthy ageing. Women who elect to continue on oestrogen therapy as they age can also expect to have a reduced risk of osteoporotic fractures (Refer AMS information sheet Osteoporosis).

Weight gain at menopause

Between the ages of 45 and 55 women gain on average half a kilo a year. A comprehensive review by the International Menopause Society has determined that this weight gain is not caused by menopause1. However, the decrease in oestrogen levels at menopause is associated with the way fat is deposited, leading to more abdominal fat. Obesity and increased abdominal fat are major risk factors for a variety of diseases including diabetes and heart disease. Women need to be aware of these changes and adjust their food intake and exercise accordingly to prevent weight gain.

The review paper1 also notes that hormone replacement therapy (HRT) does not cause women to gain weight. There is good evidence that HRT can prevent abdominal fat after menopause.

Exercise for well-being

Physical activity and exercise may improve general health and quality of life. National guidelines for physical activity advise 150-300 minutes of moderate physical activity each week2. Exercise does not reduce vasomotor symptoms3. Moderate exercise incorporates activities such as: brisk walking, cycling, tennis and golf. See section below on aerobic activity. Women should incorporate three types of activities into a weekly fitness plan: Aerobic exercise, flexibility training, and strength training. Exercise regimens should be modified according to each woman’s needs and consultation with a physiotherapist is often helpful.

Aerobic activity:

Best form of exercise for the cardiovascular system

Helps endurance but also helps burn fat e.g. walking for 30 minutes or jogging for 18 minutes burns 840 kJ.

  • Vigorous aerobic exercise includes jogging, brisk walking, cycling, tennis, aerobic class, dancing, martial arts, skipping rope
  • Even activities such as climbing stairs, walking the dog, golf, gardening and playing with the children gives a light aerobic workout 

Flexibility training:

This form of exercise improves balance and provides muscle flexibility.

  • Stretching is the simplest and easiest way to improve flexibility and agility
  • Yoga and pilates can be effective forms of stretching and flexibility training

Strength training/weight bearing:

This form of exercise builds muscle tone, endurance and can help with maintenance of bone density, especially the peripheral skeleton. Care should be advised about extreme weight training and vaginal prolapse4

Exercise benefits in many other ways:

1. Increases good (HDL) cholesterol levels

2. Reduces total cholesterol, triglycerides and may reduce blood pressure

3. Burns up kilojoules, to lose or maintain weight more easily

4. Increases endurance

5. Improves muscle tone and coordination

6. May reduce anxiety, depression and emotional stress

7. Builds a support group when done with friends

8. Improves balance reducing the risk of falling and fracture

9. May increase self-esteem and well-being

Exercise to reduce the risk of osteoporosis:

The best exercises to help reduce the risk or slow down osteoporosis are weight-bearing exercises such as power walking and strength training that include gravity and tension on muscles.

Eating to promote good health

A healthy balanced diet should contain the right proportion of carbohydrates, protein and fats and no more than 6300 to 7300 kilojoules (1500 to 1800 calories) per day.

1. To maintain weight: consume 6300 to 6700 kJ (1500 to 1600 calories) per day.

2. To lose weight: consume 5450 to 5900 kJ (1300 to 1400 calories) per day.

3. Three main meals and two protein containing snacks per day

4. Smaller portions

5. More oily fish

6. Restrict meat intake

7. Use less fat and sugar

See Table 1: Food Groups for a list of the major food groups, their function and source. 

Table 1: Food Groups

Food group

 Daily requirements

 Why needed

 Food sources

Carbohydrates

50-65% of daily kJ

Provide energy

Bread, cereals, pulses, fruit, sugar

Proteins

10-20% of daily kJ

Build tissue and muscles

Meat, fish, chicken nuts, seeds and dairy products

Fats

20-30% of daily kJ

Supply fatty acids, help fat-soluble vitamin absorption, provide energy

Meats, dairy and plant foods

Fibre

Up to 40 g per day

Improves digestion, prevents constipation

Cereals, wholegrain products, fruits and vegetables

Alcohol and tobacco consumption:

  • Experts recommend no more than two standard drinks of alcohol per day for women, with at least two alcohol-free days per week. Alcohol increases the risk of breast cancer in women5 and the risk increases with increasing consumption. For every additional standard drink consumed per day there is a 7-10% increased risk in breast cancer6,7.
  • Advise cessation of smoking and provide psychological or medication support.

Reducing the risk of osteoporosis

Loss of oestrogen after menopause leads to loss of bone density and increased fracture risk. The absolute risk of fracture depends on the premenopausal bone density and the rate of bone loss. Hormone therapy after the menopause will reduce the risk of bone loss (Refer AMS information sheet -Osteoporosis) but attention to dietary calcium intake and exercise is also important.

Post-menopausal women should consume 1200 to 1500 milligrams (mg) of calcium each day, preferably with the intake spread throughout the day. To improve absorption of calcium, 400 International Units (IU) of vitamin D a day is needed. Although, theoretically, 10 to 15 minutes of sunshine daily should provide sufficient vitamin D, lifestyle factors, such as indoor habitus, clothing styles, sun-block skin foundation, mean that many women in Australia and New Zealand may be vitamin D deficient and vitamin D supplements may be required.

See Table 2: Calcium Sources for the major sources of calcium. Dairy foods are by far the best means of obtaining sufficient dietary calcium. If a woman cannot maintain the recommended dietary intake of calcium, supplements may be recommended (Refer AMS information sheet -Calcium Supplements).

Table 2: Calcium Sources

Type of food

 Amount

 Calcium content

Milk (Lower fat milks may contain more calcium)

250ml

285 mg

Yoghurt, tub

200g

340 mg

Cheddar cheese (Harder cheeses may contain more calcium)

35g

275 mg

Almonds

100g

220 mg

Brazil nuts

100g

150 mg

Peanuts, roasted and salted

100g

40 mg

Salmon, pink with bones, canned

100g

310 mg

Silverbeet

100g

70 mg

Spinach

100g

50 mg

Apricots, dried

50g

35 mg

Orange, medium

 

50 mg

References

1. Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, Villaseca P. Understanding weight gain at menopause. Climacteric. 2012 Oct;15(5):419-429. doi: 10.3109/13697137.2012.707385.

2. www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

3. Cochrane Database Syst Rev. 2011 May 11;(5):CD006108. doi: 10.1002/14651858.CD006108.pub3.

4. Jelovsek JE et al Pelvic organ prolapse. Lancet. 2007 Mar 24;369(9566):1027-38

5. Corrao G, Bagnardi V,Zambon A,Arico S. A meta-analysis of alcohol consumption and the risk of 15 diseases. Preventive Medicine. 2004 38, 613-619

6. Hamajima N, Hirose K, Tajima K, et al. Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. British Journal of Cancer 2002;87(11):1234-1245.

7. Allen NE, Beral V, Casabonne D, et al. Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute 2009;101(5):296-305.

AMS New directions in women's health

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content created June 2014

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