The average woman today has more than one-third of her life ahead of her after menopause. The menopausal transition is a good time for lifestyle changes that can help women make the most of the coming years.
You know about quitting smoking, exercising regularly and working toward a healthy weight. Still there’s more you can do to stay healthy after menopause and to avoid health conditions which are more common after menopause.
A balanced diet will give you most of the nutrients and calories your body needs to stay healthy. Eat a variety of foods from the five major food groups. Look for foods that have lots of nutrients, like protein and vitamins, but not a lot of calories. These are called nutrient-dense foods. As you grow older, you need fewer calories for energy, but just as many nutrients.
The USDA Food Guide is one eating plan suggested by the Federal Government’s Dietary Guidelines for Americans, 2005. Another eating plan also suggested in the Dietary Guidelines is DASH, Dietary Approaches to Stop Hypertension.
The number of calories a woman over age 50 should eat daily depends on how physically active she is. Basically you need:
- 1,600 calories, if your physical activity level is low
- 1,800 calories, if you are moderately active
- 2,000-2,200 calories, if you have an active lifestyle
The more active you are, the more calories you can eat without gaining weight.
Eating the foods recommended in the USDA Food Guide or in DASH will help you get needed nutrients. But, people over 50 have trouble getting enough of some vitamins and minerals through diet alone, including calcium and vitamin D (see "Postmenopausal Health Concerns"). Just remember that these recommendations include how much of each nutrient you get from food and drinks as well as any supplement you use. Women past menopause who are still having a menstrual cycle because they are using menopausal hormone therapy might need some extra iron over the 8 mg (milligrams) recommended for women over age 50. Iron, important for healthy red blood cells, is found in meat, duck, peas, beans, and fortified bread and grain products.
Women over 50 also need more of two B vitamins. Getting 2.4 mcg (micrograms) of vitamin B12 per day will maintain the health of your blood and nerves. Some foods, such as cereals, are fortified with this vitamin. Vitamin B12 is also found in red meat and, to a lesser extent, fish and poultry. But, up to one-third of older people can no longer absorb natural vitamin B12 from their food. Furthermore, common medicines taken to control the symptoms of GERD (gastroesophageal reflux disease), also known as acid reflux, slow the release of certain stomach acids and, therefore, interfere with the body’s absorption of vitamin B12. You might need a supplement if you have GERD.
Another B vitamin, B6, helps your body breakdown proteins and make hemoglobin, a part of red blood cells. Women should have 1.5 mg of vitamin B6 daily. This vitamin is found in fortified cereals, as well as meats, legumes, and eggs.
Don’t forget to drink plenty of fluids, especially water. If you drink alcohol, do so in moderation—for a woman, only one drink a day according to the Dietary Guidelines for Americans. A drink could be one 12-ounce beer, 5 ounces of wine, or 1½ ounces of 80-proof distilled spirits.
Practice Preventive Health Care
Eating well, exercising, and not smoking are things you can do for yourself to stay healthy as you get older. It is also important to discuss your goals for healthy aging with your doctor. He or she may be able to help you prevent health problems or recognize problems early when they are probably easier to manage.
Here are some other ways work with your doctors to stay healthy.
- See your doctor. Continue to visit your doctor regularly. When you meet with any doctor, be prepared to discuss your family medical history. You might be at increased risk for certain diseases, like diabetes or heart disease, if other close family members had them. Knowing about this family history will help your doctor decide whether you need any screening tests, like cholesterol or blood sugar tests, more often or earlier than other people your age.
- Have routine screening tests, pelvic and breast exams, and a Pap test for cervical cancer. After age 50, you need to be checked for colon cancer, and don’t forget your mammogram every 1 to 2 years, especially if you are still using menopausal hormone therapy. And remember to talk to your doctor about whether or not you are at risk for osteoporosis and what types of physical activity are best for you.
- Check your skin every month for unusual blemishes, especially moles that seem to change size, shape, or color. Have your doctor look at your skin during checkups. Use sunscreen, SPF 15 or higher, when you are outside during the day. Try to stay out of the sun when it is strongest—from about 11 a.m. until 3 p.m.
- See your dentist once or twice a year. Not only will he or she clean your teeth, but the dentist will also check for cavities and gum disease. If you have dentures, you should still see a dentist periodically to check their fit and to look for gum problems.
- Check your eyes. As you age, reading may become harder. You may need to hold things farther away in order to see them clearly. Reading glasses might help. Start regular visits to an eye care professional, who can check for glaucoma. This eye problem becomes more common after your forties. In glaucoma there is increased pressure on the optic nerve. The pressure can permanently damage your vision before you realize you have glaucoma. Special eye drops often control it.
- Manage your medications. Make sure all your doctors know which medications you are taking. This includes vitamins, minerals, other dietary supplements, and over-the-counter medicines like aspirin, antacids, or antihistamines. Some of these may change how your prescription medicines work; others might not be safe for you to use at all. If your health care professional prescribes a medicine, take it as directed. Make sure you understand the possible side effects of the prescribed medicines. Some drug stores or mail order services keep a computer file of all your prescriptions so they can check for possible drug interactions if a new medicine is added. That is a benefit of getting all your medicines from the same place. But the pharmacist still doesn’t know what nonprescription medicines and supplements you are taking, so it is important to keep your doctors informed.
- Get vaccines. If you are over age 50, you should get a flu shot every fall, especially if you have other health problems. The Centers for Disease Control and Prevention (CDC) recommends that people over age 65 get the pneumococcal pneumonia vaccine—most need it only once. You should also have a tetanus shot every ten years, or sooner if you have an injury that puts you at risk for getting tetanus. Tetanus or lockjaw is a serious, painful infection that causes muscles all over the body to tighten. A vaccine to prevent shingles is now available. Most adults 60 years and older should get one dose. Check with your doctor to see what you should do.
- Listen to your body. Don’t wait for your next checkup if you notice any suspicious changes in your body—swelling, unexpected weight loss or gain, persistent pain, unexplained fevers, a cough that won’t go away, or recurring headaches, for example. Check with your doctor about any of these symptoms.
Certain health conditions are more common in postmenopausal women. These include osteoporosis, heart disease and urinary problems.
Osteoporosis is a condition in which bones become very weak and can break easily. Often, the first sign of osteoporosis is a bone that cracks, sometimes after just straining or twisting. Bone is constantly changing, removing old bone and adding new bone. Because estrogen plays an important part in building new bone, the decline in estrogen starting with menopause leaves many older women at risk for developing osteoporosis.
In fact, half of American women over the age of 50 will probably have a bone break or fracture later in life because of osteoporosis. For too many, the broken bone, especially if it is a hip fracture, will mean they can no longer live independently. Broken bones because of osteoporosis are also common in the wrist and spine. Breaks in bones of the spine (vertebrae) are especially serious as this can lead to curvature of the spine, loss of height, and pain. A broken hip or wrist is often the result of a fall, but for a woman with osteoporosis in her spine, bending over or coughing strongly can be enough to cause a broken vertebra.
Some women are more at risk of developing osteoporosis than others. Risk factors, things that increase your chance of developing a health problem, include:
- a family history of osteoporosis
- a broken bone while an adult
- surgery to remove both ovaries before natural menopause
- early menopause
- insufficient calcium throughout life
- extended bed rest
- long-term heavy drinking
- using certain medicines, such as glucocorticoids or some anticonvulsants, for long periods of time
- being thin or having a small body frame
If you have any of these risk factors or are concerned about the health of your bones, talk to your doctor about what you can do to protect them.
There are steps you can take to prevent osteoporosis after menopause. The first step in preventing osteoporosis is to build as much bone density as possible by age thirty. After that age, some people may begin to lose bone strength. In women, bone loss picks up speed around the time of menopause and slows again a few years later. But bone loss continues into old age. So, if you have daughters or granddaughters, encourage them to exercise and get plenty of calcium and vitamin D while they are younger.
Keeping the bone strength you have at menopause is the next step in preventing osteoporosis. Exercise and a proper diet helped build bone early in life. Those same actions can help maintain its strength or slow its loss now. Regular weight-bearing exercise (such as walking, running, stair climbing, or using weights to exercise) at least three or four times a week can help keep your bones strong. Strengthening and balance exercises can help you avoid falls which could cause a broken bone.
You can also preserve bone density by eating foods rich in calcium and vitamin D or, if needed, taking calcium and vitamin D supplements. Foods high in calcium include milk and milk products (low-fat ones are probably best), canned fish with soft bones such as salmon, dark-green leafy vegetables, and foods with calcium added, like orange juice, bread, and cereals.
If you think you may not be getting enough calcium in your diet, talk with your doctor before trying a calcium supplement. But be careful. Too much calcium can also cause health problems.
Vitamin D Recommendations
Your body uses vitamin D to absorb calcium. Getting between 5 and 30 minutes of sunlight outdoors twice a week will help your body make the vitamin D it needs. But people over the age of 50, especially those who live in northern urban areas, may not be exposed to enough sunlight year round to make enough vitamin D. Cereals and milk fortified with vitamin D, as well as eggs and fatty fish, are good sources of this vitamin.
Lifestyle changes can also help protect your bones. If you smoke, preventing bone loss is yet another reason to stop. Women who smoke also seem to go through menopause about 1 1/2 to 2 years earlier than those who don’t smoke. And, if you drink alcoholic beverages, be careful how much you drink. Having too much alcohol might cause you to fall and break a bone in addition to other serious health problems.
How will you know if exercise, diet, and lifestyle changes are protecting your bones? If you are over age 65 or if you are 60 to 64 and have any of the risk factors described earlier, don’t wait for a broken bone to find out if you have osteoporosis. Talk to your doctor about a bone density test, perhaps a DEXA-scan (dual-energy x-ray absorptiometry), to find out how solid your bones are. Two spots at high risk for fracture will probably be checked—hips and spine.
Sometimes exercise, diet, and lifestyle changes are not enough, and medicines are needed. Medications include bisphosphonates, raloxifene, estrogen, calcitonin, and parathyroid hormone. Some of these build up bone density. Others prevent further bone loss. Talk to your doctor to find out which would be best for you.
Common cardiovascular diseases include a narrowing and hardening of the arteries (atherosclerosis), chest pain that happens when not enough blood is getting to the heart (angina), heart attack, and stroke. High blood pressure (hypertension) is a strong risk factor for cardiovascular disease and stroke.
Many women think, wrongly, that only men need to worry about cardiovascular disease. Heart disease and stroke affect women too. Women seem to be protected from these diseases until after menopause when this protection fades. While many women fear breast cancer, in fact heart disease kills 11 times more women every year. That is why it is so important for women to take steps to reduce their risk.
Make sure your blood cholesterol (a fatty substance in the blood), blood pressure, and blood sugar are at normal levels. Regular medical checkups will show whether your results are at normal levels (see chart below). If your blood pressure or blood sugar is too high, follow your doctor’s advice to control it. Uncontrolled blood pressure or blood sugar can also lead to heart disease, including a heart attack. Blood sugar that is too high also puts you at risk for diabetes, another strong risk factor for cardiovascular disease.
Around the time of menopause, total cholesterol, LDL (low-density lipoprotein) cholesterol, and triglyceride levels may go up, and your HDL (high-density lipoprotein —the so-called “good” cholesterol) level may go down. High levels of LDLs can, in time, lead to blocked arteries. In turn, blocked arteries can result in a heart attack or stroke. High triglycerides can be another sign that you are at risk for heart disease or diabetes. HDLs (think of H as in healthy) help keep your arteries clear, so that blood can flow freely. Get treatment for high LDL, cholesterol, and triglyceride levels to lower your risk of having a stroke or heart attack.
High triglycerides can also be a sign of metabolic syndrome, a group of conditions that put people at risk for heart disease and diabetes. These include obesity, low HDL level, high blood sugar, insulin resistance (a condition in which the muscle, fat, and liver cells do not properly use the insulin produced by the pancreas), and high blood pressure. Metabolic syndrome is also sometimes called syndrome X. If your doctor says you have metabolic syndrome or if he or she is worried that you might be at risk for it, consider changing your lifestyle.
At a regular checkup your doctor will look for five signs of metabolic syndrome:
- Waist size greater than 35” in women
- Blood pressure reading of 130/85 or higher
- Fasting blood sugar of 100 mg/dL (milligrams/deciliter) or higher
- High triglycerides (over 150 mg/dL)
- Low HDLs (less than 50 mg/dL in women)
Having only one of these signs can put you at risk for heart disease or for diabetes. If you have at least three of these, you have metabolic syndrome. People with metabolic syndrome are now known to be at much greater risk of heart disease, stroke, and type 2 diabetes.
Preventative Cardiovascular Care
Lifestyle changes—not smoking, avoiding second-hand smoke, exercising, and following a healthy diet—can also help prevent heart disease. Not smoking or quitting, if you do, will also protect your bones and greatly lower your risk for cancer, especially lung cancer. Work with your doctor to set up a plan to lower your risk of heart disease.
Being physically active at least 30 minutes almost every day will help lower your risk of heart disease. You don’t have to be active all at one time. For example, try ten-minute intervals three times a day. Exercise should include endurance, also known as aerobic, activities—the kind that gets your heart pumping, like walking, running, swimming, tennis, or bike-riding.
If you are just beginning to exercise, start slowly. Maybe begin by taking the stairs whenever possible. First walk up one flight of stairs and then add more when you can. When shopping, don’t look for the closest parking space—choose one farther away from the stores to add more walking to your day. Or, don’t use the bus or subway to go one stop—walk instead. Almost anyone, at any age, can start being more physically active. You might check with your doctor if you aren’t used to energetic activity or you have a chronic health problem or a family history of early heart disease.
Heart-healthy nutrition starts with less fat in your diet and more fruits, vegetables, and whole-grain foods. By using nonfat or lowfat dairy products, you can still get the calcium you need for your bones while taking care of your heart. Fruits and vegetables are generally low in unhealthy fats, unless fat is added during cooking.
Keeping a healthy weight will also help prevent heart disease. Exercise and a heart-healthy diet should help you do that. More than 30 minutes of moderate physical activity on most days are needed if you want to lose weight—experts recommend 60 minutes daily. Watching portion sizes when you eat is important. So is limiting added sugars, including drinks like sodas, juices, fruit drinks, and alcohol. And get enough sleep. Some studies show that women who get the least sleep gain the most weight.
These lifestyle changes—exercise, a heart-healthy diet, and weight control—will also help prevent or reverse metabolic syndrome. This, in turn, will lower your risk for heart disease, stroke, or type 2 diabetes—major causes of illness and death in older women.
Urinary problems such as frequent infections and urine leakage sometimes also develop at this time. While these changes are not unusual, they are not necessarily related to menopause. You should still see your doctor, who may be able to help you control any of these problems.
When women have problems controlling their bladder, especially as they grow older, that’s called urinary incontinence, and there are several types. If you have stress incontinence, you might leak urine when you sneeze, laugh, cough, or step off a curb. Overflow incontinence means there is a problem emptying the bladder, so you might leak urine because your bladder is always full. Urge incontinence means you can’t hold the urine until you get to the toilet. Somewhat similar is functional incontinence, in which you can’t get to the toilet in time because physical problems keep you from moving quickly.
Urinary incontinence is treatable—don’t try to ignore it or to just live with it. Many things cause urinary incontinence, including muscle weakness, nerve damage, or infection. Your doctor can decide on the cause and suggest the most effective treatment. This might include bladder control training, medicines, implants, or surgery.
Practice Safe Sex
After menopause, some women may think they needn’t worry about sexually transmitted diseases. But, any woman, regardless of her age, who is not in a long-term relationship with a faithful partner and has unprotected sex, is at risk of sexually transmitted disease. If you have more than one sexual partner or have recently begun dating again, you need to be aware of the risk of these diseases and take necessary precautions to make sure you don’t become infected.
The list of familiar and unfamiliar sexually transmitted diseases includes syphilis, gonorrhea, Chlamydia, genital herpes, human papillomavirus/genital warts, and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). Some can be cured—Chlamydia, syphilis, and gonorrhea. But some—genital herpes, human papillomavirus/genital warts, and HIV/AIDS—can’t. Being informed about HIV/AIDS is critical because an HIV infection that develops into AIDS is life-threatening. HIV/AIDS can be treated, although not cured, and new drugs enable people to live longer with HIV/AIDS.
HIV is found in body fluids such as blood, semen, and vaginal secretions. The virus can enter your body through any opening in the skin. Postmenopausal women are at special risk because of the fragile tissues of the vulva (the external female genital area around the opening of the vagina) and the lining of the vagina. These delicate tissues may be more susceptible to virus-infected fluids. Don’t be afraid to talk to your partner or potential partner about HIV/AIDS. Ask if he or she has been tested for HIV recently.
This new phase of your life can be as busy and fulfilling as you would like to make it. Stay active—not only physically, but also mentally. If you don’t work outside of the home, you might consider getting a part-time job or volunteering with a nonprofit organization. You might find a hobby or learn to play a musical instrument. Maybe you would enjoy taking a class at a local community college or even working toward a degree. You could join a book group or learn to garden.
This is the time to do something you always wanted to try, but never had the time before. Or maybe now is a good time to reconnect with an interest you had when younger.
While exploring new things and keeping active, try to avoid adding stress to your life. Stress can make it harder to deal with the symptoms of menopause. Mid-life can be a complex time for many women. For example, if you have a family, there are probably changes at home—maybe you now have an “empty nest” because your children are leaving home for college, work, or marriage. Maybe you have young children who are still in need of attention, which can be extra challenging if you are tired because you aren’t sleeping well at night.
Other possible stresses come from outside the home. If you work, you may be taking a different look at your career, starting to think about retirement, or feeling challenged by younger coworkers. Or, your parents may be having health problems that now need your attention. Maybe a combination of such challenges is causing you stress.
How do you know you are feeling stressed? Perhaps you feel overwhelmed by life, depressed, or anxious. Do your shoulder muscles feel tight? Do you sometimes realize your hands are clenched? Do you wake up with a sore jaw because you are grinding your teeth or tightening your jaw as you sleep? Do you have headaches, stomach problems, fatigue, trouble sleeping, or high blood pressure? These can be signs of stress.
Avoid stress as much as possible. That might be very hard to do if you are a caregiver—whether of a child or an adult. Try to identify the times when you feel overwhelmed so you can try to keep those situations to a minimum. Take time to relax, eat well, exercise regularly to release tension and feel better overall, and keep in touch with family and friends. Try to find activities that may help get your mind off things that stress you. Maybe even try relaxation breathing or meditation. Get enough sleep. Don’t be reluctant to ask for help when you need it—from family or friends or even from a professional counselor.
Keep in mind the possibility of saying no when asked to do something that you think will add to your stress, and try not to feel guilty afterward. Some women find accepting the fact that there are some things in life that they can’t change is helpful. Set realistic goals for what you want to get done. Talk to friends or family members who might be going through similar life changes. Sharing ideas about how to handle common new responsibilities like taking care of aging parents might be helpful to everyone.
The menopausal transition is a natural stage for every woman who is in her forties or fifties. If you have no symptoms or if you aren’t bothered by the symptoms you have, there is nothing you need do. But, if hot flashes, night sweats, or vaginal dryness are making you uncomfortable, talk to your doctor about ways you can get relief.
Mid-life can be an exciting period in your life. It is a time of change—physical changes, of course, but possibly emotional and social adjustments, too. It might also be a time of acceptance—of these changes and of your evolving roles in life. This is also a time of opportunity and promise—a chance to make healthy changes in your lifestyle that will allow you to get the most out of the rest of your life.
So, don’t look back. This is the time to explore your world, expand your horizons, and learn more about yourself. It’s time to enjoy yourself, friends and family, and your life!
Based the NIH/National Institute on Aging publication, "Menopause: Time for a Change."