With all of the buzz around hormone health and “balancing hormones” it can be difficult to navigate what is helpful during the perimenopause and menopausal transition, and what is just another insta-tok-book scheme to sell supplements and health guides.

Here’s the thing, as you mature, your estrogen will start to decline, and this will cause all sorts of changes in your mind and body. Some you will see, some you will feel, and some you will not notice at all. While hormone replacement therapy (HRT) is an excellent way to address several disconcerting peri/menopausal symptoms, not all women will need (or even want) HRT.

Here is a list of 8 things that can support your health during the menopausal transition. I’ve also included the “how” and “why” because you should always be asking those questions.

Finally, please remember, as you wade through the plethora of information surrounding hormone health, chances are, if it sounds too good to be true, it probably is.

Anyway, let’s get started with the list! Coming in at #1 we have:

Vitamin D- take 1000-2000 IU in the morning (AM)- incredibly important for bone health, also involved in many chemical pathways and deficiency is much more common in menopausal females. It is fat soluble, so try and have it with eggs, avocado etc. (something fatty) to help maximize absorption.

Here is a list of important pathways that Vitamin D is involved in:

1. Bone health- it helps us absorb and retain calcium and phosphorous (important for bone health and structure)
2. Muscle strength- helps to increase muscle strength by preserving muscle fibers
3. Cardiovascular health- helps to control blood pressure by keeping blood vessels flexible and relaxed
4. Type 2 diabetes- states of deficiency may promote the progression of prediabetes to type 2 diabetes (supplementation may therefore have a protective effect)
5. Cancer- vitamin D has been shown to reduce the growth of tumors (including prostate, ovarian, breast, colon and brain) in lab/animal studies
6. Immune function- A two-fold observation.
   a) Vitamin D deficiency may be linked to the development of autoimmune disease like Multiple Sclerosis and Type 1 Diabetes. One study in particular- the VITAL trial found a 22% reduction vs placebo in the development of autoimmune conditions such as rheumatoid arthritis, psoriasis, polymyalgia rheumatica, and autoimmune thyroid diseases. This study consisted of participants 25,000 aged 50 and older who were assigned to take vitamin D 2000IU daily or vitamin D plus 1000mg of marine Omega-3 fatty acids daily.
   b) Vitamin D may also play a role in modulating immune function and our ability to fight infections based on the observation that the flu (along with many other respiratory illnesses) is seasonal and tends to be much more active in the winter. This is a significant finding because it is the time of year when we have the least amount of sun which is important in synthesizing our own vitamin D!
7. Cognitive disease- low vitamin D levels (below 25nmol/L) were associated with an increased risk of dementia vs. vitamin D levels at 50nmol/L or higher.
   Vitamin D – The Nutrition Source

Magnesium Glycinate (PM)– this is a highly bioavailable (easily absorbed) form of magnesium- magnesium is a natural way to help promote healthy sleep in the perimenopause/ menopausal transition.

Our magnesium requirements vary widely throughout different stages in our life and subclinical (below medically detectable levels) are common! In fact, anywhere from 2.5% to 15% of adult women have subclinical magnesium deficiency, with numbers as high as 20% in women aged 18-22. How does this happen? One of three ways:

1. A change in a hormonal pathway that regulates absorption (PCOS, type 2 diabetes, systemic inflammation, obesity, metabolic syndrome)
2. Inadequate intake (malnourishment, selective eating patterns, unbalanced diet)
3. Increased demand (pregnancy, highly active, excessive sweating)

which foods are rich in magnesium?

1. nuts
2. almonds
3. bananas
4. black beans
5. brown rice
6. cashews
7. spinach
8. seeds
9. whole grains

Magnesium levels are closely related to calcium. The optimal calcium to magnesium ratio is about 2, meaning very high calcium intake can also cause a subclinical magnesium deficiency. Magnesium is anti-inflammatory and a crucial mineral for women’s health.

Studies have shown that Premenstrual syndrome symptoms (PMS) are higher in those with lower magnesium levels. Magnesium supplementation may be a therapeutic and preventative approach for PMS. Vitamin B6 in combination with magnesium has shown greater efficacy for PMS symptoms. B6 is also anti-inflammatory and is necessary to maintain normal levels of magnesium inside your cells. The dosing from the randomized controlled trials that demonstrated benefit included 250mg of magnesium along with 40mg of vitamin B6.

Magnesium, along with a host of other micronutrients are also involved in PCOS (I will cover this in detail another day) but for now, here is what you need to know: magnesium deficiency is implicated in worsening PCOS symptoms, metabolic syndrome and obesity.

Magnesium deficiency is implicated in low bone density in both pre and postmenopausal women.

Magnesium supplementation may improve symptom scores in patients suffering from menopausal hot flashes. Further studies need to be done to confirm this benefit.

There are no confirmatory studies, though magnesium deficiency is also thought to be linked to postmenopausal development of high blood pressure. (we’ve now talked about 2 supplements important for blood pressure regulation- vitamin D and magnesium).

Try to the get majority of your magnesium from food sources; you can take a 200-250mg supplement daily to make up the rest.

Creatine- at baseline, women have 70-80% lower creatine stores than males, however, the role of creatine supplementation in women remains largely understudied. That being said, the risks and adverse side effect profile of supplementation in females are far outweighed by potential benefits. Creatine supplementation enhances athletic performance and muscle recovery, mood, cognition and even bone mineral density. These effects are magnified in postmenopausal females where supplementation may counteract some of the inflammatory muscle wasting associated with the naturally decreasing estrogen levels experienced in perimenopause and menopause. I’ll do a full post on creatine supplementation, for now you’ll have to take my word for it and aim for 3-5g of creatine monohydrate daily- also, don’t pay a pink tax for this one, just make sure it is monohydrate and 3rd party tested. You’re welcome.

Omega-3- Omega-3’s are polyunsaturated fatty acids or PUFAs. They are essential for cognitive functioning, vision, and can improve blood flow in the brain. Omega-3 fatty acids may also help stave off heart disease by lowering the risk of high blood pressure and coronary artery disease. Omega-3’s are essential fatty acids, meaning we don’t make them, and instead need to get them from food. They are abundant in fish, and 2-3 servings per week should support healthy levels of omega-3’s in the body. For my vegetarian friends (and for those that get the ick from the idea of consuming fish)- you can try these foods instead: walnuts, ground flaxseeds, algae oil, chia seeds, edamame. Marine sources are superior, since they contain EPA/DHA, while plant-based omegas are primarily ALA and the conversion of ALA to EPA and DHA is not as efficient as direct consumption. I will do a full post on omega-3’s another day, for now be sure to talk to your doctor about individual dosing recommendations.

Probiotics- aim for 2-3 servings daily, as we mature the composition of our gut microbiome changes drastically, consuming probiotics helps to encourage the growth and action of gut friendly bacteria- they are also very important in hormonal balance and weight management! Excellent sources of probiotics include kimchi, yogurt, sauerkraut, cottage cheese, kefir, miso, raw apple cider vinegar, buttermilk, tempeh.

Focus on Fiber- women should consume between 25-30 grams of fiber daily, fiber is a prebiotic– its role in satiety is likely related to its action in the gut, it supports of the growth of healthy bacteria and keeps your bowels moving regularly. Just remember to drink plenty of water, and if you’re new to fiber, increase consumption gradually to avoid gas and bloating.

Why is fiber so important?

1. Aids in healthy digestion by bulking and softening stool (this speeds up transit time through your GI system)
2. Helps with weight management
3. Lowers your bad (LDL) cholesterol
4. Reduces your risk of heart disease
5. Reduces your risk for diabetes
6. Supports the immune system
7. Protects against inflammation
8. Involved in the production of short chain fatty acids (through the gut microbiome)- may prevent chronic disease like ulcerative colitis and Crohn’s disease

Here is a list of excellent sources of fiber from Harvard. Foods high in fiber: Boost your health with fiber-rich foods – Harvard Health

Protein- I’ll cover all the macronutrients in detail in a separate post, for now- just focus on including lean protein in all your meals. Starting your day with a high protein meal (30+ grams of protein) will help keep you full and keep your blood sugar balanced (versus a meal that is high in refined carbohydrates, like cereal, pastries etc)

Movement: Focus your efforts on engaging in a weightlifting program that stresses progressive overload. You should be lifting to failure- meaning you can’t do any more reps. This is how you can ensure muscular hypertrophy (growth) and the maintenance/production of lean muscle mass.  Do this 2-3 times a week. The other 3-4 times a week you can work on cardiovascular fitness with steady state cardio- like power walking, elliptical etc or a quick HIIT session (this should not be done more than 1-2 times a week and should be for 10-15 minutes of maximal effort). If you’re just starting out and new to movement with intention, pick anything! Even if its just 5 minutes, it’s 5 minutes more than you did the day before, and it all makes a difference in your mental and physical health!

Mood: Give yourself grace. You are going through major change, that only you can see and feel, while simultaneously conducting “business as usual.” The prevalence of anxiety and depression are exceedingly high during perimenopause and menopause, yet they often go undiagnosed. Depending on your symptoms and comorbid medical conditions, treatment may include lifestyle changes, anti-depressants, hormone replacement therapy, or a combination of all three!

The takeaway: know that you aren’t alone and consider talking to your doctor about how you’re feeling, it’s the first step to getting help!

I hope this information has been helpful. I know it’s tempting to fill up your amazon cart with everything I just told you about, but maybe try one thing at a time, you’ll know what’s working and what isn’t, plus gradual change is always the safest option! Remember, your health isn’t a race, it’s a marathon!

Sincerely,
Corsano MD- Your friendly neighborhood PCP

Foods high in fiber: Boost your health with fiber-rich foods – Harvard Health
Fabulous fiber – Harvard Health
Effect of magnesium supplementation on women’s health and well-being – ScienceDirect
Vitamin D – The Nutrition Source
Bringing the Potential Benefits of Omega-3 to a Higher Level
Ask the expert: Omega-3 fatty acids – The Nutrition Source
Omega-3 Fatty Acids & the Important Role They Play
Creatine Supplementation in Women’s Health: A Lifespan Perspective – PMC