Menopause represents a significant milestone in a woman's life, marked by hormonal fluctuations that profoundly impact metabolic processes. As health care professionals, it's imperative we grasp the intricacies of these metabolic changes and employ evidence-based strategies to optimize patient outcomes during this transitional phase. In this blog post, we'll explore the multifaceted nature of metabolic health in menopause and delve into actionable interventions to support women through this transformative journey.
How Menopause Affects Metabolic Health
The onset of menopause triggers a cascade of hormonal shifts. Progesterone declines first, followed by an eventual decline in estrogen levels. This hormonal transition, specifically with estradiol, exerts far-reaching effects on various metabolic pathways, including lipid metabolism, insulin sensitivity, and adipose tissue distribution. Consequently, women entering menopause face an increased susceptibility to metabolic syndrome, cardiovascular disease, and weight gain, necessitating proactive management strategies to mitigate these risks.
Effective management of metabolic health in menopause hinges upon attentive monitoring of key biomarkers that reflect the underlying metabolic environment. These include:
- Cholesterol and triglycerides: Dysregulated lipid metabolism is a hallmark of menopause, characterized by altered cholesterol and triglyceride profiles. Regular assessment of lipid parameters enables early detection of dyslipidemia and informs targeted interventions to mitigate cardiovascular risk.
- Insulin and glucose: Insulin resistance commonly accompanies menopause, contributing to dysglycemia and metabolic dysfunction. Close monitoring of fasting insulin and glucose levels facilitates the timely identification of insulin resistance and guides therapeutic interventions aimed at improving metabolic health. Read more about helping patients control blood sugar.
- Inflammatory markers: Chronic low-grade inflammation is a central feature of metabolic dysfunction in menopause, underscored by elevated levels of high-sensitivity C-reactive protein (hs-CRP). Monitoring inflammatory markers provides insights into cardiovascular risk and informs interventions aimed at attenuating inflammation through lifestyle modifications and pharmacological interventions.
- Leptin: Leptin resistance, prevalent in menopausal women, disrupts appetite regulation and energy balance, predisposing individuals to weight gain and metabolic derangements. Understanding the role of leptin in metabolic regulation facilitates targeted interventions to mitigate leptin resistance and promote metabolic homeostasis.
An integrated approach encompassing dietary modifications, physical activity, stress management, and collaborative care is paramount for optimizing metabolic health in menopause. Key strategies include:
- Dietary interventions: Emphasize a balanced diet rich in whole foods, protein, fiber (including prebiotics and resistant starch) and healthy fats while minimizing processed carbohydrates and sugars. Individualized dietary plans tailored to metabolic needs can optimize nutritional status and support metabolic homeostasis.
- Physical activity: Encourage regular exercise, specifically weightlifting and flexibility training to improve insulin sensitivity, enhance metabolic function, and promote weight management in menopausal women. Sarcopenia is a major concern as women age; therefore, building skeletal muscle and improving strength is important.
- Stress management: Implement stress-reduction techniques such as mindfulness, meditation, and relaxation exercises to mitigate the impact of chronic stress on metabolic health. Addressing psychosocial stressors is essential for optimizing hormonal balance and metabolic function in menopause. Chronically elevated cortisol levels can contribute to elevated glucose through gluconeogenesis and glycogenolysis. When appropriate, add in HPA axis support such as bacopa, ashwagandha, eleuthero root, rhodiola, vitamin C, and L-theanine for added benefit.
- Collaborative care: Foster interdisciplinary collaboration among healthcare providers to deliver comprehensive care that addresses the multifaceted nature of metabolic health in menopause. Regular monitoring of metabolic markers and timely adjustments to treatment plans are essential components of personalized care delivery.
The Bottom Line
Navigating the complex terrain of metabolic health in menopause demands a multifaceted approach that integrates medical expertise, lifestyle interventions and patient-centered care. By adopting evidence-based strategies and fostering collaborative partnerships, we can empower women to navigate menopause with resilience and vitality. Through proactive monitoring and targeted interventions, we can optimize metabolic health outcomes and enhance the overall well-being of menopausal women, ensuring they thrive during this transformative phase of life and beyond.
This blog was adapted from a presentation by Dr. Jones at the 2024 Spring PLMI Conference, Endocrine Typing: Connecting the Dots Between Toxic Load, Weight Loss Resistance, and Hormonal Dysfunction. Enjoy a complimentary viewing of her full talk here, or purchase the on-demand recordings of all conference lectures here, for a limited time only.
Carrie Jones, ND, FABNE, MPH is an internationally recognized speaker, consultant and educator on the topic of women's health and hormones with more than 20 years in the industry. Dr. Jones graduated from the National University of Natural Medicine in Portland, Oregon where she also completed a two-year residency in women's health, hormones and endocrinology. Later, she graduated from Grand Canyon University's Master of Public Health program. Dr. Jones was one of the first practitioners to become board-certified through the American Board of Naturopathic Endocrinology and currently serves on the board. For several years, she served as the medical director for Precision Analytical, Inc. (DUTCH Test). Dr. Jones is currently the head of medical education at Rupa Health and host of Root Cause Medicine podcast. Dr. Jones serves on Under Armour’s Council on Human Performance and as LMRC's Clinical Expert for the SOS Stress Recovery Program.
