Menopause Part 16: Optimal Takeaways

Welcome to our final wrap-up post for the ODX Menopause Series. Here you'll find optimal takeaways that can help optimize the transition from premenopause to postmenopause and beyond.

The ODX Menopause Series

1. Menopause Part 1: A Quick Overview of a Slow Process
2. Menopause Part 2: Biology and Physiology of Menopause
3. Menopause Part 3: Increased Risk of Disease Associated with Menopause
4. Menopause Part 4: Identifying Menopause: Signs and Symptoms
5. Menopause Part 5: Laboratory Evaluation of Menopause
6. Menopause Part 6: Cardiovascular Risk in Menopause
7. Menopause Part 7: Beyond Hormone Testing in Menopause
8. Menopause Part 8: Natural Approaches to Menopause
9. Menopause Part 9: Diet and Nutrition Intervention in Menopause
10. Menopause Part 10: Characteristic of Herbal Derivatives used to Alleviate Menopause Symptoms
11. Menopause Part 11: Lifestyle Approaches to Menopause
12. Menopause Part 12: The National Institute on Aging Addresses Hot Flashes
13. Menopause Part 13: Hormone Replacement Therapy (HRT) in Menopause
14. Menopause Part 14: North American and European Guidelines for Hormonal Management of Menopause
15. Menopause Part 15: Bioidentical Hormone Therapy
16. Menopause Part 16: Optimal Takeaways for Menopause
17. Optimal The Podcast - Episode 10

Although the phenomenon of menopause is inevitable, the symptoms and increased risk of chronic disease that accompany it may not be. A healthy lifestyle and diet along with targeted supplementation may not only help alleviate symptoms but also help reduce risk of preventable disease going forward.

The following optimal takeaways can help the clinician manage menopause safely and effectively.

• Menopause occurs in phases and usually begins between ages 45 and 52
• Alterations in menstrual cycles can be the first noticeable sign of menopause, followed by symptoms and biomarker changes
• Estrogen and progesterone regulate mitochondrial, cardiometabolic, neurological, skeletal, and reproductive functions
• Estrogen specifically
  • Reduces oxidative stress, promotes nitric oxide production, has anti-inflammatory actions, and regulates metabolic, anti-inflammatory, mitochondrial, and apoptotic genes.
• Physiological and biochemical changes associated with menopause increase risk of chronic disease and dysfunction including obesity, CVD, metabolic syndrome, depression, NAFLD, inflammation, and oxidative stress
• Monitoring biomarkers associated with menopause and cardiometabolic comorbidities would be prudent and should include
  • Estradiol, progesterone, testosterone, DHEA, SHBG, FSH, AMH, lipids, leptin, adiponectin, vitamin D, thyroid markers, inflammatory markers, homocysteine, oxidative stress markers, and bone markers
• Natural medicine, nutrition therapy, and targeted supplementation may relieve symptoms without hormone replacement therapy
• If utilized, HRT should be initiated at the lowest dose needed to resolve symptoms, especially vasomotor symptoms, and minimize systemic estrogen exposure
• Most postmenopausal women will have a serum estradiol level of 9.3 pg/mL (34 pmol/L) or less without hormone replacement therapy
• A clinical goal for estradiol of 60 pg/mL (220 pmol/L) would be required to reduce risk of osteoporosis and reduce hot flashes by 50%
• Transdermal HRT may have a better safety profile than oral estrogen
• A sustainable Mediterranean diet is recommended for reducing menopause symptoms, and reducing risk and severity of the chronic disorders that can increase during menopause
• Targeted supplementation may be needed to address micronutrient insufficiencies or increased requirements
• A trial of natural products can be implemented including black cohosh, chasteberry, evening primrose oil, isoflavones, and traditional Chinese Medicine
• Mind-body techniques may help relieve symptoms and can include cognitive behavioral therapy, hypnosis, deep-breathing, relaxation, yoga, and mindfulness-based stress management.