The middle way

Hot flushes are the most common symptoms in post-menopausal age group leading to wide range of variations in day-to-day living,can affect quality of life,quality and duration of sleep. Other symptoms include memory loss,bone pains,anxiety,decreased sexual drive,urogenital symptoms. Hormone therapy is one of the most effective treatments for relief of hot flushes and reduces their frequency by 70-80 per cent,compared to placebo which decreases frequency of hot flushes by 20 to 40 per cent. Hormone therapy nowadays is not accepted by many women for symptomatic relief because of the potential risks associated with their use. Menopause presents a unique opportunity to reassess these lifestyle choices,including regular exercise,adequate nutrition,weight management,stress reduction and substance use (such as smoking).

* Adequate Exercise: Brisk walk,running,aerobics,dancing,tennis,and weight training are activities that help the heart,bones,muscles,balance,body weight,mood,and one’s overall sense of well-being. Exercise not only promotes better,more restorative sleep,but also stimulates production of endorphins (feel-good brain chemicals) that reduce negative thoughts and depressed feelings.

* Healthy Diet: You are what you eat. A balanced diet low in saturated fat and high in whole grains,fruits,and vegetables,with adequate water,vitamins,and minerals,contributes to good health. 5 ounces of protein,11/2 servings of fruit; 2 to 21/2 cups of vegetables,3 cups of either fat-free or low-fat milk or equivalent milk products such as yogurt and cheese; 5 to 6 ounces (150-180 g) of grains,including at least three ounces of whole grain,avoid adding sugar or sweeteners to foods and beverages,limit salt and fat intake,particularly saturated fat (found in meat,dairy products,tropical oils such as coconut and palm) and trans-fat (found in vegetable shortenings,some margarines,snack foods).

* Calcium: One nutrient of special importance for women at menopause and beyond is calcium. Early in life,this helps to build bone mass and bone strength to a peak during the 20s,allowing the body to draw from this “bone bank account” from then on. An adequate intake for postmenopausal women is at least 1,200 mg of elemental calcium daily. Dietary sources are preferred means of obtaining adequate calcium,and dairy products such as milk,cheese,and yogurt are excellent choices. Intakes higher than 2,500 mg/day have the potential to lead to kidney stones.

* Vitamin D: The body cannot absorb calcium without adequate vitamin D. A typical daily “multi” supplement contains 400 IU of vitamin D,providing the amount that most women aged 51 to 70 need. Older women should aim for 600 IU/day,and those with little sun exposure may need even more. The safe upper limit is 2,000 IU/day.

* Weight Management: Being overweight increases risks for heart disease and other diseases,such as diabetes and arthritis. The most dangerous location of body fat for heart health is the waistline and stomach. Midlife women often gain two or more pounds (about 1 kg) per year because their metabolism decreases with age and they are less active.

* Stress Reduction: Although menopause has not been shown to raise stress levels,women at midlife face many stressors,some of them for the first time. A number of coping strategies can help reduce stress. Exercise is a proven stress reducer,as is meditation. Deep,slow,abdominal breathing can increase relaxation.

The writer is Assistant Professor,Department of Gynecology & Obstetrics,PGIMER ,Chandigarh

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