The current menopause movement is not enough to bolster the health of midlife women. But a broader “midlife movement” just might.
October is Menopause Awareness Month. But there is already a menopause movement gaining momentum. Whether it’s the explosion of menopause awareness in the UK, online menopause clinics like Midi Health popping up, or the expected rise in the global menopause market to a whopping 24.4 billion by 2030, the evidence is undeniable.
As a registered dietitian who specializes in developmental stages, I believe the menopause movement is missing the mark. And it has to do with something that occurs more than a decade prior when the midlife developmental stage begins. Although no official definition exists, midlife extends from about age 40 to 65. The average age of natural menopause – defined as a year without a period –is right around 50. This means women are almost halfway through midlife when menopause occurs.
What shows up in our 40s is due to a physiologic shift after age 30. By the third decade, relative muscle mass and power start to decline. And according to a 2019 study in the Journal of Osteopathic Medicine, 26% of premenopausal women (35-50) already have osteopenia, weakening of the bones. Changes to the brain start early too. After 35, we steadily lose 0.2% brain volume per year, which increases to 0.5% after 60. Nitric oxide, a vital signaling molecule that keeps arteries flexible – and plaque from forming on the arterial wall – is roughly half of what it was in our 40s compared to our early 20s.
In short, before a woman’s sex hormones decline, the effects of aging are already in place. Yet we are not addressing it because midlife is not a defined developmental stage. For instance, the 2020 Dietary Guidelines for Americans took a life stage approach for the first time, making recommendations based on life stage. They hit all the childhood stages – infancy, toddlerhood, adolescence — and then lumped together the entire adult stage from 18 to 65, before acknowledging older adults (>65). There was nothing about midlife.
“It’s fair to say that of all the periods in the life course, the middle years, roughly ages 40 to 59, are the most overlooked,” wrote Margie Lachman, psychologist and lifespan development expert, in the 2015 journal Research in Human Development. “There are no journals or professional societies specifically devoted to midlife, yet all other age periods, infancy, childhood, adolescence, young adulthood and old age, have dedicated publications and organizations.”.
Leaving midlife unexamined is full of pitfalls. For instance, the mainstream help for midlife women focuses on relieving vasomotor symptoms with hormone therapy or medications like antidepressants. While this has a place, it’s a limited long-term health strategy because it doesn’t address the changing needs of midlife women.
What if we approached midlife the same way we do other developmental stages? For example, a 6-month-old infant has a high need for iron due to rapid growth and declining iron stores. We don’t aim to manage symptoms of iron deficiency. No, we increase iron requirements. Why is it so foreign to think that an aging woman moving from being fertile to infertile wouldn’t also have changing needs?
There is evidence to support this theory. When sex hormones like estrogen decline, the risk of several micronutrient deficiencies rise including choline, vitamin D, magnesium, and the long chain omega-3 fatty acid DHA. For instance, women capable of becoming pregnant are more efficient at making DHA from dietary sources. In the Framingham Offspring Cohort, those in the highest quintile of red blood cell DHA had a 49% reduced risk of Alzheimer’s disease, when compared to the lowest quintile. Because most Alzheimer patients are women, isn’t it feasible that women over 50 who have declining estrogen, also have higher DHA needs?
And many of the “symptoms” that occur during perimenopause and menopause—hot flashes and sleep issues especially – are not benign but signs of diminishing vascular health. Because both estrogen and progesterone stimulate nitric oxide synthesis, which is already declining with age, menopausal women are hit hard. In fact, nitric oxide has been implicated in hot flashes, although it’s not a mainstream theory yet.
Nitric oxide expert Nathan Bryan has been sounding the alarm for making nitrates found in vegetables (inorganic nitrates), essential nutrients. That’s because the diet provides roughly half of the nitric oxide we need via nitrates in leafy green vegetables, root vegetables like beets, and celery. In fact, post-menopausal women who ate two salads a day for 10 days had higher flow mediated dilation, which is a test for nitric oxide vasodilation. So, tell me, where are the studies examining the relationship between dietary nitrates, vascular health, and hot flashes in women?
And strength training can protect women from bone and muscle loss that occurs early and through midlife. According to a 2007 study, resistance training prevents bone loss in early post-menopause just as much as menopausal hormone therapy. A recent meta-analysis shows exercise as a promising strategy to combat osteoporosis, but the quality of evidence is low. Let’s do high-quality studies! And why do most insurance companies only cover bone density screening after 65, when midlife is essentially over?
This Menopause Awareness Month let’s stop ignoring the changing needs of midlife women. It’s time researchers, policy makers, and health professionals recognize midlife as a vital development stage and support the research needed to define the changing needs of women. A bigger and broader “midlife movement” has the power to change the face of health for future generations of women, while focusing solely on menopause will keep us stuck.