Dear editor, I read with interest the interview with Prof. Elian Rachev about the climax. I found answers to many of the questions I ask myself, as I am currently in such a period. I hope Prof. Rachev will answer a few more questions related to menopause. I am interested in how a woman should eat when she is in menopause? What tests should be done before starting the treatment, since my menopause is more severe?
Veneta Mihailova Shtelyanova, city of Pazardzhik
Assoc. Dr. Elian Rachev is the head of the "Reproductive He alth" Clinic at the "Maichin Dom" SBALAG - Sofia. He has over 120 scientific publications and three rationalizations in the field of obstetrics and gynecology. He works mainly on the problems of gynecological endocrinology, sterility and pathological climacteric. Specializing in Great Britain, Canada, Italy and Japan. Author of the monograph "Climacterium in the Woman". Founder and chairman of the Bulgarian Menopause and Andropause Association. Member of the European and World Menopause Associations.
Prof. Rachev, what should be the diet during menopause? Which products can best help balance the hormonal deficiency during this difficult period?
- The nutritional needs of a woman in menopause differ from those during her fertile age, being determined by the physiological characteristics of metabolic processes during this age and by the change in lifestyle.
The most characteristic feature of nutrition during this period is the tendency towards overeating and obesity. About a quarter to a third of women significantly increase their body mass, falling into the category of obesity. The reasons for this so-called menopausal obesity can be reduced to reduced energy needs and inadequate nutrition.
It should be emphasized that the estrogen deficiency that has occurred is also important. After menopause, the fat profile changes in an unfavorable direction, known as "masculinization" of fat metabolism, and in some women, elevated cholesterol levels are also proven.
If until the age of 30 the average need is up to 2300 kcal, then from the age of 40 to 60 the intake of food should be limited to an amount whose energy equivalent corresponds to at least 10% lower than normal. Daily intake of food exceeding metabolic needs by 200 kcal for one year leads to an increase in body mass by 10 kg!
Practical tips for eating during this period include:
• taking a variety of food
• reducing fats and fatty products, as well as carbohydrates
• including a sufficient amount of vegetables and fruits in the diet
• intake of foods containing calcium - milk and milk products
• to regularly monitor body mass and reduce the diet
The menopausal woman should be recommended an exercise regimen that matches her nutrition and physical capabilities.
Compensating for estrogen deficiency can also be a step towards curbing obesity.
Are specific tests necessary if treatment is required in women with a more severe course of menopause, as is the case with our reader?
- It is necessary to carry out a gynecological examination, to establish the symptoms and, in the absence of contraindications, to offer hormone replacement therapy. Establishing the menopause itself requires the determination of three main hormones - FSH (follicle stimulating), LH (luteinizing), as well as the main female sex hormone - estradiol. When menopause occurs, the first two have increased values, and estradiol is low.
Mammological examinations - echo or mammography, are performed periodically, according to age. It is also important to determine the bone mineral density (osteodensitometry), because with the cessation of ovarian activity, a progressive loss of bone tissue begins with age, and from there the risk of fractures seriously increases.
When prescribing such therapy, should the woman be followed up with laboratory tests and for what period?
- The standard approach includes two examinations per year, Pap smear - once a year, mammological control and determination of bone density. Since bone turnover is conservative, the examination can be performed every two years. Usually specific laboratory tests are not required.