Menopause, Menstrual irregularity, Precision Medicine, Women's Health

Precision Medicine Interventions for Menopausal Transitions

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Menopause is a significant milestone in every woman’s life. It can look and manifest differently for each woman which is why the individualized nature of a precision medicine approach can be so beneficial in navigating this stage of life.  

What is menopause? 

Menopause is defined as the permanent cessation of a woman’s menstrual cycle, which is diagnosed retrospectively after 12 months without a period (amenorrhea). At this stage, there are no more remaining ovarian follicles and hormones created by the ovaries (estrogen and progesterone) have declined. While the average age for menopause is 52, the menopausal transition typically begins about four years earlier and starts with early stage perimenopause.  

Stages of Menopause:  

A woman’s ovarian follicles decrease as she ages, eventually triggering changes in the menstrual cycle as hormones begin to fluctuate. The menopausal transition has multiple stages that manifest over a number of years. 

  • Perimenopause: This first stage can be broken down into early and late perimenopause. Accompanying this stage is the onset of symptoms like hot flashes and trouble sleeping. 
  • Early: At this stage, regular periods begin to become irregular in their frequency. The intermenstrual interval will increase, meaning the menstrual cycle during reproductive years of 25-35 days can extend to as much as 40-50 days during the menopausal transition.  
  • Late: More dramatic changes occur where menstrual cycles are skipped completely. Some women may experience long periods of amenorrhea or even an anovulatory cycle due to the hormonal imbalances. The latter is a menstrual cycle without ovulation. 
  • Menopause: Following the years of menstrual irregularity, clinical menopause occurs. As we noted earlier, this is defined retrospectively after 12 months of no menstrual activity.  
  • Post-menopause: Similar to perimenopause, this stage can also be broken into early and late segments: 
  • Early: The first two-six years after menopause is referred to as early post-menopause.  
  • Late: anything after six years. 

Common Symptoms 

The menopausal transition is marked by a multitude of symptoms that are often interrelated and thus compound upon one another. In addition to the symptoms noted below, many women also experience menstrual migraines, joint pain, breast pain and changes in sexual function and libido. 

Hot flashes are the quintessential symptom associated with the menopausal transition and are caused by hormonal fluctuations, most notably the decrease in estrogen. Up to 80% of women can experience hot flashes, which increasingly worsen further along the menopausal transition.  

Hot flashes are one reason many women have trouble sleeping, but sleep disturbances can occur without them. Many women entering the menopausal transition experience anxiety and depression which can exacerbate many primary sleep disorders already common in this demographic (sleep apnea, restless leg syndrome).  

There is a significant increased risk of new-onset depression in women during the menopausal transition compared to when they were premenopausal. This is especially noted in women with a prior history of depression or mood disorders. Additionally, perimenopausal women with hot flashes are more likely to be depressed.  Fortunately, this elevated risk for depression begins to decline in the early postmenopause stage.  

Many women report experiencing “brain fog” or forgetfulness during the menopausal transition which could point to cognitive changes during this time due to the decline in estrogen. While biologic and epidemiologic evidence suggest that estrogen is important for cognitive function in women, however it remains uncertain what, if any, long-lasting effects of this hormonal fluctuation exist. However, anxiety and depression during menopause can have adverse effects on cognitive performance.  

Precision Medicine Interventions 

Precision medicine is a 21-Century method of practicing medicine by making health care personalized and proactive. Instead of being reactive or applying general population recommendations, this approach precisely addresses each individual’s health needs using a range of tools and tests to gather detailed information. 

While hormone therapy can be a viable solution for many women experiencing menopause symptoms, there are other interventions focused on lifestyle habits that can offer relief and potentially lessen the symptoms. 

These recommendations can be helpful for many menopausal women, however a precision medicine approach allows a physician to create a more individualized action plan using evidence-based data unique to each patient.  

Nutrition 

A wholesome, nutritious diet is good practice for everyone at all stages of life. 

Two examples of helpful foods during menopause are soy and flaxseed because they contain phytoestrogens which are plant-based compounds that can mimic our own estrogen. Eating foods with phytoestrogens can support our natural estrogen activity and provide nutritional support if needed. 

Soy contains several isoflavones (phytoestrogens) that have activity at estrogen receptors. The highest concentration can be found in fermented soy with very little or none in processed soy products. Flaxseed contains lignans, a precursor to phytoestrogens, which are absorbed in circulation and have an effect on estrogenic activity. 

In contrast, certain foods can trigger hot flashes, mood swings and night sweats. Avoid common triggers like spicy or sugary foods, alcohol and caffeine. They can be especially troublesome if you consume them at night. 

Exercise & Meditation 

Along with anxiety, many women experience changes in mood that can include irritability and weight gain. A regular movement regimen can alleviate these symptoms, help maintain a healthy weight and facilitate better sleep.  

Meditation is another route to calm the mind and reduce anxiety and irritability. Yoga, Pilates or Tai Chi are movement disciplines that combine movement and provide a mind-body connection that encourage mental focus and good breathing techniques. 

Exercise will also strengthen muscles and bones, which is especially good for women in menopause as bone loss and osteoporosis can occur as estrogen levels decline.  

 
Nutraceuticals 

Natural supplements can provide relief in some menopausal symptoms including hot flashes, depression/anxiety, trouble sleeping and mood changes. Some of the most common ones include: 

  • Red clover extract 
  • Black cohosh  
  • Sage 
  • St. John’s wort 
  • Valerian Root 

Consult your healthcare provider before starting any supplements. 

The bottom line is that a precision medicine approach recognizes that each person deserves their own health action plan that is proactive, preventative and precisely designed for them. 

Because one size does not fit all, working with a physician who listens to your health concerns and works alongside you to improve your health is meaningful. Even before a menopausal transition begins, having a proactive plan in place for overall wellness can make a world of difference. 

by Haley Scellick, ARNP

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