Lifestyle modifications lead to cardiometabolic health benefits during menopause

Key takeaways:

• Menopausal vasomotor symptoms increase the risk for future CVD events.
• Diet quality plays an important role in cardiometabolic health during the menopause transition.

DENVER — Therapeutic lifestyle modifications, particularly focusing on diet quality, can improve long-term cardiometabolic health for perimenopausal and postmenopausal women, according to a presenter at the Lifestyle Medicine Conference.

The average age of natural menopause, which is defined as going 1 year without a menstrual cycle, in the U.S. is 51 years. In the U.S., the average life expectancy for women is 79 years.

In contrast, the average health span in the U.S. is 67 years, meaning that most women in the country spend the last 12 years of their life living with functional limitations, disease and disabilities, according to Michelle L. Tollefson, MD, FACOG, FACLM, DipABLM, board-certified lifestyle medicine expert and professor at the Metropolitan State University of Denver.

“We are No. 83 globally in life expectancy for women, even though we spend the most per capita on health care in the world. That’s a tragedy,” Tollefson said during her presentation. “We, as health care professionals within the lifestyle medicine community, want to not only lengthen the life span, but also shorten that disease span, and that’s what we can do with lifestyle medicine.”

Impact of vasomotor symptoms

Tollefson said one way to increase the health span of women in the U.S. is to consider the longer lasting changes that occur during the menopause transition and not just weight gain and hot flashes, as women also experience body composition changes, which negatively affect physical and cognitive function and increase cardiometabolic risk.

“We want our patients to thrive late into old age. If we see someone on a trajectory where they’re most likely going to end up with suboptimal health, healthy lifestyle behaviors are what we can use as to help change the trajectory,” Tollefson said. “Not only are we impacting the trajectory and what a woman’s last 10 or 20 years will be like, but we’re also helping them thrive along the journey.”

Hot flashes negatively affect sleep, mood and quality of life for many women and can persist for 5 to 13 years, Tollefson said. She recommends that physicians talk to women with frequent and persistent vasomotor symptoms, whether treated with hormone therapy or not, about the importance of cardiometabolic health, as they have a 50% to 77% increased risk for future CVD events.

With age, Tollefson said, men and women may gain fat mass and lose lean mass, but women may gain more visceral fat and central adiposity and lose more lean muscle mass compared with men. During the decade prior to menopause, women tend to start gaining more weight compared with before perimenopause and double the rate of fat mass gain, she said, which increases cardiometabolic risk.

Diet quality benefits

Consuming a healthier diet is another way to improve one’s cardiometabolic health trajectory. Better diet quality and can contribute to a healthy gut microbiome, which can reduce metabolic changes observed during the menopause transition, Tollefson said.

In the ZOE PREDICT study, researchers found that phytoestrogens, or soy products, can increase anti-inflammatory species in the gut microbiome. In addition, phytoestrogens have ben associated with decreased inflammation, glucose levels and visceral fat.

In a randomized controlled trial published in Menopause, researchers evaluated vasomotor symptoms after a 12-week intervention of a low-fat plant-based diet with a half cup of cooked soybeans daily. Women in the intervention group reported an 88% reduction in moderate to severe vasomotor symptoms compared with a 34% reduction among women in the control group.

Finally, studies published in Menopause and Maturitas found that women who consumed more poultry and had a higher dairy intake experienced worse menopausal symptoms, and women who consumed more high fat and sugar diets had more vasomotor symptoms. Conversely, consuming more vs. less fruit and vegetables was associated fewer menopausal symptoms, and women following a vegan diet vs. omnivorous diet had fewer vasomotor symptoms.

“When we’re thinking about the cardiometabolic health trajectory, I’d like you to think about nutrition, physical activity, stress and sleep as they relate to cardiometabolic health because they play a huge role too,” Tollefson said.

References:

• Barnard ND, et al. Menopause. 2023;doi:10.1097/GME.0000000000002080.
• Beezhold B, et al. Maturitas. 2018;doi:10.1016/j.maturitas.2018.03.009.
• Bermingham KM, et al. EBioMedicine. 2022;doi:10.1016/j.ebiom.2022.104303.
• Soleymani M, et al. Menopause. 2019;doi:10.1097/GME.0000000000001245.