Hormonal Changes that Occur with Ageing
Note: In this article, the acronym AFAB will be used to designate individuals Assigned Female At Birth. The processes described affect AFABs, individuals who have a uterus and who have experienced a menstrual cycle. We acknowledge that, while not necessarily going through menopause, some individuals who identify as women may experience symptoms related to changes in hormones and may also benefit from the interventions named in this article.
The human body has the incredible ability to adapt and function based on our most basic to more individualized needs. When we change our external environment, whether we are performing our daily tasks, starting a new hobby or activity, or trying certain foods for the first time, our body can process and keep its internal environment stable, which allows us to remain healthy and function to the best of our abilities. As part of the natural ageing process, the way our body processes our external environment changes progressively. As we get older, our body composition changes and we gradually lose some of our muscle mass and bone density. We also begin to experience changes in hormone balance, molecules that affect our metabolism, sleep, mood, and stress levels amongst other functions. For individuals Assigned Female at Birth (AFAB) in particular, there is a drastic plummet in the estrogen and progesterone hormones that occurs at the end of the reproductive phase of life. This plummet is known as menopause, and the years leading up to this plummet are known as perimenopause.
Perimenopause: To mark the end of the reproductive years, the body begins its transition to menopause, called perimenopause. This period involves fluctuating levels of estrogen and variations in menstrual flow and cycle length. Different AFABs may experience the following to varying degrees: menstrual changes, hormonal symptoms, cognitive symptoms and other symptoms. Menstrual periods often become more irregular and change in length, and times between menstrual flows can increase. Individuals may also experience hot flashes, mood swings, vaginal dryness, trouble sleeping, short-term memory problems, weight gain, etc. Perimenopause can begin as early as the mid-30s in some individuals, up until the mid-50s. After the first signs of symptoms appear, perimenopause lasts on average for 4 years, but symptoms can persist for shorter or longer depending on varying factors.
Menopause: Menopause is defined as the biological stage in a person’s life when the ovaries stop releasing eggs, at which point an individual has gone at least 12 months without a menstrual period. In many cases, this is marked by a resolution of most symptoms experienced during perimenopause. The average person will reach menopause between the ages of 45 and 55 years, but this may occur earlier or later in some people. The decrease of symptoms and their resolution may also vary.
The Importance of Nutrition as We Age
A Balanced Diet: Throughout our lives, a balanced diet is recommended to help with our growth and development and for the maintenance of our body’s functions. The general recommendations for all adults are the same: we should aim to have a balanced diet with foods from all food groups. One way to follow these recommendations is to use Canada’s Healthy Plate as a reference: ½ of our plate is filled with vegetables and fruit, ¼ of our plate with a source of protein, and ¼ with grain products. Eating a variety of foods will allow us to meet our nutrient needs, and provide us the energy to continue doing the things we enjoy. Additionally, due to the changes in the body as we age, certain nutrients become more important when we reach menopause, as the body begins to use and store them less efficiently over time.
Calcium: At around the age of 50 years, bone resorption–the process through which older bone tissue is broken down– becomes quicker than new bone formation. This means that over time, our bones are susceptible to becoming weaker. During perimenopause, the decrease in estrogen also weakens our protection against fragile bones, which results in an increased risk of osteoporosis and fractures.
Calcium is an essential mineral in building and preserving bone density, as it combines with other minerals to form the crystalline bone structure. In fact, 99% of our body’s calcium is stored in the bones because of this vital role. Having an adequate oral calcium intake allows us to keep the stores necessary to keep our bones strong and healthy.
For people who experience menopause that are above the age of 50 years old, Health Canada recommends a dietary intake of 1200 mg of calcium per day. Good sources of calcium include dairy products, calcium-fortified foods and beverages, canned fish with bones, leafy green vegetables, and nuts and seeds.
Vitamin D: This vitamin helps absorb calcium from foods into the blood. It therefore plays an important role in maintaining bone density, as calcium cannot perform its necessary functions without the help of vitamin D. Due to the increased risk of osteoporosis, once we reach menopause, it becomes especially important to have a sufficient daily intake.
Vitamin D can be found naturally in only a few products, such as fatty and oily fish (salmon, herring, sardines and mackerel), egg yolks, and some red meats. Vitamin D is also found in fortified products such as milk, some plant-based beverages, and cereals. In addition, our bodies can also produce vitamin D when we get enough exposure to UV rays from sunlight. During the summer months, it is recommended to have about 2-3 hours of sun exposure per week to meet our vitamin D needs (this amount of sun exposure in shorts and a t-shirt can provide between 800-1600 IU of vitamin D). However, in the winter, the UV level and our exposure are often not sufficient to meet our needs. Health Canada recommends 600 IU-800 IU of daily vitamin D for people who experience menopause over the age of 50 years.
Healthy Fats: Changes in hormonal balance with age can cause a natural decline in organ function and a redistribution of body fat towards visceral areas. This means that more fat is stored in the abdominal cavity surrounding organs. A combination of these changes can increase our risk of cardiovascular disease when combined with other factors such as low physical activity, family history of the disease, etc.
One way to help decrease the risk of developing cardiovascular disease is to include many sources of unsaturated fats in our foods. Monounsaturated and polyunsaturated fats help to lower blood cholesterol, reduce triglycerides, and improve blood sugar control, all of which contribute to a well-functioning heart. Including a large variety of foods in our meals and snacks helps to offer all of the different nutrients of importance to the body.
Some examples of good sources of unsaturated fats include plant-based oils (olive, canola, sesame), nuts and seeds, eggs, avocados, fatty fish (salmon, sardines, mackerel, anchovies), tofu and soybeans.
Consulting with a Registered Dietitian can help you choose the best plan of action for keeping a balanced diet while meeting your needs for these various nutrients and maintaining a good relationship with food. Your dietitian can help you navigate through your dietary and health objectives, go over appropriate educational tools and give you the proper resources and support to eat the foods you want without the accompanying sense of guilt or restriction that may come with traditional forms of dieting.
Mélissa Mcallister, Nutritionniste, Dt.P.