Energy, Age, & Estrogen

Dr. Alyssa Dweck discusses what’s really happening during menopause.

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By Alyssa Dweck MS, MD, FACOG

Women who come into my office often ask me the same thing: How do some women age so gracefully? I tell them it is in part genetically determined, but that they can take a proactive role to optimize the process. The reality for most women is that well before the first menopausal symptom is experienced, a series of hormonal changes is already well underway. 

What’s Happening During Menopause

Menopause signals the end of the natural reproductive potential and declining hormone levels for women. You see, women are born with a full complement of eggs which are stored in and released by the ovaries on a monthly basis, in most cases. Typically, a well-orchestrated sequence of estrogen, progesterone, and testosterone (aka sex hormones) production occurs each month with ovulation. Over our lifespan, our ovaries age as we age. In other words, we do not produce more eggs over time. In fact, as ovaries age, ovulation becomes less frequent and eventually ceases. As such, these sex hormone levels start to fluctuate and eventually decline significantly. This can last for upwards of 10 years prior to the last menstrual cycle.  

It may come as a surprise that our brain, muscle, and fat cells all have hormone receptors, thus, these changes occur on a cellular level. In addition to the well-known vasomotor complaints associated with this transition, aka hot flashes and night sweats, other common but less-publicized symptoms are numerous. These include sleeplessness, fatigue, less energy, memory loss, poor concentration, weight gain, mood volatility, joint pains, imbalance, and yes, even a lower libido.  

While it is never too late, the sooner healthy lifestyle habits are initiated, the less dramatic and more positive this transition can be.
— Dr. Alyssa Dweck

Although the transition to menopause can take upwards of 10 years for some, the average age of menopause is 51. Menopause is defined as a full year without a period. While it is never too late, the sooner healthy lifestyle habits are initiated, the less dramatic and more positive this transition can be. 

Here are some helpful pearls to ease the menopausal transition and maximize energy at the same time.

You Age How You Eat

The Mediterranean diet emphasizes eating primarily plant-based foods including fruits and vegetables, whole grains, legumes, and nuts—all of which are helpful for controlling weight and preventing hot flashes. More importantly, this diet, rich in natural antioxidants, is encouraged for prevention of major chronic diseases such as heart disease and cancer, including breast cancer in women. The Mediterranean diet suggests limiting salt intake and replacing it with herbs and spices for flavor, which may reduce hypertension (high blood pressure), an independent risk factor for heart disease. 

The low glycemic index in a plant- and lean protein-based diet promotes stable insulin and glucose levels and helps to reduce hot flashes, often associated with a high sugar intake. Sugar highs and subsequent lows or “sugar crashes” are avoided on this diet. Healthy fats such as olive oil and canola oil, instead of butter, help promote a normal lipid profile including elevated HDL (good cholesterol) and lower LDL (bad cholesterol). The Mediterranean diet is also rich in complex carbohydrates, but devoid of simple ones, promoting satiety.

Caffeine, commonly found in coffee, black tea, and chocolate, should be consumed in moderation or avoided altogether, as excessive caffeine intake triggers hot flashes. Not only can caffeine prompt hot flashes, but it can also zap energy upon its withdrawal, contributing to the overall energy loss women feel during this transition.

Exercise Does More Than Keep You Fit

During menopause, lean body mass or muscle is naturally lost. In part, this is due to diminished ovarian production of testosterone. Testosterone naturally declines with age; the most rapid loss occurs during the perimenopausal transition. This leads to a lower metabolism, diminished lean body mass (muscle), and difficulty with weight control. Remember, muscle cells have testosterone receptors (a site on the surface of a cell that binds to and responds to testosterone). Less circulating testosterone means lowered lean body mass. This alteration occurs on a cellular level. 

Exercise, including cardio (running, elliptical, biking, swimming, walking) and weight training, are essential to build and maintain muscle mass and a strong metabolism, particularly with lower circulating testosterone levels.

Exercise, including cardio and weight training, are essential to build and maintain muscle mass and a strong metabolism, particularly with lower circulating testosterone levels.
— Dr. Alyssa Dweck

Stress A Little Over Your Stress Levels

Chronic stress spurs the hot flashes and night sweats of menopause, leads to weight gain around the middle, visceral (around internal organs) fat accumulation, and is generally unhealthy. This in part occurs since chronic stress leads to increased cortisol production by the adrenal glands (small glands that sit on top of the kidneys). This starts a cascade of events including increased insulin levels, plummeting glucose levels, increased dietary intake of carbohydrates, and eventual deposition of adipose tissue (fat), particularly around the waistline, aka the dreaded “muffin top” so many menopausal women struggle with. Remember, less stress means less cortisol secretion.

Stress reduction through exercise, yoga, meditation, and mindfulness exercises are vital to a healthy lifestyle. Many find these practices, even for short time spans first thing in the morning, promote energy and well-being throughout the day.

Start Now To Stay Healthy Later

It may seem overwhelming to commit to dietary and lifestyle changes, but here are some helpful hints to ease the transition. Avoid smoking and moderate alcohol intake to minimize uncomfortable vasomotor symptoms of menopause, lessen cancer risk, and maximize cardiovascular health. Both smoking and alcohol affect blood vessel tone. Smoking constricts blood vessels which increases blood pressure and skin temperature and decreases tissue oxygenation. Conversely, alcohol dilates blood vessels on the skin surface to dissipate heat. Both have effects on the blood vessels of the brain as well.

Regular sexual activity raises endorphins (the feel-good chemicals in the brain), diminishes stress, and promotes a general sense of well-being.

Many women are also deficient in vitamin D, which is vital for bone health, and provides numerous other health benefits. Ensure adequate levels of vitamin D with a simple blood test and supplement with vitamin D3 if levels are low. 

NAD Increases Energy Levels

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On a cellular level, it’s important to note that levels of a molecule known as NAD also decline with age. NAD (nicotinamide adenine dinucleotide) is critical for mitochondria function. It fuels the cell's powerhouse and enhances cellular metabolism. Increasing NAD through supplementation may further boost energy levels before, during, and after the menopausal transition.

In my busy OB/GYN practice, I try to impress upon my patients that menopause can be and should be a liberating time rather than one of fear or dread. With age comes wisdom, freedom, and confidence. So, what is the secret to a smoother transition to menopause? I try to practice what I preach: commit to healthy lifestyle habits, maximize energy, and manage stress. With these principles and a little bit of genetic good luck, women can and should take an active role to embrace the aging process with grace and ease. Make it a priority!


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ALYSSA DWECK, MS, MD, FACOG is a practicing gynecologist in Westchester County, New York and Assistant Clinical Professor in the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai School of Medicine. As an author of three books, a Massachusetts General Hospital, Vincent Memorial OB/GYN Service consultant, and accomplished triathlete, Dr. Dweck offers her expertise across various platforms in an effort to destigmatize gynecologic issues and support women’s health across the country. She resides in Westchester County with her husband, their two sons, and their extraordinarily girly English bulldog.   


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