AL2.0 EDUCATION NIGHT NOV 25TH

Why are we doing this?

-some new info that has not been spread through the medical system yet so the system is not set up for treating women in mid-life
-need to feel empowered to advocate for yourself when you go for help
-arm yourself with info and important questions to ask 

What is Peri/Menopause? 

-PeriMenopause-transition phase from regular cycle can start 35-49yrs
-egg supply starts to run out- no eggs =no hormones.
-estrogen secreted as prep to release egg, progesterone developed after egg release.
-Menopause is 1 day in time.  Exactly 12 months after the last period.
-2 types of aging in women:
1) reproductive agimg- quantity of follicles important but quality most important or else can’t make proper ratio of hormones (eggs in ovaries are critical marker of female health, if no eggs- no hormones 
2) biological age (ie. The rest of the body beyond reproductive organs

Symptoms that can be related to menopause:
Surprising to learn all the issues that can be associated with peri/meno, Estrogen receptors is literally in every area of the body – so it makes send that we would feel effects in brain, bone, muscle etc.
-Brain Fog, anxiety, mental health
-Orthopedic pain- tennis elbow, frozen shoulder,
-Vasomotor ie. Hot flashes/flushes
-Sleep issues
-Bone loss (year before menopause and 3-4 years after are critical times for bone loss)
-Genitourinary syndrome-
Incontinence with skipping/jumping,
bladder urgency,
pain, dryness, libido issues,
constipation (gut health changes during this time- sensitivities, motility       slows)
        prolapse (loss of support of organs- bladder, rectum, uterus- bulging/ pressure on vaginal wall)

Lots of doom and gloom here with this BUT…..

We need to learn and control what we can
Control your controllables
 a)movement b)what you put in your mouth/body c) lifestyle/stress levels

 

Things you can do to break up the ‘doom and gloom’

1)  Movement is medicine
–Have a goal and find someone to help you create a plan and a way to measure if you are moving towards your goal so you don’t quit after 1 month.
-Understand that it takes 6-9 months for a plan that is sustainable to start to reach your goal (took me 1 month to figure out what i was doing with food/exercise, and another month to make the changes)
-Consistency and repetition is key here
-know your own body/injuries and take the time to find out how to build on them.  Only as strong as your weakest link.  Talk to coaches, ask for modifications.
–Strength is key during this phase
-you are losing muscle as estrogen wains- need to LHS to counteract this.   -Muscle is the key to longevity/function later in life.
-Strength ranges should be progression to working between to 3-10reps while keeping 2 reps in reserve
-if pelvic health (ie. pain/prolapse/inconinence) maybe just need to change the position of torso or technique to still be able to do but don’t let it be a barrier to lifting!
-If you have a body Composition goal (increase lean mass/ decrease body fat) then consistent/ properly progressed strength training will be your key to reaching this.

–Conditioning– HIIT training is super helpful with improving cardiovascular health, decreasing anxiety/ stress levels, insulin  and metabolic issues and burning body fat.
-high Intensity work (85-100% effort) for short duration (30-60sec) and long rest (2-4 mins) for 15-20mins
– response for body is great- helps insulin at cellular level and teaches body to be better at burning glucose, body comp, anxiety
-If only doing Long slow Duration cardio (ie. slow jogging, hiking) this keeps you in a state of high stress/high cortisol and can increase symptoms of peri/menopause
-Need some weight bearing activities to stimulate bone building so if just cycling or swimming they wont help with bone health- need to supplement with jumping/ ground based activities

 

2) What we put in our mouth/body (ie. Nutrition)

-get yearly blood work (thyroid changes, blood sugars, iron, B12, vit D, c-reactive protein ). Learn what it all means.
-Do not restrict calories (women when body changes and in stress doesn’t function as well with low calories/fasting)
– Calorie restriction can increase loss of muscle mass, make sleep quality poor.
-if Skin feelling looser/ and body fat gain find someone to help you look at it objectively not just subjectively by looking in the mirror.
-Ideal to eat 3 meals/day with protein, vegetables, smart carbs, healthy fats
-Aim to eat only when it’s light out
-Protein- 1 g/lb ideal body weight. Split into 3 meals with threshold of 30g in each meal (this will help protect and maintain lean muscle mass

revised-protein-guide Check out this amazing protein document above put together by a local Naturopath Aranka Jones.  Lots of tips on calculations and good protein sources!

-If you restrict carbs it is stressful for your body and can make hot flashes/stress levels worse
-for gut health and GI function-do a fibre audit (aim for 25g/day minimum)as this helps keep blood sugar and cholesterol regular and lowers risk for cardiovascular disease and cancer.  You will see fibre amount in your 3 day diet recall in CM+.
-During periomenopause there is a loss of thirst sensation (hypothalamus in brain)
– hydration is key for skin & joint lubrication (drink half body weight in ounces/day 32 oz/L so~2.5 L h20/day)
-Some electrolytes are helpful (LMNT) bc/ water follows salt- hydrates better with electrolytes. If you’re peeing all day it means you need to add some electrolytes to get that water into tissue instead of excreting it out.

Pre workout
Do not go into workouts fasted when in peri/menopause
ie.Banana & PB (150-200cal right before)

Metabolic Testing
-Briana discussion on the benefits of metabolic testing to help with body composition goals
– gives you a sense of where you are at with respect to fuel utilization and metabolism and what your macros (protein/carb/fat) needs to be to reach your goal.
-Coach me plus has a nutrition section where you can do a 3 day diet recall and figure out where you are and need to make small adjustments to work towards your goal.
-Remember it takes 6-9 months to start to see some progress with a sustainable goal.

3)Lifestyle/ Stress management/Mental Health/ Sleep/ positive relationships and community
-8+ hours of sleep needed
-Peri is a highly Stressed state as hormones are in flux so we need to bring down environmental stress levels in order to allow other things to have a positive reaction otherwise even the helpful things will make your body feel bad (ie lifting weights, trying to breathe etc.) 
-adding Box Breathing (4sec in, 4 sec hold4 sec out, 4sec hold)before bed, regular yoga/pilates (working “in” not just “out”)
-There is a 2yr window of vulnerability around meno where 14x more likely to suffer Major Depressive Episode.
-Anxiety can be brushed off as being ‘normal for this phase because we are in the sandwich generation with Aging parents and teenagers
-How can you tell if what you are doing is working in your body? Monitor your HRV (heart rate variability). This is a measure of your body resilience by measuring the balance between sympathetic system  (Fight or Flight) and parasympathetic system (Relax and Digest). If this is low (ie. below 50 on apple watch or 80 on a more sensitive monitor) you need to find ways to bring it up.

 Menopausal Hormone Therapy:

2 types:
Systemic– estradiol (must be transdermal in cream or patch evidence that helps with CVD risk and bone health) with a progesterone (gold standard 100-200mg of microionized progestin cycled 14 days or lower everyday) evidence that it helps with sleep and hot flashes
Local– vulvovaginal cream helps with thinning vaginal tissue, dryness,libido etc.
-Womens health initiative did ‘that’ study that reported an increase risk 26% of breast cancer with HRT.  HOwever this study didnt tell the whole story because we now know that age and method of delivery is crical to know when talking about the risk factors.  This study was done with a pill form of estrogen in average age 63 year olds.
-More research has been done very recently with evidence to show HRT/MHT can help: preserve muscle and bone loss that occurs during peri/menopause, help with systemic inflammation, sleep, hot flash and flushes.
-as with any drug you need to do a risk analysis for yourself and weigh the pros and cons with an informed medical practitioner

Study from 2022 released “Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture. The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS and prevention of bone loss. For women who initiate hormone therapy more than 10 years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia. “
-2022 Position statement from NAMS https://pubmed.ncbi.nlm.nih.gov/35797481/

-However HRT/MHT is just the cherry on top
-need to get the rest of the ‘house’ in order first.  ‘You cannot ‘MHT’ your way out of this.  You need to modify lifestyle factors to find your ‘new normal’
-Control your Controllables

 

Ps The Delicious salad, almond crackers and dips can be ordered and picked up at ALC courtesy of @crookedtreefood

Some local resources (many more to come) and education :

  • Pelvic Health in area
    Laura Powers Higher Function Physiotherapy  Laura@higherfunction.ca
    Jessica Doig hello@collingwoodpelvichealth.com or via instagram, @theathleticpelvis or @collingwoodpelvichealth
    Julie Moss-Kujala julie.moss-kujala@lifemark.ca 
  • Exercise
    Active Life 🙂
    Dr. Stacy Sims @drstacysims
  • Social Media to follow
    Stacy Sims
    Thebraindocs