Every woman knows that fluctuating hormones are a fact of life, but it's only when our hormones are dwindling that we discover how important they really are. In addition to hot flashes, night sweats and mood swings, some menopausal women face increased risks for very serious health conditions. Find out how women of a certain age can protect their health for the decades to come.

Hormone combinations

Annually, approximately 2 million women reach menopause at about age 51. Since American women live approximately 84 years, that's more than 30 years without reproductive hormones. Reproductive hormones, (estrogen, progesterone and testosterone) are intricately connected with other hormones, like thyroid, cortisol and insulin.

Together, these hormone combinations choreograph the delicate operations that go on behind the scenes inside our bodies. When hormone levels change, many body systems can be affected. That's why menopause affects women's cardiac, reproductive and endocrine systems, as well as skin, bones, hair, mental acuity, emotional wellbeing and sleep.  

Most women remain healthy after menopause. Some, however, develop health problems when changing hormones combine with the effects of aging, genetics, lifestyle issues and stress. Janet Gibbens, MD, OB/GYN with Women's Health Today in Portland, Ore., says, "The biggest health issues are osteoporosis, cardiac disease and weight gain."

Bone health

Osteoporosis causes bones to become porous and brittle. The National Osteoporosis Foundation says the disease causes half of women over age 50 to break bones. According to Gibbens, "Osteoporosis is thought to be caused by estrogen loss plus inadequate calcium and vitamin D. The most rapid decline in bone density happens during the first five years of menopause. If a woman uses estrogen replacement therapy, bone loss doesn't happen as quickly. Even without estrogen, she can help maintain bone density with vitamin D3 and calcium supplements. Vitamin D is more important than calcium. Women should have a baseline bone density test within a year or two of menopause."

Other factors that contribute to osteoporosis are:

  • Genetics
  • History of broken bones 
  • Height loss
  • Being small and thin
  • Poor nutrition
  • Smoking
  • Alcohol consumption
  • Lack of exercise   

Ask your gynecologist whether estrogen replacement therapy is appropriate for you and if you should take calcium and vitamin D3 supplements, and at what dosage. Then, hit the gym. Weight bearing exercises, like running and weight lifting, help maintain and build bone density. If you already have osteoporosis, ask your doctor about medications to improve bone strength.

Heart health

Before they hit menopause, women lag behind men in all the scary heart attack statistics. After menopause, they catch up. Estrogen is thought to provide protection for women's cardiovascular systems. When estrogen declines, that protection goes away. In addition, menopause impacts blood levels of cholesterol, lipids and triglycerides, and causes weight gain. That's why heart disease is the biggest killer of women over 50.

According to Gibbens, the impact of hormone replacement therapy (HRT) on cardiac health has been strongly debated. "Before the Women's Health Initiative study was halted in 2002, we thought HRT provided strong cardiac benefits" she says. "That study was halted when evidence showed HRT created increased cardiovascular risk."

It was later discovered that the second study was flawed, because it only looked at one type of HRT. Newer studies indicate that when women begin HRT within a few years of menopause, it appears to provide cardio-protection. Getting started early is key, Gibbens points out. "Started later, it doesn't seem to provide the same benefits."

The American Heart Association says that to maximize heart health, all women need to:

  • Eat a heart healthy diet rich in fruits and veggies, whole grains and high-fiber foods 
  • Eat fish at least twice a week or take omega-3 fatty acid supplements; flax seeds are also an excellent source of omega-3s
  • Limit sodium to 1,500 mg per day
  • Avoid trans fats 
  • Eat very little saturated fat (from meat, cheese and butter)
  • Eat less than 150 mg of cholesterol per day
  • Drink no more than one alcohol drink per day
  • Quit smoking
  • Maintain a healthy body weight
  • Exercise at least 150 minutes per week 

In addition, women should try to maintain personal heart health numbers within these guidelines:

  • Blood pressure: less than120/80 mm HG
  • Total cholesterol: less than 200 mg/dL
  • LDL  ("Bad") cholesterol: less than 100 mg/dL
  • HDL ("Good") cholesterol: greater than 50 mg/dL
  • Triglycerides: less than 150 mg/dL
  • Glucose (HbA1c): less than 7%
  • Body mass index: 18.5 to 24.9
  • Waist circumference: less than 35 inches

Weight gain, really?

Weight gain causes major frustration for most menopausal women. Hormonal changes cause women's metabolism to slow down, which causes weight gain around their abdomens. Post-menopausal women are also often less physically active, so muscle mass tends to diminish. Genetic factors and unhealthy eating habits added to the mix can cause many women to develop the "apple shape" associated with increased risks for diabetes and heart disease.

"Menopausal women have to eat less and exercise more just to maintain the same weight," says Gibbens. "To lose weight, they have to work even harder. Women who use HRT might not gain as much weight, but it won't provide complete protection."

What about cancer?

More women develop cancer after menopause, but research indicates that's probably related to aging, lifestyle and genetic factors, not menopause. The best ways to avoid developing cancer are the same diet, lifestyle and exercise tips that help reduce risks for osteoporosis, heart disease, weight gain and diabetes.

Should you use HRT?

HRT has many benefits, but it also has risks. It can increase your risk of breast cancer, heart disease and stroke. "It's not appropriate for every woman," says Gibbens, "but many can take it safely to improve a long list of menopausal symptoms." 

If you're approaching the age of "the change," talk to your doctor about your options. Getting an early start can maximize your health and wellbeing for life.

Jeanne Faulkner

Jeanne Faulkner is a freelance writer and registered nurse in Portland, Ore. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.