Many women think that once menopause has ended, their body will cease to change. You will however continue to experience changes: for instance, the lower levels of oestrogen still circulating in your body will affect your skin, and have an impact on your risk of certain diseases. Fortunately, many of these risks can be mitigated by paying careful attention to a healthy lifestyle.
Thinning of uterine lining
Changes to your skin are among the most visible effects of low oestrogen levels following the menopause. This extends to the lining of your uterus. Loss of elasticity can make the uterus fragile and inflamed, leading to post-menopausal bleeding, which is called endometrial atrophy. This condition is usually treated with medication, but ensuring that your diet is rich in healthy oils, antioxidants, and other vitamins and minerals that promote healthy skin, may improve the situation. Fruits and vegetables, oily fish, and foods rich in vitamin E, like sunflower seeds, almonds, peanuts, leafy green vegetables and eggs, all help to nourish the lining of the womb.
How osteoporosis treatments can affect uterine health
The reduction in oestrogen after menopause can also increase your risk of the brittle bone disease, osteoporosis. Many women opt for hormone replacement therapy to prevent, or treat, postmenopausal osteoporosis. However, oestrogen-only HRT increases a woman's risk of uterine cancer, so it may be better to opt for HRT with progesterone, or consider alternative treatment options.
According to Cancer Research UK, an estimated 1% of uterine cancers each year are linked to HRT use. Yet where progesterone is combined with oestrogen, it's quite a different story: “Endometrial cancer risk is 22% lower in ever-users [long-term users] of continuous combined HRT (oestrogen and progesterone taken together daily), versus non-users," says the charity.
The risk of all cancers increases as you age, says Professor Karen Lu MD, from the Anderson Cancer Center in Houston. So perhaps we shouldn't be surprised that postmenopausal women have an increased risk of uterine cancer. However, Lu says, "It's counterintuitive, because at menopause there is a drop in oestrogen, a hormone we know is related to uterine cancer". The suggestion then, is that the popularity of hormone replacement therapy may be partially to blame.
Back in the UK, NHS Choices reports that most cases of uterine cancer are diagnosed in women aged 40-74, naming a hormone imbalance as one of the most important risks. Risk is also increased if you have high levels of oestrogen in your body.
Hormone replacement therapy artificially raises your oestrogen levels, so is an obvious risk factor, but other risk factors include obesity, diabetes, and use of the breast cancer drug, tamoxifen. Controversially, there is also an argument that endocrine-disrupting chemicals in food and household products may increase the levels of oestrogen in your body.
NHS Choices advises that the best way to manage risks of womb cancer is to maintain a healthy weight, whilst advocating a healthy, nutritious diet, and exercise plan. Aerobic exercises such as brisk walking or cycling, five times a week for half an hour, can be hugely beneficial, as well.
For women on oestrogen-only HRT, there's also an increased risk of endometrial hyperplasia, a thickening of the lining of the womb. It is often related to an imbalance between oestrogen and progesterone. The early symptoms are uterine bleeding. If left untreated, it can turn cancerous, so it's important to get any postmenopausal bleeding checked out.
The condition can be caused by obesity, so the solution in this case is to focus on improving diet and lifestyle. Ensure you are getting all the essential nutrients you need, including healthy fats (omega 3 and omega 6), as well as including plenty of green, leafy vegetables, and fruit. Studies have identified diet, exercise, and weight loss plans as ways to manage risks of developing endometrial hyperplasia, or even endometrial cancer. Therefore, it’s important to speak to an expert to identify any nutritional gaps there might be in your diet, before making any supplement or lifestyle changes.
Healthy eating can help to reduce many postmenopausal symptoms, from keeping your weight in check, to reducing your risk of all cancers. A healthy diet with plenty of fluids will also promote good all round health. Soya products contain the isoflavones, genistein, and daidzein, which may help protect against hormone-related cancers. Fish and omega 3 supplements can help to keep your skin supple, and nourish the lining of the womb. Evening primrose oil may help regulate hormonal balance, too.
Aim for at least seven portions of fruit and vegetables every day, avoid processed foods, and cook healthy meals at home. Choose wholegrains, oily fish, and other nutritionally dense foods. Maximise the absorption of your food by avoiding anti-nutrients such as smoking, alcohol and caffeine, which inhibit the absorption of beneficial nutrients. Also avoid artificial sugar (i.e. not naturally occurring), which provides empty calories of no nutritional value.
A specially designed, ‘combined’ supplement can help ensure that you get all the vitamins and minerals you need for optimal nutrition during and after the menopause. If you're on medication, do check with your health care practitioner before taking supplements, in case of interactions.