TO STUDY THE

NUTRITIONAL PROFILE
OF
POST MENOPAUSE
WOMEN

NAME: NITTALA . S . R AKSHITA

A project report submitted in partial

fulfillment of the requirements for the
Diploma in Nutrition and Health Education

School of Continuing Education

Indira Gandhi National Open University
2023-2024
 DECLARATION

I here by declare that the work done on the dissertation entitled “To Study
The Nutritional Profile Of Post Menopause Women” has been carried by me and
submitted in partial fulfillment for the Diploma in Nutrition and Health Education,
Indira Gandhi National Open University.
CONTENTS

CHAPTER TITLE PAGE NO.

NO.

I. INTRODUCTION

II. REVIEW OF LITERATURE

III. MATERIAL AND METHODS

IV. EXPERIMENTAL RESULTS AND DISCUSSION

VI. SUMMARY AND CONCLUSION

VII. REFERENCES

VIII . APPENDIX
 INTRODUCTION
Menopause is a natural part of a woman’s life. It is a phase when she no longer
experiences menstruation, technically her body begins to produce less and less
progesterone and estrogen, and eventually her periods cease. Menopause typically occurs
in a woman’s late 40’s to early 50’s. A “premature” menopause is one which occurs
spontaneously before the age of 40 as a result of surgical removal, irradiation or
abnormalities of ovaries, occurring in the fashion in 8 per cent women (Devi et al., 2003).
In most women, the amount and number of days of flow decreases skipping
one or more months during several years before complete cessation is common, in
contrast to the relatively infrequent occurrence of abrupt menstrual cessation. It is usually
different for every woman, rocky time with fluctuating hormones which leads to various
emotional and physiological symptoms (Macdonald etal., 2004).

❖ STAGES OF MENOPAUSE

Menopause can be seen as three phases :-

➢ pre menopause phase
➢ peri – menopause phase
➢ post menopause phase
❖ Pre menopausal phase :-
Where a little disruption of the ovarian function is observed and the
menstrual cycle remains regular, nevertheless, a few symptoms may begin to occur.
❖ Peri – menopausal phase :-
It is a phase that represents declining ovarian function with menstrual irregularities
and symptoms commonly start or become troublesome and this phase lasts till the end of
menses.
❖ Post menopause phase :-
Where experiencing permanent cessation of menstrual cycles over a year is seen.
 Women are born with about 1.5 million ova and reach menarche
with around 4,00,000. Most women menstruate about 400 times between menarche
and menopause, using all responsive ova. When all these ova become atretic, the
ovary is no longer capable of responding to pituitary gonadotropins, and the
production of estrogen and progesterone, and the other ovarian hormones is reduced.
The result of these low levels of hormones is often manifested by deleterious
physical, psychological and sexual changes in postmenopausal phase. The
postmenopausal phase is now recognized as a time of decreased hormonal production
with associated problems that reduce the quality and length of life for a large number
of women (Sellmeyer et al., 2001).

❖ Symptoms of menopause :-

The symptoms can begin 2 to 8 years prior to menopause. During

menopause, the woman develops certain physical, physiological changes. The
symptoms Start appearing soon after the ovaries stop functioning. The main cause for
the symptoms is lack of estrogen and progesterone. The symptoms may be mild in
some and severe in others.
Physiological symptoms: -

▪ Hot flushes
▪ Cold sweats
 ▪ Dizziness
▪ Faintness
▪ Nausea
▪ Vomiting
▪ Breast tenderness
▪ Bloating
▪ Vaginal dryness
▪ Aching sore joints, muscles & tendons
▪ Anorexia nervosa
▪ Changes in bowel habit Weight gain
▪ Headaches or migraines
▪ Pelvic discomfort
▪ Skin and hair disorders
▪ Edema
▪ Swelling
These in turn are thought to increase the risks of various chronic diseases including
heart diseases and osteoporosis (Frankenfeld et al., 2003). After menopause, a
woman’s risk of heart disease grows to almost equal the risk of a man. Falling
estrogen levels may lead to high cholesterol levels.

❖ Psychological symptoms :-

▪ Mental stress
▪ Feeling of stress
▪ Mood disturbances
▪ Fatigue
▪ Panic attacks
▪ Confusion
▪ Depression
▪ Lowered judgement
▪ Irritability
▪ Lowered motor co-ordination
 ▪ Crying spells
▪ Forgetfulness
▪ Anxiety
▪ Insomnia
▪ Sleep disturbances
▪ Restlessness
▪ Loneliness
▪ Tension

Behavioral changes of menopause women include avoiding social activities, lowered

work performance, staying at home and in bed.
All these, psychological and physiological changes have an impact on food intake
and food choices of menopausal women. It is an established fact that a well
balanced diet is important for good health and to combat some of the complications
of menopause to certain extent. Therefore, there is a need to study the nutritional
status of menopausal women.

Apart from a nutritious diet an active life style which includes exercise
pattern is a cure for a trouble free menopause. Regular exercise benefits the heart
and bones, helps to regulate weight and contributes to a sense of overall well being
and improvement in mood.
Most of the menopausal women are not aware about the symptoms and
their effects on health status and the remedial measures. Therefore, it is very
important to educate the menopausal women about how to combat and tackle this
important phase in their life.

Very few studies have been conducted on nutritional status of

menopausal women. Hence it enforces to debate the need for special attention to
this group by health care centers.
 Nutritional importance of menopausal women

An essential nutrient is a nutrient that supports human life but is not made by the human body and
must be consumed through food and beverages. There are seven essential nutrients: carbohydrate,
protein, fat, vitamins, minerals, fiber and water. The macro nutrients carbohydrates, fat,and protein
provide calories and are rarely deficient in the diets of menopausal women, with the expection of
a specific type of fatty acid.

Good nutrition is essential throughtout life but particularly vital during the menopause as it helps
to keep hormone levels balanced and reduces the chances of symptoms.

There is risk for certain vitamin and mineral deficiences in menopausel women’s diets and intakes
of fiber and water are often insufficent. Energy (calorie) needs generally decline with age;
however, micro nutrient needs do not, and, in some cases, the intake of micronutrients should
increase.

For example, women over 50 years of age need to increase the intake of calcium. Encourage
women to consume nutrient-dense foods and avoid empty calories or energy- dense foods in order
to meet their micronutrient needs and maintain a healthy body weight.

Nutirent- dense foods provide necessary micronutrients in addition to calories, whereas energy-
denese foods provide excess calories in small volumes of food without providing many
micronutrient needs to make appropriate food choices.

Energy and carbohydrate :

High- calorie, nutrient-poor foods are usually loaded with fats that promote estrogen dominance,
making it difficult to balance hormones naturally. Diets excessively high in carbohydrates and too
low in calories and fats can lead to nutritional deficiencies.Carbohydrates provide enery and fuel,
both of which are especially important for women whose hormonal changes mean they can often
feel tired and lethargic throughout the day.

Menopausal stress can be improved dramatically by balancing blood sugar levels, allowing the
body to circulate those hormones it has more efficiently. The trick is to avoid refind, sweet foods
such as biscuits, chocolate and sweets as these quickly release their sugars into the blood. Starchy
carbohydrates such as whole grains, beans, pulses and vegetables and fresh fruits release sugars
more slowly and help maintain a balance.

Protein :

Protein plays an increasingly important role in helping the body to recover from illness, infection
and surgery. It can be found in meats, nuts, pulses and dairy. Dietary protein may come from plant
or animal sources. There may be a finite amount of dietary protein that can be utilized from one
meal or snack. Protein rich foods are meat, pulses, milk and milk products etc.

Fat:

Fat comes in three forms –saturated, polyunsaturated and monounsaturated. Polyunsaturated fats
are the fatty acids, omega3 and omega 6, which are essential for good health and good sources
include flaxseeds, rapeseeds and their oils, soya beans and their oil and nuts, particularly walnuts.
Avoid hydrogenated fats and oils entirely as they increase the risk of heart disease.Saturated fats
in meat also reduces the absorption of essential fatty acids which are important in reducing
symptoms of the menopause.

Calcium:

Calcium is crucial for preventing or treating osteoporosis and may reduce hypertension. Dietary
sources of calcium provide many essential nutrients, unlike supplements, which provide calcium
alone or in combination with only a few other nutrients. For example, dark, leafy greens provide
fiber, potassium, and folic acid in addition to calcium. Good sources of calcium include fish, dairy
products, leafy green vegetables, oat meal, ragi and other grains, tofu, cabbage, green beans, garlic
and sea vegetables.

Vitamin-D:

Because of the hormonal changes during menopause will experience increased bone loss. To
decrease this bone loss, they should particularly look out for two nutrients that are associated with
bone health and get sufficient amounts of them: calcium and vitamin D.

Vitamin D can get from about half an hour of direct exposure to sunlight, and from foods and
supplements. Salmon is an excellent source of vitamin D. Other good sources include shrimp ,
vitamin-D fortified milk, cod and eggs.
Vitamin A,Cand E:

Eat fruits, vegetables and whole grain cereal products, especially those high in vitamin C and
carotene. These include oranges, grapefruit, carrots, tomatoes, broccoli, cauliflower, and green
leafy vegetables. These foods are good sources of vitamins and minerals and the major sources of
dietary fiber. Fiber helps maintain bowel mobility and may reduce the risk of colon cancer.
VitaminC can reduce and hot flushes and vitamin E also has some powerful benifical effects. It’s
found in nuts, seeds, peppers, tomatoes and avocados.

B-complex vitamins:

VitaminB complex, found in wholegrains, green leafy vegetables, yeast extracts and fortified
products such as soya- based mock meats, can improve energy levels and reduce fatigue,
irritability, breast tenderness, and dry skin and improve libido.

Fiber:

Adequate fiber intake prevents constipation and divertucularis, promotes a healthy weight, and
prevents heart diseases, type2 diabetes, cancer. Many women do not meet recommendations for
fiber, particularly those on low- calorie or low- carbohydrate diets. Encourage the consumption
of vegetables, fruits, whole grains, beans, peas, and lentils.

Water:

Dehydration is a risk for women as they age. The sensation of thirst decreases with age and
various factors increase the risk for dehydration in menopausal women (mahan and escott-stump
2008).

Dehydration can lead to headaches, tiredness and concentration difficulties, symptoms which are
common among some menopause suffers. In order to stay hydrated don’t have to drink just
water aolne and juices and hot beverages with a high water content will also work in the same
way.

Phytosterogens:

Plant hormones called phytoestrogens (isoflavones) also play an important role in reducing
symptoms and delaying the onset of menopause. Phytoestrogens are found in soya products,
celery, fennel, liquorice, rhubarb and ginseng and in a supplement called phytoest.
 REVIEW OF LITERATURE

Menopause is one of the crucial stages in women’s life which leads to

various physiological changes. Menopause is the physiologic cessation of menses
associated with the failing ovarian functions, may be diagnosed in retrospect when a
year has passed with no menses. Symptoms of menopause may be alleviated or
decreased by altering their nutritional status, which is one of the important
environmental factors to lead a healthy life during menopause. Menopause women
may experience increase in body fat mass and redistribution of fat mass from the
limbs to a more central or android location. These changes can increase the risk of
diabetes and cardiovascular diseases.

NUTRITIONAL STATUS OF MENOPAUSE WOMEN

The influence of nutrient intake on menopausal health status is still largely undefined.
Nutrients such as calcium, Vitamin D affect bone health and adequate intake may
influence bone turnover. Vitamin K and C, magnesium, zinc, manganese,
molybdenum and copper all influence the synthesis of bone matrix proteins. Boron
potentiates estrogen action and zinc stimulates the production of insulin like growth
factor. Inadequate dietary intake and age related changes in the absorption, utilization
or excretion of these nutrients may affect health status in menopausal women.

Effective of Diet

➢ Yoshiaki et al. (2001) evaluated the effect of dietary isoflavones from soy products on
menopausal symptoms, lipid profiles and bone mineral densities in 478 post-menopausal (age
48-56 years) Japanese women. Results revealed that mean estimated intake of isoflavones
among 478 women was 54.3 mg/day. Weight and years since menopause were significant
predictors of bone mineral density (BMD). BMD adjusted to years since menopause and
weight were significantly different in the highest intake compared with lowest intake category
(P < 0.001). Within the early and late post-menopausal groups, in the early post-menopausal
group, significant differences were found in palpitation and backaches between the high and
 low intake categories but were not significant in the late postmenopausal group. Thus, it can
be concluded that high consumption of soy products is associated with increased bone mass in
post menopausal women and might be useful for preventing hypoestrogenic effects.
➢ Brooks et al. (2004) supplemented 46 post-menopausal women (age 51-55 years) with flax
seed muffin (25 g/d) for 16 week and analyzed biochemical markers of bone metabolism at
Toronto. Urinary concentrations of 2 hydroxyestrone (estrogen metabolite) increased
significantly. The ratio of 2 hydroxy-estrone to 16a hydroxl estrone was positively correlated
with urinary lignin excretion. No significant change in serum hormones or biochemical
markers of bone metabolism was observed. Supplementation with 25 g flax seed significantly
alters the metabolism of estradiol in favour of the less biologically active estrogen metabolite
in post menopausal women. Flax seed suggests no negative effect on biochemical markers of
bone metabolism.

➢ Isabelle et al. (2004) assessed the association of intake of low fat and high carbohydrate intake
on risk of breast cancer in 475 Mexican women aged 40 to 55 years. Carbohydrate intake was
positively associated with breast cancer risk compared with women in the lowest quartile of
total carbohydrate intake, the relative risk of breast cancer for women in the highest quartile
(2.22 vs. 1.63). This association was present in post-menopausal women (RR 2.31 vs. 3.30).
Among carbohydrate components, the strongest association was observed for sucrose and
fructose. No association was observed with total fat intake. In conclusion, a high percentage
of calories from carbohydrate, but not from fat was associated with increased breast cancer
risk.
➢ Xianglan et al. (2005) examined the relationship between ‘usual soy food consumption and
fracture incidence in 403 post-menopausal women in the Shanghai women’s health study (aged
40-57 years). After adjustment for age, major risk factors of osteoporosis, socio-economic
status and other dietary factors, the relative risk of fracture were 1.00, 0.72, 0.69, 0.64 and 0.63
across quintiles of soy protein intake (P < 0.001). The inverse association was more
pronounced among women in early menopause. The relative risks of fracture comparing the
extreme quintiles of soy protein intake were 0.52 for women within 10 years of menopause vs.
0.71 for late post-menopausal women. In conclusion, soy food consumption may reduce the
 risk of fracture in post menopausal women, particularly among those in the early years
following menopause.

➢ Martin et al. (2006) evaluated the risk of breast cancer among 475 Mexican women (median
age, 53 years). Compared with women in the lowest quartile, the risk for breast cancer for
women in the highest quartile of folate intake was 0.64 and 0.32 for vitamin B12 intake.
Among post-menopausal women, intake of folate and vitamin B12 were associated with a
lower risk of breast cancer and this association was stronger than among pre-menopausal
women. The inverse association of folate and breast cancer was stronger among women who
consumed a high level of vitamin B12 as compared with women consuming diets low in
vitamin B12. No association was observed for vitamin B6 intake. In conclusion, high intakes
of folate and vitamin B12 were independently associated with decreased breast cancer risk,
particularly among post-menopausal women.

➢ Barbara et al. (2006) tested the hypothesis that a dietary intervention, intended to be low in fat
and high in vegetables, fruits and grains to reduce cancer, would reduce CVD risk in 48,835
post-menopausal women aged 48 to 58 years. Mean follow up in this analysis was eight years.
By year six, mean fat intake decreased by 8.2 per cent of energy intake in the intervention Vs.
the comparison group, with small decrease in saturated (2.9%), monounsaturated (3.3%) and
polyunsaturated (1.5%0 fat. There was increase in intakes of vegetables/fruits 91.1 servings/d)
and grains (0.5 servings/d). Over a mean of eight years, a dietary intervention that reduced
total fat intake and increased intakes of vegetables, fruits and grains did not significantly reduce
the risk of CHD, stroke, or CVD in post-menopausal women.

➢ Perry et al. (1997) compared the anthropometric measures of fat distribution in overweight
postmenopausal women (n=46) aged 52.4 ± 0.3 of Miami Post-menopausal women had
significantly higher mean values for fat distribution viz., WHR (0.90 ± 0.09 vs. 0.85 ± 0.08)
and waist circumference (114.50 ± 15.2 vs. 104.57 ± 16.3 cm) than pre-menopausal women,
which is a risk factor of cardiovascular diseases.
➢ Key et al. (2003) explained the relationship of body mass index (BMI) with serum sex hormone
concentration in 624 post-menopausal women. Breast cancer risk increased with increasing
BMI ( P = 0.002), and this increase in relative risk was substantially reduced by adjustment for
serum estrogen concentrations. Adjusting for free estradiol reduced the relative risk for breast
cancer associated with a 5 kg/m2 increase in BMI from 1.19. This increased risk was reduced
after adjusting for other estrogens (total estradiol, non-sex hormone binding globulin, estrone
and estrone sulfate) and moderately reduced after adjusting for sex hormone binding globulin,
whereas adjustment for the androgens had little effect on excess risk. In conclusion, increase
in breast cancer risk with increasing BMI among post-menopausal women is largely the result
of the associated increase in estrogens, particularly estradiol.

➢ Vitamin B6 status gets reduced with age and inturn modulates bone metabolism.Masse et al.
(2004) examined the Vitamin B6 metabolites in equal number (n = 30) of post-menopausal
women (age : 54 ± 3.8 years) of Canada. Plasma pyridoxal phosphate, pyridoxal concentration
and erythrocyte plasma pyridoxal phosphate, pyridoxal and pyridoxamine phosphate
concentrations were in normal range in both groups and did not differ significantly between
the two groups. Plasma and erythrocyte 4 pyridoxic acid concentrations were significantly
higher in postmenopausal than in pre menopausal women. Authors concluded that menopause
may not be necessarily associated with a decrease in Vitamin B6 status.

➢ Markers of bone formation in serum include total and bone specific alkaline phosphatase,
osteocalcin and type 1 collagen carboxy terminal extension peptide. Bone resorption can be
assessed by measuring plasma tartarate resistant acid phosphatase and urinary excretion of
collagen degradation products : hydroxy-proline, hydroxylysine glycosides and more recently
the pyridinum crosslinks and associated peptides. Ashuma et al. (2005) compared the excretion
of hydroxyproline in women of reproductive age group to those of menopausal age group (40-
55 years) and found a significant difference in the two age groups. Urinary hydroxyproline was
found to be significantly raised in post-menopausal women. Thus hydroxyproline may be used
as the earliest indicator in the prognostic assessment of postmenopausal women of their risk
of developing osteoporosis and fracture.
➢ Amirthaveni and Vijayalakshmi (2003) observed the effect of supplementation of Max EPA
capsules for 27 hyperlipidemic females (age 45-54 years) (1.8 g of EPA and 1.29 of DHA) for
a period of two months at Coimbatore. Results indicated that the mean total cholesterol levels
(266.3 mg/dl to 231.4 mg/dl) (P < 0.01), mean LDL cholesterol (165.4 to 123.46 mg/dl), mean
VLDL cholesterol levels (38.6 to 33.93 mg/dl), mean triglyceride levels (196.5 to 169.4 mg/dl)
reduced significantly (P < 0.01) and mean HDL cholesterol increased significantly from 61.9
to 74.0 mg/dl (P < 0.01) after supplementation.

➢ Shailaja and Charu (2005) assessed the efficacy of supplementation of 20 mg of psyllium husk
(Sabgol) twice a day for eight weeks on hyper cholesterolaemic women (age : 45-57 years).
The results indicated that there was a significant reduction (P <0.01) in mean total cholesterol
(298.70 to 249.50 mg/dl), LDL-C (217.85 to 170.24 mg/dl), VLDL-C (40.55 to 36.46 mg/dl),
triglycerides (202.75 ± 182.30 mg/dl) and increase in HDL cholesterol (40.30 to 42.80 mg/dl).
Thus psyllium husk has a significantly lowering blood lipid profile of hypercholesterolaemic
patients.

SYMPTOMS OF MENOPAUSE

The decrease in circulating estrogen results in specific symptoms such as aching

joints and muscles, allergy symptoms, breast tenderness, depression, anxiety, mood
swings, dry thin or wrinkly skin, facial hair growth, hair loss, thinning of hair,
headaches, migraines, heart palpitations, heavy or light periods, hot flashes, irregular
periods, irritability, lack of concentration, low metabolism, lower or loss of sex drive,
night sweats, sleep disturbances, insomnia, urinary tract infections, water retention
and unexplained weight gain (Kaira and Wadhwa, 2002).

➢ Long range symptoms include osteroporosis, heart and vascular diseases and
otherorthopedic problems. In menopausal women as age increases metabolic rate
declines and percentage of body fat increases which leads to diseases such as heart
disease, cancer, hypertension, diabetes (Atkinson et al., 2004).
➢ Dennerstein et al. (1993) conducted a study at Australia to describe the 2000 Australian-
born women’s (aged 45-55years) experience of symptoms during the natural menopause
transition and the relative contribution of menopausal and health status, social factors
and lifestyle behaviours. Menopausal status based on menstrual history was significantly
related to two groups of symptoms : Vasomotor symptoms, which increased through the
menopausal transition; and general somatic symptoms which were more frequent in the
peri-menopause. Fewer symptoms were found al complaints, not currently smoking,
exercise at least once a week and positive attitudes to ageing and menopause. Thus
authors concluded that many factors unrelated to hormonal changes contributed to the
symptoms.

➢ Guthrie et al. (1996) determined the frequency of hot flushes in a post-menopausal women
(aged 48-59 years), and to investigate the relationship of hotflush reporting with menstrual
status, serum levels of estradiol (E2), inhibin, FSH, history of pre-menstrual complaints,
physical and life-style factors. Frequency of hotflush reporting was associated with
menstrual status (P < 0.001). Twenty-nine per cent of women had more than 3 and less
than 12 months of amenorrhoea, and 62 per cent of post-menopausal women, and 15 per
cent of women on hormone therapy reported having at least one hot flush in the previous
2 weeks. Follicle stimulating hormone levels were higher in women who experienced hot
flushes at least once a day or more (P < 0.001). E2 levels were higher in women
experiencing one or no hot flushes per week (P < 0.001). In the post-menopausal group,
there was no significant difference with any of the variables studied between the women
who were experiencing hot flushes and those who were not. Reporting of hot flushes is
greater 3 months or more after the final menstrual period. The frequency of hot flushes is
associated with increasing FSH, decreasing E2 and a history of pre-menstrual complaints.

➢ Punyahotra et al. (1997) conducted a cross-sectional survey of 286 women aged between 40
and 59 years to describe their experience of symptoms and attitudes to menopause and to
examine the relationships between symptoms, attitudes to menopause, socio-demographic
variables and menopausal status. Mean age at menopause was 50.13 (SD 4.67) years. 40 per
cent post-menopausal. The symptoms which showed strongest association (P < 0.001) with
 menopausal status were joint aches, hot flushes, depression and insomnia. Women most
likely to experience symptoms were older than 50 years of age, had more children, peri-or
post-menopausal, of little education, house wives or landowners and reported their health
was not so good and required treatment (P<0.001).

➢ Most women in developing countries cannot afford the conjugated estrogen cream
commonly used intravaginally to treat urogenital symptoms after menopause. This
randomized clinical trial tested a cheap, readily available substitute : a combined
contraceptive pill administered vaginally once a week. Forty post-menopausal women
suffering from urogenital symptoms of estrogen deficiency (vaginal dryness, burning
itching, dyspareunia, urinary frequency, urgency and dysuria) were randomly assigned
to either the cream or the pill. After eight weeks, both groups of women reported a
marked and comparable improvement in the symptoms. Both groups also experienced
similar decrease in vaginal pH and comparable improvement in symptoms
(Chompootaweep, 1998).

➢ Singh and Kulkarni (2002) conducted a study at Bangalore to determine the efficacy of
Menosan, a polyherbal formulation (2 tablets a day for 6 months) enriched with
phytoestrogens in women with postmenopausal symptoms. Among the 29 women, 27
presented with hot flashes, 22 with irritability, 11 with depression, 5 with bone and joint pains,
9 with night sweats, 6 with insomnia and 2 were excluded as they had complaints of diarrhea
and abdominal pain. At the end of the treatment, the mean serum follicle stimulating hormone
and serum luteinizing hormones did not show significant change. Depression was relieved in
90 per cent, insomnia in 83.33%, irritability in 50%, weight gain in 50%, bone and joint pains
in 40%, sweating in 37.88% and hot flushes in 37.03% of the women. Thus it can be concluded
that Menosan is significantly effective in treating postmenopausal syndrome.

➢ A representative sample of 300 women aged 45-55 living in the capital city of Rabatwere
interviewed about their current menopausal symptoms. Women complained most frequently
about fatigue (61%), hot flushes (61%), headaches (57%), joint pain (54%), anxiety (44%) and
 irritability (42%). Peri and post-menopausal women were significantly more likelythan pre-
menopausal women to report five or more symptoms. Menopausal status was associated with
hot flushes, dizziness, fatigue and nervousness (Obermeyer, 2002).

➢ Singh and Kulkarni (2002) conducted a study at Bangalore to determine the efficacy of
Menosan, a polyherbal formulation (2 tablets a day for 6 months) enriched with phytoestrogens
in women with postmenopausal symptoms. Among the 29 women, 27 presented with hot
flashes, 22 with irritability, 11 with depression, 5 with bone and joint pains, 9 with night
sweats, 6 with insomnia and 2 were excluded as they had complaints of diarrhea and abdominal
pain. At the end of the treatment, the mean serum follicle stimulating hormone and serum
luteinizing hormones did not show significant change. Depression was relieved in 90 per cent,
insomnia in 83.33%, irritability in 50%, weight gain in 50%, bone and joint pains in
40%,sweating in 37.88% and hot flushes in 37.03% of the women. Thus it can be concluded
that Menosan is significantly effective in treating postmenopausal syndrome.

➢ Rhonda et al. (2003) conducted a study with objectives to determining the prevalence of use
of four herbal products promoted to reduce menopause symptoms (phytoestrogens, St.John’s
wort, Gingkobiloba and Ginseng) among women (n = 397) approaching or in menopause. A
cross section of ethnically diverse women 40-55 years of age (35.5% African American, 60.2%
Caucasian) were recruited from eight primary care centers in Michigan. Herbal product users
reported more to provide menopause symptoms relief than non-users and 68 per cent of the
users said that the herbs improved their symptoms.

➢ Erin et al. (2004) assessed the efficacy and tolerability of phytoestrogen for treatment of
menopausal symptoms. The study involved 2,348 participants with the mean age was 53.1
years, mean duration of menopause was 4.3 years and mean daily hot flush frequency was 7.1.
Mean study duration was 17 weeks. Soy foods, beverages, or powders (n = 11); soy extracts
(n = 9); and red clover extracts (n = 5) were given. Of the 8 soy food trials reporting hot flush
frequency outcomes, 7 were negative. Five trials of soy foods provided a small to medium
range, favouring placebo in 3 trials and soy in 2. Of the 5 soy extract trials reporting hot flush
frequency, 3 were negative. Effect sizes were calculated for 2 soy extracts trials : one favoured
 placebo with small effect size and the other favoured soy with moderate effect size. Red clover
trials showed no improvement in hot flush frequency. Adverse effects were primarily gastro-
intestinal and taste intolerance in the soy food and beverage trials. In conclusion, soy foods,
soy extracts and red clover extracts do not improve hot flushes or other menopausal symptoms.

➢ In a study, Kamala et al. (2005) made an attempt to determine median age at menopause and
frequency of various related clinical symptoms among educated women (n =539, age : 40-50
years) of Amritsar district of Punjab. Among 256 women (47.50%) of the study population
were classified as post-menopausal.Median age at menopause was 47.54 ± 2.31 years which is
close to the estimates from other Punjabi populations. The most common clinical symptoms
associated with menopause were hot flushes and night sweats (55.08%), insomnia (53.12%),
headache and body aches (38.28%), fatigue (42.18%), irritability (35.15%), perspiration
(34.76%), palpitation (22.26%), short breath (20.31%), nervous tension (10.56%) and
depression (8.20%).

Factors affecting menopause :

➢ Guthrie et al. (1995) selected 1181 Australian born women aged 45 to 55 to test whether
physical activity is a major contributor to health and well-being. These women were
divided into pre, peri, natural and surgical menopausal groups on their menstrual history.
Theresponse rate in all groups was significantly associated with years of education,
employment status, body mass index (BMI) and self-rated health of the participants. The
relationships between physical activity and certain health outcomes, such as menopausal
symptoms, psychological well-being, self-rated health and BMI. Levels of physical activity
were significantly associated with better self-rated health, lower BMI measurements,
moderate alcohol intake and self breast examination. There was no significant association
between levels of physical activity, psychological well-being and women’s experience of
symptoms during the natural menopause transition.

➢ Guthrie (1999) assessed the role of life style in the management of menopause. The life
style variables i.e., physical activity, dietary intake and smoking are considered in relation
 to menopausal symptoms, skeletal and cardiovascular health in women experiencing the
menopausal transition and in the post-menopausal years. Aerobic physical exercise is
recommended to reduce risk factors for coronary heart disease. Site specific high-resistance
exercise maintains bone density in post-menopausal women. Intake of calcium greater than
1000 mg per day had a beneficial effect on cardiovascular and bone health. The weight
gain and an increase in abdominal fat which occurs during mid life is detrimental on
cardiovascular risk factors. Reduction in calorific intake and an increase in physical activity
can diminish these changes. Dietary intake of phytoestrogens are reported to reduce
menopausal symptoms, improve serum lipid profiles and reduce bone loss.

➢ Devi et al. (2003) conducted a study at Manipur to know the relationship of menopause
with parity in 250 healthy menopausal women aged 40-55 years. Results showed that 80
per cent of high parity women attained menopause in between 45-55 years, 20 per cent of
them had early menopause in between 40-43 years.

Lifestyle of menopausal women

➢ Willett et al. (1983) conducted a study to examine the inter-relationships of cigarette

smoking, relative weight and the occurrence of natural menopause in 66,663 female US
nurses who were pre-menopausal in 1976. Over a two-year period, 5004 women became
post-menopausal. Current smokers were more likely than past or never smokers to develop
menopause, although the effects of smoking diminished with age. The rate ratios of
menopause for current smokers vs. never smokers (with 95% confidence limits) for
women aged 30-39, 40-4, 45-49 and 50-55 years were 1.90 (1.10-3.28), 2.16 (1.73-2.69),
1.53(1.41- 1.67) and 1.20 (1.12 –1.28). These rate ratios were not affected by adjustment
for relative weight. Median ages at menopause were 52.4 for never smokers and 51.9,
51.0, 50.7 and 50.4 years for women who currently smoked 1-14, 15-24, 25-34 and 35 or
more cigarettes per day. A relationship between relative weight and occurrence of
menopause was observed. The effect of relative weight was in part explained by the
tendency of current smokers to weigh less than non-smokers. After adjustment for current
 cigarette consumption a weak relationship between weight and menopause remained
among women who smoked, although no such association was seen among non-smokers.

➢ Dennerstein et al. (1994) aimed to determine whether the well-being during mid-life
related to menopausal status, social circumstance, health status, interpersonal stress,
attitudes and lifestyle behaviours in 2000 Melbourne women aged 45-55 years.
Menopausal status did not significantly affect well being. Well-being was found to be
significantly related to current health status variables of general psychosomatic symptoms,
general respiratory symptoms, history of pre-menstrual complaints, overall health
assessment and interpersonal stress. Attitudes to ageing and to menopause were also
significantly related to well-being. Lifestyle behaviours of smoking, exercise and marital
status were also significantly related to well-being. Thus well-being of urban Australian
born, mid aged women was related to current health status, psycho-social and lifestyle
variables rather than to endocrine changes of the menopause.

HEALTH RELATED PROBLEMS

Osteoporosis, cardiovascular diseases, hypertension is the leading cause of death in
menopausal women. Deficiency of calcium and also malabsorption due to hormonal imbalance
may lead to disorders of bone mainly osteopenia and osteoporosis. Diets high in saturated fat and
cholesterol increase the risk of coronary artery diseases and other mortalities. During weight
reduction, bone turnover is elevated along with changes in serum hormone profiles such as
elevation in parathyroid hormones and reduction in concentration of sex steroids.

➢ Wang et al. (1994) studied the changes in body composition in 373 postmenopausal
women aged 49-50 years in Denmark. Total body fat increased significantly with age but
was not related to years since menopause. Total lean tissue mass decreased significantly
with years of menopause, but was not related to age. Abdominal fat per cent significantly
increased with age but not with years since menopause. Android fat increased and gynoid
fat decreased with increasing age, but was not related to years since menopause. Authors
concluded that age was significant predictor of all fat indices but not years since
menopause.
➢ Ebelling et al. (1996) measured lumbar spine and femoral neck bone mineral density
(BMD) in 281 women aged 45-57 years. Women were classified into pre, peri and
postmenopausal groups depending on menstrual bleeding patterns compared with
premenopausal women, BMD was lower only in post-menopausal women.

➢ Guthrie et al. (1996) assessed the relationships between bone mineral density (BMD) at
the lumbar spine and femoral neck and menopausal status, age, physical variables and
lifestyle and gynecological factors in 167 women born in Australia, aged 46-57 years.
Mean lumbar spine and femoral neck BMD were 15 ± 3% and 10 ± 3% lower, respectively,
in postmenopausal.. The difference between femoral neck BMD in the pre and post-
menopausal women was explained by the difference in age between these groups, whereas
for lumbar spine BMD the menopausal status was an additional determining factor. There
was a negative effect of smoking on BMD (P < 0.05) in post-menopausal women. In the
peri-menopausal, the femoral neck BMD is primarily dependent on age, whereas lumbar
spine BMD is dependent both on age and menopausal status

➢ Cromer (1999) reviewed how various hormonal contraceptives affect bone mineral
density in pre-menopausal women. The oral contraceptives have a positive effect on bone
mineral density on women of all ages. Levonorgestrel implants have a positive impact on
bone density, while the depot medroxyprogesterone acetate injectable has a negative
effect.

➢ Taechakraichana (2000) randomly assigned 80 healthy Thai women who had experienced
menopause within the past five years either to HRT or to oral contraceptive for 12 months.
The author was looking for a less expensive alternative to HRT that would be equally safe
and effective. Both regimens caused significant increases in bone mineral density, but only
oral contraceptive therapy was associated with a significant increases in femoral neck.
Thus, it can be concluded that oral contraceptives are a good alternative to HRT, especially
for women with rapid bone demineralization.
➢ Scholes (2002) conducted population based cohort study followed 457 women (183 depot
medroxy progesterone acetate (DMPA) users and 274 non-users) enrolled in US health
maintenance organization over a three-year period. DMPA use was strongly associated
with loss of bone density at the spine and hip, but women regained bone density among
women who previously used DMPA was similar to that of non-users.

➢ WHO defines, osteopenia as BMD between 1.0 and 2.5 standard deviations below peak
bone mass (at 30 year old), T-score of -1.0 to –2.5, osteoporosis as BMD at least 2.5
standard deviations below peak bone mass, T-score of –2.5 standard deviations below
peak bone mass, BMD of –2.5 or lower as established osteoporosis, T-score of –2.5 or
lower and fracture (Anon., 2003).

➢ Ebelling et al. (1996) measured lumbar spine and femoral neck bone mineral
density(BMD) in 281 women aged 45-57 years.BMD was lower only in post-menopausal
women.

➢ McWeekney et al. (2006) at New Brunswick identified post-menopausal women at high

risk for osteoporotic fractures utilizing heel ultrasound screening in 47 post-menopausal
women. Results revealed that 32 patients were identified as having at least one major
osteoporosis risk factor. Seventeen of these patients had heel ultrasound T-scores £ - 1.0
and 14 of these patients had subsequent central dexa T-scores £ - 1.5 (Spine and hip). Thus
it can be concluded that use of onsite peripheral bone mineral density screening devices
as part of a comprehensive osteoporosis program can help improve the diagnosis and
treatment of post-menopausal women.

➢ Grimes et al. (2006) conducted an observational study of post-menopausal women (n

=70), aged 40-60 years with lumbar and hip bone mineral density (BMD) T scores between
0 and –2.5 enrolled in an osteoporosis prevention trial at New Brunswick. Results revealed
that of the 70 women 10 (14%) were African American 11 per cent had less than 20 ng/ml
(optimum Vit D level in serum is above 20 ng/ml). The vitamin D levels mean was 38
 ng/ml. Lower vitamin D values were associated with African Americans and subjects with
exercise duration of less than one hour per week (P < 0.05). Further more, there was no
relationship observed in the BMD’s T scores, BMI or smoking status. Results emphasize
the role that race and exercise play in low vitamin D levels.

Other health complications

➢ Hu et al. (1994) examined the relation of age at natural menopause with risk of
coronary heart disease (CHD) and stroke in 1107 naturally menopausal women at
Boston, 757 cases of CHD and 350 cases of stroke were documented. After
adjusting for age, smoking status and other cardiovascular risk factors, the relative
risks across categories of age at natural menopause (<40, 40-44, 45-49, 50-54 and
>or = 55 years) were 1.53, 1.42, 1.10, 1.00 (reference) and 0.95, respectively. The
relative risk for each 1 year decrease in age at natural menopause was 1.03.
Elevated risk with younger age at menopause was observed among current smokes
(RR, 1.00). Age at menopause was not significantly associated with ischemic
stroke or hemorrhagic stroke. An overall significant association between younger
age at menopause and higher risk of CHD among women who experienced natural
menopause was observed.

➢ Berger et al. (1995) conducted a study at Durban, South African to know the effect
of menopause on insulin metabolism in non-insulin dependent diabetes mellitus
Indian nurses (n = 177, age 40-55 years). Fasting insulin concentration was higher
in 75 post-menopausal subjects (23.9 mUI-1) than in the 102 pre-menopausal
women (11.7 MUI-1 (P < 0.0001). Forty three (57%) of the post-menopausal
subjects had insulin values more than 20 MUI-1 (the upper normal limit).
Hyperinsulinaemic post-menopausal subjects had higher fasting glucose levels
than normoinsulinemic nurses (P <0.03). Thus fasting hyperinsulinaemia was
marked and common among a group of healthy, post-menopausal Indian nurses
below the age of 55 years, suggesting that menopausal transition may permit or
provoke insulin resistance.
 ➢ Signorelli et al. (2000) conducted a study in Italy on the carotid vascular wall to
evaluate its behavior in post-menopausal women suffering from arterial
hypertension compared to normotensive post-menopausal women. Intima-media
Thickness (IMT) of carotid artery was determined by ecoduplex scanner in 182
post-menopausal women (age range 40- 60 years) divided into four age classes
(40-45, 46-50, 51-55, 56-60 years). Ninety one women presented normal arterial
blood pressure and 91 were hypertensive (SBP 172.6 ± 11.7 and DBP 97.4 ± 6.6
mm Hg). The normotensive women presented the following IMT values 1.19 ±
0.21 mm (40-45 years), 1.21 ± 0.25 mm (46-50 years), 1.25 ± 0.20 mm (51-55
years), 1.25 ± 0.20 mm (56-60 years). IMT values in hypertensives women were
1.75 ± 0.25 mm (40-45 years), 1.77 ± 0.30 mm (46-50 years), 1.91 ± 0.28 mm (51-
55 years), 2.02 ± 0.33 mm (56-60 years). A significant difference was observed
between 40-45 and 46-50 year old hypertensive classes (P < 0.001) and between
51-55 and 56-60 year old hypertensive classes (P < 0.02). Thus it can be concluded
that a correlation exist between age and IMT in the hypertensives and carotid wall
thickening was constantly higher in hypertensive women compared with
normotensive ones.

HORMONE REPLACEMENT THERAPY (HRT)

All menopausal and post-menopausal women go through estrogen deficient years, which can
manifest in both physical and emotional ways leading to impairement of the quality of life. As the
female life expectancy has increased, it is possible for a woman to live one third of the life after
menopause. HRT is a treatment for menopause given to women to correct the hormonal deficiency
in post-menopausal state.

Ebelling et al. (1996) measured urine markers of bone resorpotion, serum markers of bone
formation and serum gonadotrophin, estradiol and inhibin concentrations in 281 women aged 45-
57 years. Post-menopausal women had greater levels of bone turnover markers (P < 0.0001),
except free deoxypyridinoline and type I procollagen propeptide. Levels of all bone turnover
markers were positively related to serum FSH concentrations (P < 0.0007). Estrogen deficiency
may also contribute to the pathogenesis of post-menopausal osteoporosis.

Studies on Nutrition and Health Education

➢ Nutrition education has shown a significant benefit in increasing nutritional knowledge

And improving infant feeding practices amongst mothers who receive nutrition education
compared to mothers who do not receive nutrition education (Guldaneal.,2000). Ladzani
et al. (2000) reported that a nutrition education programme had significantly improved
breastfeeding and infant feeding practices in rural areas amongst local women who had
been trained. It was also shown that teaching mothers about complementary feeding
improved the mother’s knowledge and the children’s diets (Ilett& Freeman, 2004). In
addition, Guldan et al. (2000) indicated that children of mothers who received nutrition
education had lower rates of anemia and were significantly heavier and taller than the
control group

➢ Walsh et al. (2002) indicated that, in the Free State and Northern Cape Province, utrition
education significantly improved the weight for age of boys and girls in urbanAreas and of
boys in one rural study area. Walsh et al. (2002) further reported thatNutrition education
accompanied by food aid succeeded in improving the weight status Of children, but was unable
to facilitate catch-up growth in stunted children after two Years of intervention. Stunting is a
chronic form of malnutrition and takes longer toDevelop than underweight, so catch-up growth
also takes longer in stunted children.Nutrition education presents some unique challenges in
the health education area. InOrder for nutrition education to be more effective, the educational
methods should beSelected on the basis of what is appropriate for the target groups and the To
the diet should include not only information about what foods should be given, Nutrition
education may alsoRequire the development of skills to grow and prepare specific foods. On
this basis, itCan be seen that face-to-face methods are likely to be the most effective method
ofNutrition education. Mass media strategies, on the other hand, are based on a marketing
andCommunication model that tends to deal with simple messages. Nutrition educationRarely
deals with a single behaviour or single food. using mass media
 MATERIAL AND METHODS

Menopause is the physiologic cessation of menses associated with failing ovarian function,
may be diagnosed in retrospect when a year has passed with no menses. The decrease in circulating
estrogen results in specific symptoms. The current medical view of menopause, however, is a
pathological event with its own distinct set of symptoms and diseases as the result of the impact
of changing hormone levels particularly (Kaira and Wadhwa, 2002). Considering the above
rationale, an investigation on the “Nutritional status of post-menopausal women” was carried out
during 2014. The details of material used and the methodology employed in carrying out the study
are described in this chapter.

3.1Selection of the Sample:

The investigator according to convenience selected the women from Visakhapatnam.

Women of 55 – 65 age group were only considered as sample. Out of 50 women 25
women were identified with menopausal symptoms.

Questionnaire was followed to identify the sample

3.2 DEVELOPING OF QUESTIONNAIRE

A detailed questionnaire was structured to collect necessary information of the subjects. The
details of various aspects of questionnaire are furnished below :

3.2.1 General information

General information of menopausal women such as age, education, occupation, type of family,
income, number of children were collected by self structured questionnaire through personal
interview method.
 3.2.2 SAMPLE DESIGN :

Visakhapatnam

Madhuranagar ( 55 - 65 age )

50 women

post-menopausal women
(n = 25)

3.2.3 Dietary information

Information on the food habits viz., existing food frequency and food consumptionpattern were
assessed by 24 hours dietary recall method (Pai, 1987). A set of standardized vessels were used
to obtain estimates of the amount of raw and cooked foods consumed by women.

3.2.4 Nutrient intake and adequacy

The raw food equivalents of cooked food were computed from the standardized cups. The
nutrients present in the food were computed from Annapurna VAR-3 a software developed by
M.R. Chandrashekar of Bangalore. Recommended Dietary Allowance of Indian Women
Sedentary Worker (ICMR) was considered for computing per cent adequacy of nutrients, (Anon.,
1994). The per cent adequacy of nutrients for each subject was computed using the formula.
 Nutrient intake
Nutrient adequacy = -------------------------------- x 100
RDA of the nutrient

3.3. ANTHROPOMETRY

Anthropometric measurements viz. height (cm), weight (kg), waist and hip circumference (cm)
were recorded as per the guidelines suggested by Jelliffe (1966).

The height was measured using anthropometric rod to nearest 0.1 cm. The subjects were
weighed on portable platform weighing balance to nearest 0.5 kg with ordinary clothes. A non-
flexible tape was used to measure the waist and hip circumference. The measurements were made
to nearest 0.1 cm.

The anthropometric data were further used for computing BMI, by using the formula
expressed as the ratio of weight in kgs to height in square meters.

Weight (kg)
BMI = -----------------
Height (m)2

BMI classification for adult Asians (WHO)

BMI classes Presumptive

diagnosis
<18.5 Under weight

18.9 – 22.9 Ideal BMI

>23.0 Over weight

>25.0 Obese grade 1

>30.0 Obese grade 2

 The abdominal obesity was assessed by waist/hip ratio (Lean et al., 1995). Females
having equal to or more than 0.80 were categorized as abdominally obese.

3.4. BIOCHEMICAL PARAMETERS:

Serum levels of total cholesterol, High Density Lipoprotein Cholesterol (HDL-C), triglycerides
and serum calcium were noted from the general check up report of the respondents.

3.5. DETAILS ABOUT THE MENOPAUSE

Information about the age of onset of menarche and menopause of the respondent, mothers
age of menarche and menopause, present and past trend of menstrual cycle, number of days of
bleeding at present and past, symptoms of menopause and irregularity of menses were collected.

3.6. LIFE STYLE

The life style pattern of the women such as exercise behaviour and physical activities
performed were assessed by personal interview.
.
3.7. INTERVENTION : dietary and yogic regimes were suggested among the selected
menopause women of yoga village. Total six sessions were given for the selected sample who
were post menopause groups. Three sessions on symptoms, factors and diets for menopause.

3.8. STASTICAL ANALYSIS

The responses of subjects were expressed in frequency and percentages. mean values, graphs ,
correlation are shown in results (next chapter
 RESULTS AND DISCUSSION

The results of the present study on “nutritional status of postmenopausal women” presented
in this chapter. The results related to demographic profile, anthropometry, dietary history,
nutrient adequacy and biochemical assessment are included in this section.

GENERAL INFORMATION

Demographic profile of post-menopausal women:

The data collected on the demographic profile of 50 women consisting of 25 post-menopausal

women are presented in Table 1. Among the different age groups, post-menopausal women
belonged to the age group of 46-50 years followed by 51-55 years (40%) and 40-45 years (12%).
When the women were distributed based on education level, nearly half of the Post - menopausal
women (60% respectively) Only 8 per cent were post-menopausal women. Percentage of women
who had post-graduation(40% respectively).Only 4 per cent of post-menopausal women were
employed.
Nuclear family system was common among the study group. All of the women of post-menopausal
women (98%) belonged to nuclear type of family, while very few belonged to joint family from
postmenopausal group (16%).

Majority of 64 percent of post-menopausal women had one to two children.80 per cent post-
menopausal women belonged to middle income group and rest of them were in low income group
( 20%, respectively). Maximum number of women of post-menopausal 92%) were vegetarians and
had undergone tubectomy (post-menopausal 72%).
Table -1 Demographic profile of menopausal women (N= 25)

Particulars Stage
Post-menopausal
(n-25)
Frequency %
Age(years)
40-45 3 12.00
46-50 12 48
51-55 10 40

Llliterate 2 8.00
High school 15 60.00
Graduate 6 24.00
Post-graduate 2 6.00
Occupational
status
Employed 1 4.00
Non-employed 24 96.00
Types of family
Nuclear 21 84.00
Joint 4 16.00
Marital status
Married 23 92.00
Un-married 2 8.00
Number of
children
1-2 16 64.00
3-4 5 20.00
>4 2 8.00
No children 2 8.00
Family Income
(Rs./>10,000)
LIG(<10,000) 5 20.00
MIG 20 80.00
(10,000-25,000)
Food Habits
Vegetarians 23.00 92.00
Non-Vegetarians 02 8.00
Tubectomy
status
a.YES 18 70.00
b.NO 7 30.00
NUTRITIONAL STATUS OF MENOPAUSAL WOMEN

Table.2 Mean food intake of menopausal women

Food groups
Stage

Post menopause

(n = 25)

Cereals 350.51 ± 74.50

Pulses 82.05 ± 56.44

GLV 63.72 ± 55.41

Other vegetables 116.16 ± 56.49

Roots & tubers 88.14 ± 50.09

Fruits 101.14 ± 81.38

Milk and milk 195.24 ± 95.40

products

Sugar and jiggery 27.72 ± 10.55

Nuts and oil seeds 13.60 ± 13.09

Fats and oil seeds 30.83 ± 12.01

Table.3 Mean nutrient intake of post-menopausal women

Nutrients
Stage
Post – menopause RDA
(n=25)
Energy (k.cal/d) 2206 ± 713 1875
Carbohydrates 360.65 ± 160.10 -
(g/d)
Proteins (g/d) 64.69 ± 15.80 50
fat (g/d) 52.92 ± 14.18 20
Fibre (g /d) 30.69 ± 7.70 -
Thiamine 2.15 ± 0.90
Ascorbic acid 5.36 ± 1.39 40.00
Calcium 779.90 ± 294.54 400.00
Iron 3.36 ± 3.19 30.00

Table.4 Mean per cent adequacy of nutrients by menopausal women

Nutrients Stage

Post –
menopause
(n = 25)
Energy (kcal/d) 117.70 ± 38.04
Proteins (g/d) 135.44 ± 26.33
Fat(g/d) 264.64 ± 70.91
β-Carotene 95.86 ± 83.43
(mg/d)
Thiamine 239.77 ± 54.85
 Table.5 Frequency of consumption of calcium rich foods by menopausal women

Foods daily Twice Thrice weekly fortnightly monthly occasionally Not at

a week a week all

Post
menopausal(n=25)
Milk 25 - - - - - - -
(100.00)
Ragi - - - 4 1 1 3 16
(16.00) (4.00) (4.00) (12.00) (64.00)
Nuts and oil seeds 5 12 8
(20.00) (50.00) (30.00)
Green leafy 7 13 4 1 - - -
vegetables (28.00) (52.00) (16.00) (2.00)

Table 6. Mean intake of different type of fat components menopausal women

Types of fat stage Mean

Total fat Post-menopausal 52.92±14.18

Cholesterol(mg/d) Post-menopausal 43.90±20.75

SFA Post-menopausal 19.01±5.70

MUFA Post-menopausal 21.34±6.36

PUFA Post-menopausal 11.69±3.50

ANTHROPOMETRIC MEASUREMENTS OF MENOPAUSAL WOMEN

Table 7. Mean anthropometric Measurements of menopausal women

Types Stages Mean

Height(cm) Post-menopausal 149.12±19.85
Weight(kg) Post-menopausal 67.11±9.22
Waist circumference(cm) Post-menopausal 89.61±8.47
Hip circumference(cm) Post-menopausal 110.87±8.86

Table 8 . Mean BMI and WHR of menopausal women

Indices stage mean

BMI+ Post-menopausal 29.15±3.39

WHR Post-menopausal 0.80±0.03

BIOCHEMICAL PARAMETERS OF MENOPAUSAL WOMEN

Table 9. Biochemical profile of menopausal women

Blood profile Stage

(mg/di)
Post-menopausal
(n=10)
Total cholesterol 207.53±8.51
Triglycerides 178.33±30.73
HDL-C 47.60±2.44
LDL-C 124.86±7.14
VLDL-C 33.86±7.14
Hemoglobin (g/100 ml) 10.49±0.61
(8.0-12.0)
 Table.10 Exercise behavior of menopausal women

particulars
Stage
Post-menopause
women

(n=25)
Frequency %
Exercising habit 7 28.00
a.yes 18 72.00
b.No
Type of exercise
a.walking 12 24.00
b.yoga - -
c.walking and yoga 1 4.00
Period of initiation

1-2 1 4.00
2-5 4 16.00
5-10 2 8.00
Frequency of exeicise
Daily 2 8.00
Once a week 2 8.00
Thrice a week 6 12.00
Duration
a.30 minutes 3 12.00
b.45 minutes 3 12.00
c.1 hour 1 4.00
Table .11 MENOPAUSAL SYMPTOMS OF POSTMENOPAUSAL WOMEN.
particulars
Psychological symptoms
Irritability
Mood swings
Tension and depression
Physiological symptoms
Aching joints and muscles
Dry and wrinkly skin
Facial hair growth
Thinning and hair loss
Headaches/migraines
Heart palpitation
Hot flushes
Night sweats
Sleep disturbances
Loss of bladder control
water retention
Weight gain
Breast tenderness
post-menopausal women followed by peri (86.66%).
stage
Post – menopause
women
(n =25)
Frequency %
8 32.00
8 32.00
5 20.00
9 36.00
1 4.00
1 4.00
11 44.00
5 20.00
1 4.00
3 12.00
1 4.00
2 8.00
8 32.00
2 8.00
12 48.00
8 32.00
Table. 12 .Age of menarche and menopause in post-menopausal women (N=25)

Variables Post- menopausal stage

Age of menarche frequency %

11-13years 9 34.00

>13 years 16 66.00

Age of menopause

40-43 years 2 10.00

44-50 years 20 78.0

51 years and above 3 12.00

Age of menarche and menopause in post-menopausal women Majority of post-menopausal women

had reached menarche at the age of more than 13 years (66%) followed by 11 to 13 years of age
(34%). Maximum number of postmenopausal women had reached the stage of menopause between
the ages of 44 and 50 years (78%) whereas, almost equal number of them reached menopause after
51 years and between 40 and 43 years (12 and 10%, respectively)

DEVELOPMENT OF EDUCATIONAL MODULE FOR MENOPAUSAL WOMEN FOR

BETTER NUTRITIONAL AND HEALTH MANAGEMENT

In the present study, the nutritional status of the menopausal women was assessed by diet survey,
anthropometry and biochemical methods.

Based on the data of nutritional status of post-menopausal women, the need for
development of education module was needed. Thus the educational module developed has
following section.

Therefore there is a need for educating and councelling the menopausal women. An
educational module was formed which included dietary tips, lifestyle modifications,
supplementation and health checkups (Detailed educational module for menopausal women has
been presented in Appendix V).

Dietary tips :

• Drink plenty of water

• Avoid carbonated beverages, sugary foods, sweets and processed foods, since their
raise the weight and lead to calcium loss.

• Increase the intake of calcium rich foods. Such as milk without cream, ragi, nuts and
oilseeds, fresh seasonal fruits, citrus fruits and green leafy vegetables and fresh
salads.

• Avoid frequent consumption of tea and coffee.

• Decrease the frequency of intake of cholesterol rich foods such as mutton and organ
muttons.

• Decrease the intake of fried foods and snacks rich in oil.

Lifestyle modifications

- Household work is not an exercise. To maintain good bone health and control the obesity
exercise is a must.

- Walking for 20-30 minutes atleast 3-5 times a week is to be followed, daily exercise is the best.

- Aerobic exercise and yoga are also recommended now-a-days for better bone health.

- Maintain ideal body weight. Simple formula to know your ideal body weight is Height in
centimeters – 100.
Ex : 5’ = 150 cm - 100 = 50 kg is ideal body weight.

- Avoid weight bearing and muscle building exercises. Avoid over exercise, it may lead to
osteoporosis.

Supplementation

• Include phytoestrogen rich foods like soyabean (40 g/d) and flax seed because phytoestrogen
are rich in isoflavones and they substitute estrogen action in the menopausal women

• Include omega-3 fatty acid rich foods (soybean, flax seed, linseed, green leafy
vegetables).
• Take calcium and vitamin D tablets every day according to doctor’s recommendation.

Health checkups

• Visit your gynaecologist and physician as and when needed, get you pap smear test and pelvic
examination done.

• Self breast examination is important for lumps to rule out the incidence of breast Cancer.

Others

• Developing positive attitude about menopause, which is a natural process and inevitable for
every women.

• Counselling about menopause problems to their spouse and other family members.

• Wear cotton clothes, keep a glass of cold water to overcome hot flush and night sweats.

• Exercise and yoga can relieve the symptoms of hot flush.

• The women with severe symptoms and health problems can consult the doctors for HRT
(hormone replacement therapy).
 DISCUSSION

At menopause, hormone levels do not always decline uniformly, but fluctuate. The changing
ovarian hormone levels affect also the other glands in the body besides reproductive targeted ones.
Menopause problem has become important now-a-day as the female life expectancy has increased
and most of the women spend their 30 years of active life in post-menopausal phase. Increasing
menopausal complaints such as osteopenia, osteoporosis and cardiac diseases call for growing
public health concern and demand. Nevertheless, a few of the women may cross the menopausal
stage without facing any symptoms, others may face a number of health related problems with
severe symptoms and very few may even need medical interventions. The salient results of the
present study on “Nutritional status of pre, peri and post-menopausal women” have been discussed
in this section.

NUTRITIONAL STATUS, HEALTH RELATED PROBLEMS AND SYMPTOMS OF

MENOPAUSAL WOMEN

An advancement in chronological stage the visible signs of aging begin to appear. The With
physical activity of the women in the middle years decreases along with metabolic rate.
Conversely, the energy requirement decreases and even regular or routine eating may lead to
weight gain.
In the present study, there was no apparent differences in food intake of post menopause
women. Further the diet or nutrient intake shows that the fuel and related nutrients were higher
than RDA in the studied group. This indicated the prevalence of the obesity or over weight among
the sample .which was further related to low or poor exercising habit. Therefore, it was not
surprising to visualize the incidence of health related problems being higher in menopausal women
.
During menopause, weight gain is very common, after menopause many women begin slow
but steady weight gain. One of the reasons is water retention due to hormonal imbalance as in case
of post-menopausal women .There is a decline in lean body mass and increase in fatmass in
menopausal women possibly due to declining estrogen levels.

Therefore due to more of abdominal obesity in post-menopausal phase, women under this
group are more prone to health complications.
Some of the common symptoms of menopause such as skin and hair changes was observed
in menopausal women .which occurred due to loss of collagen. Therefore menopausal women
should be encouraged to eat ascorbic acid rich foods. Since ascorbic acid is an antioxidant, it has
a role in collagen formation and also helps in iron absorption as all the menopausal women were
mildly anaemic in the present study .
The problems of joint pain was found in higher percentage of menopausal . which may be
due to lack of awareness among women about importance of calcium rich and also due to lower
exercising habit and age related factors. Similar results were obtained by Punyahotra (1997)
symptoms like joint aches, hot flushes, depression and insomnia was experienced more in post-
menopausal women.
Immobilization can decrease bone mass. Moderate exercise has a modest effect on
preventing post-menopausal bone loss. Sedentary women suffer more from chronic backache,
stiffness, insomnia and irregularity of mensus. They often have poor circulation, weak muscles
and loss of bone mass. Just like muscles, bones adhere to the “use it or lose it rule”.
Hotflush symptom may be due to surge of brain gonadotrophin releasing hormone (GnRH)
which has direct effect on the part of brain that regulates body temperature. This hormone levels
are low when the ovaries are functioning at normal level. As menopause draws nearer, increasing
amount of GnRH are released increasing severe hot flush symptoms.
Estrogen promotes cell proliferation, DNA synthesis and cell division, it controls and
regulates hair growth and skin elasticity. Decrease in estrogen levels leads to collagen loss from
bone matrix and decrease the blood supply to the skin leading to dry, thin, translucent, inelastic
skin. Loss of collagen lead to brittle nails and loss of hair.
Age of menopause is dependent on nutritional, climatic and socio-economic conditions.
The age at which menopause occurs is genetically predetermined unlike the age of menarche. In
our study, no correlation was observed between the age of menarche and menopause Devi et al.
have reported similar results who observed no correlation between age of menarche and age of
menopause.
To manage the menopausal symptoms, it is very important that women should be
educated and counselled about it. Menopause is an inevitable stage and therefore one has to be
good to oneself under this stage. Having positive attitude towards life, sharing concerns with
friends, spouse, relatives or a support group can help.
In present study, most of the menopausal women were not ready to accept that they
were growing older and not able to accept aging process. They never visited gynaecologist unless
there was a serious problem may be due to economic conditions or feeling shy to share the matters
with doctors, scared about medical procedures. The medical practitioners lack time and patience
to counsel the menopausal women. So an attempt has been made to educate them by creating a
module for the benefit of menopausal women.
module with regard to diet modification includes minimizing intake of saturated fats like
ghee, butter, dalda, avoiding red meat, going for vegetarian diets rich in green leafy vegetables and
fresh fruits and vegetables. Avoid ready to eat and refined foods and snacks rich in oil, since they
increase calorie intake leading to obesity. Include whole grain cereals, millets, pulses, citrus and
orange coloured fruits which are rich in antioxidants. Tea and coffee hinders calcium and iron
absorption, so they are to be limited. Phytoestrogen containing foods (Soya, linseed, flaxseed)
should be encouraged to prevent bone problems, CVD and to relieve menopausal symptoms.
Along with balanced diet, regular exercise is a must.
Visit to gynaecologist for routine health checkups are needed to rule out complications in
the early stage. Supplements can be started during climateric period by consulting physicians. The
counseling of menopausal women to avoid the emotional upset and stress is another tip. The famiy
members and spouse counseling is also needed to see that menopausal women do not become
irritable and emotionally upset during this phase.
From this study, it can be concluded that menopausal phase has been a moderate problem
in the study group. The abdominal obesity and border line dyslipidemia prevalent among the
women may create health related problems. Hence an intensive orientation and education is
absolutely necessary.
 SUMMARY

The investigation entitled “To Study the Nutritional Profile of Post Menopause
Women” was carried out during 2023-24 at Indira Gandhi National Open University with the
objectives of studying the nutritional status of post-menopausal women in terms of anthropometry,
dietary and biochemical methods, to document the incidence of non-communicable diseases and
to develop an educational module for menopausal women.
A total of 50 post-menopausal women between the age group of 55 – 65 years were
selected for the study which are 25 post-menopausal women. General information regarding the
subjects was collected using questionnaire by personal interview technique. The information
included the age, education, occupation, type of family, marital status, income, number of children.
The information on dietary habits like frequency of food consumption pattern were recorded
using 24 hours recall method with standardized cups. The raw equivalents of the cooked foods and
nutrients present in the diet were computed. Further, the recommended dietary allowances for
Indian adult sedentary women were used for comparison for selected nutrients such as minerals
and vitamins for computing adequacy.
Further anthropometric measurements viz., height, weight, waist and hip circumference,
waist to hip ratio and BMI were calculated
Information about the age of onset of menarche and menopause of the respondent, mother and
sisters was collected. Present and past trend of menstrual cycle, symptoms of menopause and
irregularity of menses was also collected. The salient findings of the study are summarized below.
• The mean weight and hip circumference was significantly higher in post-menopausal women.
• Maximum number of post-menopausal women belonged to obese I. Majority of post-menopausal
women were obese.
• Majority of post-menopausal women suffered from physiological symptoms such as thinning and
loss of hair, breast tenderness, aching joints and muscles, loss of bladder control, lower sex drive
when compared to peri and pre-menopausal women.
• Symptoms like sleep disturbances, night sweats, water retention, headaches or migraines, hot
flushes, palpitations, dry and wrinkly skin, facial hair growth was higher in post-menopausal
women.
• Weight gain was maximum in post-menopausal women.
• Maximum number of post-menopausal women (90%) were obese. Similar trend was observed
for hypertension and diabetes mellitus. The incidence of cardio vascular disease was maximum in
post-menopausal women.
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 APPENDIX-1 Questionnaire

Proforma to elicit information about post-menopausal women

PART A: General information

1. Name of the respondents :

2. Place, home address, telephone number: :
3. Age (Date of birth) :
4. Education : SSLC/PUC/Graduate/PG/Professionals
5. Occupation : Employed/Not employed (details of employment)
6. Composition of family :
7. Monthly income : Salary other source
Total

PART B : FOOD FREQUENCY QUESTIONNAIRE

Qty Consumption
Food group Evey Twice Thrice Once a Once Once Some
day a week week week in a in a times
week month
Cereals grains and
products
Rice
Wheat
Jowar
Ragi
Maize
Barley
Any other
Pulses of legume
Bengal gram dhal
Black gram dhal
Green gram dhal
Red gram
Cow pea
Peas
Rajmah
Soyabean
Beans
Milk and milk
products
Milk
Curd
Cheese
Skimmed milk
Chicken
Fish
Egg
Mutton
Fruits and vegetables
Fruits
Mango
Guava
Tomato
Papaya
Grapes
Orange
masumbi
Banana
Apple
Chickoo
Watermelon
Lemon
Amla
Vegetables(green
leafy)
Amaranth(rajgiri)
Spinach(palak)
Gogu
Coriander leaves
Fengreek leaves
Cabbage
Curry leaves
Shepu(sabsige)
Other vegetables
Beetroot
Potato
Raddish
Sweet potato
Onion
Carrot
Turnip
Ashgourd(Bud gum
bala)
Bitter gourd
Bottle
gourd(Sorekai)
Brinjal
Cauliflower
Clusterbeans
Cucumber
Chillies
Lady’s fingers
Pumpkin
(Kuumbala)
Ridgegourd
(Hirekai)
Snakegourd
(Padavalu)
Tomato(green)
Nuts and oilseeds
Almond(Badam)
Cashewnuts(geru)
Coconut
Gingerlly seeds
Ground nut
Mustard
Fats and sugars
Fat
Butter
Ghee
Hydrogenated oil
Cooking oil
Sugars
Sugar
jaggery
PART C: Anthropometric measurements:

1) 1. Height (cm):

2. Weight (kg):

3. BMI

4. Waist circumference

5. Hip circumference:

6. WHR =

PART D : Schedule of exercise behavior

1. Do you exercise regularly : Yes/No If yrs,

a. When did you start exercising ( years/ months):

b. Who suggested you to do exercise :
c. How many times a day : Morning / Evening / both
d. Duration (hrs)
e. Problems/ Benefits observed :

PART E: Physical activities

PART F: Non –communicable diseases :

SL.NO Diseases Presence of From how long Medicines taken

diseases/disorder
1 Obesity
2 Diabetes I/II
3 Cardiovascular diseases
4 Cancer
5 Joint pain
6 Osteoporosis and bone fractures
7 Arthritis
8 Asthma
9 Anemia
10 Blood pressure
11 Mental depression
12 Any other
PART G: Morbidity pattern

S L.No Morbidities Frequently Occasionally Rarely

1 Fever
2 Cough

3 Cold
4 Headache

5 Diarrhea
6 Dysentery

7 Vomiting
8 Any other

PART H: a. Do you taken any tonics, if “YES” name them

Name Amt/day Reason Contents

b. Tea/coffee consumption per day ?

PART I: Biochemical parameters

1. Haemoglobin level : g/dl

2. Blood lipid profile :

a. Total cholesterol : g/dl

b. Triglycerides : g/dl

c. HDL- Cholesterol : g/dl

d. LDL-Cholesterol : g/dl

(by differences)

3. Serum calcium level :

PART J: Dietary intake pattern : (24 hrs recall method).

PART K: INFORMATION ELATED TO MENOPAUSE

1. Age of Menarche : _____________ years

2. Age of menopause : __________ years
3. Mothers age menarche and menopause : _____ years __________ years
4. Sister age of menarche and menopause
a. Younger : _______ years ___________ years
b. Elder : ___________ years _____ years

5. Whether undergone tubectomy /laprotubectomy

If yes, at which age: ___________ years

6. Menstrual cycle: Regular/Irregular/Completely stopped

7. Days of cycle at present?________ (27, 30, 40days, 2 months, 3 months, 4/6 months)

8. No of days of bleeding at present: 1, 2, 3, 4, 5>5.

9. Bleeding is heavy or scanty to be indicated

1st days: ……….. II: ………… III: ………. IV: ……… V:……………

10. NO. Of days of bleeding previously: 1.2.3.4.5.>5.

11. Symptoms during menses or periods:

12. Irregular menses: Always/sometimes.

 APPENDIX- II

EDUCATION MODULE FOR MENOPAUSAL WOMEN

Menopause is derived from a Latin Word. Meno (month), pause halt. Menopause may be defined
as stopping of periods or menses. It occurs because she no longer produces sufficient estrogen
hormone. This is a time of fluctuation of hormones and emotions. It occurs between the ages 45
and 55 with an average age around 50. In menopause, the ovarian function gradually declines and
leads to irregular menstrual cycle. This is the cause for the occurrence of menopausal symptoms
and prominent pre-menopausal symptoms are seen in menopausal women.

Pre-menopausal symptoms : The pre-menopausal symptoms begin 2-10 days before

menstrual bleeding. The symptoms are both physiological and psychological. They become very
common few years before menopause. The symptoms are tender breasts, bloated abdomen,
appetite changes and cravings, pimples, headache, stomach upset, swollen hands and feet. Women
show changes in moods, depression, fatigue, irritability, lack of concentration, over sensitivity,
crying spells and social withdrawal.

MANAGEMENT AND THERAPY FOR PRE-MENSTRUAL SYNDROME

• Life style change (aerobic exercise for 20-45 minutes, three times weekly, or mild exercise such
as walking everyday).

• Include adequate protein and complex carbohydrates

• Avoidance of alcohol, caffeine (coffee, tea, cocoe) and simple sugars.

• Take frequent small meals

• Eat more of fresh fruits and green leafy vegetables, whole grains.

• Reduce salt intake as it increases the water retention in body.

• Increase the intake of fibre rich foods like raw cucumber, carrot, raddish, green leafy
vegetables and salads.

• Avoid soft drinks or carbonated beverages.

• Increase the intake of Vitamin A rich foods (papaya, drumstick and yellow coloured fruits). In
severe pre-menopausal syndrome the doctors treat the women with pain killers, mdiuretics for
water retentions and anti depressants in extreme cases.

Menopause symptoms

Menopause women experience a number of symptoms caused by hormonal imbalances and low
estrogen levels. The menopausal symptoms seen in women are

• Aching joints and muscles

• Allergy symptoms
• Breast tenderness
• Chronic fatigue and morning sluggishness
• Cold or tingling hands or feet
• Craving for certain food like sweets, coffee and tea
• Depression, anxiety and mood swings
• Dry, thin or wrinkly skin
• Facial hair growth
• Fibrocystic breasts
• Hair loss, thinning hair
• Headaches, migraines
• Heart palpitations
• Heavy or light periods
• Hot flushes with reddening of face, neck and chest
• Night sweats and insomnia (sleeplessness)
• Incontinence (loss of bladder control)
• Irregular periods
• Irritability and inability to handle stress
• Lack of concentration, foggy fuzzy thinking and memory lapses.
• Leg cramps
• Low metabolism (poor digestion and absorption of food)
• Lower sex drive / loss of sex drive
 • Osteoporosis (bone disease caused due to increased calcium loss from skeleton)
• Urinary tract infections
• Water retention and unexplained weight gain, especially in hips, waist and
stomach
• Sudden food intolerance
• Dryness of vagina
• Increase in acidity
• Uterine fibroids.

Effect of menopause on health

The health consequences of menopause are due to the deficiency of estrogen or imbalance of
hormone levels.

➢ Estrogen is protective against risk of heart disease.

➢ Menopause increases the risk of heart diseases in women due to increase in low density
lipoprotein cholesterol and decrease in high density lipoprotein cholesterol.

➢ Accelerated loss of calcium from skeleton after menopause leads to bone demineralization,
osteopenia and later to osteoporosis. In case of negligence it may lead to bone fractures.

➢ Hormonal imbalances and deficiency in estrogen levels causes atrophy of genital tract, vulva,
vagina and uterus and can lead to fibroids, uterine cancer and strokes.

➢ Estrogen protects heart, as it decreases during menopause the risk of cardiac disease
increases as in case of men. Management of menopause through diet

➢ Eat balanced and wholesome diet

➢ Minimize animal fats (red meat) and saturated fats (ghee, butter, dalda)

➢ Use nuts and oilseeds and vegetable oils

➢ Increase water intake (10-12 glass per day)

➢ Minimize coffee and caffeine products, limit coffee to 2 cups per day
➢ Encourage herbal tea to avoid calcium loss.

➢ Avoid carbonated soft drinks since they cause bone loss.

➢ Include dark green leafy vegetables (spinach, drumstick leaves, Amaranthus, methi, shepu.

➢ Use whole grains and peanuts, root vegetables, potatoes.

➢ Include lot of fresh fruits and vegetable

➢ Include yellow coloured vegetables, fruits and legumes.

➢ Avoid foods rich in pesticides like cabbage and cauliflower.

➢ Avoid antacids (ENO) as they neutralize stomach acids, needed for absorption of nutrients.

➢ Avoid hot drinks, chocolate, spices and foods with a high-acid content (eg., citrus, tomatoes)
which are known to trigger hot flushes.

➢ Use phytoestrogen rich foods like soybean, yam, flax seed, sweet potatoes. Include 25 g of
soybean every day.

➢ Use chicken or lamb with bone (remove skin). Make a stew or stock out of the bones (for non-
vegetarians). Since it is rich in calcium.

➢ Use foods rich in omega fatty acids like agase, (linseed), green leafy vegetables.

➢ Foods rich in alpha-linolenic acid like cereals wheat, bajra), pulses and legumes (blackgram,
cowpea, rajmah, soya), vegetables (fenugreek), oils (soybean) and in animal foods (fish)
should be included in diet to reduce various menopause symptoms and heart diseases.

Management of menopause through lifestyle changes

➢ Wear layered, cotton clothing and avoid synthetics.

➢ Avoid being in hot weather, hot showers, hot tubs, hot beds, hot rooms and consuming hot
foods.

➢ Take cool shower bath before bed

➢ Avoid sedentary life style and be active and sportive. Health related problems of menopausal
women Long term health related problems of menopause women include osteoporosis, heart
diseases and breast and cervical cancer.

What is osteoporosis

➢ ‘Osteo’ means bone. Osteoporosis literally means ‘Porous bones’. Osteoporosis is thinning of
the bones that occur with age. Bones become weak and fragile, until even a slight impact may
cause them to break.

What happens to bones during osteoroporosis

By about 20, the average women has acquired 98 per cent of her skeletal mass. This process slows
down as you get older. Between ages, 35-40, women lose bone mass, which levels off around age
30, remains reasonably stable until age 50 and then declines progressively. This loss, if severe, can
lead to osteoporosis.

How does a person know that she has osteoporosis

Osteoporosis is difficult to detect at early stage. Most people don’t realize that they have it. The
disease slowly and silently steals bone, often giving no pain or sign, until the first fracture.
Therefore, the disease is also referred to as “silent thief”. Fractures of the spine, wrist or hip after
menopause could be due to osteoporosis.

Signs and symptoms of osteoporosis

• Bone pain in the hip, arm or wrist

• Low back pain
• Loss of height and a stooped posture
• Neck pain
• Fractures of the hip, spine, back or wrist, sometimes without
falling

The following general risk factors may trigger osteoporosis.

• A family history of osteoporosis

• Low calcium diet and low vitamin D intake
• Lack of physical exercise or sedentary life style
• Alcohol consumption
• Smoking
• Medicines such as corticosteroids, diuretics, medications for blood pressure, etc.
• Early menopause
• Women whose ovaries are surgically removed
• High caffeine intake and high protein intake
• Endocrine disorders such as diabetes mellitus, hyperthyroidism.

How to prevent osteoporosis

• Adequate calcium and vitamin D intake are necessary to develop and preserve healthy
bones throughout your life

• Good sources of calcium are dairy products such as milk, cheese, yogurt, green leafy
vegetables, nuts especially almonds and sea food like fish.

• Vitamin D may be obtained from eggs, liver, or by spending 15 minutes in the sun 2-3
times a week .

• About 15-20 minutes walking daily helps stop further weakening of bones

• Low-impact aerobics, stair climbing, helps to keep your bones strong.

• Muscle building exercises are not recommended for people with osteoporosis. Avoid
caffeine and meat to conserve calcium.

Tests recommended for menopausal women

• Annual mammogram, annual pelvic tests like pap smear test

• Thyroid and cholesterol screening if possible every 6 months or as suggested by doctor

.
• Bone mineral density test

• Pelvic and breast examination (monthly breast self examination)

Hormone Replacement Therapy (HRT)

Hormone replacement therapy is one of the treatments offered by physicians for physical and
psychological ailments of menopausal women. HRT replaces body’s decreasing estrogen and can
provide relief to many menopausal symptoms and it is preventive against the related diseases.
Short term HRT is useful in releasing the menopausal symptoms. Long term use of HRT can last
for 5-10 years or even life long. Long term use is recommended for older women against diseases
like osteoporosis, heart disease and Alzeimers disease. The use of HRT in India is only 1 per cent
in post-menopausal women. It is not popular in India due to its high cost and side effects. Before
using HRT consulting with gynaecologist or physician is a must to avoid complications.