The physiological transition of menopause
Menopause is a period in women’s lives characterized by a significant number of physiological changes, the main cause of which is the progressive decrease in hormone secretion by the ovaries, particularly estrogens¹. It generally lasts 4 to 5 years at a median age of 51 years²,³ and is characterized mainly by modifications in body composition, metabolic functioning, and cardiovascular health that will take place. Indeed, estrogen receptors are located on a large number of organs, and it has been shown that they participate in the normal functioning of the cardiovascular system and adipose tissue⁴,⁵, and the cessation of estrogen production is responsible for a progressive deregulation of their function.
More precisely, they stimulate the local production of antioxidant and anti-inflammatory molecules and nitric oxide, which maintain the elasticity of blood vessels and limit the onset of high blood pressure and associated complications⁵. Furthermore, these hormones are involved in energy regulation, the insulin sensitivity of adipocytes as well as their subcutaneous localization while maintaining a local anti-inflammatory environment⁴. Consequently, the cessation of estrogen production is responsible for a deterioration of vascular function, an increase in insulin resistance and inflammation of adipose tissue, which are phenomena associated with obesity⁶.
The physiopathological consequences of menopause
As mentioned in the previous paragraph, the cessation of estrogen production by the ovaries is responsible for progressive changes in the functioning of numerous tissues, including adipose tissue, the skeleton, and the cardiovascular system. Indeed, during menopause, it is possible to observe numerous changes in body composition, notably an increase in fat mass and a migration of adipose tissue towards the abdominal area concomitant with a decrease in muscle mass and bone mass¹. Furthermore, these changes in body composition are associated with an increase in insulin resistance and systemic and adipose tissue inflammation, favoring the onset of metabolic dysfunctions and the onset of obesity and associated comorbidities⁴. In the medium/long term, these hormonal changes also favor the onset of sarcopenia and/or osteoporosis which are deleterious for functional capacity and quality of life to ensure healthy aging. Finally, the disappearance of the protective effect of estrogens on blood vessels associated with the increase in systemic inflammation favors the onset of cardiovascular complications such as high blood pressure, the risk of stroke, or coronary pathologies⁵.
Management through lifestyle and contributions of bioimpedance
aimed at treating the symptoms of menopause, lifestyle modifications are also implemented to limit, or even reverse, the physiological changes induced by menopause. These changes involve notably an increase in physical activity as well as nutrition whose objective is to maintain normal metabolic functioning. In this context, bioimpedance constitutes a relevant tool to detect body composition imbalances associated with the onset of menopause, i.e., an excess of fat mass, sarcopenia, and/or osteopenia, and to guide management. At the nutritional level, there are no particular recommendations, and it is advised to follow global recommendations which are to prioritize fruits and vegetables, legumes, and complex carbohydrates as well as unsaturated fats containing omega-3s and omega-6s⁷. Furthermore, it is also advised to maximize foods containing vitamin D and calcium as well as protein intake to increase or maintain bone mass and muscle mass with a minimum of 1.2 g/kg(body weight)/day⁷,⁸.
These nutritional changes must also be accompanied by aerobic and/or resistance exercises in order to act directly on body composition, i.e., to increase muscle mass and bone mass and/or decrease fat mass. More precisely, aerobic exercises are particularly relevant for decreasing excess fat mass and maintaining normal metabolic functioning, whether through moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT)⁴,⁹. Resistance exercises, for their part, are particularly adapted to increase muscle mass if they are performed at least twice a week at intensities ranging from 60 to 80% of the maximum¹⁰. In addition to guiding management at the beginning, bioimpedance is also relevant for controlling fat mass loss and/or muscle mass and bone mass gain and for reorienting management if needed.
Conclusion
Menopause is a pivotal moment in women’s lives as it involves numerous physiological changes favoring the onset of metabolic and/or cardiovascular pathologies. Among these changes, those in body composition are particularly important and can be avoided or limited by adequate lifestyle modifications. In this context, bioimpedance proves to be a particularly useful tool for detecting these changes, adopting adapted management, and monitoring its effects.
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