Category Archives: menopause

menopause

How to Manage Your Menopause

How to Manage Your Menopause by Cleanmarine Nutritional Therapist Susie Perry Debice

When can a woman expect their menopause symptoms to start?

Most women will start to see early menopause symptoms from the age of 50, although an early menopause can start at 45 and a late menopause may start at 55-60 years old. The best way to gauge when you are likely to begin heading into the menopause is to ask your mother when she started her menopause as you are likely to start at a similar time.

How long does the menopause usually last?

A short menopause can last around 5 years whereas a long menopause may take up to 15 years, but on the whole most women are completely through the menopause after 10 years.

What causes the symptoms?

The signs and symptoms of the menopause become pronounced when your body naturally starts to shut down your fertility. During the fertile phase of your life you experience a monthly ebb and flow of the female hormones progesterone and oestrogen which stimulate ovulation and then either support a pregnancy or initiate a period. These hormones also have an impact on other areas of your health such as your skin quality, bone health, heart health, mood, energy and memory.

Women are born with a set number of immature eggs that are stored in the ovaries and a handful of these eggs are matured at each monthly cycle. Eventually, after years of the cycle running smoothly, the egg stores start to decline. This is when your body decides that it’s time to begin the menopause and start shutting down your monthly cycle. Over the next few years, levels of oestrogen and progesterone slowly start to drop, ovulation stops and periods also stop, but this process doesn’t happen overnight. You can go through years of irregular periods, hormone highs and lows along with accompanying symptoms until eventually your body reaches a baseline level of oestrogen production that is constant and doesn’t fluctuate across the month. When this baseline of oestrogen has settled in, periods have stopped and all symptoms have settled down, then you enter into the post-menopausal phase of life.

What dietary advice should women follow when experiencing menopausal symptoms?

The best dietary advice is to reduce their intake of caffeine, alcohol, sugar, cheese, and refined carbohydrates. Eat plenty of fresh, natural foods and keep your blood sugar balanced by eating small frequent meals and snacks. Start the day with an oat-based cereal with fresh berries and natural yoghurt, have a fresh salad with egg, fish or white meat for lunch and always have 3-4 vegetables with your evening meals and include wholegrains such as quinoa, brown rice, wild rice, red rice and lentils and pulses for added fibre and B-vitmains.

What supplements would you recommend and why?

There are so many supplement options that it can get confusing so I would choose a multi-nutrient formula, such as Cleanmarine MenoMin that offers plenty of hormone balancing support. Look for one that contains Krill Oil (to help reduce hot flushes and to support mood and hormone balance), soy isoflavones (to support hormone balance), B-vitamins – folate, biotin, B1, B2, B6 and B12 (for liver, mood and energy support) and vitamin D (for bone health).

About the Author

Susie Perry Debice – Nutritional Therapist of Cleanmarine

Susie has over 15 years of clinical experience working as a Nutritional Therapist helping women with a diverse range of female health conditions such as PMS, menopause, PCOS, endometriosis, fibroids and healthy dieting. In her book ‘Premenstrual Syndrome: The Essential Guide’ Susie shares her diet and lifestyle tips for restoring hormone balance.

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Vitamin D: Building Muscle in Menopausal Women

Vitamin D: Building Muscle in Menopausal Women

Vitamin D Builds Muscle in Menopausal Women

A new Brazilian study suggests that post-menopausal women may benefit from vitamin D supplementation to increase muscle strength and reduce frailty (1). The study, conducted at Sao Paulo State University, found that older women given vitamin D supplements were stronger and had fewer falls.

Menopause and Muscle

It is well known that going through menopause increases women’s risk of bone loss, as a result of hormonal changes that influence bone health. However, many women are less aware of the effect of menopause on muscle strength.

During and after menopause, a decline in oestrogen levels leads to a gradual and ongoing decrease in muscle mass, known as sarcopenia.

This type of muscle loss is a key health concern for post-menopausal women for several reasons. Post-menopausal muscle loss puts women at risk of frailty, falls and reduced mobility. It can reduce their independence and quality of life. Additionally, a reduction in muscle mass also leads to a lower metabolism, putting older women at risk of unwanted weight gain.

Vitamin D and Muscle Mass

Vitamin D is crucial for healthy muscle function. It acts on special receptors in muscle, helping to boost muscle mass and strength. Vitamin D also plays a role in protein synthesis and works with calcium and magnesium to enable more powerful muscle contractions.

Unfortunately many adults in the UK have low levels of vitamin D. In fact, 39% of adults have low vitamin D levels in the winter months and older adults who spend more time indoors are particularly vulnerable to deficiency (2).

Trial Results

The double-blind trial tested the effects of vitamin D supplements versus a placebo on the muscle strength and muscle mass of post-menopausal women. Muscle mass was estimated by the use of a total-body DXA (an X-ray scan), as well as tests of hand grip strength and fitness tests.

At the end of the 9-month study, the women receiving the vitamin D supplement showed a 25% increase in muscle strength, while the placebo group actually lost muscle mass. Over the 9 months, the women receiving the placebo supplements also had twice as many falls as those taking vitamin D.

“We concluded that the supplementation of vitamin D alone provided significant protection against the occurrence of sarcopenia, which is a degenerative loss of skeletal muscle, says Dr. L.M. Cangussu, one of the lead authors of the study.

Supplementing Vitamin D – Do’s and Don’ts

The ideal way to optimize vitamin D levels is through sensible sun exposure. This can be difficult in the winter months and can be especially challenging for those with darker skin who have a harder time converting sunlight to vitamin D.

Current recommendations are that anybody over the age of 65 should be supplementing 10 micrograms (400 IU) of vitamin D each day. Vitamin D3 is widely considered to be a better form to take than synthetic D2.  Taking vitamin D supplements alongside a fat-containing meal will also enhance absorption. Finally, many people prefer to take vitamin D alongside vitamin K as these two vitamins work synergistically.

References
1. The North American Menopause Society (NAMS). “Vitamin D3 supplementation helps women build muscle even after menopause: New study demonstrates vitamin effectiveness in reducing degeneration and risk of falls.” September 2015
2. NICE. Vitamin D: increasing supplement use in at-risk groups. November 2014. https://www.nice.org.uk/guidance/ph56 Accessed 30/10/2015.

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New research links FOS and Bone Health

A recent study published in the Journal of Nutrition suggests a link between fructooligosaccharides (FOS) and bone health. It indicates that combining a calcium supplement with FOS is more effective than taking a calcium supplement alone (1).

The two-year study followed 300 post-menopausal women and measured markers of bone health. The women were randomly divided into three groups. One group of women were given a daily calcium supplement, while a second group were given a combination of calcium and FOS . The third group were given a placebo supplement. At the end of the study, measures of bone turnover and bone density were taken.

At the end of the study, there were no significant differences in bone density between any of the three groups. However, the results showed that the combination of FOS and calcium had the greatest effect on bone turnover.

Bone is constantly being broken down and rebuilt. The rate at which this happens is known as ‘bone turnover’ and is a known indicator of bone quality. The change in bone turnover markers in the women taking both FOS and calcium indicates ‘a more favourable bone health profile’ according to the researchers in this study.

FOS seems to enhance calcium absorption in the large intestine, and the researchers suggest that this is the reason for its effect on bone health. These findings certainly support the need for more research in this area, particularly for vulnerable groups such as postmenopausal women.

More about FOS

FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils.
FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils.

FOS is a prebiotic nutrient found in plant foods. Prebiotics are not digested, and simply pass through the body. In doing so, they act as ‘food’ for healthy bacteria in the bowel, boosting numbers of health-promoting acidophilus and bifidobacteria, and crowding out disease-causing bacteria. As well as improving calcium absorption, FOS also supports both digestive and immune health.

High concentrations of FOS or prebiotics are found in chicory root, jerusalem artichoke, asparagus, leeks, onion, beans, peas and lentils. FOS can also be taken in supplement form, and its sweet taste means that it works well mixed into oatmeal, yoghurt or smoothies, or simply used as a low-calorie sweetener to enhance flavour.

In the UK, most of us average an intake of around 12g of fibre each day – only half of the recommended amount. More research is still needed in the area of FOS and bone health. In the meantime, increasing fibre intake, and prebiotic foods in particular, seems a sensible measure to ensure the recommended intake for optimal health.

References

Slevin, M, Allsopp P, Magee M, Bonham V, Naughton J, Strain M, Duffy J, Wallace E, McSorley E. 2014. “Supplementation with Calcium and Short-Chain Fructo-Oligosaccharides Affects Markers of Bone Turnover But Not Bone Mineral Density in Postmenopausal Women”. Journal of Nutrition Jan 2014

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Iron and Zinc Intake Linked with PMS

An iron-rich diet lowers the risk of pre-menstrual syndrome (PMS) according to a new study published in the American Journal of Epidemiology (1).

The study is one of the first to investigate whether dietary mineral intake is linked with PMS. The diets of more than 3,000 American women were analysed, with women completing three food frequency questionnaires over a 10-year period. After 10 years, 1,057 of the women were diagnosed with PMS while 1,968 of the women were free from the condition. The researchers then compared the diets of the women with PMS with the diets of the women with no symptoms. The researchers adjusted for factors known to affect PMS such as calcium intake.

The results showed that non-heme iron intake is linked to a lowered incidence of PMS. Non-heme iron is the iron found in plant foods and supplements, rather than iron from animal foods. Senior research Elizabeth Bertone-Johnson said that the women who consumed the most non-heme iron from both foods and supplements had “a 30 to 40 percent lower risk of developing PMS than women who consumed the lowest amount of non-heme iron”. The results also showed that women with the lowest iron intake were almost twice as likely to suffer with PMS compared to women with the highest intake.

“The level of iron intake at which we saw a lower risk of PMS, roughly greater than 20 mg per day, is higher than the current recommended daily allowance (RDA) for iron for pre menopausal women,” Bertone-Johnson says.

The researchers also suggested that iron may be related to PMS because it is involved in producing serotonin, a neurotransmitter that helps to regulate mood.

Juice
Vitamin C intake is linked with helping the absorption of iron

While iron supplements may of course be helpful to ensure adequate intake, it’s important to ensure that good dietary sources of iron are included each day. Good plant-based sources of iron include pulses such as lentils, beans and chickpeas, nuts and seeds, dried apricots and leafy greens such as spinach and kale. Iron-fortified cereals are another rich source. Adding citrus fruit or a glass of orange juice is also helpful as Vitamin C boosts iron absorption.

Another mineral was also highlighted by the study as significant in its influence on PMS. “We also saw some indication that high intake of zinc was associated with lower risk” Bertone-Johnson explains. The level of zinc linked to a lower risk of PMS was greater than 15mg each day which again is higher than the RDA.

Zinc is needed for the proper action of many hormones and it can also lower levels of hormones such as prolactin which are implicated in PMS.

Ensuring a good intake of zinc through the diet means eating zinc-rich meats such as venison, beef and turkey, while vegetarians should emphasise foods such as yoghurt, spinach, mushrooms and oats. Zinc from plant sources is less well-absorbed and so vegetarians may benefit from a zinc supplement to ensure adequate intake. It should be noted, however, that excessive levels of zinc can be detrimental to health and should only be taken under the supervision of a health practitioner.

More research is needed in this area to confirm the results of this study. In the meantime, however, ensuring an adequate intake of both iron and zinc seems a sensible measure for those who suffer with PMS.

References

1. Patricia O. Chocano-Bedoya, JoAnn E. Manson, Susan E. Hankinson, Susan R. Johnson, Lisa Chasan-Taber, Alayne G. Ronnenberg, Carol Bigelow, and Elizabeth R. Bertone-Johnson. Intake of Selected Minerals and Risk of Premenstrual Syndrome. American Journal of Epidemiology, 2013 DOI: 10.1093/aje/kws363.

2.Image courtesy of topfer.

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Successful Weight Loss after Menopause: Four Key Strategies

Statistics surrounding weight loss often make for depressing reading. Losing weight, especially if done rapidly, causes changes in appetite-regulating hormones and brain chemistry, which can make long-term weight loss difficult. In fact, after a weight loss diet, up to 50% of lost weight is typically regained within one year, and around 90% is typically regained within 5 years (1).

However, a new study from the University of Pittsburgh suggests that a few simple strategies can make a big difference (2). Researchers followed 508 overweight and obese post-menopausal women over a period of four years to evaluate the most consistently successful weight-loss strategies.

Menopausal women have a particularly difficult time losing weight. Changes that take place in menopause, such as altered oestrogen levels, result in an accumulation of abdominal fat and an increase glucose and insulin levels (3). Coupled with a natural decline in energy expenditure, these menopausal changes appear to be the perfect recipe for weight gain.

Fresh fruit can help with long term weight loss.
Fresh fruit can help with long term weight loss.

The study divided the women into two groups. The first group of women attended Lifestyle Change classes run by nutritionists and psychologists. They were given detailed dietary advice and a goal-oriented exercise programme. The second group attended classes on general women’s health. The researchers then assessed the eating behaviours and weights of the women at the 6-month mark, and again after four years.

The researchers discovered that while strategies such as reducing restaurant visits and reducing fried foods were helpful in the short-term, they were not linked to weight-loss after four years.

Study leader Dr Barone Gibbs concluded that some weight loss strategies are simply not sustainable in the long-term, after initial motivation begins to decline “Maybe you can say no French fries for six months,” she said, “but not forever.”

So which strategies were helpful in the long-term? At the four-year mark, there were just four factors linked to successful weight loss:

  • Reduced consumption of meat and cheese;
  • Fewer sugar-sweetened drinks;
  • Fewer desserts;
  • An increase in fruit and vegetables.

Overall the winning dietary strategy for weight loss in the long term was found to be replacing meat and cheeses with fruits and vegetables. A simple and manageable change such as this would not only lower levels of saturated and trans fats, but it would increase levels of phytonutrients and soluble fibre, boosting digestion and even helping to curb troublesome menopausal symptoms in older women.

The simple message to take from these findings is that restrictive diets are destined to fail in the long-term, but committing to small, healthful changes can make a big difference. Weight loss needs to be viewed as a permanent healthful change in diet and lifestyle. This is especially true for menopausal women who can find weight management particularly challenging.

Written by Nadia Mason, BSc MBANT NTCC CNHC.

References

1. Wadden TA, Sarwer DB. Behavioral intervention of obesity: new approaches to an old disorder. In: Goldstein D, editor. The management of eating disorders. Totowa (NJ): Humana Press; 1996. pp. 173–199.
2. Barone Gibbs (2012) Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study. J Acad Nutri Dietetics112(9):1347-1355.e2.
3. Carr MC (2004) The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88(6):2404-11.
4. Image courtesy of Grant Cochrane.

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Dried plums can help prevent osteoporosis

As a nutritional therapist, I am always interested in new dietary approaches to protect our health as we age.  I was particularly interested to read about a recent study which found dried plums to be of significant benefit in supporting bone health.

The study, published in the British Journal of Nutrition, found that eating dried plums increased bone formation in postmenopausal women.

Although bone is often thought of as inert, it is in fact a ‘living structure’, constantly being broken down and rebuilt.  This is a process known as ‘bone turnover’.  If bone is broken down more quickly than it is remade, then osteoporosis can result.  This condition is of particular concern to postmenopausal women who produce less of the bone-protecting hormone oestrogen.

Dried plums can help prevent osteoporosis
A recent study has found dried plums to be of significant benefit in supporting bone health (2)

The bone-thinning disease, osteoporosis, is in fact a major health concern in the UK.  In the over-50s, 1 in 3 women and 1 in 12 men are affected.

The study, conducted by Professor Bahram H. Arjmandi, tested the effects of daily consumption of 100g dried plums on the bone density of 55 postmenopausal women over a 12 month period.  A control group were given 100g dried apples.

Bone health in the women was measured at 3, 6, 9 and 12 months, by measuring markers of bone turnover in the blood.  X-rays were also used at these intervals to assess bone mineral density.

Over the 12-month period, dried plums resulted in increased bone density of both the ulna (a bone in the forearm) and the spine.  No such effect was seen in the group taking the dried apple.

Professor Arjamandi reasons that the special phenolic compounds in dried plums increase levels of a hormone linked to bone formation.  These compounds also help to prevent bone from being broken down. Dried plums, or prunes, are also high in antioxidants and provide essential nutrients for bone health such as potassium, boron and copper.

Introducing dried plums into the daily diet may therefore be a positive step in the prevention of osteoporosis.  “Don’t wait until you get a fracture or you are diagnosed with osteoporosis and have to have prescribed medicine,” Arjmandi suggests, “People could start eating two to three dried plums per day and increase gradually to perhaps six to ten per day.  Prunes can be eaten in all forms and can be included in a variety of recipes.”

Dried fruits certainly offer a variety of health benefits, as they are higher in fibre and phenols, and are more nutrient-dense, than fresh fruit.  For those interested in maintaining or improving their bone health, this initial research suggests that introducing prunes in particular to the diet could be a positive step.

Written by Nadia Mason

References

1.  Shirin Hooshmand, Sheau C. Chai, Raz L. Saadat, Mark E. Payton, Kenneth Brummel-Smith, Bahram H. Arjmandi.Comparative effects of dried plum and dried apple on bone in postmenopausal women. British Journal of Nutrition, 2011; 1 DOI: 10.1017/S000711451100119X

2.  Image courtesy of Just4you.

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St John’s wort may ease hot flushes

Many individuals are aware of the anti-depressant properties of St Johns Wort and I have previously written about the herb in this regard and in relation to Seasonal Affective Disorder (SAD).  New evidence now suggests that the herb may be useful during the menopause.



A recent study (1) was set up to compare the efficacy of St John’s wort with an inactive placebo in women who were experiencing hot flashes.  Hot flashes occur because of the decline of a hormone, oestadiol, during the menopause (in women who are perimenopausal) and also premenopausally and postmenopausally.  A total of 100 women participated in the clinical trial, the average age of the women was 50 years old.  Half of the women received the herb and half received the inactive placebo.  On the 8th week of treatment there was a statistically significant difference in hot flash frequency between the two groups, with the group receiving the herb experiencing fewer hot flushes than the placebo group.  In addition the women who received St John’s wort also had a decrease in the severity of hot flashes in the 4th and 8th week of treatment.  Among the women taking St John’s wort, the average number of hot flashes declined from around four per day at the start of the study, to less than two per day at week eight.  The authors conclude that St John’s wort can be used as an effective treatment for the hot flash symptoms of perimonopausal and postmenopausal women.



During my research I came across two other study papers (2,3) which looked at St John’s wort for menopausal symptoms, both papers were preliminary-small scale trials.  Both found the herb was useful in some regard.  One (2) found that women who received the herb reported significantly better menopause-specific ‘quality of life’ and significantly fewer sleep problems than women receiving placebo.  The other paper (3) found that St John’s wort aided psychological as well as hot-flash symptoms in menopausal women, the women also found that their sexual well-being improved after treatment with St John’s wort.


 


It is not precisely known how St John’s wort is acting.  The herb does contain estrogen-like plant compounds called phytoestrogens, and it could be that these compounds explain the benefits seen in this study – but further research would be needed in order to confirm this.  Further trials are also needed to see if the effects of the herb on hot-flashes and other menopausal symptoms, can be replicated on a larger scale, before firm recommendations for the use of St John’s wort in menopausal women can be made. 



Another reason that St John’s wort may be useful to women going through the menopause is for its anti-depressant action.  Many individuals would rather not take anti-depressant medication because of the various side-effects and the herb could be a valuable alternative.  This seems particularly relevant since a recent (4) study found that older women who take an antidepressant seem to have a small but noteworthy increased risk of stroke and death compared to older women not on an antidepressant medication.  This is quite worrying due to the increasing numbers of people taking anti-depressant medications.  Further investigations and research needs to be carried out in order to evaluate the risks, but I alsdo think that any investigation looking into alternatives is also worthwhile.  Please also read my previous posts relating to depression for useful ideas.



St John’s wort is generally considered safe when dosage instructions are followed, however it is always best to talk to a medical doctor prior to supplementing with this herb as it can have powerful effects and is also known to interact with certain medications. 



(1)Khadijeh A eta l.  2010.  Effect of St John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study.  Menopause.  February 2010 EPub ahead of print doi: 10.1097/gme.0b013e3181b8e02d
(2)Al-Akoum M et al.  2009.  Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 16(2):307-14.
(3)Grube B et al.  1999.  St. John’s Wort extract: efficacy for menopausal symptoms of psychological origin. Adv Ther. 16(4):177-86.
(4)Smoller JW et al.  2009.  Antidepressant Use and Risk of Incident Cardiovascular Morbidity and Mortality Among Postmenopausal Women in the Women’s Health Initiative Study.  Arch Intern Med.  169: 2128 – 2139.


Written by Ani Kowal

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Omega 3 fatty acids from fish oil may be helpful for some menopausal symptoms

A common problem for women going though the menopause is the experience of psychological symptoms such as anxiety, mood swings and depression.  Hormone replacement therapy (HRT) and/or antidepressant medication is often offered to women going through the menopause in order to address such features.  These medications are linked with a variety of side effects and often women prefer to seek more natural alternatives in order to deal with their symptoms. 



A very recent study (1) has indicated the usefulness of the long chain omega 3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), naturally found in oily fish such as salmon, mackerel, trout and sardines, in the protection against depressive and mood related symptoms in menopausal women.  The study involved 120 women with moderate-to-severe psychological distress.  These individuals were randomly assigned to receive either an omega 3 supplement (containing EPA and DHA) or a placebo supplement (containing sunflower oil) for 8 weeks.  Changes in psychological wellbeing and depressive symptoms was assessed in these women via the use of specific medical scales and questionnaires.



Previous studies have shown the usefulness of using omega 3 fatty acids in the treatment of depression and mood disorders but this was the first trial using omega 3 fats in the treatment of psychological distress and depressive symptoms in menopausal women.  The results were useful and positive.  In a press release (2) the lead study scientist, Dr Lucas, said that the test results before and after the eight-week period indicate that omega-3s significantly improved the condition of women suffering symptoms of psychological distress and mild depression.  (No positive effect was observed among a small sub-group of women with more severe depressive symptoms). These results suggest that omega-3 supplementation may be beneficial for improving the psychological wellbeing of some menopausal women.



Women with hot flashes also noted that their condition improved after consuming omega-3 fatty acids.  The change that could be attributed to the use of omega-3 fats was equivalent to results obtained with hormone therapy and antidepressants (1,2).



The results do not surprise me.  There is now mounting evidence to support the use of omega 3 fatty acids in the treatment and prevention of anxiety and depression/depressive symptoms in a range of individuals (including children with ADHD).  Omega 3 fatty acids are absolutely essential for healthy brain structure and function.  Our bodies cannot make these essential omega 3 fatty acids (that is why they are known as essential fats), they must be taken in through the diet and are vital to numerous aspects of health.  We really do need to feed our brains!



If you do not regularly eat oily fish you may wish to consider a fish oil supplement providing around 350mg EPA and 350mg DHA daily.  Vegetarians may wish to think about taking a flaxseed oil supplement providing 500-1000mg alpha linolenic acid daily.  In the UK, and western world as a whole, most of us do not get enough omega 3 fats from our diets.  A supplement could be very useful to provide widespread health benefits.  As you will notice from my previous blog posts I mention omega 3 fatty acids regularly and am incredibly interested in the ongoing medical research surrounding these fats.



(1)Lucas M et al.  2009.  Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am J Clin Nutr 89: 641-651.
(2)Université Laval (2009, February 1). Omega-3 Fatty Acids Ease Depressive Symptoms Related To Menopause.
ScienceDaily. Retrieved February 2, 2009,


Written by Ani Kowal

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