This piece was written by one of our contributors; consultant dietitian (and resident dietitian for The Food Medic) – Maeve Hanan.
The menopause is the time in a woman’s life when her period stops, along with the ability to get pregnant naturally. This usually occurs between the age of 45 and 55. Oestrogen levels decline at this time, which often causes symptoms such as: hot flushes, night sweats, reduced libido, sleeping issues, vaginal dryness and issues with mood, memory or concentration.
The menopause can be divided into three stages:
- Perimenopause: The transition stage around the time of a woman’s last period, this usually lasts about 4 years, but can last up to 10 years. The levels of oestrogen produced by the ovaries reduces during this stage.
- Menopause: When a woman has not had a period for 12 months (for no other medical reason than reaching the age of menopause). Ovulation stops and oestrogen levels reduce significantly.
- Postmenopause: This is the stage following the menopause. Menopausal symptoms often reduce during this stage.
This article will cover the main dietary factors to consider around the time of the menopause.
Bone Health
Oestrogen helps to protect our bones by reducing the breakdown of bone tissue. Therefore, declining oestrogen levels during the menopause can increase the rate at which bone tissue breaks down. It is estimated that one in three postmenopausal women has osteoporosis, this is a loss of bone mass which increases the risk of fracturing a bone (1).
Diet can play a big role in improving bone health. Important nutrients for our bones include:
- Protein: Include high protein foods at every meal. Good sources include meat, poultry, seafood, dairy, beans and legumes.
- Calcium: Good sources of calcium include: dairy, calcium-fortified plant-based drinks, tinned sardines (with bones), tofu and dried figs. Depending on dietary intake and bone health, some women will be advised by their doctor to take a calcium supplement.
- Vitamin D: This is created in our skin by the action of sunlight during the summer, but most women living in the UK should consider taking a daily 10mcg vitamin D supplement, especially from October to March (2). Vitamin D is also found in egg yolks, oily fish and some fortified foods, but it is difficult to get all of the vitamin D that we need from diet alone.
- Vitamin K: This is found in many foods, including: turnip, broccoli, spinach, kale, dairy, meat and chicken. Avoid taking vitamin K supplements if you are on blood thinning medication.
- Phosphorus: This is usually abundant in our diet, as it is found in lots of food such as: meat, poultry, oily fish, dairy, potatoes, wholegrains, beans and pulses.
- Magnesium: Good sources include pumpkin seeds, wholegrains, spinach, almonds and beans.
For more information about diet and bone health, check out this article.
Resistance exercise is also very important for strengthening the bones. It is advised that adults aged 35 and above resistance train on at least two days per week, (3). Examples of this type of exercise includes: brisk walking, weight-lifting, gardening, yoga and pilates.
Heart Health
The risk of heart disease increases during and post-menopause. This is thought to be related to various factors, including the impact of age on body composition and heart disease risk. Oestrogen also plays a role in keeping our arteries and cholesterol levels healthy, so declining levels can lead to narrowing of the arteries and an increased risk of having a heart attack or stroke (4). Furthermore, lower levels of oestrogen impacts body composition, as fat is more likely to be stored on the abdomen (5). Carrying more fat on the abdomen is associated with heart disease risk factors, such as raised: inflammation levels, blood pressure, LDL cholesterol and triglyceride levels (6, 7).
Key principles of a heart healthy diet include (8):
- Replacing saturated fat (found in: butter, coconut oil, pastries and fried food) with unsaturated fat (found in: plant based oils like olive oil and rapeseed oil, avocado, nuts and seeds).
- Include plenty of wholegrains in the diet.
- Eat at least 5 portions of fruit and vegetables every day.
- Consume at least two portions of fish per week, one of which should be oily fish (like salmon, trout, mackerel, herring, kippers or sardines). For those who don’t eat fish it is no longer recommended to take an omega-3 supplement for heart health, as this doesn’t confer the same health benefits as consuming oily fish – check out this article for more information about omega-3.
- Have at least 4 portions of unsalted nuts, seeds and legumes (like beans, lentils and chickpeas) each week.
- Limit intake of salt and sugar.
- Women should consume no more than 2-3 units of alcohol per day, have a few alcohol-free days per week and consume no more than 14 units of alcohol per week (1 unit of alcohol is a single shot of spirits, half a 175ml glass of wine, half a pint of 4% beer).
This article includes more information about how diet impacts cholesterol levels in the blood.
For optimal heart health it is also important to avoid or quit smoking, exercise regularly, get plenty of sleep and manage stress levels. In some cases medication targeted at lowering blood pressure and cholesterol levels may be recommended by your doctor, as this can play an important role in the prevention of heart disease.
Minimising Menopausal Symptoms
Menopausal symptoms like hot flushes, mood swings and concentration issues can have a big impact on quality of life. It is important to seek support from your GP if you are struggling to cope with menopausal symptoms or if you experience menopausal symptoms under the age of 45.
Treatment options for menopausal symptoms include: hormone-replacement therapy (HRT), psychological support and lifestyle changes. Certain diet adaptations may be helpful in managing these symptoms, although this can be quite individual and most of these changes aren’t backed by strong evidence.
Lifestyle measures
Alcohol can be a trigger for hot flushes (9). So it is wise to stick to the recommended alcohol limits for women of 2-3 units per day and 14 units per week. Limiting alcohol intake also has many other health benefits such as a lower risk of: liver disease, heart disease and certain types of cancer (including breast cancer and head and neck cancer). Alcohol can also have a negative impact on our mental health and sleep quality.
Caffeine and spicy food can be a trigger for hot flushes for some women (10, 11), but this varies between individuals so it is best to experiment with whether reducing these impacts your symptoms.
Phytoestrogens (or plant oestrogens) have a similar structure to human oestrogen, although their impact in our body is much weaker. There is some evidence that consuming phytoestrogens a few times per day over the course of a few months may help to ease menopausal symptoms like hot flushes for some women (12, 13). However, the quality of the overall evidence related to phytoestrogens and menopausal symptoms is questionable (13).
Phytoestrogens occur naturally in some plant-based foods such as:
- Soybeans and soya-based foods
- Chickpeas
- Flaxseeds
- Sesame seeds
- Peanuts
- Barley
- Berries
- Apricots
- Grapes
- Garlic
- Tea (both green and black version)
Soy isoflavone and red clover supplements are a more concentrated form of phytoestrogens. A meta-analysis from 2015 found a significant reduction in hot flushes associated with the use of these supplements (14). It is important to note that women who have breast cancer need to avoid red clover and soy isoflavone supplements (15).
Lifestyle factors such as regular exercise, getting enough sleep, relaxation and quitting smoking can also be beneficial in the management of menopausal symptoms. In relation to hot flushes, it can also help to maintain a cool environment, by wearing light layers, using fans, opening windows and having cold drinks.
Summary
Diet plays an important role during and after the menopause. Particular attention should be paid to diet and lifestyle factors which can improve bone and heart health. This includes following a Mediterranean-style diet and consuming enough protein, calcium and vitamin D. Regular exercise, limiting alcohol intake, not smoking and managing stress levels
Certain dietary changes, like consuming more phytoestrogens, may also help to reduce menopausal symptoms like hot flushes. However the effectiveness of these changes varies between different people, and most of these changes aren’t backed by strong evidence.
If you are suffering with menopausal symptoms your GP can help you to explore management options.
References:
(1) Rizzoli et al. (2014) “Nutrition and bone health in women after the menopause” [assessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/25482487]
(2) SACN (2016) “Vitamin D and Health” [accessed October 2019 via: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf]
(3) NHS Website “Exercises for strong bones” [accessed October 2019 via: https://www.nhs.uk/live-well/exercise/exercises-for-strong-bones/]
(4) BHF Website “Menopause and heart disease” [accessed October 2019 via: https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease]
(5) Karvonen-Gutierrez & Kim (2016) “Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/27417630]
(6) Ritchie & Connell (2007) “The link between abdominal obesity, metabolic syndrome and cardiovascular disease” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/17110092]
(7) Goh et al. (2013)”Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study “ [accessed October 2019 via: https://bmjopen.bmj.com/content/4/2/e004138]
(8) NICE (2016) “CG181 Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease” [accessed October 2019 via: http://www.nice.org.uk/guidance/cg181]
(9) Wilsnack & Wilsnack (2016) “Alcohol use and menopause” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/27028261]
(10) Faubion et al. _2015) “Caffeine and menopausal symptoms: what is the association?” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/25051286]
(11) Hunter et al. (2013) “The International Menopause Study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/22946508]
(12) Rietjens et al. (2017) “The potential health effects of dietary phytoestrogens” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429336/]
(13) Lethaby et al. (2013) “Phytoestrogens for menopausal vasomotor symptoms” [accessed October 2019 via: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/abstract]
(14) Chen et al. (2015) “Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review” [accessed October 2019 via: https://www.ncbi.nlm.nih.gov/pubmed/25263312]
(15) NICE (2009) “Do Not Do Recommendation” [accessed October 2019 via: https://www.nice.org.uk/donotdo/red-clover-is-not-recommended-for-the-treatment-of-menopausal-symptoms-in-women-with-breast-cancer]
