Menopausal Nutrition

Stages of the Menopause

Menopause can be divided into three key stages:

• Perimenopause – the first signs and initial bodily transitions before the onset of the menopause. Perimenopause can happen years in advance, most noticeably in the last 1-2 years when oestrogen levels deplete significantly.
• Menopause – The point at which a woman’s periods cease.
• Postmenopausal – this begins from one year after a woman’s last menstrual cycle (period) and onwards through the rest of life.

What are the symptoms of menopause?

Menopausal symptoms can occur months before periods cease, and can continue for up to four years after the last period – sometimes even longer. Some symptoms are more well-known than others, and the most common include:

• Hot flushes – short and sudden sensations of heat in the face, neck and chest area which can lead to red and sweaty skin.
• Night sweats – a hot flush occurring through the night
• Sleeping difficulty/insomnia leading to tiredness throughout the day
• A reduced libido (sex drive) from the fall in oestrogen levels
• Vaginal dryness from the fall in oestrogen levels
• Memory and concentration issues
• Headaches
• Mood changes – often felt as a low mood or feelings of anxiousness
• Stiff joints, aches and pains
• Recurrent urinary tract infections (UTIs)
• Reduced muscle mass

What can I do to treat or improve my symptoms?

Menopausal symptoms are heavily influenced by genetic factors, and as with periods, what you experience may be very different from what your peers may experience. However, there are some medications to take and lifestyle changes you can make before, during, and after the menopause to ensure your health is kept in a prime condition.

Hormone replacement therapy*, or HRT, is a popular form of treatment taken by menopausal women used to bring oestrogen and progesterone levels up. Testosterone can also be taken to increase libido, and antidepressants or therapy can be used to treat low mood.

It’s important to remember nutrition is not equivalent to medication and so won’t be as effective as HRT, however, there are a few particular nutrients you may want to pay extra attention to:

• Saturated fat: after the age of 65, the risk of cardiovascular disease (CVD) becomes equal in men and women, so it’s important to be mindful of our saturated fat intake. It is not necessary to cut it out of the diet completely but to ensure the balance of our fat intake favours monounsaturated and polyunsaturated. This may mean consuming less fat from meats, butter, and coconut oil/cream, and more from nuts, seeds, other plant-oils (such as olive oil and rapeseed) as well as oily fish.
• Fibre: Dietary fibre is also valuable as research has shown it can reduce the risk of developing CVD. The Scientific Advisory Committee on Nutrition (SACN) recommends aiming for 30g/day.
• Protein: Protein turnover speeds up in postmenopausal women, which means they are being broken down and rebuilt at a faster rate. Ensuring you are eating enough protein can help to protect against loss of muscle mass in old age, particularly in the arms and legs. This is particularly important as basic functions such as squatting, arm and grip strength are dependent on our muscle mass and allow us to remain independent for longer in old age. Try to aim for at least 2 meals with a major protein component daily.
• Calcium and Vitamin D: Postmenopausal women lose around 1% of bone mass every year, so it’s important to use the time before this as the last opportunity to improve your bone mass before it undergoes a gradual decline. With lower bone mass and density comes frailty and risks of osteopenia and osteoporosis. Dairy or fortified plant-based milk is a great source, as well as cheese, yoghurt, tofu, cooked leafy greens, and fish with bones. It also may be worth taking a Vitamin D supplement, particularly in the winter months. 10-25 micrograms (mcg) or 1000 international units (IU) should be a sufficient daily amount.

Will eating foods rich in oestrogen help me?

Phytoestrogens, or plant oestrogen, may also help to raise oestrogen levels in the human body. Good sources of phytoestrogens include chickpeas, hummus, and soy products.

Whilst research has shown consuming phytoestrogens can alleviate certain symptoms such as hot flushes, dryness, and libido, it is inconsistent and they may need to be consumed in very large quantities for these effects. It may be worth trying out different foods and seeing what works for you.

Are there any foods I may want to avoid?

You may find some foods, drinks or stimulants are potential triggers for your symptoms. Common examples include alcohol, smoking, caffeine and spicy food which can worsen the feelings of hot flushes and night sweats. However, this can be very individual, so it’s important to not completely cut out your favourite foods and drinks if they make you happy, too.

What else can I do to improve my symptoms?

Including exercise in your routine during this time will be beneficial for your wellbeing as well as bones and joints. In particular, exercises which include shifting of bodyweight e.g. yoga, Pilates, and weightlifting can be particularly useful.

Maintaining a good sleep routine is especially important, as it is likely that symptoms of menopause may impact your sleep. Research has shown that as many as 61% of postmenopausal women report insomnia symptoms. Try to sleep at a similar time, avoiding screen time and stimulants well before bed. HRT can also improve sleep.

Managing stress during this time is another important factor to be aware of, as it can worsen symptoms. It may be worth being more mindful of stressful triggers and creating ways to minimise, combat, or avoid these. Talking to peers or even a therapist can be another great strategy to enhance your mental state. Perhaps listening to your favourite podcast, doing a meditation or even some skincare pampering can help you to destress, so find what works for you.

Always bear in mind that each person will experience the menopause differently, from an internal and external perspective, and it is still not too late to make small lifestyle or diet changes at this age to keep your health in optimum condition. Remember to consult your pharmacist or GP if you require any further advice on the menopause.

*Please note at the time of writing, there is a national supply shortage of several HRT products in the UK, speak to your local pharmacist for more information. 

References:

https://www.nhs.uk/conditions/menopause/

• Li Y. , Hruby A, Bernstein A, Ley S, Wang D, Chiuves, et al. (2015). Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risks of coronary heart disease. Journal of the American College of Cardiology, 66(14) 1538-1548.
• Gregorio, L. , Brindisi, J. , Kleppinger, A., Sullivan, R. , Mangano, K. M. , Bihuniak, J. D. , . . .  & Insogn, K.L. (2014). Adequate dietary protein is associated with better physical performance among post-menopausal women 60-90 years. The Journal of Nutrition, Health & Aging 18(2), 155-160.
• Chen, M. N. , Lin, C. C. , & Liu, C. F. (2015). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, 18(2), 260-269.