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Dietary Management of the Menopause

Updated: Oct 9, 2022

Experience of Menopause varies from one woman to the next and this is partially due to our diet and lifestyle which can play a part in influencing the onset of menopause and the severity of its symptoms.


Factors influencing menopause onset


Low BMI = early onset. Mainly due to women not eating enough to produce the hormones needed for a healthy functioning reproductive system.


High BMI = late onset. Having a high BMI has a negative impact on hormones, more body fat increases oestrogen levels in the body and low levels of leptin and adipokines which are involved in inflammation.


Smoking = early onset, although the mechanism is not clear it is thought that toxins in tobacco decrease oestrogen levels.


One research study showed that a high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day. Omega 3 fats have been shown to improve antioxidant capacity which has a positive effect on hormone balance.


B6 and Zinc are important for antioxidant capacity and healthy ovaries. To find out about dietary sources of B6 and Zinc click here.



Diet and menopause
Surrey Dietitian


The stages that occur during the menopause:


Peri-menopause


Usually occurs 5 years before going through the menopause.


Symptoms may include:


· Irregular periods

· Hot flashes and sleep problems

· Mood changes

· Decreased fertility

· Changes in sexual function

· Changes in cholesterol levels

· Difficulty losing weight


Menopause


Occurs naturally as the ovaries age and produce less reproductive hormones. Eventually the ovaries stop releasing eggs. Women have reached menopause after 12 consecutive months of no menstruation. The average age at menopause in the UK is 51 years. Premature menopause can occur before the age of 45 and might be brought about by surgical removal or damage to the ovaries.


The symptoms are the same as peri-menopause, with the most common symptoms being hot flashes and night sweats.


Post-menopause


Likely to no longer experience symptoms of the menopause.


Likely to have an increase in risk of health problems, including:


· Bone deterioration.

· Heart disease.

· Changes in body composition, commonly more fat distribution around middle and less muscle mass.

· Higher risk of Alzheimer’s disease.

· Bladder and digestive issues.


What is happening at a hormonal level?


There are 5 hormones involved, follicle stimulating hormone (FSH), Luteinizing hormone (LH), GnRH (Gonadotrophin releasing hormone), progesterone and oestrogen.


Oestrogen and progesterone are the most important because they decrease during menopause resulting in the subsequent effects of menopause.


Oestrogen and progesterone levels decline from the age of 35. Ovary follicles are exhausted and stop releasing eggs. Because they stop releasing eggs, they stop producing oestrogen and progesterone. Oestrogen in-particular is involved in almost every physiological function including weight management, bone health, brain function, skin health, cholesterol, libido and is the main cause of changes.


Although the menopause can be treated by hormone therapy (HRT), dietary changes can also be significant in symptom management.


Menopause and change in body composition


Due to reductions in oestrogen, progesterone and the aging process, muscle mass decreases and abdominal fat increases.


The changing hormone levels during the menopause cause increased glucose levels in the blood which means the body must produce more insulin to keep blood sugar levels under control. This increase in insulin signals for the body to store fat.


The consequence of increased body fat means that menopausal women are more likely to develop pre-diabetes and inflammation in the body. The body is also generally under more oxidative stress.


For the reasons described above, dietary modification should aim to keep blood sugar levels under control.


Diet and menopause
Surrey Dietitian


A low glycaemic index (low GI) diet


The term glycaemic index refers to how quickly our blood sugars increase after eating a particular food or meal. High GI foods cause our blood sugars to enter a ‘rollercoaster’ cycle where they rapidly increase and decrease, whereas low GI foods keep our blood sugars steadier. The higher our blood sugar levels, the more insulin we produce. As discussed above, too much insulin signals to the body to store fat. Additionally, when our blood sugar levels drop, we produce more of the stress hormones adrenaline and cortisol which signal to our body to break down muscle for energy.


By choosing low GI foods and limiting intake of high GI foods, insulin levels are not as high, resulting in a lower tendency to store abdominal fat. We also reduce production of cortisol and adrenaline therefore reducing muscle breakdown.


High GI carbohydrates include foods with added sugar and refined carbohydrate such as white bread.


Low GI carbohydrates include complex carbohydrates such as granary bread, boiled new potatoes, wholegrain cereals.


You can also help to lower the GI of a meal or snack by adding protein and fibre. Protein and fibre take a long time to be broken down into sugar so will help to prevent rapid increases in blood sugar levels.



Diet and menopause
Surrey Dietitian

Be smart about the timing of your starch


Eating more of your starchy carbohydrate portions earlier in the day is another effective method for keeping blood sugar levels under control.


If you were to eat a high carbohydrate meal shortly before going to bed, your insulin levels would be higher because you are inactive and therefore not using up the sugar in your blood for energy.


You might want to start by swapping starches such as pasta, rice and potatoes for pulses and beans.


Doing some form of exercise, even going for a short walk after a meal can also help to improve insulin sensitivity.


Low carbohydrate diets


Low carbohydrate diets can be effective in the short term for weight loss and improving blood sugar control but unfortunately, evidence has shown that sticking to a low carbohydrate diet long-term is not sustainable. Carbohydrates remain an important part of our diet. They are our primary energy source so without them we would likely feel low in energy and potentially quite hungry. Restricting whole food groups is also likely to lead to increased cravings.


Carbohydrates are a rich source of fibre and micronutrients and help to optimise the good bacteria in our gut therefore aiding digestion, immunity, and mood.


If you are considering trialling a low carbohydrate diet, it should only be considered short term and I would recommend discussing this with a dietitian first.


Further tips for improving body composition:


· Reducing alcohol consumption.


Alcohol is a source of carbohydrate and is high in calories and therefore likely to increase visceral fat and decrease muscle growth. It also has a negative impact on sleep which can increase production of the stress hormone cortisol.


· Limit intake of trans fats.


Trans fats increase fat storage around stomach.


· Combine resistance training and cardiovascular workouts.


For muscle maintenance try to do resistance training once a week or three times a week to gain muscle mass.


Cardiovascular exercise can help to burn calories and therefore shift visceral fat. As mentioned above, exercising after a meal may also be beneficial.


· Intermittent fasting (time restricted feeding).


The most common type is 16:8 – which involves a 16-hour fast each day, and an 8-hour eating window. The post-menopausal benefits are particularly high due to the potential to improve insulin sensitivity.


Heart health


Heart disease is the leading cause of death in post-menopausal women, this is due to reduced oestrogen levels. Oestrogen plays a role in normalising blood lipid profiles and reduces blood pressure.


As discussed above, weight gain is common during the menopause and being overweight increases risk to heart health.


Tips to optimise heart health:


· Reduce your intake of salt by adding less salt to food and eating less processed food and takeaways.

· Aim for at least 5 portions of fruit and vegetables per day. Learn what counts as a portion here.

· Include omega 3 fatty acids contained in oily fish, rapeseed oil, flaxseed and avocado.

· Cut down on your intake of saturated fats found in butter, cheese and fatty meat.

· Choose wholegrain options such as wholemeal or granary bread, brown rice, oats and quinoa.

· Swap butter for a plant-based spread.

· Limit your alcohol intake to no more than 2 units per day and include 2 alcohol free days a week. Learn your units here.

· Maintain a healthy weight. For more information about weight loss click here.

· Do not smoke.



Diet and menopause
Surrey Dietitian

Bone health


During the menopause women have reduced calcium and vitamin D absorption, resulting in increased bone deterioration and weaker bones.


It is recommended that all women (and men) in the UK take a daily Vitamin D supplement throughout the Autumn and Winter months as a minimum. This should provide at least 400IU or 10mcg of vitamin D daily. If you get little skin sunlight exposure in the Spring and Summer, then you should continue to take the supplement all year round.


Enough calcium is also important, but avoid over-supplementing due to risks to heart health. Over-supplementing with calcium can lead to calcification of arteries which means more plaque is likely to form. Plaque formation in the arteries can lead to a blockage and increase the risk of a heart attack or stroke.


The recommendation for calcium is 700mg per day. Calcium is more bioavailable when we consume it in our diet rather than through supplementation. Aim to include 3 portions of calcium rich foods in your diet per day. You can find out more about how to get enough calcium in your diet here.


Intake of added sugars and alcohol should be limited, and smoking should be avoided. Studies have shown that too much sugar and alcohol and smoking can cause diminished bone health.


Take part in weight bearing exercise which will exert force through your bones and help to strengthen them.



Diet and menopause
Surrey Dietitian

Soy and phyto-oestrogens


During menopause a woman’s ovaries stop producing the hormones oestrogen and progesterone. A decline in these hormones can cause menopausal symptoms such as hot flushes, anxiety and low mood, all of which can contribute towards disrupted sleep.

Plant oestrogens called phyto-oestrogens may help to reduce the severity of night sweats, changes in mood and help you to get a good night sleep. Plant oestrogens are very similar to human oestrogens, which if eaten regularly, and in sufficient quantities can partially mimic the action of human oestrogen.

Soya beans, soya-based foods and linseeds are sources of plant oestrogens. Soya-based foods include tofu, tempeh, edamame beans, soya drinks and soya yoghurts. Consuming these foods several times per day has been shown to be more effective than consuming one daily large dose. Soya can also help the body to absorb calcium and therefore strengthen bones.

It can take a few months to start seeing a benefit and consuming plant-oestrogens is more effective in some women than others.


Mental health


During the menopause many women experience emotional highs and lows, this is because oestrogen regulates many of the hormones which influence our mood such as serotonin, norepinephrine, and dopamine.


It is normal to experience memory loss, lack of clarity and trouble sleeping. Mood may be further affected by changes in sleep pattern, reduced energy levels and stress due to weight gain.


Tips to improve your mood:


· Blood sugar control is very important so that stress hormones can be used to manage things that are actually stressful.

· Try to moderate caffeine intake because caffeine is a stimulant, and it therefore puts pressure on adrenal glands which produce stress hormones. Drinking too much caffeine is also linked to increased anxiety.

· Increase your intake of omega 3 rich foods. This may be of benefit as omega 3’s are the building blocks of neurones in the brain which can help to improve mood.

· Supplement with vitamin D because low levels are linked to poor mood.

· Consider mindfulness or cognitive behaviour therapy (CBT).

· Take part in regular exercise.


Diet and menopause
Surrey Dietitian


Sleep quality


Drinking alcohol, particularly shortly before going to bed is likely to disrupt sleep. At lower doses, alcohol has a stimulating effect due to the release of dopamine in the brain. This takes effect about an hour after consuming the alcohol. Drinking alcohol at higher doses has the opposite effect and is likely to make you feel more tired. Although this may help you to fall asleep initially, this is shortly followed by a rebound stimulant effect 2-3 hours later which could then lead to you waking in the night. Either way, you are unlikely to wake in the morning feeling well rested.

Caffeine has a similar stimulating effect. If you struggle to sleep, I recommend you aim to stop drinking caffeinated drinks after 3pm.

A few studies have shown that consuming large quantities of refined carbohydrates just before bed can cause a decline in the levels of the sleep hormone serotonin in the brain. This suggests that it would be better to avoid consuming foods such as cakes, pastries, biscuits and chips just before bed.

Emerging research has however shown that consuming small quantities of food containing the sleep-inducing amino acid tryptophan may help promote sleep. Tryptophan helps with the production of sleep hormones serotonin and melatonin. The best sources of tryptophan include eggs, fish, meat, soya beans and cheese. Tryptophan containing foods do need to be consumed with a carbohydrate food to have a sedative effect.


Melatonin supplementation has been demonstrated to improve sleep quality. In the UK, melatonin is only available on prescription. Consuming certain foods however can help to increase our levels. Foods containing melatonin include nuts, seeds, strawberries, grapes and oats.

Studies have also shown the importance of having a high enough intake of vitamins and minerals. For most people, it is possible to achieve a sufficient intake of vitamins and minerals by following a well-balanced diet, including consuming a variety of fruits and vegetables. For some people who struggle to meet their requirements for certain vitamins and minerals, I may recommend supplementation, but this would be recommended on an individual basis.



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Thank you Caroline. This has been very enlightening. Looking forward to putting it into practise!

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