The role of diet and nutrition in menopause
Diet and nutrition can be used to support the management of symptoms of the menopause as well as managing the long-term health conditions associated with menopause.
What is menopause?
Menopause is defined as the time in a woman's life when her periods stop as a result of the reduction and loss of 'ovarian reproductive function'. The average age in the UK is 51. It is defined as when a woman has had no periods for one year or more.
The time before a woman’s last period is defined as the perimenopause and menopause transition. During this time a woman’s oestrogen levels start to decline and it is changes in these oestrogen levels that can lead to symptoms.
What are the symptoms of menopause?
The main symptoms include hot flushes and night sweats (vasomotor symptoms), experienced by 70-80% of women. Other symptoms include disturbed sleep and insomnia, low energy levels, low mood, anxiety, low libido and low sexual drive, impaired memory and concentration, a sensation of ‘brain fog’, joint aches, headaches, palpitations and vaginal dryness and urinary symptoms. The severity of these symptoms can impact quite significantly on a woman's life.1
How does diet help the symptoms of menopause?
Phytoestrogens, also known as plant oestrogens, have been shown to help alleviate hot flushes and night sweats. There are 2 types of phytoestrogens: isoflavones and lignans. Isoflavones can be found in foods such as legumes, lentils, chickpeas, soya beans, and tofu. Lignans are found in cereals, flaxseeds, and fruit and vegetables. There are no official recommendations for the amount of phytoestrogen containing foods to eat but based on the amount of phytoestrogen consumed in studies, this equates to 2-3 servings a day.
Sleep problems are commonly reported during the menopause transition. For some individuals, caffeine can influence sleep. Caffeine consumption amongst menopausal women has been shown to increase vasomotor symptoms such as hot flushes. Reducing overall caffeine intake by switching to decaffeinated drinks or limiting caffeine intake from lunchtime may have a positive effect on sleep and other menopausal symptoms. Alcohol can also have the same effect on sleep and hot flushes for some women, therefore, reducing alcohol intake can support during menopause transition.
Eating a healthy, balanced diet can help to ensure an adequate intake of vitamins and minerals, fibre and macronutrients. All these factors can help with supporting energy levels and maintaining regular blood sugar levels as well as helping to limit cravings of poorer nutrient food choices. The Mediterranean diet has been shown to be effective in improving vasomotor symptoms, cardiovascular risk factors such
as blood pressure, cholesterol and blood glucose levels, as well as mood and symptoms of depression. Long-term adherence may: improve cardiovascular risk and events, and death; improve bone mineral density; prevent cognitive decline; and reduce the risk of breast cancer and all-cause mortality.
Weight gain and menopause
A common concern of women going through menopause is weight gain, particularly around the abdomen. During the menopause transition women report weight gain of 1–2 kg per year.Weight gain occurs due to the changing levels of oestrogen and changes to metabolism. Low oestrogen levels throughout the menopause can cause visceral fat to be stored in the lower abdomen area, which can increase the risk of insulin resistance, type 2 diabetes, and heart disease.
For women, it can be difficult to lose weight during the menopause transition therefore the goal may be to limit further weight gain. The focus should be on ensuring an adequately balanced diet to prevent any nutrient deficiencies. Additional lifestyle factors such as exercise levels, sleep quality and stress levels should also be considered.
Long-term health conditions associated with menopause
As oestrogen levels decline, the risk of other health conditions increase including osteoporosis and heart disease.
Although most osteoporotic fractures are seen in women over 60 years of age, fracture incidence increases in women at the menopause, coinciding with lower oestrogen levels, a decrease in bone mineral density (BMD) and higher rates of bone turnover. Provision of adequate dietary or supplemental calcium and vitamin D is a key part of osteoporosis management. Calcium requirements for women during menopause-transition is 700mg/day, increasing to 1200mg/day postmenopausal.Vitamin D supports the absorption of calcium from food. The recommended intake of Vitamin D is 10mcg/day.
Increased risk of cardiovascular disease coincides with menopause but also menopause is associated with a significant increase of blood pressure, body mass index (BMI), obesity, and body fat distribution. Studies have shown that oestrogen has a cardio-protective effect. The studies suggest the protective role of oestrogen in cardiovascular diseases is associated with a decrease in fibrosis, stimulation of angiogenesis and vasodilation, enhancement of mitochondrial function and reduction in oxidative stress.
Managing the risk of heart disease with diet is focussed on managing cholesterol levels, reducing blood pressure, addressing raised BMI and diabetes risk. The Mediterranean diet has been shown to be advantageous in combining weight loss with CVD risk reduction. This diet reduces the consumption of saturated animal fats in favour of unsaturated vegetable fats and a high intake of polyphenols and n-3 fatty acids with anti-inflammatory and antioxidant properties. The phenolic compounds (polyphenols) are presented in extra virgin olive oil, whole grain cereals, nuts, legumes, vegetables, red wine, and fruits.
Diet and nutrition can play an important role in supporting women during the menopause transition and beyond. Supporting women with dietary change can help to manage symptoms and reduce the impact of the long-term health conditions associated with menopause. This period of a woman’s life can be particularly challenging but educating women to understand what and how diet can help
Author: Caroline Hill
Caroline is a freelance dietitian with over 16 years experience. She supports women with their dietary needs in menopause. Caroline also provides consultancy services to industry.
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