The Menopause appears in the mainstream conversation now more than ever so it is essential that we, as evidenced-based nutritional professionals, cut the fact from fiction and get to the heart of what the menopause diet should look like and why. The menopause diet places particular focus on supporting the loss of hormones from the body, namely oestrogen as well as supporting muscular and neurological changes. Maintaining a healthy balanced diet, with more emphasis on healthy fats, protein and vegetables is trumpeted by current evidence.
What is the menopause?
Menopause is defined as “the permanent cessation of menstruation resulting from loss of ovarian follicular activity” as per the World Health Organisation (WHO). In other words, the body is no longer equipped hormonally to trigger a period, so they stop – this is a completely natural process. Technically, menopause only starts once your period has consistently stopped for 12 months, as hormone levels begin to fall and symptoms begin to show, the period may become more sporadic – this is known as perimenopause or the menopausal transition. Normally when women refer to ‘going through the menopause’ this perimenopause is what they are referring to. Typically, women hit menopause at the age of 52 but we can see it as early as the thirties.
What happens during the menopause?
During perimenopause, and thereafter a change in hormones, like progesterone, oestrogen and follicular stimulating hormone (FSH) (see Figure 1), results in changes from a physical and symptomatic perspective.
Figure 1 – during perimenopause and beyond
Not all women experience all of the following changes, and some none at all, particularly those which are symptomatic changes.
| Physical changes | Symptomatic Changes |
| Higher blood pressure | Hot flushes/flashes |
| Increased cholesterol levels | Low mood/anxiety/depression |
| Lower bone strength and density | Vaginal dryness |
| Weight gain | Insomnia |
| Brain fog |
What are the essential nutrients and foods in the menopause?
There are some key nutrients and foods to include into your diet, to support your health during menopause. These include:
Omega-3’s
These fatty acids are essential when it comes to supporting our brain health and can be found in foods like olive oil, oily fish and nuts.
Omega-3’s are what we call a type of essential fatty acid, i.e. one of our healthy fats which must be obtained from the diet as it is not naturally made within the body. Interestingly, the omega-3 that fish contain, comes from the algae that the fish eat, not the fish itself!
Omega-3s play a crucial role in the nervous system in the body, in both nervous transmission and neuroplasticity. Neuroplasticity refers to our ability to mould and change the patterns in our brains and is often linked with improved mental health. Omega’s are also anti-inflammatory. Studies have shown that regular intake of omega’s has been linked to reduced anxiety and depression in post-menopausal women. Do note that these benefits are likely seen alongside a healthy balanced diet.
Omega-3 sources;
a) Plant sources – flaxseeds, chia seeds, cranberry seeds, walnuts, almonds
b) Others – salmon, mackerel, sardines, trout, fish oil, algae, crustaceans, omega 3 enriched eggs
Vitamin D & Calcium
Vitamin D and calcium work together in the body to maintain bone health, and sources of calcium include dairy products or fortified equivalents, and vitamin D supplements are recommended.
Thankfully, most people obtain enough calcium in their diet from dairy sources or fortified plant equivalents but vitamin D intake is typically deficient . This is because we need the sun at a particular strength to synthesise the active form of vitamin D from our skin. It is therefore recommended, as per the Scientific Advisory Committee on Nutrition (SACN), a 10mg supplement of vitamin D is taken daily between at least October and April in the UK, and for some of the population, all year round supplementation is recommended.
As mentioned above, women can lose a staggering 20% of bone density post-menopause, largely due to fall in oestrogen levels. Loss in bone density creates greater ‘holes’ within our bone structure, increasing brittleness, and resulting in a greater risk of fractures. However, studies have shown that vitamin D supplementation, alongside that of calcium (if you are deficient), has been shown to increase bone density and reduce the likelihood of osteoporosis and thus hip fracture risk. Benefits are also shown from supplementation in younger women, several years before the onset of menopause, as a somewhat preventative measure for bone loss.
Vitamin D sources
- 10mg supplementation during October-April. Food sources include mushrooms, liver, egg yolks and fortified foods such as spreads.
- Calcium – milk, cheese, yoghurt, tinned fish with bones, fortified dairy alternatives, edamame & tofu (made with calcium sulphate).
Plant Oestrogens
Plant oestrogens may help relieve hot flushes/sweats due to their oestrogen-like structure, and can be found in soy-based products like tofu and soya milk.
Phytoestrogens are chemicals produced by plants that are similar to that of oestrogen.They can act as oestrogen in the body – in a weaker form. Phytoestrogens therefore may help to relieve symptoms of the menopause such as hot flushes and night sweats. In continents such as Asia where soy intake is high, studies show only 10-20% of women experience hot flushes, compared to the majority of those in the US and UK where soya intake is much lower. Some evidence shows that there may be a daily requirement of 250g of tofu, for example, for benefits to show.
Plant oestrogen sources
- soya milk, tofu, tempeh, edamame/soybeans
Fibre
Fibre is your friend! It can help negate weight gain during the menopause and can be found in many plant foods, such as beans, fruits and vegetables.
Fibre continues to be at the forefront of many beneficial diets because of its numerous benefits – from improving the gut microbiome, and weight management to heart health. Due to a shift in fat storage mechanisms, linked to hormonal fluctuations, we see an increase in abdominal fat within women, which is linked to an increased risk of heart diseases such as heart attacks and strokes. Increasing fibre intake increases fullness signals in the body, allowing us to control our weight more easily. Fibre interacts with the gut microbiome in many ways, one of which is that it results in the increased production of short-chain fatty acids (SCFAs). SCFAs have been linked with numerous benefits including improved mood, sleep, and insulin sensitivity- things which we see are often compromised during the menopause.
Fibre food sources
- Wholegrains such as wholewheat bread, brown rice and pasta, lentils, chickpeas, beans, nuts, seeds, fruits and vegetables
Protein
Protein helps our muscles stay healthy during the menopause and can be found in foods such as beans, meat and nuts.
Menopause is linked with a reduction in muscle mass – thus it is key to maintain our protein intake to help keep our muscles healthy. There are no set guidelines on protein intake for post-menopausal women but research suggests 1-1.2g per kg of body weight per day may help to limit muscle mass loss (For example, a 70kg woman would need around 70-84g protein/day). If you are exercising frequently, consider opting for an extra serving protein /day (~20g).
Protein Food sources
- meat, poultry, eggs
- pulses, beans, nuts, soy products such as tofu, tempeh
- Yoghurt, milk, cheese
Fruits and Vegetables
Fruits and vegetables are essential in any diet including the menopause diet to support our gut health, mental health and helping to prevent weight gain. Aim for variety by seeking out different colours!
Getting a variety of fruits and vegetables allows us to get in all of the micronutrients we need, as well as fibre. Micronutrients are nutrients that we still need just in smaller quantities ie minerals and vitamins, and support the body in many ways, from gut to eye health. Fibre keeps our gut microbes happy and keeps us fuller for longer – helping us to slow down when eating as well as taking longer to digest food.
Iron
Iron is an essential mineral for our immunity and can be found in red meat and dark green vegetables.
Iron is not only essential for immunity – deficiencies result in iron deficiency anaemia – but it supports oxygen transport in the body as well as the development of growing muscles. Typically pre-menopausal women are deficient in iron, but post-menopause, requirements fall as menstruation stops, so it is unlikely to be of concern. Seek GP input if you have symptoms of deficiency such as looking pale, feeling tired or lacking energy. Generally, iron can be sourced from the diet from the sources stated.
Food sources of Iron
- Animal based sources of iron- red meats (opt for lean sources such as beef steak, pork loin), as well as poultry and seafood
- Plant based sources of iron– pulses, legumes, dark green vegetables, nuts, seeds
– Seek vitamin C alongside these plant foods foods to optimise absorption e.g. peppers, tomatoes, orange juice
Magnesium
Magnesium supplementation may be recommended during menopause to reduce hot flushes and support weaker bones but insufficient evidence is apparent to back this – so focus on getting it from your diet.
Magnesium sources
- legumes, nuts, seeds, whole grains, green leafy vegetables, yoghurt, fortified cereals, soy products
Meal Ideas and quick recipes for the menopause
| Salmon and veggie wholewheat couscous | Combine harissa-baked salmon fillets with wholewheat couscous and roast veggies, using olive oil and top with nuts
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| Shakshuka with beans | Combine tinned tomatoes, mixed tinned beans, spices and olive oil and top with poached eggs or tofu, and avocado
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| Snacks |
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Are there foods to avoid during menopause?
Caffeine
Caffeine is a stimulant to the nervous system which has been linked to an increase in hot flush incidences . However, some other studies counteract this (ie showing a reduction). Unfortunately, we lack robust research to come to a consensus – therefore we would advise you to try some time without caffeine to see if this helps your hot flushes.
Alcohol
Some women report that alcohol can increase their hot flushes, particularly red wine. Alcohol is also known to disrupt sleep, which in turn may exacerbate other menopause symptoms such as low mood and weight can. Therefore, opt out where possible – if not, keep to guidelines of maximum 14 units per week.
Watch out for low-fat / high-sugar
Low-fat foods are typically high in sugar, which is likely to cause a blood sugar crash and in turn low energy, causing us to reach for convenience foods and affecting our mood negatively in the long run. Furthermore, healthy fats are encouraged (olive oil, oily fish, nuts) to support brain health. Low-fat / high sugar foods often include cereal bars, flavoured yoghurt, breakfast cereals and salad dressings.
Be mindful of saturated fats
Foods high in saturated fats, can increase risk of cholesterol, especially as we go through perimenopause. This is because oestrogen levels fall, which increases the risk of higher cholesterol.
What is the best diet for menopause?
There is not one specific dietary type that is recommended for menopause despite diets like the Japanese menopause diet, 1200-calorie menopause diet and menopause meal plans being available, we still lack sufficient evidence to recommend specific diets. Evidence for foods above such as phytoestrogens and omegas still lie in infancy, however, we know that healthy diet principles remain essential during menopause.
Generally, the following principles are advised:
- Aim for at least 5 handfuls of fruit & vegetables per day – look for colour and variety, adding in plenty of fibre to the diet to support digestive health
- Aim to have 2 portions of oily fish a week (e.g. salmon, sardines and mackerel). If you do not eat fish, you can also obtain omega 3 from nuts & seeds, though a supplement may need to be considered.
- Aim to include a handful of nuts & seeds each day, due to the range of nutrients they contain, as well as fibre
- Aim for a serving of protein at each meal. e.g. Meat, fish, eggs, pulses & beans, Greek yoghurt or soy products
- Opt for wholegrain carbohydrates in smaller amounts such as brown rice and quinoa, compared to simple carbohydrates
- Choose foods containing plant oestrogen’s such as soya, edamame and tofu regularly, at least once a day, to support heart health and possible reduction in menopausal symptoms.
- Concentrate on including 2-3 sources of calcium each day, to support bone health. This could be milk, cheese and yoghurt, as well as plant sources of calcium such as soy and calcium enriched plant milks.
- Keep well hydrated, with plenty of water, to reduce risk of headache and fatigue. Decreased levels of oestrogen leads to increased collagen loss, which can impact skin and signs of ageing. Hydration can therefore help with this.
- Be aware of foods that are high in fat. This is because higher fats, in particular saturated fats, can lead to increased cholesterol levels, which is more likely due to the reduction in oestrogen. Foods such as butter, fat on meat, cakes etc, are a source of cholesterol.
- Along with diet, also consider improvements in sleep quality and stress management, as these factors will impact symptoms during this time.
Weight management during the menopause
Statistically, we would expect women to gain weight during the menopause as muscle mass falls. Less muscle means our bodies burn less energy at rest, therefore if exercise habits and food intake remain the same, weight gain is still likely.
The weight distribution may also shift towards the abdominal (tummy) region during menopause, rather than towards the legs and glutes, which is more typical for women during fertile years. This is known as going from more pear-shaped to apple-shaped. Fat around the tummy region is linked more closely to heart disease and diabetes and therefore preventing weight gain becomes more important.
How can I manage weight gain during menopause?
- Reduce portion sizes slightly, getting smaller plates/bowels can help with this
- Aim for half the plate as vegetables
- Seek out fibre to keep you satisfied (see above)
- Start weight training – if this is new to you start with once a week and build up it overtime
- Regular walking – Build up the speed and total minutes of walking you are able to do across the week
Can a healthy diet help menopause symptoms?
A healthy and balanced diet is likely to help manage menopausal symptoms from a general perspective. Healthier diets that follow government guidelines, such as the Mediterranean diet or EatWell guide, are linked with improved outcomes generally such as reduced likelihood of diseases such as heart disease and cancer and supporting our gut microbiome and weight management. The evidence supporting the named nutrients above, such as phytoestrogens present in soya products and omega-3s in olive oil, is not yet robust enough to be included in clinical guidelines but thankfully they appear in these diets anyway. The research surrounding menopause requires greater robust research across the board, but the attention and desire for lifestyle and diet input in this region is growing.
Other tips during menopause
Resistance Exercise
- Significant muscle mass loss post-menopause is seen which indicates the need for resistance exercise
- Resistance exercise or weight training has two benefits during menopause
- Helping to prevent further muscle mass loss
- Increase the energy burnt at rest by the body (BMR), supporting long-term weight management
Aim for at least 2 weight training sessions a week, but if this is new to you, aim for one and then when this habit is established bring it up to two.
Sleep Hygiene
- Sleep disturbance is a common feature of the menopause due to increased night sweats
- Sleep hygiene can help not by not only increasing the quality of sleep you obtain but perhaps the length too
- Try waking up and falling asleep at the same time each day
- Implementing a wind-down routine before bed e.g. a bath, reading a book, some stretching
- Journaling your thoughts on paper to prevent a racing mind at night
- Opting for candles/dimmer lights in the evening or the bedroom – including avoiding screens in bed
- Consider air flow, and duvet thickness for a cooler room at night
Cut back on high-fat foods
- Cutting back on high-fat foods reduces the risk of developing heart disease which is greater post-menopause, as they typically contain saturated fats Reduce intake of foods like cakes, crips, chocolates and takeaway meals
Drink plenty of water
- Drinking plenty of water during this time is likely to help with focus, energy levels and weight management
- Opt for a water bottle with markers of encouragement or track your water intake as a reward system
Remember to Read Labels
- Look out for the traffic light system on labels – try and consume less food which is red when it comes to fat levels and sugar levels
- These ‘red’ foods are likely avoided if you are following the principles discussed in healthy eating guidelines and the menopause diet above
Summary
Menopause is not an easy time for women, and it is so encouraging that awareness and thus mechanisms to deal with this time are ever-evolving. Despite robust research being required for a menopause-specific diet, typical healthy guidelines of a balanced diet still apply at this time and help prevent diseases which are high-risk post-menopause. Lifestyle changes and weight training in particular help improve body composition overall health and happiness.
Need specific support with your menopause journey? Contact our team of private dietitians today to combat the symptoms in an achievable, evidence-based way.
By Grace Arrowsmith, Dietitian. Reviewed by Reema Pillai, Registered Dietitian, MSc
