Menopause and Diet
With the awareness of the menopause growing as of late, far more resources and advice is appearing on how one might support themselves during this time – particularly when it comes to diet. The nutritional research in the hormonal field, and female health as a whole continues to garner momentum and rigour.
As ever, here at Dietitian Fit, where are here to provide you with diet advice that is evidence-based and up to date.
Read on to explore which nutrients are important in this hormonal transition and where you might be able to incorporate more of these foods into your diet. But first, let’s ensure we know exactly what the menopause is.
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) (1). In other words, the stopping of the period, is due to a shift in hormonal levels, particularly a fall in oestrogen and its derivatives. Technically, menopause only starts once your period has consistently stopped for 12 months, (1) 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. Typically, women hit menopause at the age of 52 but we can see it as early as the thirties (2).
Why is important to pay attention to our diet during this time (3)?
Symptoms that are associated with the menopause often include night sweats, weight gain, mood shifts, brain fog and vaginal dryness. These changes are intrinsically linked to a shift in hormones within the body, notably, oestrogen levels, testosterone levels and follicle -stimulating hormone (FSH) levels, but thankfully in some circumstances, nutrition can help counteract some of these shifts. Interestingly, one of the many forms of the hormone oestrogen, estradiol (E2) is intrinsically linked with the production of serotonin known as our ‘happy hormone’ (2) which makes sense that we set an onset of mood reduction during the menopause, as oestrogen levels fall. One particular nutrient which has been linked to improving mood is omega-3 fatty acids, which we will explore below. Furthermore, plant oestrogens, the plant equivalent of oestrogen, can be consumed to help combat the fall in this crucial hormone.
Another significant feature of the menopause is a fall in bone density – a reason why we see a stark difference between the percentage of women having hip fractures compared to men. Rather shockingly, women lose on average 20% bone density during the menopause. Nutrients which are intrinsically linked with bone health include vitamin D and calcium. The incidence of heart disease is also seen to rise due to an increase in weight and fat distribution. Fibre is also essential to help improve heart health, support weight management and support the gut microbiome.
What are the essential nutrients in the menopause? Omega-3’s
Omega-3’s are what we call a type of essential fatty acid, i.e. one of our healthy fats which has to be obtained from the diet as it is not naturally synthesised within the body. Interestingly the omega 3 that fish contain do not come directly from the fish itself but the algae that is eaten by them! Omega-3’s play a crucial role in the nervous system with the body, in both nervous transmission and neuroplasticity (2). 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 (2). It is important to note, however, that these benefits are likely seen alongside the intake of a healthy balanced diet. See more below or contact us for a 1:1 consultation tailored to you.
Plant sources – flaxseeds, chia seeds, cranberry seeds, walnuts, almonds, nuts, kiwi seeds, canola oil, soybeans, and chia seeds
Others – salmon, mackerel, sardines, trout, fish oil, algae, crustaceans – recommended serving of 2 x oily fish per week
Vitamin D & Calcium
Vitamin D and calcium work together in the body to maintain our bone health. Thankfully, most people obtain enough calcium in their diet from dairy sources or fortified plant equivalents, but vitamin D continues to be typically deficient – particularly here in the UK during winter. 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), the 10mg supplement is taken between at least October-April in the UK (4).
As mentioned above, women can lose a staggering 20% of bone density post-menopause, predominantly as a result in the fall in oestrogen levels (4). A loss in bone density creates greater ‘holes’ within our bone structure, increasing brittleness, resulting in 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 (5). Benefits are also shown from supplementation in younger women, several years before the onset of menopause, as a somewhat preventative measure for bone loss (5).
Vitamin D – 10mg supplement all year round here in the UK. 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).
Phytoestrogens are chemicals similar to that of oestrogen, which are produced by plants. 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 (6). The majority of the research has been performed on a specific type of phytoestrogens called isoflavones, which are present in soya based products such as soya milk, tempeh and tofu. In continents such as Asia, where soy intake is high, 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 (6). Studies show that there is a daily requirement of 250g of tofu, for example, for benefits to show (7). It may be appropriate to consult a health professional before introducing a large amount of isoflavones into your diet. Further benefits of note from increased isoflavone intake include improved sleep and cognition and a positive affect on bone health.
Food sources – soya milk, tofu, tempeh, edamame/soy beans
Fibre is your friend! Fibre continues to be at the forefront and many beneficial diets because of its numerous benefits – from improving the gut microbiome, and weight management to heart health. Within the menopause specifically, an increased intake of fibre helps to combat the weight gain that may be experienced during this time. 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 increased risk of heart diseases such as heart attacks and strokes. By increasing fibre intake, fullness signals in the body can become more potent, 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) (8). SCFAs have been linked with numerous benefits including improved mood, sleep, and insulin sensitivity- things which we see are often compromised during the menopause.
Food sources – wholegrain bread, wholegrain rice, sourdough, lentils, chickpeas, beans, nuts, seeds, fruits and vegetables
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 (9,10), for example for 70Kg women that would be, 70-84g protein / day. Protein is available from a wide variety of foods in differing amounts, high amounts of which appear in meats, beans and eggs.
Other lifestyle changes to consider
As previously mentioned, we see a significant decline in muscle mass post menopause. However, by implementing resistance exercise, or weight training, we can improve muscle mass and prevent increased fall risk. It is recommended that we do at least 2 weight training sessions a week (11), but if this is new to you, aim for one and then when this habit is established bring it up to two.
Sleep disturbance is a common feature of the menopause due to increased night sweats. By improving sleep hygiene, it can help ensure that the sleep you do get is as high quality as possible. To establish good sleep, try the following; going to sleep and waking up at the same time each day; having a ‘wind down’ routine before bed- perhaps no screens and a bath – journaling your worries and gratitudes and removing sources of light in the room.
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. Thankfully, dietary interventions, alongside lifestyle improvements, have been shown to reduce symptoms and improve overall health and happiness. Remember to include your omega’s, take your vitamin D and eat the fibre!
Need specific support with your menopause journey? Contact us at Dietitian Fit today to combat the symptoms in an achievable, evidence-based way.
By Grace Arrowsmith, dietetic student. Reviewed by Reema Patel, Registered Dietitian, MSc