Is there such a thing as a menopause diet?
Eating well through the menopause
The perimenopause and beyond is a time to re-evaluate our diet. We know that we are more susceptible to weight gain, osteoporosis, heart disease, increased cholesterol, and insulin resistance as we transition through the menopause. Some menopausal symptoms including hot flushes, sleep difficulty, fatigue, muscle loss, changes to digestion and mood swings can be improved with changes to our diet and lifestyle habits. Adequate weight management, and nutritional intake of essential vitamins and minerals is important to improve our future health.
Take home messages!
Swap processed food for natural alternatives.
Prepare ahead to have nutritious snacks/meals on hand rather than last minute poorer choices
Increase protein with particular focus on breakfast.
Add in as many vegetable/plant-based foods as possible.
Drink plenty of water
Have healthier alternatives to hand if you know you eat under stress, boredom, or experience carbohydrate cravings
Focus on adding in positive food choices rather than restriction.
A question I often get asked from women in the menopause clinic, what should I be eating to support my health through the perimenopause and post menopause? General principles that support weight management, symptom control and help reduce your future health risk throughout your life are also applicable to the Menopause and can influence symptoms.
Many women notice changes to their body shape and composition as oestrogen levels decline, our metabolism slows, and we have a redistribution of adipose (fat) tissue to our midline. The rate of fat gain doubles while lean tissue mass (muscle), starts to decline and body weight steadily increases. Despite an increase in exercise and calorie reduction, many women struggle to lose that visceral fat and regain the slender figures taken for granted in our 20’s and 30’s.Â
Studies (1) show noticeable changes to a women’s body composition can occur up to two years prior to their last menstrual period and continues for 2 years after, then levels off. It therefore appears there is a critical 4-year window, 2 years either side of our last period, when lifestyle choices have an increased impact on our future health.
Body composition changes during menopause
The loss in muscle mass (chiefly caused by reduced oestrogen and testosterone) lowers our metabolic demand, meaning we are burning less calories. The redistribution of fat to the abdomen, increases our deep belly fat (intra-abdominal fat) this coupled with weight gain from reduced energy expenditure as our muscle mass declines, increases our risk of diabetes and cardiovascular disease.
What you choose to eat can, and does, have an impact on symptoms and long-term health (2)
Hot flushes
There are some dietary adjustments that we can make to alleviate the vasomotor symptoms of the menopause. Phytoestrogens have a very mild estrogenic activity, safe for everyone from dietary sources and if eaten regularly can reduce the severity of hot flushes and night sweats. Avoiding trigger foods such as caffeine, spicy foods, reducing sugar and processed foods in addition to increasing plant based foods can all help. Carrying excessive weight can worsen hot flushes.
Calorie requirements
As our metabolism changes and our expenditure of energy decreases it’s important to adapt our diet in response to this to prevent excessive weight gain.
Where we consume our calories from starts to matter. Ensuring our calorie intake is adequate to sustain energy levels through nutrient rich sources rather than excess calories from nutrient deficient sources such as sugary drinks, alcohol, processed snacks, biscuits, cakes, and other highly processed foods is essential. We need to eat slightly less and what we do eat ideally should be packed with nutrients and avoid wasted calories from nutrient deficient food.
Unprocessed foods from natural sources, plants and unprocessed meat keep us feeling fuller for longer, prevent energy and sugar crashes, reduces bloating, fluid retention and are less likely to cause disease. Avoiding processed foods is key to future health.
Estimated daily calories to maintain weight
Macronutrients
As our metabolism changes its important to consider the balance of the important food groups, protein, carbohydrates, fats, and water.
Fats
Fats are important to maintain our heart, brain, and metabolic health (4). There are two types of cholesterol the good HDL cholesterol, and the bad LDL cholesterol found in saturated and trans fats (often animal sourced).
Essential fatty acids are important to absorb some vitamins which are fat soluble such as vitamin A, D and E. Monounsaturated fats from olive & rapeseed oil, avocados and some nuts (reduce LDL cholesterol) and polyunsaturated fats from rapeseed, sunflower and oily fish (omega 3&6) are the healthy fats we need for our health.
Tips for adding unsaturated good fats to diet
Use olive oil-based dressings.
Rapeseed oil for cooking instead of other oils
Increasing oily fish intake
Eat nuts and seeds (small portions as calorific)
Reducing butter, and other sources of saturated fats: biscuits, cakes, fried food, bacon, sausages, fatty red meat.
Quality Protein
Eating quality protein whether from meat or vegetable sources is important during the menopause as our muscle mass declines. It’s important to eat 25-30g of protein with each meal of the day and to balance quantity of protein to carbohydrate. Breakfast is normally the meal where women struggle to eat enough protein and it can often require a change in breakfast eating habits away from carbohydrate rich processed foods or missing breakfast. Having adequate protein in our meals supports bodily requirements but also reduces carbohydrate cravings between meals that are often the cause of additional unnecessary calorie intake.
Adding quality protein sources
Swap red meats for chicken and turkey
Check suppliers and sources to avoid additives and intensive farming.
Increase intake of wild fish (farmed fish can often be high in pollutants-salmon, prawns etc)
Tofu and tempeh
Legumes- beans, pulses
Eggs from organic free-range sources if possible
Avoid all processed meats and vegetarian alternatives
Carbohydrates
Carbohydrates are not the bad guys. We do have to pay attention to the type of carbohydrate and make sure they are nutrient rich.
Whole grains including brown rice, whole grain wheat, rye, quinoa, oats, and barley have been shown to reduce disease. Curbing sugars and increasing complex carbohydrates that provide sustained energy release help to improve insulin sensitivity and reduce sugar spikes.
Plant-based
Carbohydrates from fruit and vegetables not only provide fibre, energy and nutrients but are also shown to reduce our risk of disease and cancer. There is no limit to green leafy vegetable intake, eating the rainbow and trying to eat 30 different plant-based foods each week is superior for our health. Phyto-oestrogens are safe and can also help alleviate some menopausal symptoms. Polyphenols are those red, purple, and black coloured foods such as blueberries, red currents, tea, coffee and cacao that have high antioxidant quality and quantity.
Hydration
We need water to regulate our temperature, lubricate our joints, deliver nutrients to cells, maintain our brain function and to fight infection. On average women need around 3 litres of water a day
Maintaining adequate hydration through increasing water intake but also reducing diuretic foods such as coffee and tea has shown to improve cognitive function and improve our skin health.
Signs of dehydration in your urine
Micronutrients
Especially important during the menopause is bone protection, ensuring we have an adequate calcium intake through the diet of a minimum of 700mg in the perimenopause and 1000mg post menopause is essential to maintain our bone health. Dairy, green leafy vegetables, and small bony fishes are all good sources of calcium. See the separate article on bone health for further information.
Other minerals and nutrients
Most women who have a sustained balanced diet can consume the range of minerals and vitamins without supplementation. If you follow a plant-based diet, have heavy menstrual periods or malabsorption due to gastro-intestinal disease then it can be useful to have a blood test to identify and correct deficiencies. However, taking a good quality multivitamin and mineral is perfectly suitable for most women. Be aware of perimenopause/menopause specific branding as they are often just overpriced multivitamins.
Having a balanced diet full of plant-based foods ensures we have an adequate intake of vitamins and minerals. Vitamin D is the only supplement I recommend universally for all my patients as it is essential for our bone health and recommended for all people living in the UK.
Timing of meals and fasting
There is some evidence to suggest that having a period of fasting every day for a minimum of 10 hours helps us to maintain a healthier body weight. Having a rule of not eating between the hours of 8pm and 7am for example prevents us from eating those 9pm snacks that are often more calorific and less nutritious. Teaching our bodies not to snack and to be able to be hungry while waiting for the next nutritious meal is important when trying to address weight management. Often having a large glass of water when we would normally reach for a  snack helps to fill our stomachs to last until next meal.
Stress eating
It’s very common for women to stress eat when they are chronically over-stressed through work, financial difficulty, family issues, or other overwhelming conditions on our lives. Studies show post-menopausal women who suffer from depression often have a higher calorific intake. Identifying if you eat when you are stressed, bored or out of habit is important to recognise. Preparing ahead and having a fridge or snack box full of nutrient rich alternatives is better than reaching for the packet of biscuits.
Refined Sugar
Sugar can be addictive. Reducing your sugar intake or cutting sugar from your diet can be helpful to avoid sugar spikes and crashes, reducing your risk of insulin resistance and to reduce calorie intake from nutrient deficient sources.
Our microbiome has a vital role
Maintaining a healthy microbiome helps to improve our digestive, gut and bowel health in addition to support metabolism of our food and hormones within the body including oestradiol. The bacteria capable of metabolising oestrogen is named the estrobolome.
We are also aware of the strong association between our microbiome with immunity, disease, and mental health. Building and maintaining a healthy microbiome is done in two ways. Firstly, establishing a healthy and diverse microbiome through the regular intake of probiotics, fermented and live foods and secondly feeding that microbiome with prebiotics and good quality vegetable fibre through our diet.
References
1. Weight, Shape, and Body Composition Changes at Menopause. Fenton, A. s.l. : Journal of midlife health , 2021.
2. Leonhardt, DR Hannah Short & Dr Mandy. The Complete Guide to POI & Early Menopause. s.l. : Sheldon Press, 2022.
3. Hilary Wright, Elizabeth Ward. The Menopause Diet Plan. s.l. : Rodale, 2020.
4. NHS. Fat:The facts. NHS.uk. [Online] [Cited: January 21, 2023.] https://www.nhs.uk/live-well/eat-well/food-types/different-fats-nutrition/.
5. Mukherjee, Dr Annice. The Complete Guide to the menopause. London : Vermilion, 2021.