Nutrition for Menopause - AP Nutritional Therapy
Nutrition for Menopause

What is Menopause?

Menopause is confirmed when a woman goes 12 months without a period. The transition into menopause – also known as perimcenopause – can last for several years, often beginning between the ages of 45 and 55 unless induced by hysterectomy or removal of the ovaries. During the transition, many changes take place, due to variations in the body’s production of the hormones oestrogen and progesterone.

Perimenopause may be associated with changes in the menstrual cycle, hot flashes and other symptoms. After menopause, women may develop heart disease or osteoporosis due to decreasing levels of oestrogen which is a component in the maintenance of blood pressure and regulation of calcium levels. Diet and lifestyle changes can help minimise symptoms, ease the transition, and protect against post-menopausal health conditions.

Hormonal Changes

The change in production of oestrogen and progesterone can have many effects on the body. When the body stops producing eggs for fertilization, there is no longer menstruation. There is no need for the cervix lining to thicken with mucous mid-cycle, during what would be ovulation. This can result in vaginal dryness and lowered sex drive after menopause. Many menopausal women find relief with natural lubricants.

Hot flashes – sudden feelings of flushed, hot skin, intense heat, and sweating – are commonly associated with menopause and occur mainly from a lack of oestrogen. These flashes can last a few seconds, or several minutes, and can happen without warning. Avoiding caffeinated and hot beverages can help manage these, as well as mindfulness, meditation and even hypnosis. Studies have shown that relaxation and breathing techniques can significantly reduce the frequency and intensity of hot flashes.

Weight gain can happen due to changes in energy usage and altered fat distribution and storage. Oestrogen and oestrogen receptors on our cells regulate the metabolism of sugar and fat, leading to increased fat storage, predominantly in the abdominal region, or in adipocytes (abdominal fat cells). Adipocytes in turn help control satiety and hunger in the central nervous system and influence the usage of energy in other tissues.

Variable moods are often associated with menopause, including irritability, anxiety, and depression. Changes in sleep patterns due to hot flashes, night sweats, and increased urination frequency can also contribute to changes in mood.

Oestrogen enhances the production of nitric oxide, which can be cardioprotective as it helps dilate blood vessels. Lower levels of oestrogen and nitric oxide in menopause can increase the risk of cardiovascular disease. Coronary heart disease is the leading cause of death for menopausal women. Other factors such as increased weight, smoking, hypertension, high cholesterol, diabetes, and a sedentary lifestyle significantly increase the risks associated with cardiovascular disease in older women.

Changes in the musculoskeletal systems can also occur, with losses of bone density increasing the risks of osteoporosis or bone fractures. Declining levels of oestrogen increases bone resorption (bones are broken down faster than they are rebuilt) as well as decreasing calcium absorption. Loss of muscle mass can also take place, leading to stiffness, aches, and joint pains.

Antioxidants - BlueberriesNutrition for Menopause

Nutrition can play a key role in relieving symptoms. Vitamins, minerals, and antioxidants can help correct insufficiencies and deficiencies,  protect bone health, stablise mood, and boost overall health.

Calcium

Increasing dietary calcium can help offset the rate of bone mass decrease. Calcium is needed for bone health, along with other essential vitamins and minerals, namely phosphorus, potassium, magnesium, vitamin D, and vitamin K. Dairy products are often thought of as the best sources of calcium, however there are plenty of non-dairy sources including leafy green vegetables such as broccoli, cabbage and okra; tofu; sesame seeds and tahini; pulses; nuts; and small fish with edible bones such as sardines or tinned salmon. To absorb the most calcium from food, good levels of hydrochloric (stomach) acid are needed, as well as optimal levels of vitamins D and K.

Healthy Fats

Healthy fats, such as omega-3 fatty acids may have several benefits to peri- and post-menopausal women. Some studies have shown a decrease in frequency and severity of hot flashes and night sweats with omega-3 supplementation. Dietary fats help the body absorb vitamins A, D, E and K. Polyunsaturated and monounsaturated fats such as olive oil, avocados, oily fish, and some nuts such as almonds, Brazil nuts and peanuts can help improve cholesterol levels by reducing LDL cholesterol in the blood. Healthy fats can reduce the risk of heart disease, improve joint mobility, increase satiety leading to maintenance of healthy weight, and are essential for healthy brain function and mood.

Whole Grains

Whole grains such as brown rice, wholemeal bread, barley, quinoa, and rye can be good sources of fibre and B vitamins. Whole grains have been associated with lower risks of cardiovascular disease, type 2 diabetes, cancer, and maintenance of healthy weight. Consumption of whole grains vs refined carbohydrates (white bread, pizza dough, pasta, pastries, white flour, white rice, many cereals, etc) results in significantly lowered risk of disease. For those with gluten intolerance or sensitivities, whole grains should be limited to brown rice, quinoa, and naturally gluten-free products.

Fruits and Vegetables

It is important to eat the rainbow when it comes to fruits and vegetables. Different phytonutrients contained in the various colours offer different health benefits. Fruits and vegetables are packed with vitamins, minerals, fibre, and antioxidants. Most of us don’t eat nearly enough quantity or variety – you should aim for 7 portions of vegetables and 3 of fruit every single day (a portion is approximately the size of your fist or palm), and we should aim to eat all of the colours of the rainbow every week.

Fruit is best eaten, not drunk in juices. Edible skins, like those on apples, contain an abundance of nutrients, and the fibre in whole fruits helps promote satiety, and slows the body’s sugar response. Berries are loaded with antioxidants which have been shown to reduce blood pressure in menopausal women.

Cruciferous vegetables such as broccoli, kale and cauliflower contain phytochemicals which help the body metabolise oestrogen and can help protect against breast cancer. Vegetables are also sources of antioxidants, fibre, and in some cases, calcium.

Diets rich in fruits and vegetables contribute to overall health and weight management, and menopausal women who eat a healthy diet rather than one containing fatty foods and snacks are less likely to suffer menopause symptoms and diseases menopausal women are at higher risk of.

Phytoestrogens

Phytoestrogens are natural compounds found in plants which mimic the effects of oestrogen in the body due to their similar chemical structure. Phytoestrogens are considered endocrine disruptors because they disrupt normal hormonal function. Oestrogen receptors on cells treat phytoestrogens as if they are oestrogen, however they do not bind to receptors as firmly, so their effects are weaker. Phytoestrogens may help rebalance hormones during perimenopause, decreasing the associated symptoms.

Phytoestrogens can be found in nuts and seeds (flaxseeds, sunflower, sesame, almonds), fruit (apples, pomegranates, strawberries, plums, cranberries, grapes), vegetables and legumes (carrots, chickpeas, lentils, alfalfa sprouts, mung beans), soy products (soybeans, tofu, tempeh, miso), herbs (red clover, licorice root, hops), tea (green and black), and grains (oats, barley, wheat germ).

Protein

Loss of muscle mass and bone strength are associated with menopause, and so it is recommended women over 50 eat 1-1.2g per kg of body weight of quality protein daily – or 20-25g per meal. Collagen supplements may also benefit bone density as collagen is the most abundant protein in the body.

A large-scale study of menopausal women and men over 50 (nearly 75k participants) found that plant based protein had a slightly more protective effect on hip fracture prevention than dairy sources.

Quality forms of protein can be found in eggs, meat, fish, legumes, and dairy products. Protein can also be supplemented in powder form, though the quality of these powders varies significantly.

Foods to Avoid

As much as a healthy diet can contribute to the reduction of symptoms and risks with menopause, an unhealthy diet can increase risks significantly.

Sugar and Refined Carbohydrates

Added sugar and refined carbohydrates found in processed foods such as white bread, white rice, crackers, baked goods, etc are known to raise blood sugar rapidly, contributing to obesity, disease, poor sleep, low mood, and inflammation. Limiting these foods may help reduce hot flashes and overall disease risk.

Alcohol and Caffeine

Alcohol and caffeine have been shown in studies to trigger hot flashes during menopause. Some women are not affected in this way by caffeine, which can have the opposite effect of reduced incidence of hot flashes. Both alcohol and caffeine can disrupt sleep, which should be considered.

Spicy and Salty Foods

Some women find that eating spicy foods can exacerbate symptoms, but this is not universal.

High amounts of sodium should be avoided to lower the risk of developing high blood pressure. Oestrogen affects renal activity and blood pressure regulation by modulating the activity of nitric oxide and angiotensin II, and an imbalance in homeostasis may lead to a change in salt sensitivity and increased risk of hypertension.

Meditation

Lifestyle Considerations

Exercise and Stress Reduction

Regular exercise can have many benefits in menopause, from reducing symptoms and maintaining a healthy weight, to relieving stress and enhancing quality of life. Healthy women should aim for a minimum of 150 minutes of moderate aerobic activity or 75 minutes of intense activity each week.

Exercises which increase the heart rate and promote heart health include fast walking, jogging, bike riding, swimming, dancing, aerobic classes, and HIIT classes.

Strength training is crucial as we age to improve bone density, build muscle strength, burn excess body fat, and stimulate the metabolism. Weight or resistance training is best. Speaking to a qualified personal trainer may be the best way to get started for beginners.

Flexibility training and mindfulness can help alleviate hot flashes, irritability, and fatigue while promoting relaxation, better sleep, and healthy muscles. Yoga, Tai Chi, meditation, deep breathing, and mindfulness training are just a few ideas.

Kegel Exercises

Urogenital diaphragm exercises (Kegel exercises) can help improve a common side effect of menopause – urinary incontinence (leakage). An estimated 33% of menopausal women suffer with incontinence at some point. Kegel exercises can increase mitochondrial numbers and activity, and increase blood supply, which can improve vaginal muscle strength.

Stop Smoking

Smoking can induce early menopause, trigger hot flashes, and increase risks of developing osteoporosis and coronary heart disease.

Black Cohosh
Black Cohosh

Supplements

Supplements and herbs should only be taken under the advisement of a registered, experienced practitioner. The below is a very general guide.

Vitamin C – helps build collagen,can prevent and treat vaginal dryness, and help retain elasticity in the urinary tract.

Vitamin E – helps reduce hot flashes, vaginal dryness, and can reduce the risk of heart incidents in those with atherosclerosis.

B Vitamins – help reduce the effects of stress, anxiety, irritability, low energy, and poor concentration.

Magnesium – helps improve bone strength, joint mobility, and reduce the effects of anxiety, irritability, and mood changes.

Calcium – essential for bones, teeth, nails, hair, heart health, blood pressure, and functioning of the nervous system.

Vitamin D – required for calcium absorption, immunity, disease prevention.

Black cohosh – reduces hot flashes, night sweats, mood swings and anxiety.

Agnus castus – balances hormones, improves mood swings, anxiety and tension.

Dong quai – helps hot flashes and night sweats, fatigue and disturbed sleep.

Sage – helps hot flashes and night sweats.

Milk thistle – supports liver function and detoxification of hormones.

Gingko biloba – can improve learning, memory, and concentration.


References:

What Is Menopause? https://www.nia.nih.gov/health/what-menopause

Estrogen Deficiency and the Origin of Obesity during Menopause https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964739/

MENOPAUSAL HOT FLASHES: MECHANISMS, ENDOCRINOLOGY, TREATMENT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612529/

Age of Menopause and Fracture Risk in Post-Menopausal Women Randomized to Calcium + Vitamin D, Hormone Therapy, or the combination: Results from the Women’s Health Initiative Clinical Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365363/

A Proposed Mechanism for the Cardioprotective Effect of Oestrogen in Women: Enhanced Endothelial Nitric Oxide Release Decreases Coronary Artery Reactivity https://pubmed.ncbi.nlm.nih.gov/8934619/

Hagey, A.R. and Warren, M.P. (2008). ‘Role of Exercise and Nutrition in Menopause’, Clinical Obstetrics and Gynecology, 51 (3), pp. 627-641.

Calcium https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908315/

Calcium Factsheet https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

Fat https://www.nhs.uk/live-well/eat-well/different-fats-nutrition/

Wholegrain cereals and bread: a duet of the Mediterranean diet for the prevention of chronic diseases  https://www.cambridge.org/core/journals/public-health-nutrition/article/wholegrain-cereals-and-bread-a-duet-of-the-mediterranean-diet-for-the-prevention-of-chronic-diseases/5BE9B477A9388DB2C8CFE122070D4C64

Impact of Daily Strawberry Consumption on Blood Pressure and Arterial Stiffness in Pre- And Stage 1-hypertensive Postmenopausal Women: A Randomized Controlled Trial https://pubmed.ncbi.nlm.nih.gov/29099521/

Diet rich in fruits and vegetables tied to fewer menopause symptoms https://uk.reuters.com/article/us-health-menopause-diet/diet-rich-in-fruits-and-vegetables-tied-to-fewer-menopause-symptoms-idUKKCN1NP2DW

Isoflavone Metabolites and Their in Vitro Dual Functions: They Can Act as an Estrogenic Agonist or Antagonist Depending on the Estrogen Concentration https://pubmed.ncbi.nlm.nih.gov/16965913/

What are phytoestrogens? Benefits and foods https://www.medicalnewstoday.com/articles/320630

Protein intake and risk of hip fractures in post-menopausal women and men age 50 and older https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357457/

Salt Sensitivity and Hypertension After Menopause: Role of Nitric Oxide and Angiotensin II https://pubmed.ncbi.nlm.nih.gov/16645264/

Therapeutic conduct in postmenopausal women with different forms of urinary incontinence https://www.termedia.pl/Therapeutic-conduct-in-postmenopausal-women-with-different-forms-of-urinary-incontinence,4,22062,1,1.html

Murray, M. and Pizzono, J. (2012). ‘Menopause’, The Encyclopedia of Natural Medicine, 3rd ed. New York: Atria Paperback.

Balch, P. (2010). ‘Menopausal and Perimenopausal Problems’, Prescription for Nutritional Healing, Fifth ed. New York: Penguin Group, pp. 577-583.