The menopause is a natural ageing process whereby women lose their period and can no longer become pregnant. It usually occurs between the ages of 45 and 55 years, due to a decline in oestrogen levels. In the UK, the average age for a woman to reach the menopause is 51.
Most women experience menopausal symptoms which include hot flushes, night sweats, vaginal dryness, difficulty sleeping and low mood, amongst others.
But can diet improve symptoms?
In recent years many studies have looked at phytoestrogens. These are plant compounds with oestrogen-like properties. There are two major types; isoflavones which are found in soybeans, and lignans which are found in flaxseed, whole grains, fruits, vegetables and legumes. Due to their chemical structure, when oestrogen levels are low (i.e. during menopause and post-menopause), they have an increased oestrogenic effect.
But can they help reduce symptoms? There is some evidence, including that from two systematic reviews and meta-analyses, to suggest that phytoestrogens reduce the frequency of hot flushes, without serious side-effects. According to the British Dietetic Association (BDA), consuming plant oestrogens several times a day appears to be more effective compared to one larger dose. But it should be noted that it can take 2-3 months for the benefits of plant oestrogens to be seen and their effects vary between individuals. Moreover, there are still many gaps in this area of research, with some studies suggesting that they have no effect.
Despite the uncertainty surrounding this topic, there is no harm in including these sources of phytoestrogens in your diet anyway; all are good sources of fibre, protein, vitamins and minerals. Previous studies claimed to have found a link between soy consumption and increased risk of breast cancer. However, since then evidence suggests that this is not the case and some studies have eluded that soy may in fact reduce your risk of developing breast cancer.
We do know that maintaining a healthy weight by eating a balanced diet and staying fit by taking regular exercise can improve symptoms. It has also been shown that caffeine and alcohol can exacerbate symptoms, so it may help to reduce your intake of these.
Of course, there are a number of other treatment options, including hormone replacement therapy (HRT), cognitive behavioural therapy (CBT) and oestrogen creams etc, which can be discussed with your GP.
As we age our bone mineral density declines, however this is accelerated as women go through the menopause. To maintain bone strength and to help prevent osteoporosis it is important to include good sources of calcium and vitamin D in your diet.
According to Public Health England (PHE), the recommended daily intake of calcium for adults 19-64 years is 700mg. You should be able to get all you need from your diet. Sources of calcium include:
• Dairy products (milk, yoghurt, cheese)
• Fortified foods (milk alternatives, bread, cereal)
• Fish eaten with the bones (i.e. mackerel and sardines)
• Leafy greens (watercress, kale)
• Sesame seeds
Vitamin D helps our body to absorb calcium and adults should be getting 10 µg/day.
Vitamin D is produced in our skin when we are exposed to UV radiation from the sun. During the summer months (April to September), those of us living in the UK should get enough sun exposure to make enough vitamin D to meet our needs. However, for the rest of the year we can’t rely on the sun so we need to ensure that we are consuming it through out diets. Dietary sources include:
• Oily fish
• Red meat
• Fortified foods (cereals, dairy products)
However, since dietary sources of vitamin D aren’t as plentiful, PHE recommend that everyone in the UK should take a 10 µg supplement daily at least during the winter months. Those who have a low sun exposure, cover their skin or are from ethnic groups with dark skin are advised to take the supplements all year round. In fact, in light of the current pandemic, PHE now recommend that everyone should take vitamin D supplements in the summer months as well since people are going outside less.
Post-menopausal women have an increased risk of cardiovascular disease so it is important to adapt/ maintain a diet to lower this risk.
• Reducing salt intake- daily salt intake should be less than 6g. So why not try swapping those salted peanuts for a handful of unsalted almonds instead, and refrain from adding salt whilst cooking
• Replace saturated fats with unsaturated fats- i.e. substitute butter for olive oil
• Increase your fibre intake- choose the wholegrain options and make sure to meet your 5-a day
• Try to eat fish twice a week, one of which being oily fish (such as salmon or mackerel)
Menopause is a natural part of the ageing process which can unfortunately come with some unpleasant or inconvenient symptoms. Although we may not be able to eradicate these completely, there are a number of dietary and lifestyle adaptations that we can make to help reduce symptom severity. Women also need to look after their bones and heart as they age to reduce the risk of any complications such as osteoporosis or heart disease.
This post was written by Katie Avis (BSc Hons) who is a Clinical and Public Health Nutrition MSc student at UCL. Katie is currently writing her thesis which investigates the impacts of restrictive diets on the efficacy of the low FODMAP diet. Her aim is to make evidence-based, nutritional information accessible to allow more people to make informed choices. Follow her on Instagram @e.k.nutrition for up to date research and fun recipes.
• British Dietetics Association. Menopause and diet: Food Fact Sheet https://www.bda.uk.com/resource/menopause-diet.html
• British Nutrition Foundation. Menopause https://www.nutrition.org.uk/healthyliving/lifestages/menopause.html?limit=1&start=2
• James W Daily et al., (2019) Equol Decreases Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of Medicinal Food. https://pubmed.ncbi.nlm.nih.gov/30592686/
• M-n. Chen et al., (2014) Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389700/
• Public Health England. Government recommendations for energy and nutrients for males and females aged 1 – 18 years and 19+ years https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf
•Shu et al., (2009) Soy Food Intake and Breast Cancer Survival. National Institute of Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874068/
•Trock, Clarke and Clarke (2006) Meta-analysis of Soy Intake and Breast Cancer Risk. Journal of the National Cancer Institute. https://academic.oup.com/jnci/article/98/7/459/2522023
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