Dr. Harriet Holme

What are the Best Foods to Eat During the Menopause and Beyond?

The menopause can be a difficult time for many women and so it is very understandable why many are drawn to the idea of supplements or changing their diet to help. But is there any evidence to back any of the claims? Can anything help with symptoms? Can changes you make to your diet help with your long-term health?

This article talks through the evidence behind supplements, dietary changes for menopausal symptoms, and how to reduce both your long-term risk of cardiovascular disease and osteoporosis.

Dietary Changes for Menopausal Symptoms

Caffeine and Alcohol

Reducing caffeine, alcohol and spicy food in your diet may help hot flushes, but there is considerable variation between individuals (2)(3). Current recommended limits of alcohol are a total of 14 units a week, with a maximum of two per day. Reducing alcohol also has other health benefits, such as a lower risk of liver disease, heart disease, osteoporosis, type 2 diabetes, and certain types of cancer such as breast cancer (3).

Magnesium Supplements

For some women insomnia can be a symptom of the menopause. Unfortunately, there is very little evidence to support any benefit from magnesium supplements (4). Instead you should be able to meet all your magnesium needs through a healthy diet containing wholegrains, spinach, pumpkin seeds, almonds and beans.

Phytoestrogens

Phytoestrogens are plant derived compounds, that have a similar structure to human estrogen, and similar but weaker activity. They are found in foods and in a more concentrated form in supplements. Phytoestrogens supplements are frequently marketed and chosen to target hot flushes.

Herbal Medicines That Contain Phytoestrogens

There are a number of herbal medicines that contain phytoestrogens that may help with the symptoms of menopause. There is evidence to support decreased hot flushes with St John’s wort, black cohosh (5), and genistein (6).

Isoflavones (soya products and red clover) are a type of phytoestrogen. There is mixed evidence that they may reduce hot flushes (6). Red clover is not advised in women with breast cancer (7)(8), but soya is probably safe. These supplements may also interact with other medications such as those for heart disease, epilepsy and asthma, so you should speak with your GP before starting any herbal medicine.

The contents of herbal medicines may vary considerably, as in contrast to conventional medicine, there is no legal obligation for herbal medicines to be licenced. Check for a product licence or Traditional Herbal Registration (THR) number on the label and always buy from a reputable setting.

Foods That Contain Phytoestrogens

The phytoestrogens found naturally in some foods are less concentrated than supplements. Phytoestrogens occur naturally in some plant-based foods such as:

  • Soybeans and soy based products
  • Peanuts
  • Sesame seeds
  • Flaxseeds
  • Chickpeas
  • Berries
  • Barley
  • Apricots
  • Tea (green and black)

Given the mixed evidence about efficacy of the supplements, is therefore unlikely that consuming these food items, will have a significant benefit on symptoms.

Dietary Changes for Long Term-Health

Declining levels of estrogen from the menopause and beyond increases your risk of cardiovascular disease (heart disease and strokes) and osteoporosis (brittle bones and increased risk of fractures), diabetes, depression, obesity and dementia. If you experience early or premature menopause, your risk is unfortunately higher (1). To counteract these concerns you can make some dietary changes to reduce your long-term risks.

Optimising Bone Health

Osteoporosis leads to a greater risk of having low energy fractures. Estrogen has a really important role in bone health, and as levels decline, risk of osteoporosis increases. A 50 year old woman only has a 2% risk of osteoporosis, compared with a 25% risk in an 80 year old lady, due to considerably lower levels of estrogen (9).

Diet can play an important role in bone health. There are some key macronutrients, vitamins and minerals to be sure that you are getting enough of:

  • Quality protein: Include lean protein foods at every meal such as seafood, beans, legumes, dairy, meat, and poultry.
  • Calcium is an important mineral for bone health, and as an adult before the menopause you need to 700mg per day while from the menopause this rises to 1200mg a day. Good sources of calcium include dairy, calcium-fortified plant-based drinks, tinned fish (with bones), spinach, fortified bread, baked beans, tofu and dried figs. If you are unable to have enough in your diet, you might be prescribed a supplement.
  • Vitamin D, commonly called the sunshine vitamin as it is produced by the action of sunlight on our skin during exposure outside. Current NHS guidance is for women to consider taking a supplement of 10mcg (400IU) during the autumn and winter months as it can be difficult to get enough sun exposure. Vitamin D is also found in low levels egg yolks, oily fish and some fortified foods, but is difficult to get enough from diet alone. It was previously thought that sunscreen prevented vitamin D formation, but evidence suggests that sunscreen does not inhibit vitamin D production in the skin.
  • The term vitamin K covers a number of different molecules and you need to eat a range of items to ensure you get all the different elements. Vitamin K is found in green vegetables, fermented food, dairy, and meat and has an important role in bone strength. Although there is mixed evidence as to whether vitamin K supplementation improves bone strength and reduces fractures (10), a number of countries for example Japan, now include vitamin K supplementation as treatment for osteoporosis. Vitamin K is a fat-soluble vitamin, and is stored if you take excess. It is therefore possible to have too much through supplementation, and we don’t know what these effects might be. If you are on blood thinning medication, you should avoid taking vitamin K supplements as they can interfere.
  • Phosphorus is found in foods such as poultry, meat, dairy, oily fish, potatoes, wholegrains, pulses and beans. It is usually abundant in our diet, and you should not need to take a supplement.
  • Magnesium is another mineral that is usually abundant in our diet but good sources include wholegrains, spinach, pumpkin seeds, almonds and beans. Again you should not need to supplement this.
  • Resistance exercise is very important for bone strength. The NHS advise 30 minutes twice a week for adults over the age of 35 years. Examples include brisk walking, resistance bands, yoga, squats, weight training, Pilates, gardening and a brisk walk.

Reducing Risk of Cardiovascular Disease (CVD)

The risk of cardiovascular disease increases during and after the menopause. This is partly related to the aging process, and also the effects of declining estrogen (1). Cardiovascular disease is a general term used for conditions affecting blood vessels and the heart by narrowing of the arteries (atherosclerosis) and an increased risk of blood clots such as strokes.

Weight gain associated with declining estrogen levels also leads to an increased risk of obesity, higher blood pressure, type 2 diabetes, and higher (LDL) cholesterol levels, which are all well recognised as factors for CVD (11,12)

There is evidence that dietary changes can help reduce this risk (13) so aim to follow a diet with the following principles:

  • Swap saturated fats (animal fats) to unsaturated fats such as extra virgin olive oil, rapeseed oil, avocado, seeds, nuts
  • Reduce fat content to less than 30% of your diet (approximately 60g per day)
  • Swap refined carbohydrates (white bread, white rice) with whole-grains (brown rice, brown bread, millet, teff, bulgur wheat).
  • Eat at least 5 portions of fruit and vegetables a day
  • Aim to have 2 portions of oily fish (for example salmon, sardines, mackerel) twice a week. If you do not eat fish, have daily nuts, and seeds which also contain omega 3.
  • Aim for a handful of nuts and seeds a day.
  • Regularly enjoy beans, lentils and chickpeas.
  • Avoid convenience products that have high amounts of sugar and salt, and sugary fizzy drinks.
  • Try to reduce alcohol, and try to keep less than 14 units of alcohol per week (maximum of 2 units per day).

Maintaining a Healthy Weight

A healthy weight can help reduce your risk of diabetes and cardiovascular disease, however this can be harder with declining levels of estrogen. To understand the role estrogen plays, it helps to understand about metabolism and basal metabolic rate first.

Metabolism is the production of energy from food, whereas the basal metabolic rate (BMR) is the energy required for performing vital body functions at complete rest or asleep. Our brain, liver, heart and kidneys account for almost half of the BMR. An estimate of BMR can be calculated from weight, age and gender. Our BMR accounts for most of the energy we use, with thermogenesis only 10% and physical activity between 10-30%.

Your basal metabolic rate is determined by your genes, your body composition and your sex hormones. Exercise can increase your BMR and is important for so many factors of general health.

What is the Role of Estrogen in Energy Balance and Metabolism?

The main circulating form of estrogen in the body is 17β-estradiol (E2). E2 promotes energy homeostasis, improves body fat distribution, enhances insulin sensitivity, improves pancreatic β-cell function, and reduces inflammation (20). As estrogen levels naturally decline from perimenopause, there is an increased risk of developing metabolic dysfunction, leading to obesity, the metabolic syndrome, type 2 diabetes as well as cancers and other degenerative diseases of the skeletal, central nervous and cardiovascular systems (20). This role in energy metabolism is also supported by findings in evolutionary development (phylogeny) since ancestral estrogen receptors have been found in invertebrates before advent of sexual reproduction (20).

Estrogen also has a role in energy balance, acting in the hypothalamic area of the brain to both suppresses food intake and also stimulate physical activity, energy expenditure and regulate body fat distribution (20). The BMR varies across the menstrual cycle, and is lowest in the follicular phase (from the start of your period to ovulation), when ovarian hormones are lowest (21). Experiments on rodents have found that surgical removal of the ovaries leads to weight gain, which is reversed by estrogen supplements (21).

In summary, estrogen has an important role in energy balance, BMR and weight gain. As levels naturally decline at the perimenopause, increasing weight is linked with increased risk of cardiovascular disease and diabetes.

BMR is determined by our genes, our body composition and our sex hormones. Exercise can increase BMR and is important for so many factors of general health. While maintaining a steady weight used to be thought of in terms of simple energy balance, evidence of the important role of the gut microbiota, might explain why some people can appear to eat much more than the energy they expend, without gaining weight.

Microbiota and Their Role in Metabolism

The gut microbiota contains trillions of single celled microorganisms, that play an important role in our health. Multiple associations between the gut microbiota and chemicals along metabolic pathways have been found, with suggestion that the gut microorganisms have a role in shaping metabolism (22). Recent research has found that changing the composition of the microbiota, is associated with improvement of some of the parameters of the metabolic syndrome (a name given to a set of conditions seen together including increased blood pressure, high blood sugar, a large waistline, and abnormal cholesterol or triglyceride levels) (23).

In studies of special germ-free mice, who have no organisms living on or inside them, they found that faecal transplant from obese humans, was associated with a greater weight gain than mice that received microbes from healthy weight humans (24). This suggests that maintenance of a steady healthy weight, is more than the simple balance of energy in, equalling energy out. Instead, it is also impacted by your gut microbiota. Most studies of people that were obese have found that their gut microbiota is characterised by a narrower range of organisms (lower diversity) (24). Long term weight gain (over 10 years) in humans is correlated with low microbiota diversity (narrow range of species of microorganisms), and this association is worsened by low dietary fibre intake (24).

How single celled microorganisms have such a profound effect on our weight and general health is astonishing, but it is probably mediated by a number of different routes. Gut microbiota imbalance probably promotes weight gain and metabolic complications by a variety of mechanisms including immune dysregulation, altered energy regulation, altered gut hormone regulation, and proinflammatory mechanisms (such as lipopolysaccharide endotoxins crossing the gut barrier and entering the portal circulation) (24).

Summary: Practical Tips for Optimising Your Diet

The menopause is a time of immense change, with women experiencing a spectrum of severity of symptoms. Dietary changes might not be possible for you right away, but try to incorporate them where possible for long-term health benefits.

Aim to eat a variety of colours, whole grains, quality protein at every meal, unsaturated fats, whole plant-based foods, items rich in calcium and optimise your gut health.

Ultimately the best way to support a healthy weight, reduced long-term risk of cardiovascular disease and osteoporosis is by regular exercise and a healthy diet that follows these principles:

  • Eat lots of different coloured fruit and vegetables.
  • Choose wholegrains (bulgur wheat, millet, sweet potatoes, brown rice, brown bread).
  • Eat a handful of nuts a day and add seeds to your food.
  • Eat oily fish twice a week. If you do not eat fish, have daily nuts, and seeds which also contain omega 3.
  • Chose lean or plant-based protein at every meal.
  • Regularly enjoy beans, lentils and chickpeas.
  • Enjoy healthy unsaturated fats such avocados, rapeseed, nuts and extra virgin olive oils.
  • Aim for a handful of nuts and seeds a day.
  • Avoid convenience products that have high amounts of sugar and salt, and sugary fizzy drinks.
  • Avoid sweeteners.
  • Support your microbiota to flourish by eating fermented foods, kefir, and 30g of fibre a day.
  • Try to reduce alcohol, and try to keep less than 14 units of alcohol per week (maximum of 2 units per day).
  • Enjoy lots of calcium rich foods (1200mg per day from the menopause onwards).

With regards supplements consider that regulation is different to that for medicines and beware of marketing claims. Those supplements containing phytoestrogens may help with hot flushes, so trial to see if they have an effect for you. Follow the NHS guidance for vitamin D supplementation during the autumn and winter months.

I know how confusing it can be knowing what 1200mg of calcium looks like practically. So I’ve designed a meal planner and nutrition checklist specifically for the menopause and beyond, to help you meet your needs. It’s free to download here.

References

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  5. Chung D-J, Kim H-Y, Park K-H, Jeong K-A, Lee S-K, Lee Y-I, et al. Black Cohosh and St. John’s Wort (GYNO-Plus®) for Climacteric Symptoms. Yonsei Med J. 2006;48(2):289–94.
  6. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Db Syst Rev. 2013;12(12):CD001395.
  7. Ziaei S, Halaby R. Dietary Isoflavones and Breast Cancer Risk. Medicines. 2017;4(2):18.
  8. Fritz H, Seely D, Flower G, Skidmore B, Fernandes R, Vadeboncoeur S, et al. Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review. Plos One. 2013;8(11):e81968.
  9. https://www.ncbi.nlm.nih.gov/books/NBK551799/ 2019 surveillance of osteoporosis: assessing the risk of fragility fracture (NICE guideline CG146): National Institute for Health and Care Excellence (UK); 2019 Aug 8. Available from: 2019 surveillance of osteoporosis: assessing the risk of fragility fracture (NICE guideline CG146).
  10. Ngamjarus et al. Vitamin K for the prevention and treatment of osteoporosis in post‐menopausal women. Cochrane Database of Systematic Reviews. 2020;1(22):465.
  11. Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol. 2009;5(10):553–8.
  12. Karvonen-Gutierrez C, Kim C. Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition. Healthc. 2016;4(3):42.
  13. Duerden M, O’Flynn N, Qureshi N. Cardiovascular risk assessment and lipid modification: NICE guideline. Br J Gen Pract. 2015;65(636):378–80.
  14. Horgan GW, Stubbs J. Predicting basal metabolic rate in the obese is difficult. Eur J Clin Nutr. 2003;57(2):335–40.
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  17. Kauppila TES, Kauppila JHK, Larsson N-G. Mammalian Mitochondria and Aging: An Update. Cell Metab. 2017;25(1):57–71.
  18. Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Bio. 2021;22(2):119–41.
  19. Shimokata H, Kuzuya F. Aging, Basal Metabolic Rate, and Nutrition. Nippon Ronen Igakkai Zasshi Jpn J Geriatrics. 1993;30(7):572–6.
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