Healthy eating and the menopause

What happens during the menopause?

Most women in the UK tend to start the menopause in their 40s or 50s, with the average age being 51 years. Hormonal changes, particularly a fall in oestrogen production, mean that periods are less regular and gradually they stop altogether. The fall in oestrogen levels can also cause menopausal symptoms.

The most common symptoms are:

• hot flushes and night sweats.

Other symptoms include:

• psychological problems (such as anxiety and depression)
• problems with memory and concentration
• vaginal dryness
• urinary problems
• lack of interest in sex
• sleep disturbances
• headaches
• and joint and muscle stiffness.

These typically last for about 4 years after your last period though about 10% of women will experience symptoms for much longer. If you are suffering from unpleasant menopausal symptoms, you are not alone - 80% of women in the UK suffer one or more symptoms during this time. Menopausal symptoms can be treated with medication and/or cognitive therapies so speak with your GP for individual advice if your symptoms persist.

In the long-term, oestrogen depletion can cause changes to bones and the cardiovascular system which means that post-menopausal women have an increased risk of certain chronic health complications, such as cardiovascular disease (including heart disease and strokes) and osteoporosis (thinning of the bones which increases the risk of breakage).

The good news is that a healthy, varied diet and a healthy lifestyle, including not smoking, limiting alcohol consumption, doing physical activity and maintaining a healthy bodyweight, can help to reduce the severity of menopausal symptoms and protect against long-term health problems associated with loss of oestrogen, such as cardiovascular disease and osteoporosis.

Read on to find some useful tips on eating a healthy diet during and after the menopause.

Healthy eating and the menopause

The general advice to eat a healthy, varied diet, based on starchy foods and plenty of fruit and vegetables, and low in saturated fat, sugar and salt, applies to women of all ages regardless of their life stage. Learn more about eating healthily by reading our pages on healthy and sustainable diets.

For menopausal and post-menopausal women there are aspects of the diet that are especially important, to reduce the risk of developing cardiovascular disease and osteoporosis and to help with day-to-day menopausal symptoms associated with lower levels of oestrogen.

• Diet and bone health
• Diet and heart health
• Diet, supplements and menopausal symptoms

Diet and bone health

To help to maintain bone strength and density and prevent osteoporosis, you should look out for two nutrients that are associated with bone health: calcium and vitamin D.

Calcium

The recommended intake of calcium is 700mg per day for adults. You should be able to get all the calcium you need from your diet. Important sources of calcium are:

• dairy products, such as milk, yogurt or cheese (go for the lower fat options)
• products fortified with calcium, such as bread (most bread flour is fortified with calcium), breakfast cereals and dairy alternatives (such as soya drinks)
• some green leafy vegetables such as watercress and kale (but not spinach)
• sesame seeds
• dried figs
• and fish that is eaten with bones (such as sardines).

Vitamin D

Vitamin D is also important for bone health as it helps the absorption of calcium from foods. Vitamin D is produced in our skin when we are exposed to sunlight.

Between April and September, you will usually get enough vitamin D from exposure to sunlight through time spent outdoors and from dietary sources. Between October and March, the sunlight is not strong enough to produce vitamin D in our skin and we must rely on dietary sources. Important dietary vitamin D sources are:

• oily fish
• eggs
• red meat
• and foods fortified with vitamin D by the manufacturer, such as fat spreads, breakfast cereals and dairy products.

As vitamin D is found in only a small number of foods, it might be difficult to get enough from foods that naturally contain vitamin D and/or fortified foods alone. So it is recommended that everyone takes a daily supplement containing 10μg of vitamin D during this period. People who have limited exposure to the sun (for example those who cover their skin or stay indoors most of the time) and those from ethnic minority groups with dark skin are recommended to take a daily supplement containing 10μg of vitamin D all year round as they are at an increased risk of vitamin D deficiency.

For women at risk of osteoporosis, high intakes of vitamin A may have a negative effect on bone health. If you regularly eat liver and liver products you should avoid taking supplements containing more than 1.5mg of vitamin A per day. Watch out for fish liver oil supplements as they are also often high in vitamin A.

Diet and heart health

Women who are post-menopausal have an increased risk of cardiovascular disease and so it is important to make sure you are eating foods that help to protect your heart. Learn more about tips for a healthy heart by reading our pages on heart disease and stroke.

Top dietary tips for a healthy heart include:

• Cut down on saturated fat and replace with unsaturated fats – for example swap butter and coconut oil for rapeseed, olive and sunflower oils and spreads made from these.
• Have fish twice a week – once should be an oily type (such as mackerel, salmon or sardines).
• Watch your salt intake – aim for less than 6g a day. Check the nutrition label on foods and do not add salt in cooking or at the table.
• Include high-fibre and wholegrain foods in your diet, such as wholegrain breakfast cereals, wholewheat pasta and pulses (such as lentils and beans). Fruit and vegetables are good fibre providers too.
• Do not drink alcohol to excess – adults should drink no more than 14 units a week, with several alcohol-free days each week.

Some women may put on weight after the menopause due to physiological and lifestyle changes associated with this stage of life. Excess weight gain increases your risk of developing certain diseases, such as cardiovascular disease, cancer and type 2 diabetes. Find out more about this topic by reading our pages on these health conditions.

As post-menopausal women have an increased risk of cardiovascular disease, it is important to make sure that lifestyle factors, such as weight gain, are managed so they do not contribute further to the risk of developing this condition. A healthy, varied diet and regular exercise can help you lose weight gradually and keep it off. Find out more about healthy weight loss by reading our information on overweight and obesity in women. 

To find out if you are overweight ask your GP to measure your BMI (body mass index) - a healthy BMI is 18.5-25 kg/m2 or use the BMI calculator on this NHS page

Waist circumference (size) can also be used to assess your risk of obesity-related diseases (including cardiovascular disease, type 2 diabetes and cancer) as these conditions are affected by where your body fat is stored, as well as by your weight. To assess your waist circumference, measure around your middle at a point half-way between your lower rib and top of your hips. Women with a waist circumference of 80cm and over are at an increased risk of obesity related diseases; those with a waist circumference of 88cm and over are at a very high risk.

Diet, supplements and menopausal symptoms

Several dietary factors, supplements and herbal remedies have been suggested to be of benefit in relieving symptoms of the menopause. There has been a lot of interest in the role of phytoestrogens (the two main types are isoflavones and lignans) as they are similar in structure to oestrogen and therefore may help to alleviate some of the symptoms of low oestrogen levels associated with the menopause. These substances are found in plants.

• Dietary sources of isoflavones include soyabeans, legumes, lentils and chickpeas and foods made from these such as texturised vegetable protein, tofu and soya drinks.
• Dietary sources of lignans include cereals, linseeds and fruit and vegetables.

There is some evidence that consuming isoflavones in foods or as supplements can help to reduce the menopausal symptoms of hot flushes and vaginal dryness. However, more studies are needed to confirm whether isoflavone supplements are safe and effective in reducing menopause symptoms.

There are a range of herbal remedies on the market claiming to combat menopausal symptoms but currently there is a lack of scientific studies on their safety and effectiveness. Speak with your GP before taking any of these as they may have side effects or interact with other medications.

Information reviewed November 2016