The menopause is a time in a woman’s life when she stops ovulating, her periods stop and she is no longer able to become pregnant naturally. The timing of when a woman experiences the menopause varies, but usually occurs between the age of 45 to 55 years. While the average age is 51 years, around 1 in 100 women will experience the menopause before the age of 40 years, known as premature menopause or premature ovarian insufficiency.
What causes the menopause?
The menopause is caused by a natural decline in the production of female reproductive hormones, that happens with ageing.
Premature or early menopause can occur at any time, and in many cases there is no clear cause.
Symptoms of the menopause
As estrogen levels decline, most women will experience some menopausal symptoms, which can be severe, and have a significant impact on their day to day activities. Symptoms can start months or years before periods stop, and last until approximately 4 years after the last period.
Common symptoms include:
- Hot flushes
- Night sweats
- Joint and muscle pain
- Vaginal dryness and discomfort during sex
- Low mood or anxiety
- Reduced sex drive (libido)
- Difficulty sleeping
- Problems with memory and concentration
Health Issues after the Menopause
In addition to the day to day symptoms, after the menopause, because of lower estrogen levels, the risk of certain diseases is increased. The main issues are osteoporosis, cardiovascular disease (CVD) and an increased risk of dementia. There are diet and lifestyle changes that are aimed at reducing these risks. I’ve divided the treatment options into firstly those targeting the day to day symptoms, and then those that are aimed at longer term health.
Treatment options for menopausal symptoms
Every woman experiences the menopause slightly differently, and while some opt for no treatment, others prefer some form of treatment. If you are troubled by menopausal symptoms that are interfering with your everyday life, or that start before the age of 45 years, book to see your GP. There are treatments that your GP might offer you to help with the symptoms and these are described in more detail on the NHS website (https://www.nhs.uk/conditions/menopause/).
Hormone Replacement Therapy (HRT)
Non-Hormonal medical treatment
For those women where replacement hormones are not appropriate, your GP may consider drugs such as gabapentin for hot flushes instead (1).
Cognitive Behavioural Therapy (CBT)
CBT is an effective treatment for helping low mood and anxiety related to the menopause.
There is no convincing evidence that exercise helps with hot flushes (2,3), but there is evidence that it helps reduce risk of cardiovascular disease (4) and improves bone health (5). Aim to combine moderate aerobic exercise, such as swimming, running, and also low resistance exercise (6) such as yoga, squats, resistance bands and Pilates for 30 minutes a day, five times a week.
Caffeine and Alcohol
Hot flushes may be helped by reducing consumption of caffeine, alcohol and spicy food, but there is considerable variation between individuals (7,8). Additionally, limiting alcohol has other health benefits, such as a lower risk of heart disease, liver disease, osteoporosis, type 2 diabetes, and certain types of cancer such as breast cancer (8). Therefore, it is advisable to stay within the recommended alcohol limits of a total of 14 units per week (2 units per day).
There is weak evidence that acupuncture may help with hot flushes, although more research is needed (9).
Phytoestrogens are plant derived compounds, that have a similar structure to human estrogen, and similar but weaker activity.
A number of herbal medicines are used by women to help with the symptoms of the menopause. There is some evidence that plant extracts such as St John’s wort, black cohosh (10), and genistein (11) are associated with decreased hot flushes.
There is mixed evidence that isoflavones (soya products and red clover) reduce hot flushes (11). While there is evidence that soy is probably safe in women with breast cancer, less is known about red clover (12,13) and so it is not advised for women with breast cancer. There is still also concern about interactions with medications for women with heart disease, epilepsy, and asthma. You should speak with your GP before starting any herbal medicine.
In contrast to conventional medicine, there is no legal obligation for herbal medicines to be licenced, and therefore, their contents may vary considerably. Always buy from a reputable setting, and check for a product licence or Traditional Herbal Registration (THR) number on the label.
The supplements mentioned above contain a more concentrated version of the phytoestrogen compounds found naturally in many foods. Given the mixed evidence about efficacy of the supplements, it is therefore unlikely that consuming these food items, will have a significant benefit on symptoms.
Phytoestrogens occur naturally in some plant-based foods such as:
- Soybeans and soy based products
- Sesame seeds
- Tea (green and black)
Health after the Menopause
Estrogen and testosterone play important roles in our bodies. As the level of these hormones drops, this leads to an increased risk of coronary heart disease, osteoporosis (brittle bones), diabetes, depression, obesity and dementia. If you experience early or premature menopause, your risk is unfortunately higher (14).
Estrogen plays an important role in bone health, and declining levels lead to softer bones (osteoporosis), which have a great chance of low energy fractures. 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 (15).
Diet can play an important role in bone health:
- Protein: Include lean protein foods at every meal such as dairy, meat, poultry, seafood, beans and legumes.
- Calcium is an important mineral for bone health, and as an adult you need to take between 700-1000mg per day. This would roughly equate to two slices of wholemeal bread, one portion of spring greens, a portion of broccoli, 200mls of dairy milk or fortified plant based milk, half a tin of tinned fish and a yogurt. If you are unable to have enough in your diet, you might be prescribed a supplement. Good sources of calcium include dairy, calcium-fortified plant-based drinks, tinned fish (with bones), spinach, fortified bread, baked beans, tofu and dried figs.
- Vitamin D is produced by the action of sunlight on our skin during exposure outside. However 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 produce enough. Vitamin D is also found in low levels egg yolks, oily fish and some fortified foods, and so it is difficult to get all of the Vitamin D needed from diet alone.
- Vitamin K is a micronutrient that has an important role in both bone strength. The term vitamin K, covers a number of different molecules, and these are found in green vegetables, fermented food, dairy, and meat. You need to eat a range of these items to ensure you get all the different elements that make up Vitamin K. There is mixed evidence as to whether Vitamin K supplementation improves bone strength and reduces fractures (16), but enough for a number of countries such as Japan, to now include Vitamin K supplementation as treatment for osteoporosis. Vitamin K is a fat soluble vitamin which means that it is possible to have too much through supplementation, and we don’t know what these effects might be. Avoid taking Vitamin K supplements if you are on blood thinning medication.
- Phosphorus is usually abundant in our diet, and found in foods such as poultry, meat, dairy, oily fish, potatoes, wholegrains, pulses and beans.
- Magnesium again is usually abundant in our diet but good sources include wholegrains, spinach, pumpkin seeds, almonds and beans.
- Resistance exercise is very important for bone strength, and the NHS advise that adults over the age of 35 years, undertake 30 minutes of this type of exercise at least twice per week. Examples include brisk walking, yoga, squats, weight training, resistance bands, Pilates, gardening and a brisk walk.
Cardiovascular Disease (CVD)
After the menopause, the risk of cardiovascular disease increases. This is partly related to the aging process, and also the effects of declining estrogen (14). 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. Additionally, weight gain associated with aging and also declining estrogen levels, leads to an increased risk of obesity, type 2 diabetes, higher blood pressure, and higher (LDL) cholesterol levels; these are all well recognised as factors for CVD (17,18). To mitigate these risks, best evidence suggests a diet with the following principles (6):
- Reduce fat content to less than 30% of your diet (approximately 60g per day)
- Include more extra virgin olive oil, rapeseed oil, avocado, seeds, nuts
- Eat at least 5 portions of fruit and vegetables a day.
- Replace refined carbohydrates (white bread, white rice) with whole grains (brown rice, brown bread, millet, bulgur wheat).
- Make Friday and Tuesday ‘fish’ night, where you and the family can enjoy a meal with oily fish. Or make yourself a big salad with mackerel. You can used tinned, smoked or some fresh from your fishmongers.
- Have at least 4 portions of unsalted nuts, seeds and legumes (like beans, lentils and chickpeas) each week.
- Remove convenience products that have high amounts of sugar and salt. And remove hidden sources of sugar (https://www.nhs.uk/live-well/eat-well/top-sources-of-added-sugar/).
- Choose wholegrain carbohydrates such as parsnips, butternut squash, swede, broad beans, amaranth, millet, and bulgur wheat,
- Women should consume no more than 14 units of alcohol per week (maximum of 2-3 units per day).
Be compassionate with yourself, the menopause is a time of immense change with some women suffering with symptoms more than others. Diet is a method of helping you on this transition, but is not the only tool. As risk of osteoporosis and CVD increase, it is an important time to pay attention to diet and lifestyle factors to reduce these risks. Ensure you eat a variety of colours, whole grains, soy, quality fats, whole plant based foods, and items rich in calcium.
Supplements containing phytoestrogens may help with hot flushes, so best to see if they have an effect for you, and consider a Vitamin D supplement in the autumn and winter months. If you suffer from menopausal symptoms that are interfering with your daily activities, discuss possible pharmacological options with your GP. Support groups both online and in person can help alleviate the psychological impact.
Please also do check out some of these recipes from The Doctor’s Kitchen website which include some of the ingredients mentioned in this article – and there’s many other recipes available on the website too!
- Coconut & Mushroom Curry
- 3-2-1 Laksa
- Lentil Salad with Pumpkin Seeds and Orange Segments
- Aubergine & Walnut Ragu
- Parsnip Mash Shepherds Pie
- Apricot, Squash & Chickpea Tagine
- Veggie Sausage & Swede One Pot
- Spring Minestrone Soup
Article Credit: Dr Harriet Holme (https://healthyeatingdr.com/)
- Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, et al. Non‐hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Breast Cancer Group, editor. Cochrane Database of Systematic Reviews. 2010;16(9):495.
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- Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. The Lancet. 2017 Dec 16;390(10113):2643–54.
- Zhao R, Zhang M, Zhang Q. The Effectiveness of Combined Exercise Interventions for Preventing Postmenopausal Bone Loss: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2017 Mar 31;47(4):241–51.
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- 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 Medical Journal. 2007 Apr 30;48(2):289–94.
- Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013 Dec 10;91(12):CD001395.
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- 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. Public Library of Science; 2013;8(11):e81968.
- Bernhardt L, Lawson CA. Early menopause and risk of cardiovascular disease: an issue for young women. The Lancet Public Health. 2019 Nov 1;4(11):e539–40.
- 2019 surveillance of osteoporosis: assessing the risk of fragility fracture (NICE guideline CG146). National Institute for Health and Care Excellence (UK); 2019 Aug 8.
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- Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol. 2009 Oct 1;5(10):553–8.
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