Menopause starts for most women in their 40s or 50s - with the average age being 51 years - and results in significant hormonal changes. These hormonal changes - especially the fall in oestrogen levels - causes symptoms in some 80 per cent of menopausal women, and can last for a number of years. Symptoms can be both physical, such as joint and muscle stiffness, as well as psychological, including issues with memory and concentration.. 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 women can reduce the severity of menopausal symptoms and protect against long-term health problems associated with loss of oestrogen, such as cardiovascular disease and osteoporosis through:
- Eating a healthy, varied diet - Not smoking - Limiting alcohol consumption - Being physically active - Maintaining a healthy body weight
For menopausal and post-menopausal women there are aspects of the diet that are especially important to help with day-to-day menopausal symptoms associated with lower levels of oestrogen.
Diet and bone health
To help to maintain bone strength and density and prevent osteoporosis, there are two nutrients that are associated with bone health: calcium and vitamin D.
Calcium The recommended intake of calcium is 700mg per day for adults, and 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 - Products fortified with calcium, such as bread (most bread flours are also 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 - 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, we can usually get enough vitamin D from exposure to sunlight through time spent outdoors and from dietary sources. Between October and March, the sunlight (particularly in the Northern Hemisphere) is not strong enough to produce vitamin D in our skin and we must rely on dietary sources, such as:
- Oily fish - Eggs - Red meat - Foods fortified with vitamin D by the manufacturer, such as fat spreads, breakfast cereals and dairy products.
In addition, as vitamin D is found in only a small number of foods, it is recommended that we take 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 the heart. 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 (as well as spreads made from these) - Have fish twice a week – once should be an oily type such as mackerel, salmon or sardines - Aim for a salt intake 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, and aim for 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. A healthy, varied diet and regular exercise can help you lose weight gradually and keep it off. 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 the NHS website.
Waist circumference can also be used to assess your risk of obesity-related diseases 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 may be of benefit in relieving menopausal symptoms. For example, phytoestrogens (the two main types are isoflavones and lignans) are similar in structure to oestrogen and some research has indicated they may therefore 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.
More studies are needed to confirm whether isoflavone supplements are safe and effective in reducing menopause symptoms.