This week, a new non-hormonal treatment for hot flushes was approved for use in the US. In studies, the drug, Veozah, cut the number of hot flushes in half, which given that 80 per cent of women suffer from them, is a huge breakthrough. But what about the many other effects of menopause, which Veozah doesn’t claim to treat?
In a study for the menopause care app Stella, when women were asked to list their most troublesome symptoms, hot flushes didn’t even make the top five. They rated well below fatigue, difficulty sleeping, anxiety, low mood and weight gain. Luckily, there’s growing evidence that simply tweaking the way you eat could transform your experience of menopause. Marcela Fiuza is a menopause specialist dietitian at Marcelanutrition.com.
She says: “Menopause is a critical point where women experience a lot of metabolic changes. What you eat now will be a big determinant of how healthy you will be over the next 30 or 40 years of your life. The right diet can make an incredible difference to women’s lives.”
Here’s how to build a menopause-friendly diet.
1. The power of plants
Dr Sarah Berry is an associate professor in nutritional sciences at King’s College London and the lead nutritional scientist on the Zoe Predict programme, which studies the role of food in health. She says: “We found that people who had a very high-quality, plant-rich diet during menopause had about a 30 per cent lower risk of hot flushes and sleep disturbances and a 20 per cent lower risk of brain fog and anxiety.”
The Predict study also found that women who ate more plants, compared to those who ate the least, were 15 per cent less likely to experience low libido, 20 per cent less likely to suffer joint pain and 23 per cent less likely to gain weight.
Fiuza suggests adopting a Mediterranean diet “with loads of vegetables, fruits, nuts, seeds, oats, herbs and spices, plus healthy fats from extra virgin olive oil and avocados. Half your plate should be vegetables. This way you automatically get more fibre and polyphenols and won’t have room for highly processed food. Overweight women will often see their weight drop as a result.”
2. Ditch refined carbs
The Predict study revealed that when we hit menopause, our ability to control our blood sugar goes haywire. On average, post-menopausal women experienced bigger blood sugar spikes after eating, yet they ate more sugary foods. This was associated with a greater risk of type 2 diabetes, inflammation and weight gain. Plus, studies show that a diet high in fat and processed sugar is linked to more hot flushes. Sugar dips will also increase feelings of tiredness and low energy.
Sarah Williamson is a nutritional therapist at the menopause nutrition company Womenwise.health. She says: “As oestrogen levels start to drop, we become more insulin resistant. And the more insulin-resistant we are, the more likely we are to suffer brain fog and weight gain. We may put on fat in the same areas as men, such as around the middle. The key to controlling this is to pull right back on eating refined carbs, such as white flour and sugar.”
Studies have also found that a diet high in fat and processed sugar is linked to more hot flushes. Dr Berry says: “We know that people consuming high-carb, high-sugar foods have bigger glucose dips and that drives increased hunger and increased energy intakes: up to 300 calories more over a day compared to someone who has a small dip.”
3. Up your protein – it’s not just for muscles
“Menopausal women should eat much more protein,” says Williamson. “It’s important for bones – the bone matrix is made of protein – as well as muscles, hair, skin and nails, all of which can suffer during menopause.” In a large study, post-menopausal women who ate more protein from dairy sources had an 8 per cent lower risk of hip fracture, while eating plant protein was linked to a 12 per cent reduction. In another study involving nearly 750 postmenopausal women, those who ate more dairy and animal protein had significantly higher bone density than those who ate less.
Last year, researchers at the University of Sydney published a paper suggesting that women need more protein during perimenopause due to hormonally-induced tissue protein breakdown. What’s more, women might continue to feel hungry and eat until their protein requirements are met, leading to weight gain. Guidelines recommend that women over 50 eat 0.45-0.55g of protein per pound (1-1.2g per kg) of body weight daily – or 20-25g of high-quality protein per meal, which is roughly the size of your palm.
Williamson says: “If you are trying to get leaner, aim for four to five servings of protein-rich food, such as chicken or fish, each the size of your palm. If you are trying to maintain your weight, three servings may be adequate. That’s maybe three eggs for breakfast, and a large salmon fillet or two. It may sound like a lot, but you won’t need to eat lots of carbs alongside them to feel satisfied.”
Williamson adds: “Tryptophan-rich protein also supports the production of serotonin, which affects mood, appetite and libido. Best sources are turkey, milk, yoghurt, lentils, beans and wholegrains.”
4. Just add milk
Dairy products, such as milk, yoghurt and cheese, contain calcium, phosphorus, potassium, magnesium and vitamins D and K – all of which are essential for bone health.
Julia Thompson, an osteoporosis specialist nurse at the Royal Osteoporosis Society, says: “Getting 700-1,000mg of calcium a day is particularly important for women around menopause. A big glass of milk will give you 200mg.” Hard cheeses have more calcium than soft cheeses. For example, parmesan cheese has the most, with 242mg in 1oz (28g), while 1oz of brie only delivers 52mg.
Thompson adds, “A lot of manufacturers add calcium to products such as fortified plant milk or bottled water.”
Dairy may have additional health benefits. Studies show that eating full-fat dairy rather than skimmed milk and reduced-fat cheese is linked to a lower risk of obesity and a lower risk of metabolic syndrome, a condition that raises your risk of heart disease, stroke and type 2 diabetes.
Dairy may also help improve sleep. A study found milk before bed helped older adults fall asleep faster, while calcium makes sleep more restorative. Milk is rich in nutrients including the amino acid tryptophan and melatonin, the hormone that helps us fall and stay asleep, and is synthesised from tryptophan via serotonin.
5. Try soy
A 2021 study found that a 12-week, low-fat, vegan diet including 86 g of cooked soya beans daily cut hot flushes by 80 per cent in menopausal women. Severe hot flushes declined by 84 per cent. This may be partly due to isoflavones, a type of phytoestrogen found in soy products such as tofu.
Phytoestrogens are plant compounds that mimic some of the functions of oestrogen. Lignans are another type of phytoestrogens and are found in flaxseeds, sesame, cashew nuts, whole grains, apricots, pears, grapes, kiwifruits, peppers, green beans, carrots and courgettes. Studies have found that soy isoflavone supplements can be effective in reducing menopause symptoms. Look for one that offers more than 15g of genistein (one form of isoflavone).
6. Be sceptical of supplements
Commercial herbal supplements are available to alleviate the trials of menopause, but the British Menopause Society (BMS) cautions that they may not be effective and could even be unsafe. It states, “Many available herbal medicines have unpredictable dose and purity and some herbal medicines have significant drug interactions.”
Black cohosh is a herb that can help with hot flushes, “although not as well as HRT”, according to the BMS. It does not help with anxiety or low mood, it “can interact with other medicines and there are unknown risks regarding safety”. St John’s wort has been “shown to have benefit in relieving vasomotor symptoms (hot flushes), particularly in women with a history of, or at high risk of breast cancer.”
However, like black cohosh, it interacts with drugs such as SSRI antidepressants and blood thinners, and women on the breast cancer treatment tamoxifen must also not take St John’s wort, as it makes the tamoxifen ineffective. Other herbal treatments including ginseng and Chinese herbal medicines are not shown to improve hot flushes, anxiety or low mood.
Red clover is a plant that is high in phytoestrogens, but the BMS says supplements “generally show little value. They are not recommended in patients with breast cancer.” Dr Berry says that fish oil and omega 3 supplements have also flunked in trials for menopausal symptoms. If you want to try a herbal remedy, look for the THR logo, which indicates traditional herbal registration medicines. These products have been approved and you can be sure that the product has the correct dosage, is of high quality and has suitable product information.
7. Hydrate wisely
Alcohol disrupts deep sleep, contributes empty calories and can make hot flushes worse, so minimising it can be helpful. Caffeine offers a mixed picture. One 2015 study found it made hot flushes worse.
However, other studies have found caffeine helps with mood, memory and concentration, and tea and coffee even contribute to better bone health, possibly because they are rich in anti-inflammatory antioxidants.
A 2018 study found that menopausal women plagued by recurrent urinary tract infections saw UTIs reduced by half when they drank at least 1.5 litres of water a day.