Having exercised all my life, I’d imagined that I’d have an easy ride through menopause. But that wasn’t the case and I got hit with all the symptoms. I had difficulty sleeping, which meant I no energy to train the next day and felt tired all the time. But it was the psychological symptoms that hit me hardest: brain fog, difficulty concentrating and memory lapses, loss of confidence, low mood and anxiety.
Menopause impacts each woman differently: some will barely notice it while others will have symptoms that affect their quality of life and hinder their performance. In fact, there are more than 30 recognised menopausal symptoms.
The good news is that making changes to the way you eat and exercise can help ease menopausal symptoms, reduce disease risk and improve your health overall.
How to eat during menopause
The drop in oestrogen, progesterone and growth hormone during the menopause not only puts a stop to your periods but also triggers changes throughout your body that impact bone health, heart health and brain health. Menopause increases inflammation in the body, which increases the risk of heart disease, type 2 diabetes, osteoporosis and dementia.
Studies show that plant-based diets, such as the Mediterranean diet, may help reduce the inflammation in the body that underlies many of the chronic conditions associated with menopause. The ZOE PREDICT study, which involved 1002 peri-menopausal and menopausal women found that those consuming a gut-friendly diet rich in plant-based foods were 30% less likely to report menopause symptoms such as hot flushes and sleep disturbances.
The Mediterranean diet is rich in fruit and vegetables, pulses such as beans, peas and lentils, whole grains, olive oil, nuts and seeds, with low to moderate amounts of fish, eggs, poultry and dairy and minimal amounts of red and processed meat, alcohol and sugar. The European Menopause and Andropause Society position statement (2020) concludes that long-term high adherence to the Mediterranean diet may:
• reduce cardiovascular risk
• maintain bone health
• help to prevent cognitive decline
• reduce the risk of breast cancer
• reduce the risk of all-cause mortality.
Short-term high adherence may:
• improve hot flushes
• improve cardiovascular risk factors such as blood pressure, cholesterol, and blood glucose levels
• improve mood and symptoms of depression.
Eat more soy and other phytoestrogens
Foods rich in phytoestrogens including soya products (e.g. tofu, tempeh, edamame beans, soya milk and yogurt), pulses, berries, flaxseeds, sesame seeds and cruciferous vegetables have been shown to help reduce the severity and frequency of hot flushes and night sweats in some (not all) women.
Phytoestrogens are plant compounds that have a chemical structure similar to oestrogen and have weak oestrogen-like effect in the body when oestrogen levels are low. They can bind to certain oestrogen receptors and mimic some of the actions of oestrogen, partially compensating for the reduction in the body’s own oestrogen
Populations that have high intakes of phytoestrogens, such as women in China and Japan, have much lower rates of menopausal symptoms. The average intake of isoflavones (a type of phytoestrogen) in the UK is about 2 mg/ day whereas in Asian countries it is it is between 15 and 50 mg/ day.
A 2023 study found that women who ate a plant-based diet that included half a cup of cooked soybeans daily for 12 weeks suffered 88 % fewer hot flushes than those who didn’t make any dietary changes. Aim for 1- 2 servings of phytoestrogen-rich foods per day, 1 serving = 80g edamame beans or 100g tofu or tempeh or 250ml soya milk or 200ml Greek-style soya yogurt.
However, phytoestrogens don’t work for everyone, which is likely due to differences in the diversity of our gut microbiomes. You’re more likely to see a benefit if you have particular species of gut bacteria that converts isoflavones into equol, the more active form.
Phytoestrogen-rich foods are also useful for reducing LDL cholesterol and cardio-protection, since heart disease risk increases when oestrogen drops. A study published in the European Journal of Nutrition showed that high soya intake was associated with a reduced risk of cardiovascular events and mortality.
Maintain muscle mass
It is important to ensure enough protein (along with resistance training) to offset loss of muscle mass and strength (sarcopenia) that occurs as we get older. We lose 3 – 8% of muscle mass per decade from our 30s and this rate of loss is higher after menopause. The European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommends an optimal dietary protein intake of 1.0-1.2g/kg bodyweight/d with at least 20-25g protein at each main meal.
Increase your intake of omega-3s
Getting enough dietary omega-3s is important for heart health – risk of heart disease and stroke is higher after menopause when oestrogen levels drop – but omega-3 supplements are of no benefit in alleviating menopausal symptoms.
Preserve bone health
Vitamin D is important for maintaining bone health, reducing osteoporosis risk, healthy immune function and mood. It also helps support a healthy gut microbiome by strengthening the gut lining. Vitamin D deficiency is associated with low bone mineral density and increased fracture risk, heart disease, type 2 diabetes, breast and colorectal cancer, as well as a negative effect on menopausal symptoms such as mood, sleep and joint pain.
THe UK government recommends 400 IU (10 micrograms) a day for the general population, while the ESCEO recommends a vitamin D intake of 800IU/d (20 micrograms) to maintain serum 25-hydroxyvitamin D levels >50nmol/L as well as a calcium intake of 1000mg/d, alongside regular physical activity/exercise 3-5 times/week.
Boost your gut microbiome
During menopause, as oestrogen and progesterone levels fall, the make-up of your gut microbes changes and becomes less diverse, with fewer ‘good’ species and more ‘bad’ species that are associated with inflammation and obesity.
That’s because oestrogen provides ‘food’ for a particular group of ‘good’ gut bacteria, the ‘oestrobolome’. This matters because these bacteria play an important role recycling oestrogens and thus controlling their levels in the body.
Here’s how it works: In the liver, oestrogen is bound to other compounds then passed into the gut and excreted. In the gut, the oestrobolome unbinds the compounds from some of the oestrogen, allowing it to pass back into the bloodstream (instead of excreted). During menopause when you have less oestrogen, that means less ‘food’ will be available for these bacteria, so their numbers fall and you get a drop off in microbial diversity.
Improving gut diversity by consuming lots of fibre from a diverse range of plant foods may help improve menopausal symptoms, combat weight gain and mood changes.
The truth about supplements
While multivitamin and minerals, vitamin D and omega-3s may provide helpful assurance against deficiencies there is no evidence that menopause-specific supplements have any benefit on menopause symptoms.
How to exercise during menopause
While exercise can be very beneficial in combatting menopausal symptoms, physical symptoms such as aching joints and fatigue and psychological symptoms such as loss of motivation and low mood can make exercise more challenging.
Many women find that taking HRT makes it easier to exercise as physical symptoms usually improve and their mood and levels of motivation are better.
All forms of exercise are beneficial and it is never too late to start. There are three types of exercise that are especially helpful for counteracting the loss of strength and muscle mass that occur during the menopause
- (Heavy) Resistance training – Builds and maintains strength + muscle mass; keeps your bones strong and improves posture + stability. Aim for 3 – 5 sets of 6 -8 reps of compound movements e.g. deadlifts, squats, lunges.
- Plyometrics – Builds muscle strength, increases bone strength and increases mitochondria + improves function (which will improve endurance performance). Aim for 8 – 10 reps e.g. jump squats, jumping jacks, skipping, switch leg lunges.
- High-intensity interval training (HIIT) – Improves cardiovascular fitness, improves body composition (more muscle, less fat) and improves insulin sensitivity. Aim for very short (10 – 30 sec) all-out efforts (> 85% max heart rate) with short recovery intervals.
Summary
It’s clear from the evidence that eating a largely plant-based diet, such as the Mediterranean diet, will help ease menopausal symptoms either directly by reducing inflammation or blood sugar spikes or, indirectly, by improving the composition of the gut microbiome. A plant-based diet can also help maintain a healthy weight and body composition. There’s no particular food, nutrient or supplement that will reduce symptoms but ensuring enough protein, vitamin D and omega-3s will help combat muscle and strength loss; maintain bone health and support heart health respectively. There is a small amount of evidence that phytoestrogens may help alleviate hot flushes in some women. There’s a drop in gut microbial diversity during menopause, which impacts many aspects of our physical and mental health but eating plenty of plant foods and fibre will help counteract some of this loss, reduce inflammation and improve menopausal symptoms.
If you want to learn more about the menopause, register for ‘Riding Through Menopause: in converation with Anita Bean and Dr Nicky Keay’, an on-line event packed with evidence-based sessions combining the latest cutting-edge research with the knowledge and experience of medical and nutrition experts. Full programme details and to register here.
A unique opportunity to meet world-renowned experts from the field of women’s hormonal health, nutrition and exercise for a live online workshop designed to empower everyone to take control of their menopause experience.
Whether you’re experiencing perimenopause, menopause and taking HRT (or not) and you want to improve your lifestyle or that of women around you, this workshop is for you. Sponsored by SunVitD3.
Your host & guests
Kate Auld: Host and Founder of The Personal Cyclist®.
Dr Nicky Keay: medical doctor specialising in exercise endocrinology and female hormone, and author of Hormones, Health and Human Potential: A Guide to Understanding Your Hormones to Optimise Your Health & Performance.
Anita Bean: Award-winning registered nutritionist, health writer, former British bodybuilding champion and author of The Complete Guide to Sports Nutrition and The Vegan Athlete’s Cookbook.
You’ll get:
- Cutting-edge and evidence-based advice: separating facts from fiction
- A better understanding of the menopause’s impact on your physiology and psychology: and how to navigate this journey
- Practical tips proven to work: from improving the gut microbiome to personalising your HRT
- Jargon -free, myth-busting advice for your daily life. Ideas and inspiration on how to eat, move and get in tune with your personal hormone journey
Tickets include:
Ø Live and recorded access to the workshop
Ø Opportunity to pose questions to our experts at the event
Ø Exclusive discount code for SunVit D3 NHS -approved Vitamin D
Ø Entry into prize draw to win signed copies of Anita’s and Nicky’s bestselling books and a signed Women’s Tour jersey, for those securing tickets before 1 October.
EARLY BIRD DISCOUNT: tickets £10 if purchased before 1 October 2023