Menopause is a natural part of a woman’s life marked by biological and physical changes resulting from a decreased level of estrogen. Changes can include hot flashes, weight gain, and increased risk for osteoporosis and cardiovascular disease. Medication often plays an important role in managing these changes. We are frequently asked about the role of diet during this transition. This article will define menopause, discuss associated symptoms, and explain the role of diet in promoting health in menopause.
What is Menopause?
Menopause is defined by the absence of a menstrual period for 12 months. Though the average age of menopause in the United States is 51 years old1, the transition to menopause begins on average 4 years prior.
The underlying cause of menopause is believed to be the progressive loss of follicles and egg cells (oocytes) in the ovaries. This leads to progressive decline in the circulating estrogen level, ultimately leading to symptoms of menopause.
What are Symptoms of Menopause?
Symptoms vary for each individual and can include hot flashes, sleep disturbances, vaginal dryness, menopause weight gain, and mood fluctuation. Women may also experience a higher risk of certain health conditions, such as osteoporosis and cardiovascular disease.
How are the Symptoms of Menopause Treated?
Hormone replacement therapy with estrogen +/- progesterone is one common treatment for menopause symptoms, particularly hot flashes. If the risk of hormone replacement therapy is deemed too high, non-hormonal medications can be used. Examples include a few medications within the SSRI (selective serotonin reuptake inhibitor) class.
Dietary changes play a role in decreasing the risk of health conditions more common in menopause, such as osteoporosis and cardiovascular disease. There is also data to suggest the role of dietary changes to reduce the frequency and severity of hot flashes, discussed in detail below.
Dietary Recommendations for Women in Menopause
Though there isn’t one particular best diet for menopause, there are several dietary components that can optimize a diet for a woman in menopause. Let’s discuss each part of a holistic menopause diet plan in detail.
- Calcium: Menopause increases the risk of osteoporosis, which is a decrease in bone mass resulting in weak bones. Calcium, in combination with vitamin D, has been shown to reduce bone loss in postmenopausal women. The recommended amount of calcium in postmenopausal women is 1,200mg per day. Dietary sources are the preferred method for reaching the goal of 1,200mg per day, but supplements are also available for those needing help reaching that amount.
Dairy products are the most common calcium-rich foods. Examples include milk, cheese, yogurt, and ice cream. Non-dairy sources of calcium include leafy greens and certain types of nuts and beans. A detailed list can be found below.
| FOOD | STANDARD PORTION | CALORIES | CALCIUM (mg) | ||
| Dairy and Fortified Soy Alternatives | |||||
| Yogurt, plain, nonfat | 8 ounces | 137 | 488 | ||
| Yogurt, plain, low fat | 8 ounces | 154 | 448 | ||
| Kefir, plain, low fat | 1 cup | 104 | 317 | ||
| Milk, low fat (1 %) | 1 cup | 102 | 305 | ||
| Soy beverage (soy milk), unsweetened | 1 cup | 80 | 301 | ||
| Yogurt, soy, plain | 8 ounces | 150 | 300 | ||
| Milk, fat free (skim) | 1 cup | 83 | 298 | ||
| Buttermilk, low fat | 1 cup | 98 | 284 | ||
| Yogurt, Greek, plain, low fat | 8 ounces | 166 | 261 | ||
| Yogurt, Greek, plain, nonfat | 8 ounces | 134 | 250 | ||
| Cheese, reduced, low, or fat free (various) | 1 1/2 ounces | ~55-155 | ~115-485 | ||
| Vegetables | |||||
| Lambsquarters, cooked | 1 cup | 58 | 464 | ||
| Nettles, cooked | 1 cup | 37 | 428 | ||
| Mustard spinach, cooked | 1 cup | 29 | 284 | ||
| Amaranth leaves, cooked | 1 cup | 28 | 276 | ||
| Collard greens, cooked | 1 cup | 63 | 268 | ||
| Spinach, cooked | 1 cup | 41 | 245 | ||
| Nopales, cooked | 1 cup | 22 | 244 | ||
| Taro root (dasheen or yautia), cooked | 1 cup | 60 | 204 | ||
| Turnip greens, cooked | 1 cup | 29 | 197 | ||
| Bok choy, cooked | 1 cup | 24 | 185 | ||
| Jute, cooked | 1 cup | 32 | 184 | ||
| Kale, cooked | 1 cup | 43 | 177 | ||
| Mustard greens, cooked | 1 cup | 36 | 165 | ||
| Beet greens, cooked | 1 cup | 39 | 164 | ||
| Pak choi, cooked | 1 cup | 20 | 158 | ||
| Dandelion greens, cooked | 1 cup | 35 | 147 | ||
| Protein Foods | |||||
| Tofu, raw, regular, prepared with calcium sulfate | 1/2 cup | 94 | 434 | ||
| Sardines, canned | 3 ounces | 177 | 325 | ||
| Salmon, canned, solids with bone | 3 ounces | 118 | 181 | ||
| Tahini (sesame butter or paste) | 1 tablespoon | 94 | 154 | ||
| Fruit | |||||
| Grapefruit juice, 100%, fortified | 1 cup | 94 | 350 | ||
| Orange juice, 100%, fortified | 1 cup | 117 | 349 | ||
| Other Sources | |||||
| Almond beverage (almond milk), unsweetened | 1 cup | 36 | 442 | ||
| Rice beverage (rice milk), unsweetened | 1 cup | 113 | 283 | ||
- Fruits and vegetables: In this meta-analysis, a higher consumption of fruits and vegetables was associated with a lower risk of death (mortality). The maximal reduction in risk was seen with approximately 5 servings of fruits and vegetables per day. Consumption higher than 5 servings was not associated with lower risk of death. When broken down by fruits and vegetables, the maximum risk reduction was seen with 2 daily servings of fruit and 3 daily servings of vegetables. Of note, this association of risk reduction did not hold true for fruit juices and potatoes.
- Protein: Evidence suggests an increased requirement for protein as we age2,. The recommended dietary allowance (RDA) for protein is 0.8g/kg body weight. Many individuals, including postmenopausal women, do not meet this RDA for protein, which is necessary for skeletal muscle health and function. The few studies evaluating a higher protein intake for the promotion of lean body mass in postmenopausal women did not show a benefit.
- Soy: Some studies suggest that soy products can reduce the frequency of hot flashes. Soy and certain other plant-based products contain isoflavones, which can be thought of as a plant estrogen. These are converted in the body to a molecule that acts on the estrogen receptors. In the Women’s Study for the Alleviation of Vasomotor Symptoms,3, women in the intervention group were assigned a low-fat, vegan diet including ½ cup of cooked soybeans daily. These women saw a 79% reduction in total hot flashes vs a 49% reduction in the control group. The few available studies are promising, but further research is needed to evaluate the association between soy and other isoflavone-containing foods and reduction in hot flashes.
What to Do if You Think You’re in Menopause
If you think you’re in menopause, it’s important to consult a physician for a diagnosis. Your physician can discuss menopause treatment options, including hormone therapy, lifestyle changes, and dietary changes. It is important to note that the benefits and risks of hormone replacement therapy need to be discussed thoroughly and understood before treatment is started.
Menopause can be a challenging time for women due to the various symptoms they may experience and higher risk of certain health conditions, such as osteoporosis and cardiovascular disease. Treatment is available and spans the spectrum from diet modifications to medication therapy. As we discussed in this article, dietary changes can play a significant role in reducing the risk of conditions such as osteoporosis and cardiovascular disease, and may even decrease symptoms such as hot flashes. If you’re experiencing symptoms of menopause, don’t hesitate to schedule a consultation with a board-certified endocrinologist to get the help you need.
