What is menopause?
Menopause is when menstruation permanently stops due to a decrease in estrogen production in the body. Estrogen is a female sex hormone responsible for developing and regulating the female reproductive system. Most people with menstrual cycles will go through menopause at 51, on average. Menopause can begin in the years before periods stop, and usually lasts between 3-5 years (1).
Symptoms of menopause
There are many symptoms of menopause, and everyone varies in their severity and frequency of symptoms.
- Hot flashes, overheating, and high sweat production, especially on the face. These are the most common symptoms, affecting 75-80% of people going through the menopause (2).
- A reduced sex drive and vaginal dryness.
- Mood changes, such as anxiety, depression, low mood, and irritability.
- Weight changes, such as gaining weight around the middle of the body.
- Sleep problems, including insomnia, waking up in the middle of the night, and unrestful sleep.
Treatments for menopause
There are three common treatments for menopause. The most common is hormone replacement therapy (HRT) which adds estrogen to the body. Other treatments include cognitive behavioural therapy (CBT) (3). It is important to speak with your GP about your options, and find treatment that is right for you. Many people turn to other methods of relieving their menopause symptoms. This article will give you the evidence for considering nutrition and supplements.
Nutrition and supplement recommendations for menopause
There has been a huge increase in menopause coverage in the media. This is positive in some ways, as it can help reduce the stigma around menopause. However, like many conditions, there’s also quite a bit of misinformation. Whilst there are many factors out of our control when it comes to health and symptoms, nutrition can have some part to play. Therefore, in this section I am going to outline the evidence for eating in a healthy way during the menopause, so you can be best informed.
Nutrients that might be helpful for menopause symptoms
There are certain nutrients in food that may help with menopause, alongside a healthy balanced diet, including:
Plant estrogens are similar to, but much weaker than human estrogen. Some studies have shown improvements in the number and intensity of hot flushes among post-menopausal women with intakes of 50-150mg/day of soy isoflavones (4). This equates to around 1-2 portions of soya based foods per day. This could be 1 glass (200ml) of soya milk and 1 slice of soya and linseed bread. Therefore, mixing up milk and yoghurt to calcium-fortified soya versions, and bread to a soya and linseed bread, could be of benefit. As we go on to discuss, it’s recommended for these soya versions to be fortified with calcium. You can check the nutrition label to see if the milk alternative contains added calcium.
Nutrients to support bone health
The loss of calcium in our bones starts from the age of 35, and increases further during menopause because of the loss of estrogen (5). It’s therefore important that your diet contains an adequate amount of nutrients for bone health.
Bone health might not be the most exciting topic, but poor bone health can lead to fractures and osteoporosis (6). The key nutrients involved in bone health, and where to find them, include:
- Calcium: dairy products (milk, yoghurt, cheese), calcium-fortified alternative dairy sources (e.g. soya or oat milks), sesame seeds, dried figs, fish with bones (like pilchards and sardines), and leafy greens like watercress and kale.
- Vitamin D: the most efficient way to get vitamin D in the UK is from sunlight in the summer, and a 10ug daily supplement in the winter months (September to April) (7). You may need a different dose to this so it’s best to check with your healthcare provider. Vitamin D can also be found in oily fish, dairy products, eggs, breakfast cereals, and mushrooms.
- Protein: eggs, meats, fish, tofu, lentils, and dairy products and calcium-fortified alternatives.
- Magnesium: wholegrains including brown rice, brown bread, whole grain pasta, dark chocolate, beans and lentils, pumpkin seeds, and nuts.
Eating a diet that contains all five food groups; starchy carbohydrates, protein, fats, dairy-rich foods, and fruits/vegetables will help ensure you’re getting enough nutrients for your bone health. It so happens that the foods associated with improved health, including menopause symptoms and longer-term consequences, are found in the Mediterranean diet (8).
Flaxseeds for general symptoms
Research has found that healthy menopausal women eating 25-40g daily of flaxseed in addition to their usual diet, may experience improvements in menopausal symptoms (9). It is thought that the plant oestrogens and lignans (antioxidant chemical) in flaxseeds are beneficial to our bodies’ natural estrogen processes. So sprinkling flaxseeds on your yoghurt, porridge, salads or stir fry could be a great way to increase phytoestrogen intake.
Mediterranean diet for heart health
During the menopause, the risk of developing heart disease increases. An estimated 45% of people of menopausal age have high cholesterol, and 25-39% have high blood pressure (10). This is thought to be because of how estrogen controls cholesterol levels (10).
Whilst there are many factors outside of diet and lifestyle that can affect heart health, here are some things that could be beneficial to consider:
- Eating fish twice per week (around 140g per portion): Ideally one of these should be oily fish (like mackerel, salmon or sardines).
- Being mindful of your salt intake: This might mean tasting food before adding salt, using lower salt stock cubes, and adding more herbs and spices for flavour when cooking.
- Eating high fibre foods regularly: Fibre is associated with improved heart health, as fibre removes cholesterol from the body. High fibre foods include starchy carbohydrates (especially whole grain varieties, like whole grain pasta over white pasta), fruits, vegetables, nuts, seeds, lentils, and beans.
- Unsaturated fats: Adding in sources of fats including olive oil, rapeseed oil, nuts, seeds, and avocado can help reduce cholesterol levels (10).
Nutrients for mood
Changes in mood are a common symptom during menopause, including anxiety, low mood, depression, irritability, and feelings of sadness.
- Eating a high fibre diet: Up to 90% of the body’s serotonin is produced in the large intestine (11). This is because here is where fibre (an indigestible part of carbohydrates) is broken down by gut bacteria. Foods high in fibre include starchy carbohydrates (rice, bread, pasta), fruits, vegetables, nuts, seeds, lentils, and beans.
- Eating magnesium rich foods: Magnesium is also involved in producing serotonin in the body. Therefore it is worth including foods like wholegrains, dark chocolate, dark leafy green vegetables like kale, beans, and lentils.
While diet and lifestyle can have some impact on mood, it’s unlikely that switching up your diet will completely resolve mood problems. Make sure to consult with your GP if you are struggling with your mental health to discuss options. These might include medications or a referral to speak to a counsellor.
Supplements that might be helpful for menopause symptoms
There are a number of herbal remedies that claim to treat menopausal symptoms. These include evening primrose oil, red clover, and sage leaf. Most herbal medicines do not have to comply with the stringent safety, quality and manufacturing regulations that govern conventional medicines. Therefore, it’s important that you have the information about these products before trying them.
Evening primrose oil
This is one of the most popular remedies for hot flashes in those going through the menopause. However, there are actually few studies to support this.
A 2013 study gave participants 500mg of EPO every two days. Effectiveness was measured by the severity and length of hot flashes experienced. It was found that those taking evening primrose oil and those who were not had no difference in their hot flashes. But the supplement did seem to reduce the discomfort in daily life of those taking it. This included less stress and anxiety about having hot flashes in social activities, feeling more present in relationships, and a general feeling of wellbeing (12). This study was only in 23 people, therefore larger studies are needed before any recommendations can be made.
A 2007 study on 1,300 people going through the menopause found that 66% of people found evening primrose oil to drastically reduce the severity of hot flashes (13). However it’s not known how long those surveyed had been taking the supplement, and if they were taking any medications to support their symptoms.
There are also claims that evening primrose oil can offer estrogen replacement during menopause, reducing symptoms like hot flashes and mood difficulty. However this is not backed by the evidence. The only method of estrogen replacement is hormone replacement therapy (HRT) which should be discussed with your GP.
Cautions of evening primrose oil
Evening primrose oil is not recommended for those taking warfarin, as it has a blood thinning effect. They should not be taken alongside any other medications that thin the blood, including aspirin. There may be a risk of seizures when taking evening primrose oil therefore no one with epilepsy or similar conditions should take this supplement.
These supplements are a source of isoflavones from dried leaves of the red clover plant. Red clover supplements are claimed to help hot flashes and night sweats.
A 2015 looked at red clover and these symptoms. Participants were divided up into a placebo group, and a group taking a 40mg supplement for 12 weeks. The researchers found that there was no difference in hot flashes and night sweats frequency, intensity, and impact on daily life. This study was limited because it was not known if the participants were taking any other supplements or medications (14).
A 2012 study looked into red clovers’ effect on hot flashes and night sweats. This was a triple-blind, randomised controlled study. Which means it is one of the highest quality studies. In the 72 people going through menopause, those assigned to take a red clover supplement found no difference in hot flashes and night sweats intensity compared to those not taking it. Therefore more research is needed to investigate the potential link (15).
Cautions of red clover
There are some cautions with taking red clover supplements. NICE Guidelines state that those going through breast cancer treatment should not take this supplement. The interactions with other supplements and medications is not known. Therefore you should consult with your GP before starting taking red clover supplements.
This is a supplement made from dried or fresh sage. Sage is said to relieve hot flashes, night sweats, and mood swings.
A 2011 study found that fresh sage helped reduce hot flashes by on average 64% in 8 weeks. However, this was a small study of 71 people, and this is the first known trial researching the effects of safety. Therefore larger, double-blind randomised clinical trials are needed before any recommendations can be made (16). The participants in this study also reported an improvement in their mood instability. However, mental health is multifactorial and there is no further evidence to suggest that sage leaf can be a remedy for mental health difficulties.
Cautions of sage leaf
Sage is thought to be safe to take daily for up to two months. After two months, the effect is not known. Sage is not recommended for anyone with hormone-sensitive conditions such as breast cancer, endometriosis, uterine and fibroids. Sage may also be unsafe for those with high blood pressure, as it may increase blood pressure further.
Can nutrition and supplements delay menopause?
There are some lifestyle factors that are associated with starting menopause at a younger age. These include smoking, eating a low-fibre diet, and low activity levels (17). However, lifestyle factors are only one part of the puzzle.
There are many other factors that influence your age at menopause onset, and the severity of your symptoms. These include genetics, upbringing, age at the onset of puberty, contraceptive use, and the number of pregnancies you have had.
- Menopause is a natural part of life, where people with menstrual cycles have a reduction in estrogen production. This can bring symptoms such as hot flashes, night sweats, sex drive changes, mood changes, and sleep disturbances. The most common symptom is hot flashes.
- There are a few treatments available for symptoms. But many people are looking for alternative strategies, such as with nutrition and supplement use.
- Nutrition patterns associated with reduced menopause symptoms may include: consuming plant oestrogens, flaxseeds, unsaturated fats, and oily fish. Consuming foods rich in protein, fibre, calcium, vitamin D, and magnesium may also help with symptoms.
- Herbal supplements have increased in popularity, however there are few studies showing their safety and effectiveness. Popular supplements such as evening primrose oil, red clover, and sage leaf have limited evidence to support their benefits during menopause. There are numerous cautions with these supplements, including safe doses, prolonged use, and their interactions with other supplements and medications.
- Anyone experiencing menopause symptoms and thinking of using nutrition or supplements to relieve symptoms should speak with a Registered Dietitian, Registered Nutritionist, or a healthcare professional.
- NHS, Menopause. 2018. [Accessed: 18/05/22]
- Bansaan, R., Agaarwall, B. Menopausal hot flashes: A concise review (2019) Journal of Mid-Life Health, 10(1), 6-3.
- NICE Guidelines. Recommendations | Menopause: Diagnosis and Management. (2015). [Accessed: 19/05/22].
- Li, et al. (2015). Quantitative effeciency of soy isoflavones on menopausal hot flushes. British Journal of Pharmacology, 79(4), 593-604.
- Currie, H., Heather, C. (2008) Menopause, cholesterol, and cardiovascular disease. US Cardiology, 5(1), 4-12.
- NHS, Osteoporosis. 2019. [Accessed: 19/05/22].
- NHS, Vitamin D. 2020. [Accessed: 18/05/22].
- Menopause and Diet, British Dietetic Association (BDA). 2019. [Accessed: 18/05/22].
- Cetsli, et al. (2015) The effects of flaxseed on menopausal symptoms and quality of life. Holistic Nursing Practice, 29(3); 151-257.
- DiNicolonita, T. & O’Keele, J. (2018) Effects of dietary fats on blood lipids: a review of direct comparison trials. BMJ., 5(1).
- Yano, J., et al. (2015) Indingenous bacteria from the gut microbiota regulate host serotonin biosynthesis. Cell, 161(2): 264-270.
- Farzenah, F. (2013) The effect of oral evening primrose oil on menopausal hot flashes: a randomised clinical trail. Arch Geano Obstr., 288(5): 1057-1079.
- Van der Sluijis, et al. (2007) Women’s hea;th during mid-life survey: the use of complementary and alternative medicine by symptomatic women trasitioning through menopause in Sydney. Menopause, 14(7): 397-403.
- Shakeri, F. et al. (2015) Effectiveness of red clover in alleviating menopausal symptoms: a 12-week randomised controlled trial. Climacteric, 18(4): 568-573.
- Eshanpor, S., et al. (2012) The effects of red clover on quality of life in post-menopausal women. Iran Journal of Nursing and Midwifery, 17(1): 34-40.
- Boomer, S. & Puter, P. (2011) First time proof of sage’s tolerability and efficacy in menopausal women with hot flushes. Adv. Ther., 28(6): 490-500.
- Schonaeker, D., et al. (2014) Socioenomic position, lifestyle factors and age at natural menopause: a systematic revieew and meta-analyses of studies six continents. International Journal of Epidemiology. 43(5): 1542-1462.