Gaynor Bussell, on some key facts about this crucial life-stage for women.
When a woman’s periods end it heralds a significant drop in oestrogen levels giving rise to certain symptoms in 80% of women. The most common symptoms include hot flushes (40%), night sweats (17%), insomnia (16%), vaginal dryness (13%), mood disorders (12%), and weight gain (12%).2 Symptoms vary from woman to woman in their severity and type but can affect quality of life. Evidence exists that many symptoms can be helped by changes to diet and lifestyle.
Weight gain at time of menopause is due to a fall in metabolic rate by about 10%.4 Keeping active and trying to keep in control of calorie intake is thus vital at this age to offset weight gain. Weight tends to be deposited centrally after the menopause which can lead to metabolic diseases such as diabetes5 and cardiovascular disease. There is some evidence that weight training can offset central adiposity, help preserve muscle mass and raise the metabolic rate.6, 7 Excess weight also carries other risks during the menopause such as increase in joint pain, increased risk of developing certain cancers, such as breast and colorectal cancer, exacerbation of hot flushes and night sweats.8 Weight gain at this time can also contribute to poor self-esteem and low moods.
For menopausal women with no risk of osteoporosis, the daily recommended amount of calcium (in the UK) is 700mg, but the National Osteoporosis Society suggest that those with osteoporosis requiring treatment should have between 1000-1200mg calcium a day.14,15 Weight-bearing exercise, such as walking, dancing and weight training, will also help to offset osteoporosis during the menopause.
This increases the risk of developing hormone sensitive cancers, in particular of the breast. The risk of developing these cancers can be reduced by some simple dietary measure such as avoiding excess weight gain, eating more brassica vegetables19, upping fibre intake, especially insoluble fibre20, 21, eating more oily fish but less meat,22 keeping to total fat dietary recommendations and obtaining sufficient Vitamin D.
One study showed that for every 5kg excess weight that was lost, there was a 30% improvement in vasomotor symptoms.9 Reducing the intake of alcohol, spicy food and caffeine can also help. A diet high in soya isoflavone may also reduce the incident of hot flushes – around 20mg of the isoflavone genistein as a supplement had a significant effect but this can also be obtained from food sources11.
S-equol, an intestinal bacterial metabolite of the soybean isoflavone daidzein, has also received attention for its ability to alleviate hot flushes, CVD, osteoporosis and other menopausal symptoms. Some studies have suggested that equol producers are more likely to benefit from soya consumption than non-producers.12 More research is also needed to see whether taking probiotics with the isoflavone supplement can increase the production of equol from both genistein and daidzein.
This is exacerbated if there is weight gain, especially centrally, and little physical activity. Blood pressure can also rise during the menopause and the combination of these factors along with the loss of cardio-protective oestrogen can put women at the same risk of heart disease as men. Women need to adopt strategies to lower LDL and raise HDL cholesterol at the menopause and these include keeping weight in check, reducing saturated fat intake (replacing with polyunsaturated and monounsaturated fats), keeping physically active, eating more soluble fibre such as that found in oats, and adopting a more Mediterranean type diet.17 Eating more soya-based foods such as soya milk and tofu may also help.18