Health and Nutrition in Menopause

The menopause is a good time to assess your health and make tweaks that can help you lead a healthier life, such as looking at your caffeine and alcohol intake. Caffeine can make hot flushes worse, make you want to pass urine more often and increase anxiety. Some find reducing how much you have or switching to decaffeinated versions makes a huge difference.

Many people drink alcohol to help deal with sleep and anxiety, but alcohol acts as a depressant on the brain and any induced sleep can be of poorer quality. In the long run, cutting down or switching to alcohol-free alternatives can help you feel better as well as support weight loss.

Losing weight can be a real challenge during menopause because of changes to how your body handles carbohydrates and processes calories. Small and sustainable changes to your diet can make positive changes in your body.

There are alternative remedies and herbal medicines that may help, but not all supplements are completely safe for everyone. Speaking to a practitioner, pharmacist or doctor with knowledge of herbal medicine is recommended. It’s important to know that some herbal medicines can interfere with prescribed medicines too.

When investigating herbal solutions, always look for the THR mark. The Traditional Herbal Registration certification means the product has been registered by the Medicines and Healthcare Products Regulatory Agency under the UK Traditional Herbal Registration Scheme.

Phyto-oestrogens are weaker plant-based oestrogens similar to those found in HRT. It is believed that for some people they can help ease menopause symptoms. To increase your intake of these, try eating phytoestrogen-rich foods like soy and flax seed, pulses and beans and some vegetables, or by taking supplements such as red clover, soy or sage. Please note, there is a lack of evidence on the safety of phytoestrogen supplements for those who have had hormone-dependent cancers such as breast cancer.

Any supplement taken for the menopause can have a significant placebo effect, and for many there is a lack of evidence that they work effectively. However, this does not mean you shouldn’t try taking herbal remedies or supplements and many women feel they help with symptoms.

Vitamin D supplements are recommended for everyone in winter but particularly, for anyone during and post menopause, to help reduce the risk of osteoporosis and fractures. If your diet is low in calcium, adding a calcium supplement can also be useful to help protect bones.

Talking therapies and counselling can help tackle psychological, cognitive symptoms as well as helping tackle hot flushes and night sweats. Cognitive behaviour therapy (CBT) is a non-medical intervention shown to help physical and psychological menopause symptoms. It challenges the links between thoughts, feeling, behaviours and physical symptoms.

Breathing techniques can also help quieten the mind and diminish the severity of hot flushes.

There are medicines available on prescription that can also help manage symptoms, such as Clonidine, a tablet usually used for treating blood pressure. There is evidence that it can be helpful in reducing hot flushes and night sweats. Some antidepressants can be used to help manage these symptoms also, as well as helping with anxiety and depression.

Lubricants and vaginal moisturisers can help vaginal dryness, discomfort and pain during sex. Vaginal and vulval tissue can become more delicate and sensitive and washing with soap-free wash may help prevent further dryness and irritation.

The cardiovascular system is essentially anything in the body involving the heart and blood vessels. Cardiovascular disease (CVD) encompasses a group of disorders including heart attacks and angina, through to stroke and TIAs (stroke symptoms which are not permanent).

There are various risk factors which increase the chance of developing CVD, such as high blood pressure and smoking. But we are learning more about how being female has its own risk and lower levels of hormones in the menopause is one of those.

In pre-menopausal women, oestrogen has a protective effect on the heart and blood vessels, which is why in general women have lower rates of heart disease than men, but as oestrogen levels fall in menopause, they then start to catch up. Several processes lead to this change, including the lessening ability of oestrogen to keep blood vessels stretchy, elastic and dilated.

We also tend to see higher levels of LDL cholesterol, which increases the risk of fatty plaques in blood vessels. Body weight may also increase and how we carry it changes, with more around the middle. This can lead to a higher risk of insulin resistance and diabetes, which has its own increased risk of CVD.

High blood pressure is also a risk factor, as oestrogen plays a role in regulating this. We naturally have fluctuating levels of blood pressure, but when levels are persistently high it becomes a problem and can lead to symptoms such as hot flushes, sleep issues, palpitations and fatigue.

Prevention can play a huge role in reducing the chance of developing cardiovascular disease and midlife is a great time to look at our lifestyles to see where we can make even the smallest changes.

Smoking: smoking significantly increases the risk of CVD along with other health issues and stopping can reduce the risk by half after just one year. It’s not always easy to stop, however, but there is help available through the NHS.

Alcohol: alcohol worsens symptoms such as night sweats, sleep and anxiety, and increases the risk of issues like high blood pressure and stroke. Current guidelines recommend drinking less than 14 units per week and having 2-3 alcohol-free days.

Weight: there are lots of factors which contribute to weight gain during menopause and it’s important to find an approach that works for you. Even losing a small amount of weight can have a big impact on blood pressure readings and reducing risk.

Diet: it is widely accepted that a Mediterranean diet is good for heart health as well as reducing blood pressure and cholesterol. In general, eat more plant-based foods, vegetables, fruits, beans, pulses, nuts and seeds, include unsaturated fats like olive oil, and reduce overly processed foods.

Exercise: staying active helps to maintain a healthy weight, reduces blood pressure and promotes our ‘good ‘cholesterol.

As with all things health, there will be some higher risk which runs within families or is linked to other health conditions, but this just makes any changes that can be made to reduce overall risk more important.

Understanding your risk and options for managing this is very individual, but a good starting point is to book in for a health check at your GP practice. This looks at your height, weight and blood pressure, as well as checking blood tests for your cholesterol and blood sugar levels. And then inputting these into a risk calculator, allows you to see what your current risks are.

Light up your day: spend time outside during daylight hours, even on cloudy days. A brisk 10–20-minute walk can boost your mood by increasing exposure to natural light. Osteopath and wellbeing expert Nadia Alibhai explains,

“During peri-menopause, I found the shorter winter days challenging, and research shows that lower oestrogen disrupts serotonin (the happy hormone) making us more vulnerable to depression.” She recommends letting sunlight, however dim, reach your eyes, as it stimulates serotonin production to help you feel happier and less anxious.

Get your Vitamin D: it’s difficult to synthesise Vitamin D from sunlight in winter, but it remains crucial for bone health and balanced moods. Keep levels topped up with a high-quality supplement or focus on Vitamin D-rich foods like fatty fish, fortified products, and eggs.

Comfort food: low energy during menopause is common, especially in colder weather. Instead of reaching for sugary snacks that lead to energy dips, opt for warming, nutrient-rich options like soups, stews, and root vegetables. Include omega-3 fatty acids (from nuts, seeds, and oily fish) to combat inflammation and support brain health.

Hydrate yourself happy: staying hydrated with water might not be tempting on cold days, but it’s vital for combating tiredness and dry skin. Try herbal teas like chamomile or peppermint for hydration with added calming properties.

Hot flush helpers: managing temperature regulation is key when transitioning between chilly outdoor air and heated indoor spaces. Stick to natural fibres like cotton, bamboo, or wool blends, and dress in layers to easily adjust if a hot flush strikes.

Keep moving: certified menopause yoga teacher, Libby Stevenson, highlights the importance of staying active in winter to help manage weight, improve mood, and ease joint stiffness. She suggests brisk walks, at-home yoga sessions, or dancing to your favourite tunes to boost circulation and lift your spirits. Even a little movement everyday goes a long way in making you feel happier.

Winter skincare: cold air can exacerbate menopausal skin changes. Use a hydrating cleanser followed by a rich moisturiser or facial oil to lock in moisture. A humidifier in the bedroom at night is a good way of adding moisture to the air. For dry, itchy skin on the body, try dry brushing with a natural bristle brush or flannel before a shower, and then apply a nourishing body lotion.

Sleep well: turn winter evenings into pamper sessions. A warm bath with luxurious lavender-scented products, followed by calming tea or magnesium-rich cacao, can promote better sleep. Add five minutes of mindfulness, journaling, or meditation for extra relaxation.

Stay in touch: it’s natural to prefer the couch to nights out in winter, but social connection is vital for mental wellbeing. If video calling doesn’t appeal and you prefer real-life meet-ups, invite friends for a park walk or enjoy a cosy night by the fire with a fun board game.

Nadia Alibhai is the director and principal Osteopath of Back 2 Well-being healthcare clinic in London. Libby Stevenson is a certified pregnancy, postnatal and menopause yoga teacher.

We can see that there are significant changes to the types of bacteria and the diversity of bacteria sitting in the gut of a post-menopausal woman compared to a pre-menopausal woman. When we have less oestrogen, it seems to create this reduction in diversity. There’s also a subsection of bacteria in the gut that play a role in recycling oestrogen back into the body and when we lose these, we’re no longer getting that sort of recirculation.

It’s thought that these changes can have implications in the development of disease, such as bone-related and cardiovascular diseases, as well as weight management and possibly even mood. So being able to improve our gut microbiome and the diversity and numbers of good bacteria makes sense.

You may not notice any significant differences at all. However, anecdotally, women going through the menopause and into post-menopause tend to report more bloating and general abdominal discomfort. If you already have irritable bowel syndrome, you may also find symptoms worsen as a result of going through the menopause.

Everyone is different but the first line of advice would always be to help boost the diversity of your gut. We know good bacteria thrive on a diet rich in fibre and the more diverse plant-based fibres, the better. Try to include a variety of pulses and lentils, nuts and seeds, herbs and spices, and whole grains. Bacteria also like what we call prebiotic fibres, which can be found in things like onions, garlic and artichokes.

Think about how many different portions of fruits and vegetables you eat every day but try not to get hung up on numbers and targets. It’s more about considering whether you eat the same ones all the time and encouraging that diversity. Try sprinkling some nuts and seeds on top of a stir fry or salad for example, or adding things like pulses and lentils to meat casseroles and curries.

There’s also a particular category of compounds  which we call phytoestrogens, found in rich quantities in soy containing foods in the form of isoflavones. Our gut bacteria seem to play a role in how effective these isoflavones are in mimicking the effects of oestrogen within the body.

Fermented foods also seem to help with gut diversity and some women may benefit from a probiotic, but that's a bit hit and miss because it depends on the individual and on her gut.

The same principles apply, so everything I've said relates to post-menopause and starts really from the peri-menopausal point, continuing through menopause and beyond. It's simply the point at which you pick up, essentially, that you've begun that menopausal transition.

Laura Clark is known as The Menopause Dietitian and in her work, combines a solid foundation in nutritional science with behavioural therapy and certain psychological modalities to help support women through perimenopause and menopause.

Psychological symptoms of menopause, such as brain fog, anxiety, low mood and lack of motivation, can often manifest before physical symptoms. This is due to the effects that oestrogen and progesterone have on our brain chemistry. So how should we be supporting our brain with food?

Try increasing your intake of the following foods:

Oily fish and nuts - eat oily fish two to three times a week, opting for small fish such as mackerel, trout or salmon to minimise mercury. Try eating more nuts, seeds and linseed oil too.

Phytoestrogens - tofu, tempeh, soya, linseed, nuts, apples, fennel, celery, parsley, alfalfa, pulses, beans, lentils, peas, chickpeas, green vegetables, carrots, red peppers, broccoli and cabbage, sage and red clover are all excellent sources.

Phosphatidylcholine and phosphatidylserine - both are found in egg yolk, tofu, oily fish, beef, sardines and fatty cheese.

Phenylalanine - you can find this in pumpkin seeds, parmesan, soya beans, lean beef, chicken, salmon, mackerel, cod, eggs and pinto beans.

B vitamins - found in eggs, cereals, brown rice, fish, chicken, asparagus and dark-green vegetables.

Amino acids - especially tryptophan and glutamine, all these are found in lean meat, poultry, nuts, seeds and avocado.

L-theanine - an amino acid found in green tea (opt for decaf) that is traditionally used to enhance relaxation and improve concentration.

Vitamin C - supports brain health as we age. Get it in citrus fruits, parsley and greens.

Antioxidants - such as flavonoids. Try artichoke, basil, berries, celery, citrus fruits, parsley and turmeric.

The gut is often referred to as our second brain and the easiest way to support it is by aiming for 30+ plants per week. If you don’t have many plants in your diet at the moment, then increase them slowly as suddenly eating lots of plant-based fibre can cause bloating! Cooked over raw is easier to digest too.

These can include herbs, spices, fruit, vegetables, pulses, nuts, seeds and gluten-free grains. Also be wary of how gluten affects your concentration, gluten and dairy can have an opioid-like effect on the brain.

• Keep hydrated. Dehydration is linked to drops in memory and concentration.
• Buy the best food you can afford and take the time to enjoy it.
• Opt for warm, grounding food such as protein-rich broths and warm salads to help take energy out of the head and into the digestive system.
• Keep moving to help circulation and blood flow to the brain.
• Spend more time in nature as there are fascinating links with it improving mood.

As we age our immune systems become less effective. For those experiencing menopause, the effect is then amplified by falling levels of oestrogen, progesterone and testosterone. The result? Becoming more prone to inflammation and less effective at fending off pathogens.

During perimenopause and menopause, a number of other factors are at play too, including poor sleep, stress and anxiety, low iron levels, and hormone changes affecting digestive health, as well as tiredness and fatigue.

Nourish your gut microbiome - our beneficial microbes enjoy colourful fruits and vegetables, wholegrains, beans, and pulses, which contain soluble fibres for them to feed upon. Fermented foods like sauerkraut, kefir, kimchi, and natural yoghurt help too. They contain different strains of natural bacteria that support the balance and diversity of our own microbiome.

Cut back on free sugars - high amounts of free sugars like table sugar and sugars found in syrups, sweets, chocolate, cakes, honey, and fruit juices (but not whole fruits) disturb the gut microbiome and weaken the ability of immune cells to respond to infections.

Check your vitamin D levels - vitamin D is crucial for immune health yet deficiency is common in Northern hemisphere countries like the UK. Government advice is for all adults to take a supplement between October and April and you may need to supplement all year round, especially if you have darker skin, cover most of your skin, or have little time outdoors.

Top up on iron - if you still have regular periods, it’s a good idea to eat plenty of iron-rich foods like red meat, poultry, eggs, dried apricots, leafy green vegetables, lentils, and tofu.

Eat a rainbow of fruits and vegetables - colourful fruits and vegetables supply vitamin C, beta carotene, and plant-based antioxidants that help manage inflammation and support immune cell activity. Combining vitamin C foods like berries, watercress, broccoli, and kiwi with plant-based sources of iron aids iron absorption too.

Neuropsychiatrist and author of The Upgrade, Dr Brizedine, says that hormonal changes can help reshape women’s brains for the better in a way that creates a bracing clarity and laser-like sense of purpose. “Without the monthly cycles of fertility hormones pushing and pulling like tides through our brain, our creativity and vision can take hold powerfully,” she explains.

There’s also a drop in anxiety that allows the brain to flip its attentional style from multitasking to focusing on one thing at a time. “This isn’t a deficit,” she insists. “It means you'll become more engaged, more thorough.” In addition, “the brain is no longer stressed by its wiring being hormonally altered by 25% every month, and so the freedom to solidify its circuitry allows easier access to feelings of firmness and conviction unlike at any other time in a woman’s life.”

Incidentally, Brizendine was among the first to explore why women feel, think, and communicate differently than men through her book, The Female Brain. Her latest roadmap and positive understanding of ageing came about from her own experiences and those of the thousands of women at her clinic - she founded the Women’s Mood and Hormone Clinic at UCSF in San Francisco back in 1994.

It is here that she has listened to countless stories of joy and loss, discovery and fear, freedom and disorientation from women in 'transition' (perimenopause). “Doing 100 butt-squeezes per day helps your brain!” she enthuses. “In a large study of women at age 80, those with the greatest leg strength also had the best cognition.”

Brizendine also reveals that we genuinely get happier with age, too. “It’s called the ‘positivity effect’,” she states. “Research at Stanford and other places shows that we get happier and happier with each decade of life. There’s no real known reason for why this is, but it’s something to look forward to. And it’s important to know because it’s almost counterintuitive, as we tend to say and think the opposite.”