What does a balanced diet for menopause look like?
The menopause can be a difficult time for many women.
There's lost sleep, low libidos, anxiety and low mood to content with.
Healthwise too, due to the decline of the hormone oestrogen, there's also increased risk of cardiovascular disease (heart disease and strokes) and osteoporosis (brittle bones and increased risk of fractures), diabetes, depression, obesity and dementia. And if you experience early or premature menopause, your risk is unfortunately higher (see footnote one for citation).
It is all very understandable then why we are drawn to the idea of changing our diets and boosting nutrition with supplements to help ease symptoms, increase health and reduce the long-term risk.
But is there any evidence to back any of the claims about which changes to make? Can anything help with symptoms? What adjustments do you need to make to your diet to help with your long-term health?
Related: Explore our menopause resources area.
1. 'Reducing caffeine and alcohol can help with hot flushes'
Reducing caffeine, alcohol and spicy food in your diet may help hot flushes, although there is considerable variation between individuals (footnote 2,3). Current recommended limits of alcohol are a total of 14 units a week, with a maximum of two per day.
Reducing alcohol also has other health benefits, such as a lower risk of liver disease, heart disease, osteoporosis, type 2 diabetes, and certain types of cancer such as breast cancer (3). So for these reasons, it's definitely a good idea to limit the alcohol you consume.
2. 'Magnesium supplements can help with insomnia and disrupted sleep'
For some women insomnia can be a symptom of the menopause. Unfortunately, there is very little evidence to support any benefit from magnesium supplements (4).
Instead, you should be able to meet all your magnesium needs through a healthy diet containing wholegrains, spinach, pumpkin seeds, almonds and beans.
3. 'Phytoestrogens can help with menopausal symptoms'
Phytoestrogens are plant-derived compounds, that have a similar structure to human oestrogen, and similar but weaker activity. They are found in foods (full list below) and in a more concentrated form in supplements.
There are a number of herbal medicines that contain phytoestrogens that may help with the symptoms of menopause. There is evidence to support decreased hot flushes with St John’s wort, black cohosh (5), and genistein (6).
Isoflavones (soya products and red clover) are a type of phytoestrogen. There is mixed evidence that they may reduce hot flushes (6). Red clover is not advised in women with breast cancer (7,8), but soya is probably safe. These supplements may also interact with other medications such as those for heart disease, epilepsy and asthma, so you should speak with your GP before starting any herbal medicine.
The contents of herbal medicines may vary considerably, as in contrast to conventional medicine, there is no legal obligation for herbal medicines to be licenced. Check for a product licence or Traditional Herbal Registration (THR) number on the label and always buy from a reputable setting.
These supplements are more concentrated than the phytoestrogens that are naturally found in some foods.
Phytoestrogens occur naturally in some plant-based foods such as:
- Soybeans and soy based products
- Sesame seeds
- Tea (green and black)
Given the mixed evidence about efficacy of the supplements, it is therefore unlikely that consuming these food items, will have a significant benefit on symptoms.
4. 'Calcium is the main nutrient for bone health'
Osteoporosis or softer bones, leads to a greater risk of having low energy fractures. Oestrogen has a really important role in bone health, and as levels decline, risk of osteoporosis increases. A 50 year old woman only has a 2% risk of osteoporosis, compared with a 25% risk in an 80 year old lady, due to considerably lower levels of oestrogen (9).
Diet can play an important role in bone health.
As well as calcium, there are a range of key macronutrients, vitamins and minerals to be sure that you are getting enough of:
Quality protein: Include lean protein foods at every meal such as seafood, beans, legumes, dairy, meat, and poultry.
Calcium is an important mineral for bone health, and as an adult you need to take between 700-1000mg per day. See my menopause nutrient checklist below to ensure you are getting enough. Good sources of calcium include dairy, calcium-fortified plant-based drinks, tinned fish (with bones), spinach, fortified bread, baked beans, tofu and dried figs. If you are unable to have enough in your diet, you might be prescribed a supplement.
Vitamin D, commonly called the sunshine vitamin as it is produced by the action of sunlight on our skin during exposure outside. Current NHS guidance is for women to consider taking a supplement of 10mcg (400IU) during the autumn and winter months as it can be difficult to get enough sun exposure. Vitamin D is also found in low levels egg yolks, oily fish and some fortified foods, but is difficult to get enough from diet alone.
The term vitamin K covers a number of different molecule and you need to eat a range of items to ensure you get all the different elements. Vitamin K is found in green vegetables, fermented food, dairy, and meat and has an important role in bone strength. Although there is mixed evidence as to whether vitamin K supplementation improves bone strength and reduces fractures (10), a number of countries for example Japan, now include vitamin K supplementation as treatment for osteoporosis. Vitamin K is a fat-soluble vitamin, and is therefore stored if you take excess. It is therefore possible to have too much through supplementation, and we don’t know what these effects might be. If you are on blood thinning medication, you should avoid taking vitamin K supplements as they can interfere.
Phosphorus is found in foods such as poultry, meat, dairy, oily fish, potatoes, wholegrains, pulses and beans. It is usually abundant in our diet, and you should not need to take a supplement.
Magnesium is another mineral that is usually abundant in our diet but good sources include wholegrains, spinach, pumpkin seeds, almonds and beans. Again you should not need to supplement this.
Resistance exercise is very important for bone strength. The NHS advises 30 minutes twice a week for adults over the age of 35 years. Examples include brisk walking, resistance bands, yoga, squats, weight training, Pilates, gardening and a brisk walk.
5. 'Reducing saturated fats reduces the risk of cardiovascular disease (CVD)'
The risk of cardiovascular disease increases during and after the menopause. This is partly related to the ageing process, and also the effects of declining oestrogen (10). Cardiovascular disease is a general term used for conditions affecting blood vessels and the heart by narrowing of the arteries (atherosclerosis) and an increased risk of blood clots such as strokes.
Weight gain associated with declining oestrogen levels also leads to an increased risk of obesity, higher blood pressure, type 2 diabetes, and higher (LDL) cholesterol levels, which are all well recognised as factors for CVD (11,12).
There is evidence that dietary changes can help reduce these risks (13) so aim to follow a diet with the following principles:
Swap saturated fats (animal fats) to unsaturated fats such as extra virgin olive oil, rapeseed oil, avocado, seeds, nuts
Reduce fat content to less than 30% of your diet (approximately 60g per day)
Swap refined carbohydrates (white bread, white rice) with whole-grains (brown rice, brown bread, millet, teff, bulgur wheat).
Eat at least 5 portions of fruit and vegetables a day
Aim to have 2 portions of oily fish (for example salmon, sardines, mackerel) twice a week. If you do not eat fish, have daily nuts, and seeds which also contain omega 3.
- Aim for a handful of nuts and seeds a day.
- Regularly enjoy beans, lentils and chickpeas.
Avoid convenience products that have high amounts of sugar and salt, and sugary fizzy drinks.
Try to reduce alcohol, and try to keep less than 14 units of alcohol per week (maximum of 2 units per day).
Practical tips for optimising your diet
The menopause is a time of immense change, with some women suffering more symptoms than others. Be compassionate with yourself, and if you aren’t able to optimise your diet right away, then arm yourself with the tools to help for the future.
As risk of osteoporosis and cardiovascular disease increase, it is an important time to pay attention to diet and lifestyle factors to reduce these risks. Try to eat a variety of colours, whole grains, quality protein at every meal, unsaturated fats, whole plant-based foods, and items rich in calcium.
With regards supplements beware of marketing claims. Those supplements containing phytoestrogens may help with hot flushes, so trial to see if they have an effect for you. Follow the NHS guidance for vitamin D supplementation during the autumn and winter months.
I know how confusing it can be knowing what 700mg of calcium looks like practically. So I’ve designed a meal planner and nutrition checklist specifically for the menopause and beyond, to help you meet your needs. It’s free to download here.
Find out more about Dr Harriet Holme in our business & services directory.
- Bernhardt L, Lawson CA. Early menopause and risk of cardiovascular disease: an issue for young women. The Lancet Public Health. Elsevier; 2019 Nov 1;4(11):e539–40.
- Faubion SS, Sood R, Thielen JM, Shuster LT. Caffeine and menopausal symptoms: what is the association? Menopause. 2015 Feb 1;22(2):155–8.
- Wilsnack RW, Wilsnack SC. Alcohol use and menopause. Menopause. 2016 Apr 1;23(4):458–60.
- Chan V, Lo K. Efficacy of dietary supplements on improving sleep quality: a systematic review and meta-analysis. Postgrad Med J. 2021 Jan 13;19:–2020–139319.
- Chung D-J, Kim H-Y, Park K-H, Jeong K-A, Lee S-K, Lee Y-I, et al. Black Cohosh and St. John's Wort (GYNO-Plus®) for Climacteric Symptoms. Yonsei Medical Journal. 2007 Apr 30;48(2):289–94.
- Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Gynaecology and Fertility Group, editor. Cochrane Database Syst Rev. 2013 Dec 10;91(12):CD001395.
- Ziaei S, Halaby R. Dietary Isoflavones and Breast Cancer Risk. Medicines 2017, Vol 4, Page 18. 2017 Jun 1;4(2):18.
- Fritz H, Seely D, Flower G, Skidmore B, Fernandes R, Vadeboncoeur S, et al. Soy, red clover, and isoflavones and breast cancer: a systematic review. PLoS ONE. 2013;8(11):e81968.
- 2019 surveillance of osteoporosis: assessing the risk of fragility fracture (NICE guideline CG146). London: National Institute for Health and Care Excellence (UK); 2019 Aug 8.
- Sangkomkamhang T, Sangkomkamhang US, Ngamjarus C. Vitamin K for the prevention and treatment of osteoporosis in post‐menopausal women. Cochrane Database of Systematic Reviews. 2010;22(1):465.
- Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol. 2009 Oct 1;5(10):553–8.
- Karvonen-Gutierrez C, Kim C. Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition. 2016 Jul 13;4(3):42.
- Duerden M, O’Flynn N, Qureshi N. Cardiovascular risk assessment and lipid modification: NICE guideline. Br J Gen Pract. 2015 Jul 1;65(636):378–80.