Menopause is a natural biological process that marks a significant transition in a woman’s life. As women age, their bodies undergo hormonal changes that lead to the end of their reproductive years.
While menopause is an inevitable part of every woman’s life, many are left wondering: does lifestyle affect menopause?
In this article, we’ll delve into the fascinating connection between lifestyle choices and the menopausal experience. We’ll explore how diet can influence the onset and severity of menopausal symptoms, offering valuable insights into how women can navigate this life stage with greater comfort and confidence.
What is Menopause?
Menopause is when periods stop and occurs when you have not had a menstrual period for the last 12 months. It usually happens to people between the ages of 45 and 55. There are three stages involved in menopause known as perimenopause, menopause, and post-menopause.
Nutrition plays an important role in all women’s life, with differing requirements at different stages in the lifecycle, including nutrition for fertility; pregnancy; post-pregnancy; menopause; and over 65 years of age.
Nutritional recommendations for Women
The NHS generally recommends following the NHS Eatwell Guide as a basis for your diet. This guide highlights how much we should eat from each food group to achieve a healthy, balanced diet. A general overview of the Eatwell Guide recommendations are as follows:
- Aim to eat at least 5 portions of a variety of fruit and veg each day, such as fresh, frozen, tinned, dried, or juiced.
- Starchy food such as wholewheat pasta, brown rice, or potatoes, should make up just over a third of the food we eat.
- Include good sources of protein, like beans, peas, lentils, lean meats, and fish. Aim for at least 2 portions of fish every week, 1 of which should be oily.
- Include some dairy sources into your diet, such as milk, cheese, yoghurt, and fromage frais. These are an important source of calcium. Try tofu, kale, and fortified plant milks if you do not eat dairy.
- Choose unsaturated fats and eat in small amounts.
- Eat foods high in fat, salt, and sugar less often and in small amounts. This includes chocolate, cakes, butter, ice cream, and crisps.
- Drink plenty of fluids, at least 6-8 glasses a day .
Evidence for Nutrition before Menopause
The Eatwell Guide is a good place to start regarding nutrition, but how does this impact our health throughout menopause? There is little evidence regarding the direct link between pre-menopausal nutrition. However, inferences can be made based on current evidence available.
Weight gain is a common occurrence during menopause, with women gaining on average 1-2kg during the peri-menopausal period. However, this can be more if a woman is overweight or obese before menopause.
One study viewed the impact of obesity on menopausal symptoms, based on 749 women aged 45 to 60 years. They viewed the intensity of menopausal symptoms related to clinical characteristics and obesity. The study found that obese women were less physically active. Therefore, more likely to be hypertensive (high blood pressure), diabetic, and suffer from urinary incontinence. Additionally, hot flash severity, and joint and muscle pain was higher relative to BMI .
This suggests that preventing obesity pre-menopause by being physically active and enjoying a healthy, balanced diet, can prevent adverse effects during menopause.
Following on from weight gain, CVD risk may also be lowered by what you eat pre-menopause. Heart health is a concern during aging, as well as for women experiencing menopause. As we age our hearts tend to become enlarged and start to stiffen, this decreases how well our hearts can fill with blood leading to an increased risk of cardiovascular disease (CVD) .
Weight gain occurs due to changes in hormone levels. Low oestrogen levels can lead to the accumulation of hard-to-lose visceral fat in the lower abdomen area. Fat storage in this area can lead to an increased risk of insulin resistance and type 2 diabetes, as well as heart disease .
Nutrition for CVD
Preventing hypertension and increases in LDL (bad) cholesterol may help to prevent CVD as we age. Nutrition can be an effective way to manage symptoms of ageing and decrease the risk of developing CVD, for example:
- Increasing intake of unsaturated fats (to increase HDL cholesterol levels) and decrease intake of saturated and trans fats (to decrease LDL cholesterol levels).
- Reducing the intake of processed and red meats and replacing them with plant-based protein sources, fish, and poultry is associated with a lower incidence of CVD.
- Try implementing elements of the DASH diet, aimed at reducing blood pressure, by consuming whole grains, fruit, vegetables, and low-fat dairy products, and avoiding foods high in salt and saturated fats.
- Increase your intake of foods containing plant sterols (fruit and vegetables), which helps to reduce blood cholesterol levels.
- Aim to increase intake of fruit and vegetables as these have protective effects on CVD, with risk decreasing up to an intake of 800g per day.
- Increase intake of pulses, such as beans and lentils. These foods are associated with a reduced risk of chronic heart disease.
- Consume fish at least once a week, preferably oily fish. These foods are high in omega-3 fatty acids and have been shown to reduce the risk of mortality in coronary heart disease. They are also used to treat hyperlipidaemia and hypertension. Some plant-based omega-3 sources include walnuts, seaweed, edamame, and chia seeds.
- Similarly, to the DASH diet, the Mediterranean diet has a protective effect against CVD. This diet consists of fruits, vegetables, legumes, nuts, beans, cereals, wholegrains, fish, and unsaturated fats, with a low intake of meat and dairy.
Bone health is another concern during menopause, with menopausal women being at increased risk of osteoporosis and fractures. One study viewed the dietary intakes of pre- and postmenopausal women and the effects on menopause-associated diseases.
They found that the diets of postmenopausal women studied were closer to national nutritional recommendations than that of premenopausal controls. They also found that those with inadequate dietary calcium and vitamin D intakes were at increased risk of osteoporotic fracture later in life. Suggesting that ensuring adequate intake of these nutrients throughout life may prevent problems whilst ageing .
Diet and age at natural menopause
Age at natural menopause is affected by a number of factors, including genetics, socio-demographic factors, hormonal mechanisms and health-related factors as well as diet.
A study of 14,172 women in the UK who were followed up for approximately 4 years, 914 women went through a natural menopause found that intakes of oily fish and fresh legumes were associated with later age at menopause and intake of refined pasta/rice was associated with an earlier menopause . Fresh legumes are a source of antioxidants which may explain this association. Similarly, oily fish are a rich source of the omega-3 fatty acid which can potentially improve antioxidant capacity. Researchers believe that this may consequently reduce the proportion of follicles undergoing follicular atresia and postpone the onset of natural menopause. The same study also revealed that consuming high amounts of refined pasta and rice is linked to an earlier age at natural menopause. High consumption of refined carbohydrates (classified as high glycaemic index foods) increases the risk of insulin resistance.
Diet is a modifiable lifestyle factor that can affect menopause, including age at natural menopause.
Summary: Does lifestyle affect menopause?
While limited research exists on how lifestyle affects menopause. The evidence suggests that promoting bone health, maintaining a healthy weight, and reducing the risk of cardiovascular disease through diet can help prevent menopausal symptoms and related diseases during this time. We also know that lifestyle factors can also affect age at natural menopause.
Caroline Hill is a specialist menopause dietitian supporting women making dietary change. Caroline uses her extensive knowledge, skills and expertise of food and nutrition to help women manage their symptoms and weight during menopause. Caroline believes in providing sustainable, individualised, evidence-based advice to women making dietary change.