Before discussing the best diet for menopausal women, it is important to first understand what is happening during this stage of life. When a female is born, her ovaries have a set number of follicles (the small sac that contains a developing egg). It is these developing follicles that produce estrogen.

Over time as a woman ages, the number of follicles become less and less, so her oestrogen levels fall and eventually her periods will stop. This is a gradual transition, and we refer to the perimenopause as this time (i.e., when estrogen levels fall). The average age for perimenopause is 47 years old but can happen from late 30s and usually lasts around 4 years. Once periods stop, this is menopause. The menopause is 1 date in time and is exactly 1 year after the date of a woman’s last period. After this time, you are post-menopausal. The average age of menopause is 51 years old.

As well as all the wide range of symptoms experienced, low estrogen levels also have long-term health effects on the body:

• Bone Health: 50% of women will develop osteoporosis (weak/fragile bones) during this stage of life as they do not have the protective effects of estrogen anymore.
• Heart and vascular health: low estrogen levels mean less protection on the lining of blood vessels and poorer cholesterol regulation. Weight gain is common and there is a higher risk of heart disease at this time.
• Brain Health: women are more likely to develop Alzheimer’s disease than men. The decline in estrogen can cause aging of our neurones (the information messengers in the brain) and aid in the formation of plaques that are associated with Alzheimer’s disease.

There is good news though!! Women are not helpless against these changes. As well as medical treatment with Hormone Replacement Therapy (HRT), there are a number of effective lifestyle measures that can be taken, which range from diet and exercise to sleep prioritisation and stress management. For this article we will concentrate on diet.

Can diet affect menopause symptoms?

Yes! Not only can diet help with menopausal symptoms but it is essential to look at diet at this time of life to help protect against the long-term effects of these hormone changes.

Phytoestrogens are naturally occurring compounds found in foods, plants and herbs that produce similar but slightly weaker effects to oestrogen in some tissues. (They also can block its effects in others, depending on the bodies needs, and are referred to as “selective estrogen receptor modulators”). There are many types but the main ones are:

• ISOFLAVONES: found in soya beans, chickpeas, legumes and red clover.
• LIGNANS: found in flaxseeds, wholegrains, fruits and vegetables.

Studies have shown geographical variations of menopausal symptoms, especially hot flashes (hot flushes in the UK). Only 18% of women in China and 25% of women in Japan experience hot flashes compared to 75% of women in the USA and 73% of women in the UK. The reason is thought to be due to the high soy content in the traditional Asian diet. Over the years as their diet has become more westernised, the differences are narrowing. Previously, there was not a Japanese word for “hot flashes”; it is a relatively new concept for Japanese women.

What food is best for menopause?

There are many foods that need to be increased during this stage of a woman’s life. It is good to look at Soy protein at this stage. Soy is a complete plant protein containing all 9 amino acids and is rich in fibre, vitamins, minerals and high in polyunsaturated fats – all essential particularly at menopause. As well as helping with hot flashes, it also weakly occupies estrogen receptors in the bone which contributes to lower levels of osteoporosis seen in women consuming more soy.

It is safe to eat. While there were previous studies associating it with cancer, the studies looked at genetically modified soy used to feed cattle. We now know that soy actually blocks estrogen receptors in the breast and early intake of soy may have a protective effect against future breast cancer. Foods containing soy include tofu, tempeh, edamame beans, chickpeas, soy milks and soy yoghurts.

As detailed before, the other source of phytoestrogens are lignans for which good sources come from seeds (flax, pumpkin, sunflower), wholegrains (oats) beans, fruits (especially berries), vegetables (cruciferous like broccoli, kale, cabbage and cauliflower).

Menopause is a stage in life when women can look at what they can do for their health. A diet rich in wholegrains fruits and vegetables is important. These foods will give you the fibre, B vitamins, calcium, magnesium and other vitamins and minerals important at this time.

On another front, did you know we have over 100 trillion microorganisms in our gut called the microbiome? More is being discovered about how these organisms have an influence on our health from how we handle food (e.g., why someone can eat and eat and still stay thin!) to our mood and our risk of disease. The more diverse our microbiome (the more different types of bacteria in the gut), the healthier we are. For women, there are a collection of microbes within the microbiome that effect the metabolism (i.e., how we break down and use) of estrogen. There are certain bacteria—equol producers—found in higher numbers of women who have more fibre in their diet. Eating soy has a much greater effect on menopausal symptoms if you have more equol producing bacteria in your microbiome.

Another way to help look at food is the colour. The more colourful your plate with fresh fruit and vegetables, the better. The colours in the food contain phytochemicals and each colour has beneficial effects on your body. (Think red tomato, orange carrot, yellow pepper, green broccoli, blue blueberries and purple grapes—try and have every colour, every day!).

For your brain – flavonoids from berries, green leafy vegetables, nuts, seeds, seafood and wholegrains are important. Healthy fats like omega 3 are also important. Having some flax/linseeds over wholegrain cereal or with soy yoghurt and berries would be a great source of daily omega 3.

Which foods could make menopause worse?

Foods to avoid at this time in life would be processed foods. In particular, processed carbohydrates and sugars. Processed carbs such as white bread, white rice, white pasta often contain less nutrients and cause large spikes in blood sugar levels. There is already a risk of weight gain due to low estrogen and processed carbs, and sugars make this worse.In keeping with this, saturated fats should be avoided to minimise the risk of weight gain and heart disease, along with other health consequences.

We know that being overweight actually makes menopause symptoms worse. Fat cells contain estrogen but the more you have, the greater the fluctuation on your estrogen levels and the worse your symptoms. Also, being overweight greatly increases your risk of heart disease, cancer and Alzheimer’s disease. Losing weight by looking at diet will help with controlling menopause symptoms.

It may be unpopular, but cutting down or stopping alcohol and caffeine can also help to control symptoms such as hot flashes or palpitations during the menopause.

Menopause diet plan summary

A good diet can help both with the symptoms of menopause and with the long-term effects so that every woman can live a longer and healthier life.

A whole food diet avoiding processed carbs and sugars is essential. Remember to try and include some of those foods rich in phytoestrogens – tofu, tempeh, chickpeas, edamame beans, seeds whole grains beans and berries.

Foods rich in calcium include the tofu, tempeh and soybeans above as well as low oxalate leafy greens such as bok choy and kale.

Healthy fats – seeds – flax, chia, hemp, walnuts, seaweed, nori, spirulina or oily fish such as salmon and mackerel.

In general, make your plate as colourful as possible with lots of fruits and vegetables in your diet. This will keep your gut bacteria happy and your body healthy and hopefully minimise your menopausal symptoms and protect your long-term health.

Dr. Sherina Fernandes, MBBS, BSc, DCH, nMRCGP, IBLM, BSLM, is a lifestyle physician working as a clinical lead for a telehealth company in the UK. Her main interests are preventative medicine using a lifestyle approach, women's health and preventing burnout.