With life expectancy increasing, many women are now spending a significant portion of their lives postmenopause. Post menopause is defined as 12 months after a woman’s final menstrual bleed. The period leading up to this, characterised by the onset of symptoms like hot flushes, low mood, and fatigue, is known as perimenopause. The transition through perimenopause can be a difficult and often confusing time which can disrupt daily life. The lack of robust research into women’s health during this phase only adds to the challenge.
The unfortunate reality is that the scarcity of high-quality studies, coupled with a lack of understanding and empathy from some healthcare professionals, creates fertile ground for misinformation. Many online grifters and pseudo-scientists exploit this gap, peddling unproven products and services. These offerings often rely on preliminary data or stuff they’ve outright just made up, providing little benefit beyond what would be expected from a well-designed placebo. As a result, many women end up spending considerable time, effort, and money, only to feel disheartened and let down.
This article aims to sift through the available research on menopause and nutrition. By clearly distinguishing between evidence-based strategies and those built on shaky ground, I hope to help you allocate your precious and finite resources whether that be time, effort, or money, wisely. While nutrition alone cannot solve the difficulties associated with menopause, thoughtful dietary adjustments may provide some relief and improve overall health.
Specific Nutrients and Dietary Patterns
Research into nutrition and perimenopause is still developing, but some evidence suggests that dietary choices might be able to influence symptoms such as hot flushes and low mood.
Soy Isoflavones
Menopausal symptoms often result from the fluctuations of sex hormones like oestrogen and progesterone. These hormones influence various systems in the body, including temperature regulation and emotional well-being. Therapies designed to alleviate menopausal symptoms often aim to increase or stabilise hormone levels to counteract these effects. This concept is particularly relevant when discussing the potential role of dietary components like soy, as its phytoestrogen content may exert mild oestrogen-like effects in the body.
Isoflavones, a type of phytoestrogen found in soybeans, soy foods (such as tofu and miso), beans, chickpeas, and lentils, have a structure similar to oestrogen and interact with oestrogen receptors. This weak oestrogenic activity has sparked interest in their potential to reduce the symptoms of hot flushes during menopause. Observational studies have suggested lower hot flush prevalence in populations with high soy consumption, such as Japanese women[1], but clinical trials have yielded inconsistent results.
A 2013 Cochrane review concluded that evidence from 25 clinical trials was insufficient to establish a clear link between soy isoflavones (33–200mg/day) and reduced hot flushes or night sweats[2]. However, a meta-analysis by Taku et al. (2012) showed that consuming soy isoflavones (median 54 mg/day) for more than 12 weeks significantly reduced hot flush frequency and severity, with higher genistein doses (>18.8 mg/day) proving most effective[3].
While soy isoflavones may provide some benefit for managing some menopausal symptoms, further research is needed to clarify their effectiveness and establish practical recommendations. However, soy products like tofu remain excellent additions to the diet, offering a valuable source of plant-based protein that can support overall health.
Mediterranean Diet
The Mediterranean diet (MedDiet), which emphasises fruits, vegetables, whole grains, healthy fats from olive oil, nuts, and seeds, and moderate fish intake, has been associated with several health benefits during menopause. Observational studies indicate that adherence to this dietary pattern may help manage hot flushes and night sweats[4]. Intervention trials also suggest potential benefits. A review from the European Menopause and Andropause Society (EMAS) concluded that short-term adherence to the MedDiet might reduce hot flushes and support overall menopausal health[5].
While the evidence supports the MedDiet’s role in managing menopausal symptoms, adopting this nutrient-rich eating pattern may not only alleviate menopausal symptoms but also reduce the risk of chronic diseases like cardiovascular disease and diabetes, which are prevalent in later life[6, 7]. My personal frustration with advocates of the MedDiet is the overly stringent emphasis on traditional Mediterranean recipes like moussaka, caponata and a host of elaborate salads, which can be impractical for everyday use when you need something quick easy and healthy. It’s important to remember that the MedDiet is a set of dietary principles rather than specific recipes, and it can be adapted in simpler ways. For example, I doubt those on the Isle of Scilly will be claiming ownership of the humble Sheppard’s pie anytime soon but if you fry the veggies in olive oil and replace some of the lamb with some lentils you have a dish that incorporates lots of those MedDiet principles. Moving towards a healthier diet often doesn’t mean radical changes, it can just be a case of adapting recipes you already enjoy or making simple swaps that nudge you towards where you want to be.
Losing muscle mass and bone density is a significant consideration for women, as they face higher risks for osteoporosis and sarcopenia compared to men. Women generally achieve lower peak muscle mass and bone density, and their rates of loss tend to be higher as they age. Perimenopause represents a crucial life stage to make dietary and lifestyle changes to mitigate these risks. This is an area where nutrition can really shine so this section will focus on key nutrients related to bone and muscle health.
Protein
Protein plays a crucial role in preserving and gaining muscle, as it supports muscle protein synthesis, the process by which the body repairs and builds muscle tissue. Additionally, our bones are composed of a significant amount of protein making it even more important for women. As we age, a phenomenon called anabolic resistance occurs, meaning that muscles become less responsive to the stimuli that trigger muscle protein synthesis[8]. This likely necessitates a higher protein intake to fully stimulate this process.
Evidence-based recommendations suggest aiming for a daily protein intake of 1.2-1.6 grams per kilogram of body weight, with a focus on distributing protein intake evenly throughout the day[9]. For example, a 70kg adult would require approximately 84 to 112 grams of protein daily. This could look like two eggs (12g protein) at breakfast, a chicken breast (31g protein) at lunch, a salmon fillet (25g protein) for dinner, and a Greek yoghurt (10g protein) as a snack, supplemented by plant-based sources like lentils or even some soy-based products to fill the remainder. Including a source of high-quality protein in all main meals and some snacks is ideal. High-quality protein sources include eggs, lean meats, fish, dairy, legumes, and plant-based proteins. Ensure you are eating enough protein could help mitigate muscle loss and support metabolic health during peri- and postmenopause.
Omega-3 Polyunsaturated Fatty Acids (PUFAs)
Omega-3s PUFAs are essential fats, commonly found in fatty fish like salmon, mackerel, and sardines, as well as in plant-based sources such as flaxseeds, chia seeds, and walnuts. Omega-3s include two particularly important types: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are primarily found in seafood. EPA and DHA are known for their roles in reducing inflammation, supporting cardiovascular health, and maintaining brain function. These are the fatty acids that seem to provide the most benefits and are the primary focus of the research. Yet despite decades of research the median portions of fish we, in the UK, consume is still 0.
A lesser well-known function of these fats is their ability to preserve muscle mass, which could make them particularly important for peri- and postmenopausal women. A randomised control trial involving 60 adults over the age of 60 investigated the effects of omega-3 PUFA supplementation (1.86g EPA and 1.5g DHA per day) compared to a placebo over six months. While supplementation did not impact body weight, total body fat mass, or intramuscular fat, it resulted in significant improvements in thigh muscle volume, grip strength, and one repetition maximum muscle strength (measured via the combined scores from leg press, chest press, knee extension, and knee flexion) compared to placebo[10]. The theory is that omega-3s might re-sensitise muscle to anabolic stimuli, overcoming the aforementioned anabolic resistance. Although this study was conducted in adults aged 60+ and included both men and women, women can begin to lose muscle earlier in their lives. Adding omega-3s to your diet could therefore be a wise choice, not only for maintaining muscle but also for the heart and brain benefits they provide.
To reap these benefits, aim to consume two portions of fish per week, one of which should be oily. Examples of oily fish include salmon, mackerel, sardines, and herring. If you don’t enjoy fish, consider a fish oil supplement. While research often uses higher doses to rapidly increase tissue levels, a long-term supplemental dose of 500mg of combined EPA and DHA daily is sensible. Be sure to check labels carefully, as the EPA and DHA content can vary significantly and is often not displayed prominently on the front. Instead, what’s shown may simply be the total oil content, which is not the same as the amount of EPA and DHA.
Vitamin D and Calcium
Calcium and vitamin D play vital roles in maintaining bone health, particularly as we age. There is a lot of calcium in our bones, so it makes sense that it is crucial for increasing and maintaining bone density. Calcium can be readily obtained from food sources, with dairy products offering the highest bioavailability. However, plant-based sources like leafy greens, almonds, and fortified plant milks also contribute to calcium intake. Vitamin D, on the other hand, is not found in many foods. While it is present in fatty fish, fortified products, and egg yolks, most vitamin D is produced in the skin through exposure to UVB light from the sun. Unfortunately, in the UK, sunlight exposure is insufficient to meet vitamin D needs, particularly between October and March. As such, supplementation is often necessary. Experts recommend a daily dose of at least 400 IU per day. If you are already deficient you will likely need more but the only way of knowing for sure is to get a blood test, which some GPs are happy to order if they have concerns about your status.
Weight gain during menopause, whilst common is not inevitable. I know this might go against some of the narratives in this area, but I hope you can take some comfort that whilst there are absolutely challenges women face when it comes to weight loss there is a lot you can control. Let’s explore some of the key areas when it comes to fat gain and body composition changes.
Metabolic Changes
It is often claimed that metabolism plummets during menopause, but the reality is a little more nuanced. Research, including a comprehensive study on energy expenditure across the human life course, shows that when adjusted for muscle and fat mass, metabolism remains remarkably stable from ages 20 to 60, after which is does start to decline[11]. This study, involving over 6,400 participants from diverse backgrounds, used a technique called doubly labelled water which is considered the gold standard for measuring energy expenditure. While the study was not specifically designed to focus on menopause, it included women across the life course, offering really valuable insights.
This result comes with an important caveat as the researchers statistically controlled for muscle and fat mass this means this result only applies if body composition remains similar. This indicates that menopause itself might not directly cause your metabolism to slow but the changes in body composition that can occur alongside it do. A loss of muscle would lead to reductions in metabolism, although perhaps not as large as you’d think, with research showing each kilogram of muscle only burns around 13kcal per day[12]. With this in mind, the reason to prioritise muscle as we age should really be to promote overall health and functionality whether that be continuing to train and compete in your sport, taking up a new hobby or keeping up with those inbound grandchildren.
One key consideration when it comes to interpreting this data is that this study focuses on physiological factors and doesn’t address the broader life complexities women face during menopause. Many women at this stage can be balancing parenting, caring for ageing parents, advancing in their careers, and managing other life demands, all of which can make staying physically active more challenging, which is reflected in the research showing physical activity often declines during perimenopause and into postmenopausal years [13]. Reducing physical activity is of course going to reduce energy output and make it more difficult to hold into muscle mass. Despite these obstacles, prioritising physical activity is still possible and vital. Seeking activities that fit into a busy schedule, finding supportive networks like sports/fitness clubs, and being willing to prioritise your own time can make a significant difference.
Fat and Carbohydrate Oxidation
Hormonal shifts during perimenopause can alter how the body processes fats and carbohydrates. In perimenopause, fluctuating oestrogen levels can affect fuel utilisation. For example, higher oestrogen levels promote fat oxidation during moderate-intensity exercise[14]. However, these effects are inconsistent due to the varying nature of hormonal changes during this phase. Postmenopause is characterised by significantly lower oestrogen levels, which are associated with reduced fat oxidation. For example, one small study in 45 women found that postmenopausal women demonstrated a 33% reduction in whole-body fat oxidation during exercise compared to pre-menopausal women[15]. However, it must be noted that this reduction seemed to be driven by reduced muscle mass in those individuals, further emphasising the need to prioritise nutrition and resistance exercise to support muscle in women.
There are a couple of important things to unpack here. Reduced fat oxidation, or how its commonly referred to fat burning, sounds scary. However, reduced fat burning doesn’t inherently mean you are more susceptible to gaining fat or that you can’t lose fat. Whilst fat burning and fat loss are linked, they are not one in the same. For more clarity of this please read my other article that addresses this topic in the detail it requires.
Secondly, I often see people jumping on this research and using it to say women all need to be low fat because they can’t utilise fat well enough or that everyone needs to go low carb to train their bodies to burn fat better by giving it more fat. The fact we have completely polarised pieces of advice coming from the same data should tell you how much we understand about the implications of these findings. The reality is we don’t know if either of these approaches are helpful. Changes in fuel utilisation are interesting from a physiological perspective and could perhaps be useful for athletes. For everyday folks it probably shouldn’t translate into seismic shifts in your diet beyond attempting to stick to the fundamental healthy eating principles we have already discussed.
During and postmenopause, the body undergoes significant changes. Weight gain may occur, and some research even suggests menopause might lead to fat redistribution[16]. Hormones play a key role in determining where fat is stored, and as these hormones change, fat storage may shift more to the midsection. This means that even if your overall body fat does not increase, the way fat is distributed could make your body feel different as it accumulates in areas you’re less accustomed to.
These physical changes, combined with symptoms such as hot flushes or fatigue, are associated with negative body image[17]. Negative body image refers to a dissatisfaction with or critical view of one’s own body, which can affect mental well-being, self-esteem, and overall quality of life. negative body image has even been associated with missing GP and important health screening appointments. This emotional aspect is just as important as physical health.
Moving towards a more positive body image is easier said than done, however understanding what positive body image could be an important first step. It is defined within the scientific literature as holding favourable opinions of the body regardless of its actual weight or size, or real or perceived imperfections. Positive body image is more than simply the absence of the elements of negative body image in that it also encompasses a willingness to actively take care of the body’s needs[18, 19]. Focusing on what your bodies can do rather than appearance, or what it is currently unable to do is one step you can take to improve your body image. This is where exercise can be really empowering. Instead of exercising to burn calories or change the way you look you can focus on how your body performs, appreciating what it currently is capable of and setting goals related to your physical performance. Beauty standards are arbitrary and constantly changing, whereas fitness and performance is testable and quantifiable.
There are certainly dietary elements that can support women during peri- and postmenopause. Many of these align with general nutritional guidelines but may include small tweaks tailored to this life stage. For those already proactive about their health, this article might not reveal groundbreaking changes, which might even feel a little disappointing. However, it’s important to acknowledge the effort you’ve already invested and recognise that you are doing many of the right things. Take comfort in knowing that your current approach is likely making a significant difference to your health and well-being. Rather than seeking out unproven or pseudo-scientific solutions, focus your energy on other meaningful areas of your life, confident that your proactive habits are already serving you well. While diet plays a vital role, it’s only one piece of the broader health and wellness puzzle. I hope this article has helped you cut through the noise so you can make informed, logical choices during this pivotal time.
Paul is a sports nutrition consultant and educator with a PhD in Nutrition and Exercise Science. With over a decade of experience, Paul specialises in optimising performance and recovery for endurance athletes through evidence-based strategies. As a lecturer and researcher, Paul has published in peer-reviewed journals and worked with athletes, sports teams, and organisations to achieve peak performance.
