What is the best diet for menopause symptoms?
Is that even the right question?! And is there a better one?
You very often see headlines along those lines, reporting on one diet or another that promises to help with menopause symptoms. I think that the question asked in this particular way might not fully factor in that the menopause transition can potentially come with a wide range of symptoms and how it will therefore be experienced differently by each individual.
Stages of the menopause transition
I am assuming that you are already aware of the so-called stages of menopause, but here is a little refresher to set the scene. The menopause transition itself consists of several stages. The first stage is the perimenopause during which hormone levels are fluctuating more erratically over our menstrual cycle, which leads to a potentially wide-ranging number of symptoms for the majority of women. We still have periods during this time (true periods for those who aren’t on any hormonal contraception and are naturally ovulating, or potential withdrawal bleeds for those on certain types of contraception who are therefore not naturally ovulating). This is followed by the actual point of menopause and this is by far the shortest stage because it actually refers to just one very particular day in our lives when we have had not a natural menstrual bleed for exactly 12 months (if you are not on contraception you can very clearly pinpoint this day, if you are on certain types of contraception you will not know when this day has arrived). At this point we no longer ovulate (i.e. release an egg that can be fertilised by sperm). The final stage is the postmenopause, which is the rest of our lives when hormone levels are reaching a new stable level, and the wild fluctuations have come to an end. In 2011 a group of scientists developed a more detailed system that actually split the peri- and postmenopause into a total of six stages.
What happens to our sex hormones during the menopause transition and what does this have to do with menopause symptoms?
To keep things simple for this post, let’s focus on only two of the sex hormones, oestrogen and progesterone. During our fertile years before the menopause transition both oestrogen and progesterone are mainly secreted in the ovaries. As we go through the perimenopause and secretion of these two hormones from the ovaries becomes more erratic (depending on whether or not ovulation has occurred), other body tissues are increasingly taking up production, until they are the main place of secretion in our postmenopause years. For oestrogen, we have identified adipose tissue (especially the fat around the waist and the inner organs) and the adrenal glands, which are located on top of your kidneys, as main sources of production in postmenopause, and for progesterone the adrenal glands as main source of production.
We tend to talk about oestrogen as if it was just one hormone. When in reality it is actually a group of hormones with different subtypes, which are very similarly structured but nonetheless have some slight structural differences. This is important within the context of the menopause transition as we will see later on. The two types of oestrogen that have a fundamental role to play for the peri- and postmenopause years are oestrone (E1) and oestradiol (E2). Oestradiol (E2) is the type of oestrogen that is mainly produced in the ovaries and not very much anywhere else in the body. This means that before and in the early stages of the perimenopause, oestradiol (E2) is the main type of oestrogen in our bodies. In the later stage of the perimenopause and in postmenopause, oestrone (E1) is the type of oestrogen that is predominantly produced. Some of it can be converted to oestradiol, but this is very minimal. As I have said before there are some structural differences between these two types of oestrogen and sometimes the scientific literature makes statements along the lines that oestradiol (E2) is 10-times more potent than oestrone (E1). But what does this mean?! The answer to this lies in how the body reacts to and can process these two different types of oestrogen.
The role of sex hormone receptors and the impact of changing hormone levels
We have receptors for oestrogens (notice the plural!) and progesterone throughout our body. Whilst in the past the menopause and the decline in sex hormones was only really considered within the context of being no longer able to bear children, we now know that in fact a lot of places in our bodies contain these hormonal receptors. And where there is a receptor, there is a purpose for that hormone!
We also now have evidence that we have different types of receptors that respond to oestrogen and different types of receptors that respond to progesterone in different regions of the brain, the cardiovascular system, bone tissue, and the gastrointestinal tract, although this list is not exhaustive! This means that a fluctuation, change and eventual decline in sex hormone levels will have an impact on these bodily systems.
In the early stages of the perimenopause there is initially just a mismatch between the amount of a sex hormone that is secreted and the number of receptors that this particular hormone targets. This is because of the more widely and more erratically fluctuating hormone levels. Sometimes, there is too little, sometimes too much oestrogen causing some misfiring in the system. As mentioned before when we are moving into the later stages of the perimenopause and have reached the postmenopause, oestrone (E1) becomes the main type of oestrogen. The reason why we might say that oestrone (E1) is not as potent as oestradiol (E2) is because similar to a lock and key approach, oestradiol (E2) is a slightly better fit than oestrone (E1) and is therefore better at unlocking and opening the receptor so that the relevant cells in our body can take up the oestrogen. Oestrone (E1) can do this, too, but it is not as good a fit and therefore not as successful at opening the lock. As the perimenopause progresses the cells therefore do not get as much oestrogen as they were originally used to. This is very similar for progesterone, but at this point in time it is fair to say that there is an awful lot that we don’t know about these processes just yet and our knowledge with regards to progesterone is even less advanced. Eventually, our body seems to adjust to this natural process of decreasing sex hormone level and many of the more immediate symptoms disappear, although a number of health risks (for example cardiometabolic disease, osteoporosis, dementia) remain and even increase. This adjustment can take years, which is reflected in the fact that symptoms of the menopause tend to last for a while, in some case more than a decade. Again, the physiological adjustments and consequently the experience of the menopause differs between women.
The noticeable impact of changing hormone levels during the peri and postmenopause
For the majority of women these changes in hormone levels and the impact on their receptors will lead to at least one noticeable symptom giving an indication of that particular body system being affected. And more often than not we will find that we are affected in more ways than one. Research estimates that around 80% of women have a least one symptom of the menopause. Of these up to 80% experience vasomotor symptoms (e.g. night sweats, hot flushes, migraines), up to 70% put up with so-called psychogenic symptoms (anger/irritability, anxiety/tension, depression, loss of concentration, and loss of self-esteem/confidence), At least 50% are hit by weight gain or change in body composition, but in some studies this is even higher, and musculoskeletal pain is experienced by around 71%. These are just a few symptoms and often it can be difficult to determine whether something is related to the menopause transition or a different health issue. Even the list on the graphic below might not be exhaustive!
In a recent online study conducted in the UK, women reported an average of more than 10 different symptoms of menopause. The three most commonly reported symptoms, experienced by at least 75% of women were sleep disturbances, hot flushes/night sweats and memory problems, followed by incontinence, low mood, anxiety/panic attacks, low sex drive, dry skin, broken hair and nails. And yet again, this was still not the complete list of symptoms women faced!
The menopause transition as a very individual experience – Your own personal stew
This is the reason that whilst a lot of women find common ground with regards to their symptoms (nice being able to have a rant about the same thing), the menopause transition is actually a very, very individual experience. Some women wake up drenched in sweat every night and wonder whether their joints are actually approaching 90 rather than 50. Others can definitely vouch for the joint pain, but instead of experiencing night sweats they feel like they are losing the plot because their cognition is impacted so badly.
I think of this in terms of a recipe, say a stew that you cook on a regular basis. Your friends also cook a stew with exactly the same name really often as well. However, when you compare recipes, you actually find that whilst you are using one type of meat, your friend is using a different type, or no meat at all, they might be using a plant-based alternative. You also find that you might or might not use different types of broth, different types of vegetables and different types of herbs and spices – All in a stew that you both call exactly the same! Or you might find that when it comes to the actual ingredients list, your shopping lists look identical and it is only the amount for each ingredient that is different! You might use one teaspoon of oregano, your friend chucks in a tablespoon every single time. And sometimes, she might even go a bit over that because on that day even more oregano just feels like the thing to do.
Welcome to the menopause experience! Like a stew with a lot of communalities between recipes AKA individuals but variations that ultimately make up the final dish or your mix of menopause symptoms.
In addition to this, we also have evidence that the type, number and severity of menopause symptoms might depend on genetics (what did your female relatives, especially your mum go through), educational status, income (poorer and less educated women tend to have more and/or more severe symptoms) and ethnicity. In recipe-speaking terms this could be compared to you using a recipe that has been handed down in your family, or you would prefer a specific cut of meat but go for a cheaper one because of affordability, or the type of ingredients depends on what is being used in your culture.
One final thing that might influence the composition of your stew is the your exposure to different factors in your wider environment. Whilst you might have certain ingredients in your original recipe, you were not able to get hold of these in the supermarket and need to substitute. Your family recipe, i.e. menopause experience, is not what it might have normally been, because of new influences from your environment that has resulted in you having to make adjustments to a recipe that you inherited from your mum.
Eating habits as a response to your personal menopause experience
Therefore, in my eyes, apart from the purely physiological experience of the menopause transition, there is also the question of what is it that bothers an individual the most. You might find hot flushes annoying and embarrassing at times, but the fact that your joints and muscles ache is actually bothering you the most because it really stops you from being as active as you used to be. In the first case it is the temperature regulation system in the brain that is affected by the hormonal changes, in the second the musculoskeletal system. And an approach tackling one symptom does not necessarily work as well on the others. There will be a lot of overlaps when it comes to food and nutrition choices and often this is fortunately a case of catching more than one bird with the same stone, but there might be nuances in the effectiveness, and expectations need to be realistic. I think that this is important to know so that you can take a more targeted approach that works for yourself.
In addition to this, as you will come to find in future posts, not every person is responding to the same approach in the same way. What works for your friend might for some reason not work (as well) for you. Another case of not one size fits all…Therefore, I repeat that asking the question ‘What is the best diet for menopause symptoms’ is asking a question that is faaaar too generic and might not necessarily come up with useful answers for the individual person. Likewise, a statement that for example the Mediterranean Diet is the best diet for menopause might be misguided as (and I repeat again, I know!) this might not necessarily take into account that for many reasons our response to a specific diet might not be as successful as that of a friend or colleague. Finally, the adoption of more favourable dietary behaviours also depends on the acceptability (for one reason or another) of certain foods and ingredients making us willing to adjust our dietary intake. Therefore often-categorical statements might not be helpful for the individual, especially when daily life in general made even harder by menopause symptoms can already feel like a bit of a struggle.
You might say that I am too reductionist here and that I am creating a very artificial argument at the risk of actually overcomplicating things – the opposite of what I am trying to achieve. And I get that! We will see that specific dietary patterns or particular foods and nutrients will be a good choice to deal with a variety of menopause symptoms, not just one in particular. But they do not have to be the only option in our arsenal. Another dietary pattern might do the job just as well and suit an individual far better in terms of their food preferences, culture, traditions and affordability. Likewise, you might find that as you are on your journey through the menopause transition the type and/or severity of your symptoms might change. Therefore, one particular style of eating might no longer be the best option for you to improve those newer or more bothering symptoms, and some flexibility is required and a different tool in the dietary arsenal needs to be applied.
Over the next few weeks, I will be writing about some dietary patterns that have been found to have a positive impact on health, and I will explore how much we know about these with regards to whether they might be helpful to address the changes in the different systems of our body. To begin with we will take a look at the Mediterranean Diet next week.
To finish off this week’s post, here is your call to action!
This week I would like you to think about your own menopause symptoms. What are they? How severe are they? Which ones cause you the most hassle to get on with your daily life and feel like an at least halfway functioning human being? I am assuming that not everything will bother you in the same way. You might be exactly that woman that finds her severe hot flushes annoying, but they are not affecting you as much as the joint pain that stops you from being as active as you used to be!
I am not saying the other stuff (heart health, brain health etc) isn’t important, because it absolutely is (!), but we have to start somewhere, so I suggest start thinking about how your own quality of life is most affected at this point in time. My future posts can then help you to consider changes to your diet that might be particularly useful.
Once you have begun to successfully tackle these moving forward you will have a lot more energy, focus and motivation to think about your long-term health.
See you next week!