Menopause support

Dr Philippa Kaye suggests some lifestyle changes to help support your health during the menopause

In the UK, the average age when the menopause hits is 51 years old, but the average life expectancy for females is 81. This means that a third of the average woman’s life is postmenopause. So we as women, and those around us, need to change our attitudes towards this stage to ensure that we can keep being who we are, being productive, being sexual, being happy. The menopause does not have to mean the end of relationships, libido, of sex, of work, of feeling like your “old self ”. You are still who you are – let’s value that, let’s celebrate that, let’s honour that. Let’s get informed and become empowered to make our own choices about our symptoms, our treatments, our minds and our bodies.

A balanced diet

A healthy diet is a balanced one and that includes occasional treats. No food is off limits, no food is “naughty”, “bad” or a “guilty pleasure”; it is just food, without any inherent moral value. Restricting too severely is likely to be unsustainable, which means that it won’t work and could lead to unhealthy attitudes towards food. Some food is more nutritionally dense than others, some is likely to fill you up and keep you full for longer, and other food may serve to bring joy and meet a social need. The key is variety, with nothing completely off limits (unless you are allergic to it), and everything in moderation.

• Aim for at least five portions of fruit and vegetables per day, preferably with more vegetables than fruit. All forms of fruit and vegetables count: fresh, frozen, canned, dried and even one juice per day.

• Increase your fibre intake. A high-fibre diet helps prevent constipation, regulate blood sugar and cholesterol, and decrease your risk of bowel cancer. In fact, a study showed that people who ate more fibre had fewer hot flushes. Eat the skins of your fruit and vegetables and add in seeds, wholegrains, nuts and pulses.

• Cut down or limit the amount of saturated fat you eat, such as red meat and cheese, swap for poultry, fish or low-fat cheese.

• Avoid processed or cured meats such as sausages, cold meats and bacon, or limit them as they are not only high in saturated fat but also linked to heart disease and cancers.

• Some fat is good. Increase the amount of healthy fats you eat, such as oily fish, nuts and avocadoes. Aim for two portions of oily fish per week, such as salmon, sardines or mackerel which are also high in omega-3 fatty acids which are good for heart health.

• Try to decrease the amount of salt in your diet, to help keep your blood pressure at a healthy level. It can take a little time for your palate to get used to less salt. Increasing herbs and spices can help boost the flavour instead.

• Avoid processed foods, which are often high in salt, fat and sugar.

• Spicy food can trigger hot flushes so avoiding it can be helpful.

• To help keep your gut microbiome happy, aim for diversity in the fruits, vegetables, nuts, seeds, wholegrains, legumes and herbs that you eat – try to aim for around 30 different plant-based foods each week. Adding probiotic foods such as yoghurt or kefir, or fermented foods like sauerkraut or kimchi, can also be helpful.

• Phytoestrogens are compounds found in plants that are similar, though not exactly the same, as oestrogen. Most of the research has been around a type of phytoestrogen called isoflavones, which are found in soy beans. More research needs to be done and the results of research about isoflavones have so far been mixed. One study has shown that 50mg of isoflavones per day (approximately 2 servings) can reduce flushes. Two servings of soy-based foods is approximately 100g soy mince, 100g edamame beans, or 500ml soy drinks. Tofu is also a source of low saturated fat and protein. Note that consuming soy-based foods is not the same as taking a phytoestrogen supplement.

Take some vitamin D
It is advised that all adults in the UK take a supplement of 10 mcg (400 IU) of vitamin D per day between October and the end of March, as most of us do not get adequate exposure to sunshine during this time to create enough vitamin D. If you have osteoporosis or are at greater risk of developing it, you may be advised to take a supplement of calcium and/or vitamin D.

Keep hydrated
Drink at least six to eight glasses of water per day, or 2 litres. It doesn’t have to just be water though, although try to limit juice to a maximum of one glass per day as juice is high in natural sugars. Tea and coffee do count towards your fluid intake but they are slightly diuretic so make you urinate more; the amount of liquid in the drink is likely to compensate for this, however.

Cut down on caffeinated drinks
Caffeine can trigger hot flushes so limiting your intake of tea and coffee can be helpful. It is a stimulant, so try to avoid it in the evening and late afternoon, as it can interfere with sleep, which is often an issue around the menopause. Caffeine can also make you feel irritable, worsen anxiety, cause palpitations and increase heartburn, so there are lots of reasons to cut down! If you do drink a lot of tea or coffee regularly and want to cut down, do so gradually to try to prevent headaches, which can be related to caffeine withdrawal.

Reduce alcohol
Just like smoking, we all know that too much alcohol is not a healthy choice, with impacts all over the body including liver disease and various cancers. Drinking alcohol can worsen many menopause symptoms such as hot flushes, urinary symptoms such as urgency, and is even associated with an increased risk of developing osteoporosis as it can affect how calcium is absorbed into your bones. Drinking alcohol is also associated with breast cancer. Women who drink three or more alcoholic drinks per week have a significantly higher risk of breast cancer than women who abstain from alcohol.

Stop smoking
Smoking is linked to respiratory diseases (such as COPD and emphysema), many forms of cancer (not just lung cancer, but cervical cancer and others) and increases your risk of cardiovascular disease such as heart attack and stroke. With regard to the menopause, smokers tend to go through the menopause on average two years earlier than non-smokers and even regular exposure to second-hand smoke can lead to a slightly earlier menopause. Smoking is also associated with an increased risk of developing osteoporosis and increases the likelihood of you having hot flushes, or more severe hot flushes. The NHS stop smoking website has lots of information about locally available stop smoking services.

Make time to exercise
Studies show that women who do cardiovascular exercise regularly have fewer menopausal symptoms, in addition to the myriad of other health benefits related to exercise. These include improvements to your cardiovascular health and helping you to manage your weight, but also psychological benefits – the natural endorphins released during exercise make you feel good! Exercise has been proven to be beneficial for various mental health conditions and is also likely to help with mood changes related to the menopause. With regard to hot flushes, studies have shown that if you are fit and exercise, exercise can reduce hot flushes. However, if you were unfit before the menopause, exercise may make flushes worse initially, so start slowly and gradually work your way up.

This is an edited extract from The M Word: Everything You Need to Know About the Menopause by Dr Philippa Kaye (£9.99, VIE Books)

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