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We are frequently asked about menopause; what to expect? How long does it last? Why do I get hot flushes? Menopause is complex and every woman experiences it differently so we are here to shed some light on this topic.
While it can be a seamless transition for some, many women find it a more challenging experience, but why? Let’s get stuck in and discuss some of the frequently asked questions!
According to the NHS, the current average age for menopause in the UK is 51.[i] This can commonly start between the ages 45-55. Starting menopause before the age of 40 is considered to be early menopause.
Typically, the first thing you may notice is changes to your menstrual cycle. Your periods may become less or more regular, and the flow might change too, being either lighter or heavier. Any of these are normal and vary from person to person until your periods stop completely. You can also visit your doctor who can take a blood test to measure your follicle-stimulating hormone (FSH) and oestrogen to confirm this.
There are various factors that can make menopausal symptoms worse, such as oral contraceptive use,[ii] excessive alcohol consumption, weight, smoking, lack of exercise,[iii] history of Pre-Menstrual Syndrome (PMS),[iv] and stress.[v]
There are 3 distinct phases within menopause but we often refer to menopause as the whole process of these phases:
Hot flushes are a classic symptom for many women during menopause, and often oestrogen gets the blame. The temperature regulation of skin alters dramatically during menopause due to the hormonal changes.[vi] However, this is not entirely due to changes in oestrogen levels. Elevated stress response plays a vital role in temperature regulation and can increase body temperature dramatically. In fact, it is often a key contributor to hot flushes.[vii] Therefore, it is important to reduce your stress levels as much as possible. From a dietary perspective, plant oestrogens, also called isoflavones, (found in flax seeds, soya, or red clover) can help to reduce hot flushes.[viii],[ix]
Oestrogen regulates numerous aspects of fat and glucose metabolism,[x] which in a post-menopausal oestrogen depleted state, can lead to changes in our metabolism, and ultimately in weight gain. This can be compounded by sleep disruptions, digestive symptoms, and stress, which are often experienced. Stress can greatly impact the ability to lose weight by stimulating blood glucose and driving fat storage. However, it is possible to lose weight during menopause by improving dietary and lifestyle choices:
Oestrogen is known to have an influence on our gut bacteria,[xiv] and the regulation of fluids in the body.[xv] This means that the fluctuations in oestrogen could be contributing to digestive symptoms such as bloating, reflux or constipation, as well as water retention (which can cause the feeling of bloating) during menopause. Maintaining gut microbial balance by increasing intake of dietary prebiotic fibre, fermented foods, supplementing with probiotics, and reducing your intake of processed, highly refined sugar is important to prevent digestive symptoms. Being hydrated and ensuring you’re consuming enough magnesium and potassium rich foods will support healthy and regular bowel movements, and proper kidney function.
Some women may opt for HRT if their symptoms are severe, or there are other medical reasons. In some cases, not all symptoms are 100% resolved, so there are still other nutritional strategies you can employ to help. On the other hand, it is important that the extra hormones are properly metabolised by your body to reduce the risk of any potential negative effects. Whether you are on HRT or not, the following tips will be helpful to support heathy oestrogen metabolism, but this is even more paramount if you are on HRT.
Low mood and anxiety are very common symptoms for many women throughout menopause.
However, this might not just be down to menopause. It’s always worthwhile getting vitamin D, B12 and folate levels checked with your GP, as these can all contribute towards low mood. Don’t assume it’s all hormonal. Entering this new stage in life can be daunting, and sometimes it’s not all about nutrition, rather about embracing the change and finding new ways to energise yourself. Perhaps finding a hobby that motivates you, even if that’s simply taking a stroll outside, or listening to music.
Oestrogen plays a huge role in bone metabolism, hence there is an increased risk of bone conditions such as osteoporosis post-menopause. A sedentary lifestyle can worsen the incidence of bone fractures and further increase the risk of osteoporosis.[xxvii] Therefore the need to support bone density increases post menopause. What can you do? Well, increasing certain nutrients such as vitamin D, K,[xxviii] calcium and boron,[xxix] as well as incorporating daily physical activity, more specifically weight resistance exercises can help to maintain bone strength.[xxx]
Yes. If you’re suffering with vaginal dryness or wrinkles, then supplementing with collagen and essential fatty acids could be a great option. Collagen is a key component for our connective tissue including skin, blood vessels, joints and bones. Oestrogen plays a big role in collagen production, so when it’s low, it can be one of the reasons for the loss in skin elasticity. Therefore, supplementing with collagen, vitamin C (which can further promote collagen production), phytoestrogens[xxxi], and essential fatty acids (omega-3) can improve overall skin appearance.[xxxii]
Although every woman will have different needs and symptoms, and it is best to discuss your individual requirements with a Nutritional Therapist or another professional, there are certain products everyone could consider as a baseline support:
If you have any questions we haven’t answered, or you would like to talk about your menopausal experience, please don’t hesitate to contact our Clinical Nutrition team or arrange to see a registered Nutritional therapist for personalised advice.
The brand you can talk to:
We have a team of friendly Nutritionists at the end of our advice line, open to you, for free expert health and product advice (5 days a week). 0121 433 8702 or firstname.lastname@example.org.
Or head to our advice page where you can find Healthnotes.
[i] NHS. 2018. Menopause. [online] Available at: https://www.nhs.uk/conditions/menopause/
[ii] Pokoradi et al. Factors associated with age of onset and type of menopause in a cohort of UK women. Am J Obstet Gynecol 2011, 205;1-13.
[iii] Morris et al. Body Mass Index and other lifestyle factors in relation to age at natural menopause. Am J Epdiemiol 2012 175:998-1105.
[iv] Freeman et al. Premenstrual Syndrome as a predictor of menopausal symptoms. Obstet Gynecol 2004,103;90-6.
[v]Pimenta et al. Menopausal Symptoms: do life events predict severity of symptoms in peri-and post-menopause? Maturitas 2012, 72:324-31
[vi] Charkoudian N. Skin Blood Flow in Adult Human Thermoregulation: How It Works, When It Does Not, and Why. Mayo Clin Proc. 2003; 603-612.
[vii] Freedman, R. Menopausal Hot Flashes: Mechanisms, Endocrinology, Treatment. J Steroid BioChem Mol Biol. 2014; 115-120.
[viii] Bedell. The pros and cons of plant oestrogens for menopause. J Steroid Biochem Mol Biol 2012,epub Dec 25
[ix] Guttuso. Effect and clinically meaningful non-hormonal hot flash therapies. Maturitas 2012, 72;6-12
[x] Lizacano F et al Estrogen Deficinecy and the Origin of Obesity during Menopause. Biomed Res Int. 2014; 1-11.
[xi] Guess et al. A randomized controlled trial: the effect of inulin on weight management and ectopic fat in subjects with prediabetes. Nutrition & Metabolism. 2015 12:36.
[xii] Awad et al. Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system. Can J Physiol Pharmacol. 2007 Sep; 85 (9): 933-42
[xiii] Awad R, Muhammad A, Durst T, Trudeau VL,Arnason JT. Bioassay-guided fractionation of lemon balm (Melissa officinalis L) using anin vitromeasure of GABA transaminase activity. Phytotherapy Research 2009; 23(8): 1075–8.
[xiv] Mulak A et al Sex hormones in the modulation of irritable bowel syndrome. World J Gastroenterol. 2014; 2433-2448.
[xv] Stachenfeld N. Hormonal Changes During Menopause and the Impact on Fluid Regulation. Reproductive Sciences. 2014; 21(5): 555–561.
[xvi] Park EJ, Pessuto JM. Botanicals in cancer chemoprevention. Cancer Metastasis Rev 2002;21:231-55.
[xvii] Nestle M. Broccoli sprouts in cancer prevention. Nutr Rev 1998; 56:127-30
[xviii] Zhang Y, Callaway EC. High cellular accumulation of sulphoraphane, a dietary anticarcinogen, is followed by rapid transporter-mediated export as a glutathione conjugate. Biochem J. 2002; 364: 301-7
[xix] Li et al. Sulforaphane, a dietary component of broccoli/broccoli sprouts, inhibits breast cancer stem cells. Clinical Cancer Research2010 16 (9): 2580–2590.
[xx] Conaway CC, Getahun SM, Liebes LL, et al. Disposition of glucosinolates and sulforaphane in humans after ingestion of steamed and fresh broccoli. Nutr Cancer 2000;38:168-78.
[xxi] Nestle M. Broccoli sprouts in cancer prevention. Nutr Rev 1998;56:127-30.
[xxii] Barcelo S, Mace K, Pfeifer AM, Chipman JK. Production of DNA strand breaks by N-nitrosodimethylamine and 2-amino-3-methylimidazo[4,5-f]quinoline in THLE cells expressing human CYP isoenzymes and inhibition by sulforaphane. Mutat Res 1998;402:111-20
[xxiii] Michnovicz et al. Changes in levels of urinary estrogen metabolites after oral indole-3-carbinol treatment in humans. J Natl Cancer Inst 1997;89(10):718-23.
[xxiv] Auborn et al. Indole-3-carbinol is a negative regulator of estrogen. J Nutr. 2003 Jul;133(7 Suppl):2470S-2475S
[xxv] Kunimasa et al. Biosci Biotechnol Biochem. 2008 Aug;72(8):2243-6. Epub 2008 Aug 7.
Indole-3-carbinol suppresses tumor-induced angiogenesis by inhibiting tube formation and inducing apoptosis.
[xxvi] Constantinou A, Stoner GD, Mehta R, et al. The dietary anticancer agent ellagic acid is a potent inhibitor of
[xxvii] Willems H et al Diet and Exercise: a Match Made in Bone. Curr Osteoporosis Rep. 2017; 555-563.
[xxviii] Villa J et al Effect of Vitamin K in Bone Metabolism and Vascular Calcification: A Review of Mechanisms of Action and Evidences. Crit Rev Food Sci Nutr. 2017; 3959-3970.
[xxix] Daly R. Exercise and Nutritional Approaches to Prevent Frail Bones, Falls and Fractures: An Update. Climacteric. 2017; 119-124.
[xxx] Daly R et al Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Braz J Phys Ther. 2019; 170-180.
[xxxi] Hidalgo L et al The Effect of Red Clover Isoflavones on Menopausal Symptoms, Lipids and Vaginal Cytology in Menopausal Women: A Randomized, Double-Blind, Placebo-Controlled Study. Gynecol Endocrinol. 2005; 257-264.
[xxxii] Jenkins G et al Wrinkle reduction in post-menopausal women consuming a novel oral supplement: a double-blind placebo-controlled randomized study. Int J Comet Sci. 2014; 22-31.
[xxxiii] Hidalgo et al. The effect of red clover isoflavones on menopausal symptoms, lipids and vaginal cytology in menopausal women: a randomized, double-blind, placebo-controlled study. Gynecol Endocrinol. 2005 Nov;21(5):257-64
[xxxiv] Bedell. The pros and cons of plant oestrogens for menopause. J Steroid Biochem Mol Biol 2012,epub Dec 25
[xxxv] Guttuso. Effect and clinically meaningful non-hormonal hot flash therapies. Maturitas 2012, 72;6-12
[xxxvi] Chiechi. Utility of dietary phyto-ooestrogens in preventing post-menopausalosteoporosis. Current Topics in Nutraceutical Research 2005 (3)1; 15-28.