Nutritional support for Menopause

During the perimenopause and menopause life stage, the nutritional and lifestyle requirements for a woman changes with the reduction in endogenous oestrogen production.¹

Symptoms associated with menopause

Women may experience vasomotor changes including hot flashes, night sweats, perspiration and cold chills with vasomotor changes lasting on average 7 years, depending on the initiation of the vasomotor changes in the menopausal period with fluctuation also based on race and adiposity.^1,2 

Thermoregulatory signalling to the hypothalamus is thought to change during the menopausal period due to hormonal changes  with changes impacting a woman's sleep quality and energy levels.¹ 

An increase in stress, anxiety and depression incidence is correlated with the vasomotor symptom duration, making it important to support women with their symptoms to improve their quality of life.² 

Menopausal symptom treatment

Biomedical treatment of menopausal symptoms includes hormone therapy, shown to effectively reduce symptoms, despite the potential increased risk of chronic disease including cancer, blood clots, stroke and gallbladder disease.¹ As a result of these risks, many women seek support from complementary and alternative therapies to ease their menopausal transition.

Phytoestrogens

Phytoestrogens are found within plants and are structurally similar to oestradiol with weak oestrogenic properties. This structure allows the phytoestrogens to have both oestrogenic and anti-oestrogenic effects based on the up or down regulation of oestrogen receptors, operating as selective oestrogen receptor modulators (SERMS).¹ Phytoestrogens have a strong affinity for the beta oestrogen receptor, demonstrating greater effects on the blood vessels, bone, skin and central nervous system while the less responsive alpha receptors that target the breast and uterus are spared.¹

Phytoestrogens have been used to reduce the impact of hot flashes, and night sweats with genistein, a soy extract and isoflavone, associated with a reduction of symptoms due to its ability to stimulate nitric oxide production.^1,3 

Isoflavones have been used to manage changes to vaginal circulation leading to atrophy are associated with the reduction in nitric oxide production involved in vasodilation and oestrogen levels. Isoflavones are found in soy, chickpeas, lentils and beans and are considered safe for consumption.¹ 

Cardiovascular and bone health

Osteoporosis and cardiovascular disease risk increases following menopause due to the depletion of sex steroid hormones, particularly for early-onset menopause.⁴ Supplemental calcium may be required if the oesteoporotic risk is high, however, caution should be exercised to reduce the risk of cardiovascular harm, while concomitant vitamin D supplementation can support bone health and calcium absorption.⁴ Vitamin K further suports bone health by increasing bone strength and lowers the risk of oesteoporotic fractures in postmenopausal women.⁵

Oestrogen depletion changes the deposition of adipocytes in the body in an android pattern, increasing the risk of central adiposity, insulin resistance, diabetes and dyslipidaemia.⁴ Phytosterols and phytostanols are structurally similar to cholesterol, functioning to lower the absorption of cholesterol, lowering the level of circulating cholesterol and the subsequent cardiovascular risk.⁵ 

Dietary fibre can support gastrointestinal health and reduce the incidence of constipation, aid in the elimination of cholesterol.⁵

References

1. Roberts, H., & Lethaby, A. (2014). Phytoestrogens for menopausal vasomotor symptoms: A Cochrane review summary. Maturitas, 78(2), 79–81. https://doi.org/10.1016/j.maturitas.2014.04.004 
2. Avis, N. E., Crawford, S. L., Greendale, G., Bromberger, J. T., Everson-Rose, S. A., Gold, E. B., Hess, R., Joffe, H., Kravitz, H. M., Tepper, P. G., & Thurston, R. C. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine, 175(4), 531–539. https://doi.org/10.1001/jamainternmed.2014.8063 
3. Wong, W. W., Taylor, A. A., Smith, E. O. B., Barnes, S., & Hachey, D. L. (2012). Effect of soy isoflavone supplementation on nitric oxide metabolism and blood pressure in menopausal women. American Journal of Clinical Nutrition, 95(6), 1487–1494. https://doi.org/10.3945/ajcn.111.032045 
4. Lobo, R. A., Davis, S. R., De Villiers, T. J., Gompel, A., Henderson, V. W., Hodis, H. N., Lumsden, M. A., Mack, W. J., Shapiro, S., & Baber, R. J. (2014). Prevention of diseases after menopause. Climacteric, 17(5), 540–556. https://doi.org/10.3109/13697137.2014.933411 
5. Borrelli, F., & Ernst, E. (2010). Alternative and complementary therapies for the menopause. Maturitas, 66(4), 333–343. https://doi.org/10.1016/j.maturitas.2010.05.010 

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