Menopause and Nutrition

What is menopause


Clinically, menopause is diagnosed when a woman has not menstruated for one year due to the loss of ovarian follicular activity, which typically occurs at around 45–55 years of age. Menopause occurs over several years and not at a single point in time.


It is preceded by a stage where women experience irregular menstrual cycle, referred to as menopausal transition (perimenopause), which involves coping with the cessation of oocyte production in the ovaries




Symptoms / Changes

Hormonal change is among the major physiological changes associated with menopause

During a woman’s fertile life, the average level of total estrogen is 100–250 pg/mL. However, the concentration of E2 in circulation declines up to 10 pg/mL postmenopause.


This hormonal menopause is associated with pathological menopausal syndromes, such as:

  • Disturbances in sleep/mood

  • Vasomotor symptoms (including hot flashes and night sweats)

  • Urogenital atrophy

  • Osteopenia and osteoporosis

  • Psychiatric disorders

  • Sexual dysfunction

  • Skin lesions

  • Cardiovascular diseases (CVDs)

  • Cancer

  • Metabolic disorders

  • Obesity

Vasomotor Symptoms such as hot flushes and night sweats are one of the most common symptoms experienced by women during the menopausal transition. The median duration of these symptoms is 4 years but may persist as long as 15 years for some women.





A prospective study of 6040 women demonstrated that a Mediterranean-style diet and a fruit-rich diet were both inversely associated with Vasomotor symptoms. Conversely, diets with high-fat and sugar contents increased the risk of vasomotor symptoms 

Body changes


During menopausal transition (usually spans 2–7 years) clinical changes occur in the body composition due to aging and hormonal changes.

Menopause-induced estrogen deficiency may also lead to various metabolic disorders, including dysregulated lipid metabolism.


Weigh Gain


Ovarian estrogens increase the storage of peripheral fat mainly in the gluteal and femoral subcutaneous regions, while androgens—primarily bioavailable testosterones—augment the accumulation of visceral abdominal fat. The marked decrease in estrogen concentrations accompanying relative hyperandrogenism is regarded as the main factor that causes weight gain and redistribution of body fat in postmenopausal women.


In addition, postmenopausal women exhibit lower Fat Free Mass (FFM) or Lean Body Mass (LBM) in the whole body, trunk, and lower extremity regions than premenopausal women. This loss of FFM or skeletal muscle results in an age-related decline in the basal metabolic rate (BMR) and weigh gain.




Health


Menopausal women are at high risk for developing Cardio-vascular disease (CVDs) due to dysregulated lipid metabolism and estrogen deficiency. Moreover, several studies have reported that there is a positive correlation between menopausal status and high levels of total cholesterol, LDL, apo-B, and high total cholesterol to HDL ratio. The total cholesterol to HDL ratio is a better indicator of CVD than total cholesterol itself.


Also, Increased adiposity in postmenopausal women is significantly associated with hyperinsulinemia, which suggests that insulin resistance may be responsible for the development of the key features of postmenopausal dyslipidemia, obesity, metabolic syndrome, and type 2 diabetes.


Nutrition


  • Approximately 10%–35% protein-derived energy, 45%–65% carbohydrate-derived energy, and 20%–35% fat-derived energy

  • The current recommended dietary allowance (RDA) for dietary protein intake is 0.8 g/kg/day for adults. However, the high prevalence of sarcopenia observed among postmenopausal women indicates the need for higher protein intake. 1.0–1.2 g/kg/day may compensate for some loss of muscle mass.

  • The traditional healthy diet involving high consumption of sea fish, seaweeds, dairy products, cereals, fresh vegetables, and fruits and low consumption of fast foods, animal fat-rich foods, sweets, and fried foods has a protective effect against the dysregulation of lipid metabolism.

Vitamin D


  • A cross-sectional analysis of 292 postmenopausal women aged 50–79 years in the Women’s Health Initiative Calcium–Vitamin D trial revealed that higher serum 25(OH)D levels were inversely correlated with adiposity, BMI, and waist–hip ratio.

  • This indicated that postmenopausal obese women are susceptible to vitamin D deficiency. Vitamin D deficiency is also associated with high triglyceride (TG) levels in the blood.

  • Vitamin D supplementation is necessary for menopausal women as it promotes bone metabolism and prevents osteomalacia and osteoporosis

  • Furthermore, vitamin D has been reported to ease metabolic diseases, but also improving the quality of life in postmenopausal women.

  • Also, studies suggest that the intake of calcium, vitamin D, and insulin along with isoflavones have a positive effect on the quality of life parameters (hot flashes, anxiety, and depressive symptoms), sexual life, body composition, and metabolic parameters in menopausal women.


Resveratrol


Resveratrol is also recommended to improve the quality of life parameters, such as dryness of vagina, heart discomfort, and sexual problems, in healthy postmenopausal women


Omega-3


Oral supplementation of 900 mg omega-3 per day significantly decreased BMI, waist circumference, blood pressure, serum triglyceride, interleukin (IL)-6, and insulin resistance in a randomized controlled trial involving 87 postmenopausal Brazilian women.


Generally


Women experience menopause with aging. Menopause may lead to various changes in lipid metabolism due to reduced estrogen secretion. These changes include enhanced fat mass and decreased FFM, which affects the BMR. Additionally, these changes increase the susceptibility to adiposity and obesity. As menopause is associated with altered lipid levels and increased risk of metabolic disorders, including CVD, postmenopausal women must consume recommended diets and beneficial foods.



References:

  • Ko SH, Kim HS. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020 Jan 13;12(1):202. doi: 10.3390/nu12010202. PMID: 31941004; PMCID: PMC7019719.

  • Dunneram Y, Greenwood DC, Cade JE. Diet, menopause and the risk of ovarian, endometrial and breast cancer. Proc Nutr Soc. 2019 Aug;78(3):438-448. doi: 10.1017/S0029665118002884. Epub 2019 Feb 1. PMID: 30706844.

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