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We are working with Laura Clark, a registered dietitian with over 20 years experience in nutrition and dietetics.
All women will go through the menopause – it’s a rite of passage of sorts. However, it doesn’t happen overnight so let’s understand what’s happening in our bodies so we can work with them to feel good.
What is the menopause and when will it happen to me?
The transition into menopause and beyond can be divided into 4 stages:
Pre-menopause – The time in a woman’s life characteristic of menstrual cycles and periods with no signs of menopausal symptoms.
Perimenopause – (peri meaning around or near) is when hormonal changes begin. The menstrual cycle may change in length or regularity and periods may change in flow.
Menopause – When there is no period for 12 months a woman is said to have transitioned into menopause.
Post-menopause – The time of life after a woman has not had a period for 12 months. When considering average life expectancy, we may be spending at least one third of our life post-menopausal.
Is there a formal diagnosis for menopause?
There is no definitive test for menopause and any support or treatment you receive should be based on your clinical symptoms. Routine blood tests don’t add much value but may sometimes be used particularly if symptoms are occurring unexpectedly soon i.e. under the age of 40.
Some healthcare professionals may test your Follicle Stimulating Hormone (FSH) levels; we would expect to see higher levels of FSH as it encourages the ovaries to squeeze out as much oestrogen as they can. However, just like oestrogen, levels can fluctuate a lot so it’s much more important to look at the full picture.
How long does perimenopause last?
The average time that a woman is perimenopausal for is around 4 years. The UK average age for menopause is 51, so by mid-late forties most women will be experiencing their perimenopause. Everyone is different though, for some it might only be a few months and for others it might be longer than 4 years.
Perimenopause marks a time of huge adjustment for the body. Oestrogen has many functions within the body, so as levels begin to fluctuate and eventually decline, there are multiple impacts of this.
What we have become more aware of recently, is that many women do experience really difficult menopause transitions, with lots of symptoms, but don’t recognise at the time, that this is what is happening to them. Some of the symptoms such as low mood, anxiety, tiredness and poor sleep can be attributed to life stressors or aging generally and may stop women from seeking the help they need. Left unsupported or untreated, menopause can have a significant impact on our quality of life.
Thankfully, more information is available now and women are good at talking! Getting the help, support and the right treatment should feel more accessible for us. This alongside having an awareness of your own body, what ‘normal’ feels like and noting any changes is key to facilitating the right support at the right time.
What are the symptoms of the menopause?
85% of women will experience menopause symptoms to some degree. There are a broad range of menopausal symptoms, which affect women very differently but most experience at least one of the following symptoms:
When you start noticing these symptoms, it’s important you make note of them so that you can approach your GP or health professional with an accurate record of what’s been happening. The Balance app created by Dr Louise Newson, allows you to track your symptoms and download a health report which I’d recommend as a good place to start.
It’s good to know that there are lots of treatment options for menopause symptoms, from lifestyle changes to medication including Hormone Replacement Therapy (HRT).
Special menopause considerations for those with a stoma
You may notice your skin starts to feel different and that this then affects your stoma comfort. Skin can become dry, oily, sensitive or inflamed due to hormone imbalance, so you may need some help with finding the right products to support you through this phase.
Bowel habit changes associated with menopause
Changes in oestrogen also seems to have an impact on our gut health. Declining oestrogen is associated with less diversity in our gut bacteria, and this in turn might cause us to experience a change in our bowel habit. You may notice food passes through the bowel more quickly, which may cause constipation, diarrhoea, gas or bloating.
If you notice a change in your stoma output and you’re unsure what’s caused it, its useful to have on your radar that hormonal changes could be playing a part. As we’ve said the start of perimenopause can feel hard to decipher as many of the symptoms could be attributed to other things, so being aware of what normal is for you output wise is key.
What we eat can really help with the menopause transition so it’s a good opportunity to consider our diets and how we balance them to feel the best we can. You will already have a clear picture of the foods that suit your stoma and digestive health, so let’s bear this in mind when looking at what to eat for menopause.
What to eat for menopause?
Our diet can really help with easing the menopause transition. There are a number of dietary factors to consider, to protect our bones, our heart health, and help with menopause symptoms. Before we dive in, it’s important to remember, like we’ve said that there’s no ‘one-size-fits-all' approach.
What does a menopause-friendly diet look like?
Broadly speaking, there is evidence that a whole-foods diet high in fruits and vegetables, whole grains, high-quality protein and dairy products can help with reducing menopause symptoms. Phytoestrogens and healthy fats, such as omega-3 fatty acids from fish, may also help.
These dietary principles summarise the Mediterranean Diet, which is a way of eating based on the traditional cuisines of Greece, Italy and other countries that border the Mediterranean Sea. So, if you want a quick answer for what diet is best for menopause... the Mediterranean Diet is the one! The Mediterranean Diet seems to work in a number of ways to reduce inflammation in the body. A loss of oestrogen is associated with a more pro-inflammatory environment which is not good news for the body, hence why support coming from our diets is so important.
Another key consideration for any diet is controlling our blood sugar and this is particularly important during the menopause. You might have heard of the importance of blood sugar regulation for maintaining our energy levels throughout the day. During menopause, changes in the hormones oestrogen and progesterone affect how cells respond to insulin (the hormone which regulates blood glucose) and can trigger fluctuations in blood sugar levels which affects our energy levels and feelings of hunger.
Tips for maintaining blood sugar levels include eating regular balanced meals with gaps in-between them and increasing protein and fibre intake. Foods with a low glycaemic index such as wholegrain foods, non-starchy vegetables, beans and pulses, are really good choices for our blood sugar. Experiment with a level that you’re able to tolerate and retry foods as your stoma becomes more established.
Foods for bone health
The rate of bone mineral density loss increases during menopause due to the decline in oestrogen levels. One in three postmenopausal women have osteoporosis (a loss of bone mass), which increases fracture risk. To maintain bone strength and help prevent osteoporosis, try to incorporate the following nutrients in your diet:
Calcium
Public Health England (PHE) recommends a daily intake of calcium for adults 19-64 years to be 700 mg. Good dietary sources of calcium include dark leafy greens, dairy, tofu, sardines (or other fish eaten with bones), fortified plant-based drinks and dried figs.
Vitamin D
Vitamin D helps our body to absorb calcium and adults should be getting 10 micrograms (µg) of the stuff every day. Vitamin D is produced in our skin when we are exposed to UV radiation from the sun. During the summer months in the UK we should get enough sun exposure to make vitamin D and meet our needs. However, for the rest of the year we can’t rely on the sun so we need to ensure that we are consuming it through out diets. Dietary sources of vitamin D include:
However, as the Vitamin D in these dietary sources is limited, PHE recommend that everyone in the UK should take a 10µg vitamin D supplement every day at least during the winter months, and since the COVID pandemic, PHE now recommend that everyone take a vitamin D supplement in the summer months as well.
Foods for heart health
Post-menopausal women have an increased risk of cardiovascular disease, as oestrogen plays a role in maintaining our arteries and healthy cholesterol levels. Lower oestrogen levels also impact body composition, meaning fat is more likely to go to the tummy and carrying more fat on the tummy is associated with heart disease risk factors. With this increased risk it’s important to maintain a diet that lowers the risk.
Some important principles of a heart healthy diet include:
Other lifestyle factors that are important for heart health include avoiding smoking, exercising regularly, getting good quality sleep and limiting alcohol intake.
Phytoestrogens
Don’t be put off by the name! Phytoestrogens are just plant compounds with oestrogen-like properties. There are two main types: isoflavones which are found in soybeans, and lignans which are found in flaxseeds, whole grains, fruits, vegetables and legumes. Due to their chemical structure, when oestrogen levels are low (i.e. during menopause and post-menopause), these compounds can bind to oestrogen receptors and people may experience a mild oestrogenic effect such as less severe hot flushes. Most of the research on these compounds for the menopause focuses on isoflavones found in soya-based foods. Although the research is mixed, a review of over 400 studies conducted in 2021 concluded that eating around 50 milligrams of isoflavones daily is associated with both reduced frequency and severity of hot flushes. You’ll get this from just 2 servings of soya-based foods (like tofu, edamame beans, tempeh and soya milk).
Exercise and Movement in Menopause
We may have tried lots of different exercises over the years, and perhaps in the past used it simply as a method of burning calories. Our menopausal transition gives us the opportunity to approach exercise in a varied and smarter way. It has so much potential to support and strengthen us and alongside balanced nutrition, can provide a cornerstone for protecting our future health, both physically and mentally.
It's also an opportunity to give a vote for ourselves; to recognise the power of self-care and to reconnect with our mind and body for an improved sense of wellbeing.
I hope this has provided a helpful overview of the menopause and what you can do to support yourself through it.
For more information on the menopause check out:
Women's Health Concern | Confidential Advice, Reassurance and Education (womens-health-concern.org)
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