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Menopause is an important developmental phase within a woman’s life cycle and marks the transition from reproductive to non-reproductive years as sex hormone levels change and a woman no longer experiences monthly menstruations.

Menopause can occur as part of natural biological aging or as a result of surgical or medical procedures and has been associated with an increased risk of some chronic diseases, from cardiometabolic dysfunctions to musculoskeletal conditions to chronic pain.^1-4 The timing of menopause may also be linked to increased disease risks, with early menopause associated not only with higher cardiovascular (CVD) disease risk⁵ than later menopause but also with higher potential risk of chronic kidney disease⁶ and dementia.⁷

Across the stages of the menopause transition, as estrogen levels drop, impairment of endothelial function and acceleration of vascular aging have been noted.⁸ In addition, obesity, cancer, endometriosis, CVD, and poor cognitive function are all marked by gut dysbiosis and can be considered estrogen-modulated conditions.⁹ More broadly, hormonal changes in aging patients have been associated with greater risk of frailty and disability,¹⁰ likely due to disruptions along several hormonal axes rather than deficiency of a single hormone.

Lifestyle & Menopause

Research studies continue to emphasize the importance and the benefits of incorporating or enhancing lifestyle-based approaches such as nutrition and exercise to counter these increased risks and promote health at menopause and during postmenopausal years.^11-14 In the following video, functional medicine practitioner Margaret Christensen, MD, IFMCP, shares her patient-centered approach to menopause.

Mediterranean and Plant-Based Diets

Nutrition is an important pillar of lifestyle interventions that can impact hormonal balance. At the most basic level, consumption of anti-inflammatory foods—specifically fruits and vegetables—may help alleviate symptoms of many chronic conditions associated with increased inflammation.^15,16

Reduced estrogen increases cardiometabolic risks for women entering menopause, but nutrition can make a significant difference in the health impacts. For example, a recent study found that the Mediterranean diet has a cardioprotective effect for women during the menopausal transition and at menopause, but only with a high adherence to the diet.¹⁷ This cardioprotective effect included lower total cholesterol, resting heart rate, low-density lipoprotein (LDL) cholesterol, triglycerides, C-reactive protein, and clustered cardiometabolic risk.¹⁷

The Mediterranean diet includes the consumption of fish, which contains omega-3 fatty acids; therefore, some of these noted cardioprotective results may be partly due to changes in fat intake. A 2023 meta-analysis of randomized controlled trials reported that among postmenopausal women, omega-3 fatty acid supplementation resulted in a significant reduction in triglyceride concentrations and a modest elevation of high-density lipoprotein (HDL) cholesterol.¹⁸ The report also indicated that while total cholesterol values were not affected, there was a modest elevation in LDL cholesterol levels.¹⁸

During the menopause transition, vasomotor symptoms such as hot flushes and night sweats are frequently reported, and nutrition may play a part in managing vasomotor symptoms and enhancing quality of life. A cross-sectional study, based on food frequency questionnaires and survey responses only, found that women who were in the menopausal transition and ate a vegan diet reported less bothersome vasomotor symptoms than those who ate an omnivore diet.¹⁹ Also, a small study selected two diets, a lacto-ovo-vegetarian diet rich in omega-3 fatty acids and a lacto-ovo-vegetarian diet rich in extra virgin olive oil and compared their efficacy in reducing vasomotor symptoms in women entering menopause.²⁰ While improvements were not reported for all evaluated vasomotor symptoms, the diet rich in omega-3 fatty acids showed significant improvement for reports of hot flashes.²⁰

Conclusion

Healthy nutrition can affect both longevity and quality of life in women at menopause and during postmenopausal years,²¹ and understanding the significant health impact of lifestyle habits during this phase of life is important. One study found that health education interventions that focused on lifestyle modifications given to women at menopause improved sustainability of health-promoting behaviors and ultimately enhanced the women’s health status.²²

With functional medicine, a patient-centered framework promotes this collaboration between patient and practitioner to fully involve the patient in their healing and health. Practitioners trained in functional medicine use many lifestyle-based techniques and tools in their clinical strategies to help patients achieve optimal health in all stages of life. To find a functional medicine practitioner near you, click below.

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References

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2. Jeong HG, Park H. Metabolic disorders in menopause. Metabolites. 2022;12(10):954. doi:3390/metabo12100954
3. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28(9):973-997. doi:1097/GME.0000000000001831
4. Gibson CJ, Li Y, Bertenthal D, Huang AJ, Seal KH. Menopause symptoms and chronic pain in a national sample of midlife women veterans. Menopause. 2019;26(7):708-713. doi:1097/GME.0000000000001312
5. Zhu D, Chung HF, Dobson AJ, et al. Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Hum Reprod. 2020;35(8):1933-1943. doi:1093/humrep/deaa124
6. Qian D, Wang ZF, Cheng YC, Luo R, Ge SW, Xu G. Early menopause may associate with a higher risk of CKD and all-cause mortality in postmenopausal women: an analysis of NHANES, 1999-2014. Front Med (Lausanne). 2022;9:823835. doi:3389/fmed.2022.823835
7. Liao H, Cheng J, Pan D, et al. Association of earlier age at menopause with risk of incident dementia, brain structural indices and the potential mediators: a prospective community-based cohort study. EClinicalMedicine. 2023;60:102033. doi:1016/j.eclinm.2023.102033
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10.  Clegg A, Hassan-Smith Z. Frailty and the endocrine system. Lancet Diabetes Endocrinol. 2018;6(9):743-752. doi:1016/S2213-8587(18)30110-4
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13.  Silva TRD, Martins CC, Ferreira LL, Spritzer PM. Mediterranean diet is associated with bone mineral density and muscle mass in postmenopausal women. Climacteric. 2019;22(2):162-168. doi:1080/13697137.2018.1529747
14.  Lee H, Son K, Lee I, Lim H. Effects of nutrition education with intervention mapping on cardiovascular disease risk factors in women with borderline dyslipidemia: analysis according to menopausal status. J Obes Metab Syndr. 2023;32(3):269-278. doi:7570/jomes23013
15.  Zwickey H, Horgan A, Hanes D, et al. Effect of the anti-inflammatory diet in people with diabetes and pre-diabetes: a randomized controlled feeding study. J Restor Med. 2019;8(1):e20190107. doi:14200/jrm.2019.0107
16.  Poulsen NB, Lambert MNT, Jeppesen PB. The effect of plant derived bioactive compounds on inflammation: a systematic review and meta-analysis. Mol Nutr Food Res. 2020;64(18):e2000473. doi:1002/mnfr.202000473
17.  Ruiz-Cabello P, Coll-Risco I, Acosta-Manzano P, et al. Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project. Nutr Metab Cardiovasc Dis. 2017;27(3):217-224. doi:1016/j.numecd.2016.10.008
18.  Wang J, Gaman MA, Albadawi NI, et al. Does omega-3 fatty acid supplementation have favorable effects on the lipid profile in postmenopausal women? A systematic review and dose-response meta-analysis of randomized controlled trials. Clin Ther. 2023;45(1):e74-e87. doi:1016/j.clinthera.2022.12.009
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