Most medical research on the menopause has focused on relieving the hot flushes faced by up to 80% of menopausal women. Despite all the controversies of recent years, there’s no doubt that statistically speaking, HRT is the most effective treatment for hot flushes. But there’s more to life than HRT, and there’s more to the menopause than hot flushes. So here are my top tips for menopausal symptoms and how your diet might help.
Key ingredients - more soya and seeds, less curry and coffee
The Japanese have lots of bright ideas where diet is concerned. Obesity and heart disease levels are low in Japan, and much of the credit has been given to their diet. The average Japanese diet is high in soya (in the form of tofu), soya beans and soya milk and other products. They also have large quantities of oily fish and low levels of saturated fat and refined, sugary foods. Japanese women are much less likely to be troubled by hot flushes than their Western counterparts, and increasing your soya intake could just allow you to follow in their footsteps.
Seeds (linseed, pumpkin, sesame, sunflower) and red clover isoflavones, available as capsules from pharmacists (60-80 mg a day) have a similar effect. At the opposite end of the spectrum, spicy foods, coffee and alcohol may trigger hot flushes, so are worth avoiding.
The breast cancer conundrum
Key ingredients - less alcohol and animal fat, more soya?
Soya contains isoflavones, which mimic the effect of oestrogens. Importantly, concerns that this might make them unsafe for women with, or at high risk of breast cancer, have largely been allayed. In fact, one recent study suggested they might even slightly reduce the risk of dying in breast cancer patients. Recent studies also hint they don't increase oestrogen levels in humans, and the title of a review published by the American Institute for Cancer Research was clear - 'Soy is safe for breast cancer survivors'.
Personally, I'm always very wary about contradicting official medical advice, not least because there are several different types of breast cancer, some of which are 'oestrogen receptor positive' and some which aren't. So while I still currently recommend that women with breast cancer are wary about their soya intake, I do feel able to reassure healthy women that soya is safe.
Since breast cancer becomes more common after the menopause, it's worth knowing that every unit of alcohol you drink increases your risk of breast cancer by 7-11% - so keep an eye on your alcohol intake. A diet high in red (particularly processed) meat and saturated fat may also increase your risk.
Mood swings and tiredness
Key ingredients - wholegrain, nuts, seeds, whole fruit, turkey
There's still lots of controversy about how much the mood swings so often seen around the menopause are due to hormone changes, and how much are down to other life stresses around this age. But there's no doubt that keeping your blood glucose (sugar) stable can reduce irritability and counter sudden tiredness.
So keep chocolate and sugary foods for occasional treats, and major on 'slow-burn' foods to avoid sudden spikes and dips in your blood sugar. Unrefined carbohydrates (wholegrain and wholemeal), nuts and seeds, and whole fruit rather than fruit juice can help keep blood sugar steady.
Foods high in tryptophans can make it easier for your body to manufacture serotonin - a brain chemical linked to protection from depression. Turkey is the classic source, but if you don't want Christmas every day, try oats, root vegetables and cottage cheese
Key ingredients - wholegrain and wholemeal, veg, white meat, tofu, unprocessed food
Piling on the pounds isn't inevitable around the menopause, but sadly you are likely to struggle more to keep your waist trim. After the menopause, there's a tendency to accumulate any excess weight around your midriff. This apple-shape 'abdominal obesity' is more dangerous than other weight gain (the 'pear shape') in terms of type 2 diabetes and heart attack.
Being overweight also increases your risk of breast cancer - women in the obese weight range, with a BMI (body mass index) over 30 are up to 50% more likely to get breast cancer.
The key to avoiding weight gain isn't crash diets - it's sustainable changes to your diet. Key elements include:
- Managing your portion sizes (eating from smaller plates, not eating on the go, drinking a glass or two of water and eating 'mindfully' can all help).
- Filling your plate with vegetables before you add more calorie-loaded foods.
- Eating wholegrain and wholemeal 'complex carbohydrates' as well as proteins (lean white meat, tofu, eggs, seeds), which help keep you full and prevent food craving from sudden drops in blood sugar.
- Limiting sugary and processed foods.
Key ingredients - oily fish, fruit and veg, nuts, wholegrain foods, olive oil
Your risk of heart disease goes up after the menopause, probably linked to lower levels of the female hormone oestrogen. A Mediterranean-style diet has been shown time and again to protect you. And best of all, the key ingredients can help manage weight gain and mood swings too!
Key ingredients - dairy products, tinned fish with bones, tofu, green leafy veg, sunshine
Up to 1 in 3 women will break a bone due to osteoporosis and your risk rises rapidly after the menopause. Vitamin D is vital for bone health, and up to 90% of our vitamin D is made in our skins when we're exposed to sun. Of course, too much sun carries a risk of skin cancer, and many older people don't get out much. Oily fish, eggs and fortified cereals can help top up stores. An alternative is a 10 microgram daily supplement.
Calcium is also a key building block for bones, and you should try to up your intake after the menopause. Aim for three portions a day of milk/cottage cheese/yoghurt, pilchards/tinned salmon/sardines/whitebait, or tofu and seeds (again!).