Nutrition for the Menopause

The menopause happens to every woman, however it is not something that is discussed very widely, even between women. Although there have been recent articles, TV shows and books that have brought it into the spotlight there are still a lot of myths around the best medical and nutritional management.

First, it is important to understand what we mean by the menopause and perimenopause.

The menopause is defined as not having a period for at least 12 months and not using hormonal contraception (NICE, 2015). At this point the ovaries stop producing eggs and oestrogen levels are low. This usually happens between 45-55 years old.

The perimenopause is when you have symptoms but your periods are still present, however there may be change in the normal pattern of your period. They can become irregular and eventually they will stop (NICE, 2015). The symptoms are due to the hormonal fluctuations during this time.

There are a lot of common symptoms of the menopause and perimenopause these can include: 

  • hot flushes

  • difficulty sleeping, which may be a result of night sweats and make you feel tired and irritable during the day

  • headaches and migraines that are worse than usual

  • muscle aches and joint pains

  • changed body shape and weight gain

  • skin changes including dry and itchy skin

  • reduced sex drive

  • vaginal dryness and pain, itching or discomfort during sex

  • recurrent urinary tract infections (UTIs)

  • mood swings

  • low mood

  • brain fog – problems with memory and concentration

These symptoms can last for months or years, it is very variable.  It is also possible to just get one or two of the above symptoms or all of them. In general, the symptoms tend to worsen as you approach full menopause.

When reading the list of common symptoms, it’s no wonder it can affect your training and even force people to stop exercising.

There is very limited scientific research into female athletes, there is even less when looking at perimenopausal and postmenopausal athletes! Historically there has been little participation in events and competition by older women as athletes tended to retire in their 30’s.

However, with the rise of ultrarunning and age-group triathlons, to name a couple, this has encouraged continued participation to a much older age. Whilst we wait for the scientific community to catch up with this shift and provide us with some improved evidence for female athletes specifically, there is evidence the exercise can help improve some of the common symptoms including hot flushes, as well as promoting healthy ageing.

Hormone Replacement Therapy (HRT) is the main medical management for the symptoms of perimenopause and menopause. HRT replaces the hormones that have declined through the menopause, a large number of the products use oestrogen but there is a wide variation including combined oestrogen and progestogen.

I would recommend speaking with your GP or specialist about which medication would be suitable for you.

Taking HRT can be a great way to help maintain performance and also to maintain and to help promote the building of lean body mass.

There are a few dietary recommendations to focus on to ensure that your diet is optimal during this transition, this is for all women not specifically for running. However, when focusing on performance nutrition it is always important to ensure that your baseline diet is optimal therefore don’t forget the basics.  

Calcium and Vitamin D

Due to the decrease in oestrogen there is an increased rate of bone density loss and muscle loss, which can increase the risk of osteoporosis. Having a balanced diet but focusing on calcium and vitamin D is important for bone health. Alongside this, exercise and specifically resistance exercise is important to help preserve and build muscle mass. Resistance exercise is also important alongside any running training so it’s good to know that this will have added health benefits.

The recommended daily amount of calcium is 700mg per day for adults, however this may increase especially if you are experiencing or at higher risk of osteoporosis. Ensuring that you reach this amount is important, you can do this by aiming to have 2-3 portions of calcium rich foods every day. This can include:

  • 200ml semi skimmed milk/fortified milk alternative

  • Matchbox size piece of cheese

  • Small yoghurt

  • 2-3 slices of white/brown bread

  • ½ can sardines (with bones)

  • Small portion whitebait

  • Calcium -fortified breakfast cereals 

Alongside calcium it is important to ensure you get sufficient Vitamin D, as it aids the absorption of calcium from food. In the UK the sun is only strong enough during the middle of the day from April to September for our body to be able to synthesise vitamin D from it.

So, during the winter months a supplement is recommended, and if you are not getting enough sunlight in the summer months you may need to continue this supplementation all year. It is recommended to supplement with 10 micrograms per day. There are some foods rich in Vitamin D (e.g., oily fish, cod liver oil, egg yolk, meat, offal and fortified breakfast cereals), but it is very difficult to eat sufficient amounts consistently to keep your vitamin D levels up.

Healthy balanced diet

The menopause can be associated with weight gain which can be troublesome for many women as it is often unwanted but can also affect sporting performance, or confidence to exercise. Due to the reduction in muscle mass this can often mean that your nutritional requirements may slightly decrease.

Ensuring that you are having a healthy balanced diet rich in fruit, vegetables, fibre and wholegrains is important to help maintain your weight but also beneficial for a number of medical conditions.

However, it is important if you are still exercising or training for an event that you need to fuel for the work required.

It is not always needed to decrease the amount you are eating, sometimes it can be altering the timing during the day, and differing the intake day to day to match your training. This will be individual to you, so a one-size-fits-all approach is unlikely to always work.

Protein

Ensuring that you are getting sufficient protein in your diet is important to aid muscle building and preservation. This is likely to be at least 1.2g per kg bodyweight per day, however will vary depending on your type and level of exercise. But it is also important in your recovery after training sessions and races. Protein sources include meat, chicken, fish, beans and lentils, dairy, meat alternatives. Both animal and non-animal sources are good to eat.

Hot flushes

There are a few potential trigger foods and drinks that may start or make your hot flushes worse. These include spicy food, caffeine, hot drinks and alcohol. If you find these are causing your symptoms then reduce down to a moderate amount or avoid altogether. Remember to check any sports gels/products to see if they contain caffeine. If you are overweight, then you may find losing some weight beneficial and reducing the burden of hot flushes.

There has been a lot of interest in phytoestrogens (plant oestrogens), specifically isoflavones helping ease hot flushes and night sweats. Phytoestrogens have a similar but not identical structure to human oestrogen, meaning if they are eaten regularly then they can have a weak oestrogen like effect without changing oestrogen levels.

It has been evidenced to be safe to eat 100mg isoflavones daily, this equates to: 250g tofu, 100g soya mince, 100g tempeh, 100g edamame beans, 2x 250ml soya drink. It has also been proven that having regular phytoestrogens does not increase you risk of breast cancer or recurrence. 

Overall, in conclusion as with all performance nutrition there is not one size fits all. Don’t forget that ensuring your baseline diet is healthy and varied is very important. However, there may be a few dietary alterations to help with some menopause symptoms and help keep your training on track to continue enjoying your running.

References and Resources

NICE. Menopause: diagnosis and management. NG23. 2015. Accessed: https://www.nice.org.uk/guidance/ng23 

NHS website: Menopause.  https://www.nhs.uk/conditions/menopause/

BDA (British Dietetic Association) Food facts: Calcium. https://www.bda.uk.com/resource/calcium.html

BDA Food facts: Menopause and diet. https://www.bda.uk.com/resource/menopause-diet.html

About the author: 

Rachel is a sports dietitian and ultra-runner. She supports athletes with their performance nutrition via Rachel White Nutrition. 

Kate Allenultrarunning, ultrarunninglife, longdistancerunning, trailrunning, trailrunninglife, longdistancerunner, trailrunningcommunity, enduranceracing, ultramarathon, ultramarathontraining, ultramarathonrunner, ultramarathons, trailandultrarunning, trailandultra, 100mile, enduranceathlete, ukrunchat, runchat, 100 mile races, 100 mile ultra, ultra races, ULTRA magazine, ULTRA magComment