Nutrition for Menopause Management

Presented by Dalal Ahmad
Supervised by Dr. Nour Elsahoryi
Menopause
Nutrition

1) Introduction
1.1 Menopause definition & stages.
1.2 Menopause causes.
1.3 Menopause symptoms & pathophysiology.
1.4 Menopause complications.
1.5 Nutrition related menopause.
Calcium, vitamin D, dietary protein, diet for heart health,
diet for weight gain, fruits & vegetables, caffeine, salt,
alcohol, spicy food.
1.6 Exercise & life style changes.
1.7 Medications therapy.
2) Related studies
2.1 Study (1)
2.2 Study (2)
2.3 Study (3)
3) Conclusion
4) Recommendations
5) References
outline
1

1.1 Menopause definition & stages
Perimenopause
Menopause
Postmenopause
Perimenopause can begin eight to 10 years before men
opause, when the ovaries gradually produce less estrog
en.
Menopause is diagnosed when a woman has gone with
out a menstrual period for 12 consecutive months.
The rest of woman life after going through menopause.
(
Cleveland Clinic, 2019
)
Figure 1. Menopause definition & stages.
2

Hormone levels
(
Cleveland Clinic, 2019
)
As woman age, the hormone levels
drop. The strongest symptoms of m
enopause happen during the largest
drop in the hormone levels.
figure 2. Relation between hormone level & severity of symptoms.
3

1.2 Menopause physiological causes
Causes
Natural decline
of reproductive
hormone
Hysterectomy
Chemotherapy and
radiation therapy
Primary ovarian
insufficiency
(
Peritonitis - Symptoms and causes - Mayo Clinic, 2018
)
Figure 3. Menopause causes.
4

1.3 Menopause symptoms
Irregular periods
Hot flashes
Sleep disorders
Vaginal drying
A woman can have irregular periods for several mont
hs to years before her periods finally stop.
Is a feeling described as suddenly being hot, flushed
and uncomfortable, especially in the face and neck.
Sleep often is disturbed by night time hot flashes.
As estrogen levels fall, the vagina's natural lubricants
decrease.
(
Vliet, 2002
)
Figure 4.1. Menopause symptoms.
5

1.3 Menopause symptoms
Depression
Osteoporosis
Irritability
Cardiovascular
disease
The chemical changes that happen during menopause
do not increase the risk of depression.
Is commonly caused by poor sleep resulting from night
time hot flushes.
As estrogen levels drop and remain low during menop
ause, the risk of developing osteoporosis increases.
After menopause, the rate of heart disease in women
continues to rise and equals that of men after age 65.
(
Vliet, 2002
)
Figure 4.2. Menopause symptoms.
6

1.3 Severity of menopausal symptoms in
jordan
• Vasomotor signs were reported to have the highest
scores for severity as manifested by hot flushes and
night sweating.
• There was a significant relationship between the se
verity and occurrence of menopausal symptoms an
d age, family income, level of education, number of
children, perceived health status and menopausal st
atus.
(
Gharaibeh, Al-Obeisat and Hattab, 2010
)
Figure 5. Severity of menopausal
symptoms in Jordan.
Moderate
Mild
Severe
7

1.3 Menopause pathophysiology
• Menopause is a normal physiologic process in aging women, in which the
number of ovarian, primary follicles quickly diminish, such that there are in
adequate amounts to respond to the effects of FSH.
• No LH surge, and ovulation does not take place, resulting in the decline of
estrogen production and the cessation of menstruation.
• LH and FSH go uninhibited and remain at high levels years after the onse
t of menopause.
(
Peacock and Ketvertis, 2019
)
8

1.4 Menopause complications
.
Weight gain
Sexual function
Urinary
incontinence
Cardiovascular
disease
Osteoporosis
(
)
Figure 6. Menopause complications.
9

1.4 Complications- Cardiovascular disease
When the estrogen levels decline,
the risk of cardiovascular disease i
ncreases.
(
)
10

1.4 Complications- Osteoporosis
Postmenopausal women with osteo
porosis are especially susceptible to
fractures of their spine, hips and wri
sts.
(
)
11

1.4 Complications- Weight gain
Many women gain weight during the
menopausal transition and after meno
pause because metabolism slows.
(
)
12

1.4 Complications- Urinary incontinence
The tissues of the vagina and urethra lose
elasticity, woman may experience frequent,
sudden, strong urges to urinate, followed b
y an involuntary loss of urine (urge incontin
ence).
(
)
13

1.4 Complications- Sexual function
Vaginal dryness from decreased moist
ure production and loss of elasticity ca
n cause discomfort and slight bleeding
during sexual intercourse.
(
)
14

1.5 Nutrition related menopause
Menopause
Nutrition
Diet for
heart health
Vitamin D
Calcium
Protein
Diet for
weight gain
Fruit & Veg
Figure 7. Nutrition related menopause. 15

1.5 Calcium for bone health
(
Vliet, 2002
)
Figure 8. Calcium sources of food.
16

1.5 Vitamin D for bone health
1
2
3
4
Egg
Oily fish
Red meat
Foods fortified with V.D by
the manufacturer
(
British Nutrition foundation, 2018
)
Dietary V.D resources
Figure 9. Dietary V,D resources.
17

1.5 Vitamin D for bone health
• For women at risk of osteoporosis, high intakes of vitamin A may have
a negative effect on bone health.
• If woman regularly eat liver and liver products she should avoid taking
supplements containing more than 1.5 mg of vitamin A per day.
• Watch out for fish liver oil supplements as they are also often high in vit
amin A.
(
)
18

1.5 Dietary protein for menopause
Recommendations for dietary protein intake in general population with a m
oderate physical activity is 0.8 g of protein per kg of body weight per day.
The european society for clinical nutrition and metabolism has proposed a
daily recommended amount of 1.0–1.2 g/kg body weight/day as optimal for
a healthy older individual.
Physical activity and exercise require a higher protein intake than sedentary
condition.
(
Agostini et al., 2018
)
Figure 10. Recommendations for protein intake.
19

• Increased availability of amino acids has positive effects on muscle anabo
lism improving lean body mass.
• Protein intake also increases IGF-1 plasma concentration, together with
muscle mass and strength.
• Increased protein intake has also been shown to reduce bone resorption;
furthermore, protein can act modifying calcitriol and intestinal calcium abs
orption, increasing bone health.
(
)
20

• A very recent human study showed that animal derived protein consump
tion, combined with physical activity, is positively associated with muscle
mass and strength across ages in men and women.
• Milk is a high-quality protein source, able of increasing muscle synthesis
to a similar extent that whey and beef.
• The proposed protein amount of protein/meal of 30 g would require the
consumption of one liter of milk.
• Have recently proposed the addition of soy protein to milk to enhance th
e effect of resistance training in postmenopausal women muscle. (
)
21

• Leucine (an essential amino acid) supplementation has been proposed as
a strategy to counteract anabolic resistance in older muscle since it acts as
a signalling molecule able to activate mTOR and thus protein synthesis.
• Increase of leucine consumption in the diet, together with concurrent traini
ng, to counteract sarcopenia associated with chronic low-grade inflammati
on, often present during menopause.
• The nonessential amino acid glycine has anti-inflammatory and antioxidant
properties and seems to promote the preservation of muscle mass.
(
)
22

1.5 Menopause, heart health relation
• Cut down on saturated fat and replace with unsaturat
ed fats.
• Have fish twice a week.
• Include high-fiber and wholegrain foods in the diet.
• Watch salt intake.
• Don’t drink alcohol to excess.
(
)
Figure 11. Recommendations for healthy
diet for heart health.
23

1.5 Menopause, weight gain relation
• To find out if woman overweight calculate her BMI (body mass index).
• Waist circumference (size) can also be used to assess the risk of obesity-
related diseases.
(
)
24

1.5 Menopause, benefits of losing weight
Fertility p
roblems
Heart
disease
High blood
pressure
High blood
cholesterol
Type 2
diabetes
Some c
ancers
Stroke
Lower back a
nd joint pain
Weight loss can reduce risk of:
(
)
Figure 12. Health benefits of losing weight.
25

1.5 Menopause, dietary tips for healthy we
ight loss
• Avoid fad diets that recommend unsafe practices.
• Decrease the amount of foods and drinks that one is consuming that are
high in fat or sugars.
• Eat plenty of fruit and vegetables (at least 5 a day).
• Boil, steam, grill, poach or microwave food rather than frying.
• Choose lean cuts of meat.
• Eat more beans and pulses.
(
)
26

1.5 Menopause, dietary tips for healthy we
ight loss
• Read the nutrition information on food labels.
• Watch the portion size and avoid situations where that one know she may
be tempted to overeat.
• Base the meals on starchy foods, choosing wholegrain or fiber where pos
sible.
• Restrict the frequency and portion size of high energy snacks.
Woman is more likely to get better results if she increase
her energy output as well as decreasing her energy input.
(
)
27

1.5 Phytoestrogen for menopause
• Dietary sources of isoflavones include soyabeans, legumes
, lentils and chickpeas and foods made from these such as
texturised vegetable protein, tofu and soya drinks.
• Dietary sources of lignans include cereals, linseeds and frui
t and vegetables.
(
)
28

1.5 Fruits & vegetable for menopause
• Help prevent a number of menopause symptoms.
• Are low in calories and can help one feel full.
• Help prevent a number of diseases, including heart disease.
• May also help prevent bone loss.
(
Brown and Uk, 2016
)
29

1.5 Nutrition related menopause
.
Alcohol
Salts
Caffeine
Figure 13. Food that a women must be avoided.
Spicy food
30

1.5 Salts related menopause
• For an average person, cutting sodium
intake in half reduces the daily calcium
requirement by about 160 milligrams.
• For postmenopausal women,
decreasing sodium intake from the
U.S. average (3.4 grams per day) to a
low sodium diet (< 2 grams per day)
has been shown to improve skeletal
health.
(A Natural Approach to Menopause, 2002)
31

1.5 Caffeine related menopause
Caffeine intakes of >300 mg per day
have been shown to accelerate bon
e loss in elderly postmenopausal wo
men.
(A Natural Approach to Menopause, 2002)
32

1.5 Caffeine related menopause
(
Appointment, From and Thielen, 2017
)
The researchers found that postmenopausal
women who regularly drank caffeinated beve
rages (such as coffee, tea or soda) experienc
ed more bothersome vasomotor symptoms t
han did postmenopausal women who didn't u
se caffeine.
33

1.5 Alcohol related menopause
• Adults of all ages are advised to consume no more than 14 units of alcohol
per week, with several alcohol-free days each week.
• It is particularly important during and after the menopause for women to be
aware of their alcohol intake as drinking too much can impact negatively o
n bone health, increase the risk of cardiovascular disease and trigger men
opause symptoms such as hot flushes, night sweats and headaches.
(
)
34

1.5 Menopause, healthy diet plan
Breakfast
Woman can choose any of the below:
• Low fat milk with 3 spoons & cranberries.
• A slice of whole meal bread with light Philadelphia soft cheese.
• A slice of whole meal bread with almond butter.
• A boiled egg with a slice of whole meal bread (once a week).
(
Kamilali, 2016
)
35

Morning snack
• 2 fruits.
• 10 almonds.
• 2-3 whole meal biscuit with no sugar.
(
Kamilali, 2016
)
36

Lunch
• Vegetables (cooked or not) with a spoon of linseed and olive oil.
And:
• Roast fish, or meat, or chicken (once a week).
• Or legumes (once a week).
• Or cooked vegetable (twice a week).
• Or whole meal pasta (once a week).
• And a small piece of low fat cheese.
(
Kamilali, 2016
)
37

Evening snack
• 2 fruits (if woman didn’t eat at 10:30).
• Or 10 almonds.
• Or a piece of black chocolate or other low fat small sweet (twice a week).
(
Kamilali, 2016
)
38

Dinner
• 1 yogurt 2% fat, with a spoon of honey.
(
Kamilali, 2016
)
39

1.6 Menopause lifestyle & other changes
(
Vliet, 2002
)
Refrain from smoking
Wear layers of clothing
Treat vaginal dryness
Figure 14. Menopause lifestyle changes.
Exercise
40

Women should try to do:
• At least 150 minutes of moderate intensity aerobic activity
a week+ muscle strengthening activities on two days or m
ore of the week.
• Or 75 minutes of vigorous intensity aerobic activity plus m
uscle strengthening activities on two days or more of the
week.
1.6 Exercise
(
)
41

1.7 Medication therapy
• Estrogen taken as a pill or applied to the skin as a patch can reduce
hot flashes, sleep disturbances, mood changes and vaginal dryness.
• Estrogen can be prescribed alone when a woman no longer has her
uterus.
• Progesterone is necessary to balance estrogen's effect on the uterus
and prevent changes that can lead to uterine cancer.
• Evidence has shown that there are some risks associated the use of
these medicines.
(
Vliet, 2002
)
42

1.7 Medications therapy
• Antidepressants. They relieve the symptoms of hot flashes in 60% of
women.
• Gabapentin (Neurontin). Main side effect is drowsiness.
• Clonidine. This is a blood pressure medication that can relieve hot flas
hes in some women.
(
Vliet, 2002
)
43

2.1 Study (1)
(
Messina, 2014
)
Study name: Soy foods, isoflavones, and the health
of postmenopausal women.
Aim: Determine the possibility that isoflavone rich soy food
s can be especially helpful to women transitioning through
menopause.
Result:
• Isoflavone exposure does not adversely affect
breast tissue.
• Soy food intake reduces tumor recurrence in breast
cancer patients. 44

2.1 Study (1)
Conclusion:
(
Messina, 2014
)
45

2.1 Making soy a part of the daily diet
(
Overview, 2019
)
Isoflavones are short-acting. If one
use soy for health reasons, try to
eat it throughout the day, rather
than all at once. Try to eat 40 mg
to 80 mg of isoflavones each day.
Table 1. Isoflavone content of common soy foods.
46

2.2 Study (2)
(
Terauchi et al., 2014
)
Study name: Effects of grape seed proanthocynidin extract
on menopausal symptoms, body composition, and cardio-
vascular parameters in middle-aged women.
Aim: This study aims to assess the effects of proanthocyanidin
-a class of polyphenol antioxidants extracted from grape seeds
on menopausal symptoms.
Study design: Conducted a randomized, double-blind, placebo-
controlled study.
Sample size: 96 women aged 40 to 60 years who had at least
one menopausal symptom.
47

2.2 Study (2)
(
Terauchi et al., 2014
)
Method: The study participants were randomized to receive
grape seed extract tablets containing either low-dose (100
mg/d) or high-dose (200 mg/d) proanthocyanidin, or placeb
o, for 8 weeks.
Result:
• There are physical symptom score decreased in the high-dose group after 8
weeks of treatment.
• There are physical symptom score decreased in the low-dose and high-dose
groups after 4 weeks.
• Muscle mass increased in the low-dose and high-dose groups after 8 weeks
of treatment. 48

2.3 Study (3)
(
Sulaiman et al., 2014
)
Study name: Dietary carbohydrate, fiber and sugar
and risk of breast cancer according to menopausal
status in malaysia.
Aim: To examine the association of premenopausal and
postmenopausal breast cancer risk with dietary carbohyd
rate, fiber and sugar intake.
Sample size: This population was conducted in Malaysia
with 382 breast cancer patients and 382 controls.
Study design: Case-control study.
49

2.3 Study (3)
(
Sulaiman et al., 2014
)
Method: Logistic regression was used to compute odds
ratios with 95% confidence intervals (CI) and a broad ra
nge of potential confounders were included in analysis.
Result:
• A significant two fold increased risk of breast cancer
among premenopausal and postmenopausal women
was observed in the highest quartile of sugar.
• A higher intake of dietary fiber was associated with a
significantly lower breast cancer risk among both pre
menopausal and postmenopausal women. 50

3 Conclusion
Menopause is something that all women will have to go thro
ugh in their lifetimes.
There are different stages, different symptoms, and different
treatments. Each is dependent on the woman.
There are other factors that affect a woman’s menopausal
experience and the woman may have to make changes to
her nutrition and exercise plans.
Figure 14. Conclusion of presentation. 51

4 Recommendations
• Eat healthy food such as fruits
& vegetables, lean protein, low
fat dairy product, whole grain.
• Do some exercise every day.
• Get vitamins & mineral supple
ments.
• Get medications if woman need.
• Avoid caffeine, spicy foods,
salts, alcohol.
• Avoid smoking.
Table 2. Recommendations for menopausal women. 52

5 References
-A Natural Approach to Menopause (2002) The Physicians Committee. Available at: http://www.p
crm.org/health/health-topics/a-natural-approach-to-menopause (Accessed: 14 April 2020).
-Agostini, D. et al. (2018) ‘Muscle and bone health in postmenopausal women: Role of protein a
nd vitamin d supplementation combined with exercise training’, Nutrients, 10(8). doi: 10.3390/nu
10081103.
-Appointment, R., From, A. and Thielen, J. M. (2017) ‘Caffeine and menopause symptoms : Is t
here a’.
-British Nutrition foundation (no date) Menopause - British Nutrition Foundation, 2018. Available
at: https://www.nutrition.org.uk/healthyliving/lifestages/menopause.html (Accessed: 14 April 202
0).
-Brown, J. and Uk, R. D. (2016) ‘11 Natural Ways to Reduce Symptoms of Menopause’, (4).
-Cleveland Clinic (2019) ‘Menopause, Perimenopause and Postmenopause | Cleveland Clinic’.
Available at: https://my.clevelandclinic.org/health/diseases/15224-menopause-perimenopause-a
nd-postmenopause.

5 References
-Gharaibeh, M., Al-Obeisat, S. and Hattab, J. (2010) ‘Severity of menopausal symptoms of Jord
anian women’, Climacteric, 13(4), pp. 385–394. doi: 10.3109/13697130903050009.
-Marcason, W. (2015) Eating Right During Menopause, Academy of Nutrition and Dietetics. Avail
able at: http://www.eatright.org/resource/health/wellness/healthy-aging/eating-right-during-meno
pause (Accessed: 24 March 2020).
-Messina, M. (2014) ‘Soy foods, isoflavones, and the health of postmenopausal women’, Americ
an Journal of Clinical Nutrition, 100(SUPPL. 1). doi: 10.3945/ajcn.113.071464.
-Overview, T. (2019) ‘Soy for Menopause Symptoms Topic Overview’. Available at: https://wa.kai
serpermanente.org/kbase/topic.jhtml?docId=tn9521.
-Peacock, K. and Ketvertis, K. M. (2019) ‘StatPearls [Internet].’ Available at: https://www.ncbi.nl
m.nih.gov/books/NBK507826/#_article-24984_s4_.
-Peritonitis - Symptoms and causes - Mayo Clinic (2018). Available at: https://www.mayoclinic.or
g/diseases-conditions/peritonitis/symptoms-causes/syc-20376247 (Accessed: 24 March 2020).

5 References
-Sulaiman, S. et al. (2014) ‘Dietary carbohydrate, fiber and sugar and risk of breast cancer acco
rding to menopausal status in Malaysia’, Asian Pacific Journal of Cancer Prevention, 15(14), pp.
5959–5964. doi: 10.7314/APJCP.2014.15.14.5959.
-Terauchi, M. et al. (2014) ‘Effects of grape seed proanthocyanidin extract on menopausal sympt
oms, body composition, and cardiovascular parameters in middle-aged women: A randomized, d
ouble-blind, placebo-controlled pilot study’, Menopause, 21(9), pp. 990–996. doi: 10.1097/GME.
0000000000000200.
-Vliet, E. L. (2002) Menopause and perimenopause: The role of ovarian hormones in common n
euroendocrine syndromes in primary care, Primary Care - Clinics in Office Practice. doi: 10.101
6/S0095-4543(03)00073-3.
-Kamilali, D. (2016) ‘Healthy Diet for Women in Menopause’, pp. 8–10.

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