Dietetic Management through the Peri and Post Menopause

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Menopause is defined as occurring 12 months after your last menstrual period and usually happens between the ages of 45-55. The months or years leading up to the menopause is called the peri menopause when hormone levels start to change. Many symptoms can be caused by these fluctuations, and they can range from mild and manageable, to debilitating.   

 

Here are some common symptoms:

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Carbohydrate/sugar cravings

Weight gain, especially around the middle

Muscle loss

Raised cholesterol

Fatigue

Anxiety

Poor memory

Irritable Bowel Syndrome

Aches and pains

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Hormone Replacement Therapy is the most effective treatment for the perimenopause/post menopause as it replaces the hormones which the body is lacking. It can be prescribed by your GP. HRT can significantly reduce and even resolve many of the above symptoms. HRT can also reduce the risk of heart disease, osteoporosis and possibly dementia.

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Managing lifestyle factors such as stress, movement and nutrition are vitally important. Re-evaluating each of these and taking action can result in significant positive impacts on many of the symptoms, helping you to feel physically and mentally better.

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Here are some of the most common things that my patients are troubled with:

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Weight gain

Weight gain, particularly around the middle is very common during peri menopause and menopause. Many women can feel particularly distressed, confused and anxious about this. Weight control methods that previously worked no longer seem to be effective, leading to confusion about the best diet and exercise routine to follow. Sometimes this can trigger disordered eating patterns such as over and under eating.

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It can be helpful to understand why weight gain occurs:

 

• Reduced metabolism – lower oestrogen levels cause a reduction in the genes needed for efficient energy (calorie) use. This means that your body needs fewer calories than pre-menopause. 

• Sarcopenia – this is the natural reduction of muscle mass that comes with ageing, which contributes to a lower  metabolism. Ensuring a good intake of 'quality' protein and weight bearing exercise can prevent muscle loss.

• Feeling tired all the time and muscle pain makes it harder to exercise. It can also take longer to recover from intense exercise. Some times the exhaustion can be debilitating and prevent you from living and functioning normally.

• Busy with work, family, elderly parents etc. therefore less time to exercise or to think about healthy food

• Anxiety/stress and feeling fed up can make many people turn to food for comfort.

• The stress hormone, cortisol, promotes the accumulation of fat around the middle. 

• Insulin resistance - hormone fluctuations, PCOS and being overweight can cause your body to struggle with the ability of insulin to process carbohydrates/sugar. High insulin levels lead to fat storage, particularly around the middle.​

 

Although weight gain is normal during the menopausal years, it is not inevitable, and can be managed in a safe, sane and sensible way. 

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Disordered Eating

Triggering or re-triggering disordered eating can occur during the peri and post menopause. This may be for a number of reasons, including increased anxiety levels, feeling lost and out of control of life, and desperately trying to gain control over weight gain. 

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High cholesterol

Oestrogen has a protective role for the cardiovascular system. During menopause there can be changes in blood lipid (fat) levels, with increasing ‘bad’ cholesterol, and a reduction in ‘good’ cholesterol. A heart healthy diet which includes cholesterol lowering foods, as well as reducing cholesterol raising foods can be very effective at reducing heart disease risk, and avoiding the use of statin medication. The ideal way of eating is the Anti-inflammatory/Mediterranean style diet, with an abundance of veg, leafy greens, fruit, fish, chicken, eggs, nuts, seeds, olive oil, yoghurt, oats, rice etc.

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Osteoporosis

Lack of oestrogen increases the rate of bone loss and weakened bones. This makes bone fractures more likely. Osteoporosis, and osteopenia which is the precursor to osteoporosis, are diagnosed with a DEXA scan. 

Taking HRT helps to maintain oestrogen levels therefore protecting bone health. It is also important to ensure a bone healthy diet. Calcium and vitamin D are well known to be important for bone health, however there are other nutrients such as protein, vitamin K, and magnesium which also need to be thought about. It is also important that you eat enough to maintain a healthy weight. A thorough dietary evaluation can help to identify any deficiencies in these nutrients. 

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Irritable Bowel Syndrome​

Irritable Bowel Syndrome affects 1 in 5 people and although not medically worrying, the symptoms of bloating, abdominal pain, diarrhoea and constipation can really affect how you feel physically and mentally.

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There are many factors which contribute to IBS during peri menopause and beyond, including stress, poor sleep, erratic diet, food intolerances and too much alcohol. Abdominal surgery e.g. hysterectomy, fluctuating hormone levels, antibiotics, tummy bugs and COVID can also trigger IBS.

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For many women, the severity of gastrointestinal symptoms fluctuate with the menstrual cycle and this can continue through the menopause transition and into the postmenopausal period. How sex hormones trigger gastrointestinal disturbances remains unclear. Hormones may provoke changes in intestinal contractions, increase pain sensitivity, affect the intestinal wall barrier (also known as ‘leaky gut’), change the bacterial balance (microbiome), and  reduce digestive enzymes e.g. lactase. 

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Before a diagnosis of IBS is made, all women should be evaluated for any “red flag symptoms” such as unintentional or unexplained weight loss, rectal bleeding, family history of bowel or ovarian cancer and iron deficiency anaemia. 

 

In my clinic, a thorough symptom and medical history as well as a detailed dietetic assessment is fundamental to successful treatment of IBS. Avenues we consider and address include:

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• First line dietary changes

• If first line changes don't provide relief, we can explore the Low Fodmap Diet​

• Relaxation  - we discuss sources of your stress/anxiety and ways of reducing these or helping you to cope with them.

• Managing insomnia - there may be dietary factors affecting sleep e.g. waking up hungry, caffeine and alcohol. In certain circumstances supplements such as magnesium citrate can be beneficial for some women.

• Physical activity e.g. walking, pilates, yoga - these  less intensive exercises can help to reduce stress levels, build muscle and improve gastrointestinal functioning. 

• Dietary changes. It is important to prioritise good nutrition practisesa before trying more difficult dietary interventions. e.g. reduction in caffeine and alcohol, regular spacing of meals, altering types and amounts of fibre, and avoiding ultra-processed foods. The low FODMAP diet is also an option, which can be tailored to the individual patient.

• Hormone replacement therapy – HRT is very effective for treating contributory causes of IBS such as anxiety, insomnia, fluctuating hormones and improving exercise tolerance.

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Supplements

Appropriately prescribed supplements for peri menopause and menopause may include: omega 3 fish/algae oil; vitamin D, Magnesium, Ashwagandha, whey protein isolate/vegan protein powder; and calcium.

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Initial 1 hour consultation: £120

This includes (as appropriate for the client): assessment of pre appointment questionnaire and food diary; 1 hour consultation; individualised Nutrition Plan/written information; any other useful information e.g. recommendations for useful apps, websites, books

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Follow up appointments: £60

Follow up appointments last approximately 45 minutes

 

There are no unexpected extra costs. If I recommend a supplement I will suggest a number of choices, as I do not sell or promote any particular brand or product.

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