Menopause is recognized as an important reproductive health issue for women and a significant stage within a woman’s life cycle. By the year 2030, the global population will include approximately 1.2 billion women who have entered menopause.1 According to a 2019 integrative review assessing the relationship between social determinants of health and menopause, planning for lifestyle enhancements, including nutrition and exercise, was noted as an improvement needed to promote women’s health during menopause.1
No longer simply an obstetric and gynecologic concern, menopause has been linked to risk of several chronic diseases.1-3
Menopause and Chronic Disease
Early menopause is tied to increased cardiometabolic risks,4 as well as other conditions like rheumatoid arthritis and chronic fatigue syndrome.5,6 The timing of menopause has also been linked to risks for diabetes and gastroenteritis.7 A small-scale study suggested that hypertension onset during the menopause transition appears together with abdominal obesity and may be a driving force for increased cardiovascular disease (CVD) risk.8 A large 2019 study of midlife women veterans suggested that increased menopause symptom burden is associated with higher vulnerability to chronic pain.9
Across the stages of the menopause transition, as estrogen levels drop, impairment of endothelial function and acceleration of vascular aging have been noted.10-12 In addition, obesity, cancer, endometriosis, CVD, and poor cognitive function are all marked by gut dysbiosis and can be considered estrogen-modulated conditions.13 More broadly, hormonal changes in aging patients have been associated with greater risk of frailty and disability,14,15 likely due to disruptions along several hormonal axes rather than deficiency of a single hormone.16
Evidence continues to grow demonstrating that lifestyle changes can modulate hormonal function to improve health, lowering or even reversing the risk of these chronic issues. In the following video, Margaret Christensen, MD, IFMCP, a board certified OB/GYN for over 20 years, shares her Functional Medicine approach to menopause.
Anti-Inflammatory Foods & Hormonal Balance
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.17-20 Additionally, cruciferous vegetables like broccoli and cauliflower contain glucosinolates, which help the body send estrogen metabolites down the pathway that helps prevent and suppress the development of hormone-modulated female cancers.21
In a survey-based study, women who were in premenopause who were followed for nearly 13 years and reported regularly consuming the carotenoid β-cryptoxanthin (a precursor to retinol) and fruit entered menopause later than those who did not.21 β-carotene, lycopene, lutein, curcumin, and other carotenoids are being studied to identify their mechanisms of action, including stimulation of B- and T-lymphocytes.22
Reduced estrogen increases cardiometabolic risks for women entering menopause,23,24 but nutrition can make a significant difference in the health impacts. For example, researchers found that during premenopause, women who followed a Mediterranean diet rich in fruits, vegetables, whole grains, and nuts displayed a significantly lower index of preclinical atherosclerosis and lower weight than their noncompliant counterparts.25 Another study found that the Mediterranean Diet has a cardioprotective effect for women during perimenopause and menopause, but only with a high adherence to the diet.26 This cardioprotective effect included lower total cholesterol, resting heart rate, LDL-C, triglycerides, C-reactive protein, and clustered cardiometabolic risk.26
These cardioprotective results may be partly due to changes in fat intake. In a double-blind study on the impact of marine-derived omega-3 polyunsaturated fatty acids (eicosapentaenoic acid and docosahexaenoic acid) on dyslipidemia in women entering menopause, total and LDL-C cholesterol levels dropped dramatically, along with levels of anti-LDL-autoantibodies, over a three-month supplementation with fish oil and vitamin E.27 Clearly, nutrition has a number of potential impacts for women experiencing changes in hormones that occur during menopause.
Vasomotor Symptoms & Plant-Based or Vegetarian Diets
During the menopause transition, vasomotor symptoms such as hot flushes and night sweats are frequently reported, and studies suggest that these symptoms may be biomarkers for potential chronic disease, such as cardiovascular disease.10,28,29 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 perimenopause and ate a vegan diet reported less bothersome vasomotor symptoms than those who ate an omnivore diet.30 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.31 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.31
Sustainable Lifestyle Change
Strategies for keeping patients engaged in lifestyle interventions are key to long-term outcomes. One study found that health education interventions that focused on lifestyle modifications given to women during menopause improved adherence to health-promoting behaviors and ultimately enhanced the women’s health status.32 With Functional Medicine, a patient-centered framework promotes this collaboration between patient and practitioner to fully involve the patient in their healing process, and to provide them support during the treatment.
IFM offers a number of techniques and tools for treatment strategies and helping patients sustain therapeutic lifestyle change. Learn more about sustainable lifestyle change and food plans for patients with hormonal dysfunction at IFM’s Hormone Advanced Practice Module.
For more information on hormone balance and nutritional interventions, please read the following IFM-authored articles:
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Nutrition-based treatments are fundamental components of many therapeutic strategies used to combat chronic illness and restore optimal health. Patient participation and empowerment are important components of personalized treatment strategies for sustainable engagement and successful interventions.Read More
Research indicates that disease prevention and surgical recovery are improved when supported by proper nutrition. However, clinicians are rarely offered even basic nutritional training in medical and osteopathic school, a study of incoming pediatric residency interns showed. Perhaps unsurprisingly, many patients do not have optimal nutrition, and at the same time, we are experiencing record levels of chronic disease.Read More
A food first approach to treatment encapsulates the idea that changing eating habits can be an effective first step for many patients, and the improvements that they experience can serve as empowering feedback, motivating them to make other sustainable lifestyle changes.Read More