insights

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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 Early menopause is tied to increased cardiometabolic risks,^4,5 as well as other conditions like rheumatoid arthritis and chronic fatigue syndrome.^6,7 The timing of menopause has also been linked to risks for diabetes⁸ and gastroenteritis.⁹ 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.¹⁰ A large 2019 study of midlife women veterans suggested that increased menopause symptom burden is associated with higher vulnerability to chronic pain.¹¹

Across the stages of the menopause transition, as estrogen levels drop, impairment of endothelial function and acceleration of vascular aging have been noted.^12-14 In addition, obesity, cancer, endometriosis, CVD, and poor cognitive function are all marked by gut dysbiosis and can be considered estrogen-modulated conditions.¹⁵ More broadly, hormonal changes in aging patients have been associated with greater risk of frailty and disability,^16,17 likely due to disruptions along several hormonal axes rather than deficiency of a single hormone.¹⁸

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.

Nutritional Interventions at Menopause: Clinical Considerations

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.^19-22 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.²³

In a survey-based study, women who were in premenopause who were followed for nearly 13 years and reported regularly consuming the carotenoid ?-cryptoxanthin (a precursor to retinol) and fruit entered menopause later than those who did not.²³ ?-carotene, lycopene, lutein, curcumin, and other carotenoids are being studied to identify their mechanisms of action, including stimulation of B- and T-lymphocytes.²⁴

Mediterranean Diet

Reduced estrogen increases cardiometabolic risks for women entering menopause,^25,26 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.²⁷ 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.²⁸ This cardioprotective effect included lower total cholesterol, resting heart rate, LDL-C, triglycerides, C-reactive protein, and clustered cardiometabolic risk.²⁸

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.²⁹ Clearly, nutrition has a number of potential impacts for women experiencing changes in hormones that occur during menopause.

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.^12,30,31 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.³² 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.³³ 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.³³

Strategies for keeping patients engaged in lifestyle interventions are key to long-term outcomes. Nutritional habits are essential to this, as they can impact both longevity and quality of life in women during menopause.³⁴ 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.³⁵ 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 tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.

Nutrition and Impacts on Hormone Signaling

Menopause and Hormone Replacement Therapy

Chronic Stress and Hormone Disruption

References

1. Namazi M, Sadeghi R, Behboodi Moghadam Z. Social determinants of health in menopause: an integrative review. Int J Womens Health. 2019;11:637-647. doi:10.2147/IJWH.S228594
2. Innes KE, Selfe TK, Taylor AG. Menopause, the metabolic syndrome, and mind-body therapies. Menopause. 2008;15(5):1005-1013. doi:10.1097/01.gme.0b013e318166904e
3. World Health Organization. Women, Ageing and Health: A Framework for Action. World Health Organization; 2007. Accessed March 10, 2022. https://www.who.int/ageing/publications/Women-ageing-health-lowres.pdf
4. Appiah D, Schreiner PJ, Demerath EW, Loehr LR, Chang PP, Folsom AR. Association of age at menopause with incident heart failure: a prospective cohort study and meta-analysis. J Am Heart Assoc. 2016;5(8):e003769. doi:10.1161/JAHA.116.003769
5. Roa-Díaz Z, Raguindin PF, Bano A, Laine JE, Muka T, Glisic M. Menopause and cardiometabolic diseases: what we (don’t) know and why it matters. Maturitas. 2021;152:48-56. doi:10.1016/j.maturitas.2021.06.013
6. Pikwer M, Bergström U, Nilsson JÅ, Jacobsson L, Turesson C. Early menopause is an independent predictor of rheumatoid arthritis. Ann Rheum Dis. 2012;71(3):378-381. doi:10.1136/ard.2011.200059
7. Russell L, Broderick G, Taylor R, et al. Illness progression in chronic fatigue syndrome: a shifting immune baseline. BMC Immunol. 2016;17:3. doi:10.1186/s12865-016-0142-3
8. Wang M, Gan W, Kartsonaki C, et al.Menopausal status, age at natural menopause and risk of diabetes in China: a 10-year prospective study of 300,000 women. Nutr Metab. 2022;19(1):7. doi:10.1186/s12986-022-00643-x
9. Fu Y, Yu Y, Wang S, et al. Menopausal age and chronic diseases in elderly women: a cross-sectional study in Northeast China. Int J Environ Res Public Health. 2016;13(10):E936. doi:10.3390/ijerph13100936
10.  Trtica Majnaric L, Martinovic I, Šabanovic Š, Rudan S, Babic F, Wittlinger T. The effect of hypertension duration and the age of onset on CV risk factors expression in perimenopausal women. Int J Hypertens. 2019;2019:9848125. doi:10.1155/2019/9848125
11.  Gibson CJ, Li Y, Bertenthal D, Huang AJ, Seal KH. Menopause symptoms and chronic pain in a national sample of midlife women veterans. Menopause. 2019;26(7):708-713. doi:10.1097/GME.0000000000001312
12.  Biglia N, Cagnacci A, Gambacciani M, Lello S, Maffei S, Nappi RE. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017;20(4):306-312. doi:10.1080/13697137.2017.1315089
13.  Moreau KL, Hildreth KL, Meditz AL, Deane KD, Kohrt WM. Endothelial function is impaired across the stages of the menopause transition in healthy women. J Clin Endocrinol Metab. 2012;97(12):4692-4700. doi:10.1210/jc.2012-2244
14.  Moreau KL, Hildreth KL. Vascular aging across the menopause transition in healthy women. Adv Vasc Med. 2014;2014:204390. doi:10.1155/2014/204390
15.  Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45-53. doi:10.1016/j.maturitas.2017.06.025
16.  Fabbri E, An Y, Zoli M, et al. Aging and the burden of multimorbidity: associations with inflammatory and anabolic hormonal biomarkers. J Gerontol A Biol Sci Med Sci. 2015;70(1):63-70. doi:10.1093/gerona/glu127
17.  Clegg A, Hassan-Smith Z. Frailty and the endocrine system. Lancet Diabetes Endocrinol. 2018;6(9):743-752. doi:10.1016/S2213-8587(18)30110-4
18.  Maggio M, Cattabiani C, Lauretani F, et al. The concept of multiple hormonal dysregulation. Acta Biomed. 2010;81(Suppl 1):19-29.
19.  Ricker MA, Haas WC. Anti-inflammatory diet in clinical practice: a review. Nutr Clin Pract. 2017;32(3):318-325. doi:10.1177/0884533617700353
20.  Zwickey H, Horgan A, Hanes D, et al. Effect of the anti-inflammatory diet in people with diabetes and pre-diabetes: a randomized controlled feeding study. J Restor Med. 2019;8(1):e20190107. doi:10.14200/jrm.2019.0107
21.  Sköldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis. 2003;62(3):208-214. doi:10.1136/ard.62.3.208
22.  How to use food to help your body fight inflammation. Mayo Clinic. Published August 13, 2019. Accessed March 10, 2022. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-use-food-to-help-your-body-fight-inflammation/art-20457586
23.  Pearce K, Tremellen K. Influence of nutrition on the decline of ovarian reserve and subsequent onset of natural menopause. Hum Fertil (Camb). 2016;19(3):173-179. doi:10.1080/14647273.2016.1205759
24.  Milani A, Basirnejad M, Shahbazi S, Bolhassani A. Carotenoids: biochemistry, pharmacology and treatment. Br J Pharmacol. 2017;174(11):1290-1324. doi:10.1111/bph.13625
25.  Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric. 2007;10(Suppl 1):19-24. doi:10.1080/13697130601114917
26.  Park JK, Lim YH, Kim KS, et al. Body fat distribution after menopause and cardiovascular disease risk factors: Korean National Health and Nutrition Examination Survey 2010. J Womens Health (Larchmt). 2013;22(7):587-594. doi:10.1089/jwh.2012.4035
27.  Mattioli AV, Coppi F, Migaldi M, Scicchitano P, Ciccone MM, Farinetti A. Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women. Nutr Metab Cardiovasc Dis. 2017;27(11):985-990. doi:10.1016/j.numecd.2017.09.011
28.  Ruiz-Cabello P, Coll-Risco I, Acosta-Manzano P, et al. Influence of the degree of adherence to the Mediterranean diet on the cardiometabolic risk in peri and menopausal women. The Flamenco project. Nutr Metab Cardiovasc Dis. 2017;27(3):217-224. doi:10.1016/j.numecd.2016.10.008
29.  Alves Luzia L, Mendes Aldrighi J, Teixeira Damasceno NR, et al. Fish oil and vitamin E change lipid profiles and anti-LDL-antibodies in two different ethnic groups of women transitioning through menopause. Nutr Hosp. 2015;32(1):165-174. doi:10.3305/nh.2015.32.1.9079
30.  Sassarini J, Lumsden MA. Vascular function and cardiovascular risk factors in women with severe flushing. Maturitas. 2015;80(4):379-383. doi:10.1016/j.maturitas.2015.01.007
31.  Herber-Gast GCM, Brown WJ, Mishra GD. Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study. BJOG. 2015;122(11):1560-1567. doi:10.1111/1471-0528.13163
32.  Beezhold B, Radnitz C, McGrath R, Feldman A. Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores. Maturitas. 2018;112:12-17. doi:10.1016/j.maturitas.2018.03.009
33.  Rotolo O, Zinzi I, Veronese N, et al. Women in LOVe:lacto-ovo-vegetarian diet rich in omega-3 improves vasomotor symptoms in postmenopausal women. An exploratory randomized controlled trial. Endocr Metab Immune Disord Drug Targets. 2019;19(8):1232-1239. doi:10.2174/1871530319666190528101532
34.  Silva TR, Oppermann K, Reis FM, Spritzer PM. Nutrition in menopausal women: a narrative review. Nutrients. 2021;13(7):2149. doi:10.3390/nu13072149
35.  Rathnayake N, Alwis G, Lenora J, Lekamwasam S. Impact of health-promoting lifestyle education intervention on health-promoting behaviors and health status of postmenopausal women: a quasi-experimental study from Sri Lanka. Biomed Res Int. 2019;2019:4060426. doi:10.1155/2019/4060426