Dairy during perimenopause: how much, which kinds and what to do if you do not consume it

Why does calcium matter before menopause?

Calcium is the most abundant mineral in the body, and almost all of it is in the skeleton. Bones act as a store. If your diet does not provide enough calcium, the body draws on this store to maintain the levels needed by your nerves and muscles. For years, you may not notice this borrowing.

What changes in premenopause is the pace. Bone loss accelerates during perimenopause, the transition years before your final period, and in the first few years afterwards, as oestrogen levels fall [3]. This is no cause for alarm. It is a reason to enter this stage with your calcium intake covered, physical activity established and vitamin D levels adequate.

The European Food Safety Authority (EFSA) sets the daily reference amount for calcium at 950 mg for adults aged 25 and over [2]. If you already have osteoporosis, the target rises to 1,000–1,200 mg a day, and it is preferable to obtain it from food [4]. For more on this, see our diet for osteoporosis guide.

How many servings of dairy should you have each day?

For a premenopausal woman who eats a varied diet, up to three servings of dairy a day, preferably plain and unsweetened, can help bring calcium intake closer to 950 mg. This is consistent with the recommendations of the Spanish Agency for Food Safety and Nutrition (AESAN), which specify zero to three servings a day, with no added sugars and little salt [1].

One serving is a 200–250 ml glass of milk, a 125 g yoghurt, 40–60 g of hard cheese or 80–125 g of fresh cheese [1]. A 200 ml glass of milk provides about 240 mg of calcium, and a yoghurt about 175 mg.

A typical day might include milk at breakfast, a yoghurt in the afternoon and fresh cheese at dinner. Vegetables, pulses, nuts and water provide the rest. To see how this can be spread out, our healthy weekly menu for menopause lays it out over seven days.

How to choose dairy products

The most useful options are those with few added ingredients, such as milk, plain yoghurt, kefir, fresh cheese, cottage cheese and small portions of hard cheese. Two practical points:

• Skimmed and whole milk contain practically the same amount of calcium, because calcium is not in the fat. Choose whichever you prefer.
• The less water a dairy product contains, the more concentrated its calcium. Hard cheese provides a lot in a small amount, but also contains more salt and fat.

If milk does not agree with you, you do not have to give up the whole group. Yoghurt contains less lactose than milk, and hard cheeses contain very little, so many people tolerate them well. Lactose-free milk has the same calcium content. If you suspect an intolerance, your doctor can diagnose it.

If you do not consume dairy

It is possible to meet your calcium needs without dairy, but this takes planning because no other food group provides it as easily. These options can help most:

• Calcium-fortified soya drink, or a plant-based drink with at least 3 g of protein per 100 ml. Check the label to make sure calcium has been added, because unfortified drinks contain very little. Bear in mind that soya is an allergen. Our guide to plant-based drinks: which to choose explains what to look for in each one.
• Tofu set with calcium salts, with about 200 mg per 100 g
• Tinned sardines and anchovies, eaten with the bones
• Almonds, hazelnuts and sesame, as a handful or as a sugar-free spread
• Pulses, especially chickpeas and white beans
• Vegetables such as broccoli, kale and turnip greens

Spinach and chard contain calcium, but it is poorly absorbed, so they should not be counted as a main source. If you have stopped consuming dairy because of an allergy, intolerance or vegan diet, it is a good idea to ask a dietitian-nutritionist to review whether your menu provides enough calcium.

Does dairy make hot flushes worse?

There is no evidence that dairy causes hot flushes or that avoiding it relieves them. The North American Menopause Society reviewed dietary changes in its position statement on non-hormonal treatments. It does not recommend any of them for hot flushes, including soya products, because the evidence does not support their use [5].

Avoiding dairy for this reason removes an easy source of calcium without relieving hot flushes. If they are affecting your daily life, your gynaecologist or doctor can assess treatments supported by evidence.

Does dairy cause inflammation?

Studies do not show this in people without a milk protein allergy. A review of 19 trials in adults consuming milk, yoghurt or cheese found that 18 showed no effect on markers of inflammation or found a favourable effect [6]. An independent analysis of 11 trials points in the same direction [7].

There is one nuance. In crossover trials, in which each person tries both options, the favourable effect disappears [7]. The cautious conclusion is that dairy does not cause inflammation, without promising that it reduces inflammation. If you notice specific discomfort when consuming it, that warrants an assessment, not eliminating it without guidance.

What mistakes do we identify in consultations?

• Giving up milk because of hot flushes or “inflammation” without replacing it. Months can go by with low calcium intake without any noticeable signs.
• Counting a splash of milk in coffee as your serving for the day. A serving means a full glass.
• Thinking that it is no longer useful after a certain age. Bones continue to respond to what you eat and how you move.

When is a bone density scan or calcium supplement considered?

A bone density scan measures bone density; it is not done for every woman just because she has reached menopause. The Spanish osteoporosis guideline recommends it when risk factors are present [4]. These include early menopause, low body weight, a family history of osteoporosis, smoking, alcohol use, certain medicines such as corticosteroids, or a clear loss of height [4]. If any of these apply to you, mention it to your doctor, who will decide whether and when it is needed.

It is similar with supplements. Guidelines prefer calcium from food and advise against taking supplements on your own [3] [4]. If a supplement is needed, your doctor or dietitian-nutritionist should recommend it based on what you eat and your blood test results. Our role is to adjust your menu so that food provides as much of the calcium you need as possible.