Nutrition during menopause: what to eat and what to avoid

Why does weight change and fat accumulate around the abdomen?

If your trousers feel tighter at the waist even though you eat as you always have, hormonal changes may play a part. As oestrogen levels fall, fat tends to shift from the hips and thighs towards the abdomen, around the organs. The American Heart Association’s scientific statement on the menopause transition describes this change and identifies it as one of those that weigh most in cardiovascular risk [2]. See “Cholesterol in menopause”.

Added to this is the muscle loss that comes with age and less activity. Muscle is the tissue that uses the most energy at rest. That is why the same portions you ate ten years ago may have a different effect now. Eating much less speeds up muscle loss. Filling meals — vegetables, pulses and good-quality protein — and moving more help.

The Scientific Committee of the Spanish Agency for Food Safety and Nutrition (AESAN) highlights the protective measures that matter at this stage [3]: a healthy eating pattern, physical activity, and stopping smoking and drinking alcohol. Together, these help address obesity, vascular risk, osteoporosis and muscle loss.

Which foods make hot flushes worse?

No particular food has been shown in well-designed studies to worsen or relieve hot flushes. Hot flushes and night sweats arise when falling oestrogen levels disrupt the hypothalamus, the part of the brain that regulates temperature.

The Menopause Society reviewed the evidence on non-hormonal treatments in 2023 [4]. It does not recommend avoiding triggers, cooling techniques or dietary changes as treatments for hot flushes: they have not been shown to reduce them. It does identify weight loss, when someone has excess weight, and cognitive behavioural therapy, a form of psychological therapy, as helpful [4].

Many women notice their own triggers: a glass of wine, an afternoon coffee, a very spicy dish or a large evening meal. If that happens to you, it makes sense to have them less often and see whether anything changes. There is no need to cut out something that does not bother you. If hot flushes disrupt your sleep or daily life, speak to your doctor. There are hormonal and non-hormonal treatments that do work. See “Menopause and insomnia”.

Which nutrients do your bones need during menopause?

In the years after your last period, bones lose density more quickly as oestrogen levels fall. As a general reference, EFSA sets calcium intake at 950 mg a day for adults aged 25 and over. If you have osteoporosis, the Spanish Society for Bone and Mineral Metabolism Research (SEIOMM) recommends 1,000 to 1,200 mg a day [1]. Getting it from food is preferable to taking tablets.

To meet those needs, you could combine a glass of milk, two yoghurts, a tin of small sardines with their bones, pulses, almonds or sesame seeds. If you do not have dairy, calcium-fortified plant drinks are available. Your body also needs vitamin D to use calcium. Your skin makes it in sunlight, so spending some time outdoors each day can help.

If a blood test shows a deficiency, your doctor may prescribe a supplement. The same SEIOMM guideline gives a usual dose of 800 to 1,200 IU a day [1]. If you already have osteopenia or osteoporosis, you can find the full guidance in our osteoporosis nutrition guide.

How much protein do you need to avoid losing muscle?

Sarcopenia is the loss of muscle mass and strength that comes with age. It begins to become noticeable from around age fifty. Muscle is the tissue that uses the most energy and one of those that most helps control blood sugar.

If you have osteoporosis, the SEIOMM guideline recommends 1 to 1.5 g of protein per kilogram of body weight per day [1]. For a woman weighing 65 kg who has osteoporosis, that is 65 to 98 g a day. If you have kidney disease, your nephrologist should set the amount for you.

How you spread protein through the day also matters. Include a serving of protein at breakfast, lunch and dinner instead of having it all at lunch. Options include two eggs, a tin of tuna or sardines, or a portion of fish or chicken. A serving of pulses, a yoghurt or some fresh cheese also counts. Strength training is the main way to preserve muscle: without that stimulus, protein alone will not build it.

Why does cholesterol rise during menopause?

Oestrogen helps maintain a favourable cholesterol profile. According to the American Heart Association, as oestrogen levels fall, total cholesterol and LDL cholesterol, which can build up in the arteries, rise [2]. This happens around the time of the last period. A woman’s cardiovascular risk gradually approaches that of a man of the same age. If you have been told your cholesterol is high, see our high-cholesterol nutrition guide too.

Diet can make a real difference here. Guidelines from the European Society of Cardiology and European Atherosclerosis Society recommend replacing saturated fats with unsaturated fats, increasing fibre and including fish [5]. To put this into practice, use extra virgin olive oil instead of butter and have processed meats only occasionally. Add oats, pulses and fruit every day, and eat fish several times a week, especially oily fish.

What common mistakes do we see in consultations?

One common response to a changing waistline is to have only a piece of fruit or a yoghurt for dinner. It often backfires: you go to bed hungry, sleep less well and end up snacking in the afternoon or at night. Much of what is lost by eating so little is muscle.

Dinner can be light and complete at the same time. Start with vegetables, perhaps in a soup or stir-fry. Add a source of protein, such as white fish, eggs or tofu, and some carbohydrate, such as boiled potato or brown rice. This is filling, lets you sleep without hunger and helps you meet your daily protein needs.

Do you need isoflavone or herbal supplements for menopause?

Pharmacies and health-food shops sell many soy isoflavone, red clover, black cohosh and mixed herbal supplements marketed for hot flushes. The Menopause Society does not recommend them in its 2023 position statement. The evidence does not show consistent benefits over placebo [4].

Soy foods are a good source of plant protein and can be part of your diet. You could have tofu, tempeh, edamame or unsweetened soy drink. Do not expect them to relieve hot flushes, though. If you are considering a supplement, your doctor or dietitian-nutritionist prescribes it. Some interact with medicines, while others are not advised if you have a history of breast or thyroid disease.