Attention to nutrition, exercise can combat weight gain, other symptoms in menopause
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Key takeaways:
- Weight loss may reduce hot flashes for women with overweight.
- Women need more protein and strength training as they age.
- A multivitamin designed for older adults can help fill nutrition gaps.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with Elizabeth Ward, MS, RDN, and Hillary Wright, MEd, RDN, LDN, about women’s nutrition and exercise needs as they age.
Weiner: Why might women be especially susceptible to weight gain during perimenopause?
Wright: Although it’s true that the average woman does gain some weight through the perimenopause to menopause transition, researching how much is due to declining estrogen levels vs. simply aging is difficult. However, we do know that body composition changes. The Study of Women’s Health Across the Nation, or SWAN study, collected data on the body weight and composition of more than 3,000 women for more than 18 years before and after the onset of menopause. The researchers found that starting about 2 years prior to the last menstrual period, the rate of body fat doubled and lean tissue, mostly muscle, started to decline. This change in body composition continued until about 2 years after the last period and then leveled off. Body weight also steadily increased through the perimenopause/menopause transition — on average around 1.5 lb per year — and also leveled off 2 years after the last period.
Given the loss of lean mass and its potential effect on calorie balance through this time of life, the menopause transition could contribute to weight gain to some degree. It’s also well established that declining estrogen levels trigger a shift to storing more fat in the abdominal area, known as visceral fat, which most women notice as different.
But most of the existing science suggests that weight gain through this phase is more the result of aging and changing lifestyle than menopause itself. Women experience many life changes through these years, which may include mood disorders, demanding careers, sleep issues, stress related to caregiving or divorce, onset of health issues and other factors that can affect lifestyle habits and weight.
Research also supports that sedentary lifestyle predicts weight gain more than aging and menopause. For many women who have dodged developing a regular physical activity routine — which should include strength training exercises in addition to cardio — continuing on this path through perimenopause will likely mean more weight gain.
Weiner: Can eating and nutrition affect symptoms of menopause such as hot flashes, sleep and brain fog?
Ward: Hot flashes affect about 80% of women during the transition to menopause and may continue for years after menopause occurs. Some women find relief from hot flashes by avoiding alcohol and caffeine, and some find that eating soy foods, such as tofu, edamame and unsweetened soymilk on a regular basis helps. However, there is no solid proof that soy foods work for most women. That said, soy foods supply many nutrients that benefit women before and after menopause, such as complete protein, vitamins, minerals and phytoestrogens. Phytoestrogens can produce weak estrogen-like effects in the body, which may reduce hot flashes for some women.
Calories matter, too. It’s important to find a healthy way to eat that works for you with adequate calories to maintain a healthy body weight. Weight loss for women with overweight can decrease hot flashes. A 2023 review from The Menopause Society endorses weight loss for treating hot flashes. The review does not recommend supplements, such as black cohosh, soy extracts and others, based on the fact that there is little or no evidence for their efficacy. Women who smoke are at greater risk for hot flashes and may benefit from quitting.
Sleep is often interrupted because of hot flashes, called night sweats when they happen at night, so paying attention to the information above may help sleep. Limiting caffeine and alcohol are paramount to getting a good night’s sleep. Alcohol may be relaxing at first, but it interferes with deep sleep, and too much caffeine can prevent you from falling asleep. It is best to avoid alcohol at night and consume no caffeine past noon to help with sleep.
Also, one of the principles in our book The Menopause Diet Plan is not eating after dinner. Excessive snacking, which is often done as a form of relaxation or because you haven’t eaten enough during the day, or both, can mean going to bed on a full stomach, which can disturb sleep. Finding a way to relax before bedtime — no screens at all — is also helpful, as is regular physical activity earlier in the day.
As for brain fog, it’s real! However, there is light at the end of the tunnel. Experts say that, for the most part, the postmenopausal brain adjusts to the availability of less estrogen. Fat tissue produces estrogen, so you still have some. In a 4-year study that involved more than 2,300 women, declines in memory and learning ability during perimenopause bounced back after menopause was complete. A balanced diet rich in fiber and protein and low in added sugars and alcohol provides a steady supply of glucose to brain cells. The brain also needs omega-3 fats, and you can get those in at least two servings of fatty fish weekly (8 oz total).
Weiner: Do you recommend a specific eating plan for perimenopause and menopause? How would such a plan differ from one for younger or older women?
Wright: The general principles of healthy eating recommended throughout the life span apply to women in this phase as well, with some fine-tuning. Women older than 50 years need more protein than the current recommended daily allowances, or RDAs. We suggest 1 g/kg to 1.2 g/kg of body weight vs. 0.8 g/kg of body weight, which is the RDA. Including adequate protein at all meals and snacks helps to maintain lean mass, which becomes harder to hold onto as we age and estrogen levels decline.
Eating more protein may necessitate curbing carbohydrate intake from low-nutrient foods like cookies, cake and chips to facilitate calorie balance. Women should get serious about eating at least two servings of fruit and three servings of vegetables daily to help manage calorie intake, include adequate fiber, and optimize the ability of plant-forward eating to decrease risks for chronic diseases that become more common with age and menopause, including heart disease and osteoporosis.
If weight management is a concern, portion control becomes more important than ever at this stage. As we always say, managing calorie intake through the menopause transition and beyond is consequential, so proactively eating over the day to approach your next meal or snack hungry but not starving can be really helpful for managing the quantity of food we eat. Aiming for more protein at meals and snacks can help us feel full faster and keep us feeling fuller for longer after meals.
In our experience, women are often great food restrictors until late in the day when the undereating comes home to roost, resulting in eating more calories than we need later in the day and into the evening. We suggest eating according to your circadian rhythms — consuming most of your calories in the earlier part of the day when insulin is most responsive.
Weiner: Of particular concern as women age are maintaining muscle mass, bone mass and heart health. What is the role of nutrition there?
Ward: Nutrition and lifestyle play a big role in supporting heart, bone and muscle health. A fiber-rich, plant-based diet — which doesn’t have to be free of animal foods — that is low in saturated fat, sodium and added sugars is key to heart and brain health. To protect bones, this eating plan should also be adequate in protein, calcium (1,200 mg daily) and vitamin D (15 µg daily, or 600 IU), as well as many other vitamins and minerals found in a variety of foods.
To support muscle and bone health, women need enough protein. As Hillary mentioned above, the current RDA for protein is likely too low for women over 50 years. Older women can make as much muscle as younger ones, but they require more protein to do it. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) suggests that women over 50 get 1 g to 1.2 g of protein per kilogram of body weight daily to support bones and for skeletal muscle, which comprises about 30% to 40% of body mass. To show the difference between the ESCEO recommendation and the U.S. RDA suggested protein intake, a 150-lb woman would need 68 g to 81 g of protein daily with the ESCEO guideline, or about 23 g more protein than the U.S. dietary reference intakes suggests.
It’s not enough to just eat adequate protein, however. Women must do strength training at least twice weekly to build and maintain skeletal muscle, which is a metabolic engine in so many ways. Adequate skeletal muscle mass reduces the risk for insulin resistance, a condition linked to type 2 diabetes, high blood pressure, cardiovascular disease and nonalcoholic fatty liver disease, and it may also impact brain health. A 2022 study involving nearly 8,300 older adults over a 3-year period found low muscle mass was linked to a decline in problem-solving, attention and working memory.
Resistance training (strength training) helps to offset age-related skeletal muscle loss, and we can’t stress enough how important this is for women at this stage of life. Weightlifting with machines or free weights, resistance bands and activities that use your own body weight qualify as resistance training. A recent review found that resistance training was associated with a lower risk for cardiovascular disease, diabetes, lung cancer and death from any cause in adults 18 and older, and that just 30 to 60 minutes weekly was enough to produce positive results.
Weiner: Is there a role for nutritional supplements in women’s health during menopause?
Wright: Dietary supplements won’t compensate for an otherwise unhealthy diet and lifestyle but can fill some important nutrient gaps based on individual needs. Most women are aware of the importance of calcium and vitamin D for maintaining strong bones, so opting to get about half your calcium requirements from a calcium supplement can help ensure needs are being met.
A basic “over 50” multivitamin and mineral supplement can provide at least 15 µg (600 IU) of vitamin D to maintain healthy blood levels — although some women may need more based on individual needs — as well as extra vitamin C, vitamin K and magnesium.
After age 50 years, many people don’t absorb vitamin B12 as well as they did when they were younger, so many women benefit from the additional synthetic B12 found in multivitamins. Certain medications, such as metformin for diabetes or acid-blocking medications like omeprazole taken for gastric reflux, reduce B12 absorption, which may necessitate higher intake of supplemental B12. Anyone on these medications should ask their physician to periodically check their B12 levels.
Women who don’t eat seafood could also consider taking a fish oil supplement, about 200 mg to 300 mg docosahexaenoic acid (DHA)/eicosapentaenoic acid (EPA) daily, to boost their intake of heart-healthy omega-3 fats.
Recent studies suggest that daily multivitamins slow down brain aging. In a 2023 study, the brains of people who took a daily multivitamin were about 3 years younger in terms of certain cognitive functions including memory. A 2022 study had similar results. For this reason, and others mentioned above, we suggest women take a daily multivitamin that suits their stage of life. For example, if you still have your period, then it’s OK to take multivitamins with iron. If you are past menopause, no need for supplemental iron.
References:
- Greendale GA, et al. JCI Insight. 2019;doi:10.1172/jci.insight.124865.
- Momma H, et al. Br J Sports Med. 2022;doi:10.1136/bjsports-2021-105061.
- Rizzoli R, et al. Maturitas. 2014;doi:10.1016/j.maturitas.2014.07.005.
- Shufelt CL, et al. Menopause. 2023;doi:10.1097/GME.0000000000002200.
- Tessier J, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.19926.
- Yeung LK, et al. Am J Clin Nutr. 2023;doi:10.1016/j.ajcnut.2023.05.011.
- Young LM, et al. Nutrients. 2022;doi:10.3390/nu14235079.
For more information:
Elizabeth Ward, MS, RDN, is a writer, nutrition communicator and consultant who specializes in women’s health. She is the author of Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy and co-author of The Menopause Diet Plan: A Natural Guide to Hormones, Health, and Happiness. She can be reached at elizabethwardrd@gmail.com; X (Twitter): @ewardrd
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is the owner of Susan Weiner Nutrition PLLC and the Healio | Women’s Health & OB/GYN Nourish to Flourish column editor. She can be reached at susan@susanweinernutrition.com; X (Twitter): @susangweiner.
Hillary Wright, MEd, RDN, LDN, is a nutrition educator, writer, speaker and consultant. She is the director of nutrition for the Wellness Center at Boston IVF and is the author of two books, The PCOS Diet Plan and The Prediabetes Diet Plan, and co-author of The Menopause Diet Plan: A Natural Guide to Managing Hormones, Health, and Happiness. She can reached at hillary@hillarywright.com; X (Twitter): @PCOSDiet.