That’s the conclusion of the first UK study to look at the relationships of diet to menopausal age in the UK, published online in the Journal of Epidemiology & Community Health.

Several genetic, behavioural, and environmental factors are thought to be involved in the timing of the menopause, and some studies have implicated diet.

To explore this further, the researchers drew on participants from the UK Women’s Cohort Study, involving women between the ages of 35 and 69 from England, Scotland, and Wales.

The women provided information on potentially influential factors such as weight history, physical activity levels, reproductive history, and use of hormone replacement therapy (HRT).

Diet under scrutiny

They also estimated the quantities of 217 foodstuffs they ate every day by completing a food frequency questionnaire. The food items were collated into groups according to their culinary uses.

Further information on when the women had gone through the menopause naturally was gathered 4 years later.

In all, the study included the 914 women who had gone through the menopause naturally after the age of 40 and before the age of 65.

The average age at menopause was 51, and certain foods seemed to be associated with its timing.

Health protein good, carbs & snacks not so much

Each additional daily portion of refined carbs – specifically pasta and rice – was associated with reaching the menopause 1.5 years earlier, after taking account of potentially influential factors.

But each additional portion of oily fish and fresh legumes (e.g. peas, beans) was associated with a delay of more than 3 years. Higher intakes of vitamin B6 and zinc (per mg/day) were also associated with later menopause.

Similar results emerged when the analysis looked at particular groups. For example, eating meat was associated with menopause arriving almost a year later than a vegetarian diet.

Among those who weren’t vegetarian, upping daily portions of savoury snacks was associated with the arrival of the menopause almost 2 years earlier, while higher intake of oily fish and fresh legumes was linked to later menopause of more than 3 and nearly 1.5 years, respectively.

Similarly, among mothers, higher intake of oily fish and fresh legumes was associated with later menopause, while additional daily portions of pasta, rice, and savoury snacks were associated with earlier menopause.

Among childless women, eating more grapes and poultry was significantly associated with later menopause.

Do antioxidants offer an explanation?

Egg maturation and release are adversely affected by reactive oxygen species, so a high intake of legumes, which contain antioxidants, may counter this, preserving menstruation for longer, suggest the researchers. Likewise, omega 3 fatty acids, which are abundant in oily fish, stimulate antioxidant capacity in the body.

On the other hand, refined carbs boost the risk of insulin resistance, which can interfere with sex hormone activity and boost oestrogen levels, both of which might increase the number of menstrual cycles and deplete egg supply faster, they say.

Vegetarians consume a lot of antioxidants too, but they are also likely to eat a lot more fibre and less animal fat than carnivores, both of which are associated with low oestrogen levels, which may also alter the timing of the menopause, suggest the researchers.

This is an observational study, and as such, can’t be used to prove a definite link between diet and age of menopause.

But it points research in a new and useful direction since women who go through the menopause early are at increased risk of osteoporosis and heart disease, while those who go through it late are at increased risk of breast, womb, and ovarian cancers, so timing matters, say the researchers.

The scientists conclude: “Our findings confirm that diet may be associated with the age at natural menopause. This may be relevant at a public health level since age at natural menopause may have implications on future health outcomes.”

It’s a remedy rich in a type of plant estrogen known as isoflavones, that has been show to work for many – but not all – women.

Now Danish researchers suggest that the form of red clover can make a big different to how well – and how broadly – it works.  In a new study they found that fermented red clover stopped hot flushes and, in addition, prevented the accelerated menopausal bone loss affecting one in three women over the age of 50. Indeed the results showed the herbal treatment stopped bone loss in the spine completely.

“The challenge with isoflavones is that they can be difficult to digest as they naturally occur in the plant bound to sugar molecules which prevent absorption. Hence, a large proportion of the isoflavones that are consumed (e.g. as a pill or capsule) can pass through the intestine without entering circulation. This problem is bypassed when the red clover extract undergoes a fermentation process… [which] separates the sugar molecules from the isoflavones, thereby increasing bioavailability,” explains study author Max Norman Tandrup Lambert.

Fast results

In this small trial, published in PLOS One, 62 pre-menopausal women aged 40–65, who were experiencing more than 5 hot flushes per day and who had a follicle stimulating hormone (FSH) level of over 35 International Units Per Litre (iu/L, indicating they were at the menopause “stage) were enrolled.

The women received either twice-daily treatment with a liquid fermented red clover extract, providing 34 milligrams per day (mg/d) of isoflavones plus a lactic acid probiotic, or a placebo formulation for 12 weeks.

The probiotic was added, say the researchers because previous work has shown that it can improve bioavailability of red clover extract.

Within 24 hours there was a significant decrease in hot flush frequency and intensity in those women taking the red clover extract.

“After 12 weeks we tested again and were speechless about the data,” said Lambert. “There was a much greater effect than we had hoped for.”

Bioavailability too often ignored

The issue of bioavailability highlighted within this study is one which the research team say has often been ignored.

“Previous studies fail to account for inter-individual differences in GI microbiota of their participants or the molecular form of the isoflavones provided,” they commented.

“This has led to high variability in isoflavone bioavailability, bioactivity and efficacy in other clinical trials.”

These findings are important since to 80% of women may experience symptoms during menopause and it is estimated that in 2030 numbers of pre- and post- menopausal women will reach 1.2 billion globally.

While conventional approaches to menopausal such as hormone therapy may alleviate some symptoms they are also linked to an increase in cancer and cardiovascular risk. This is why, studies show, many women turn to natural remedies.

Fermented isoflavone supplements are beginning to appear on the market meaning more women can soon benefit from them. In the mean time, adding a lactic acid probiotic (eg  Lactobacillus acidophilus) to your supplement regimen may greatly improve the results you get with red clover.

A new study confirms that it is also effective in the management of postmenopausal symptoms such as hot flashes, sleeplessness, vaginal dryness, and anxiety, without serious side effects.

Previous studies suggested that the menopause was a risk factor for increased arterial stiffness, meaning that postmenopausal women have a higher chance of acquiring cardiovascular disease (CVD).

So, in this small study Japanese researchers studied 26 postmenopausal women for 12 weeks.

The women were divided into two groups. The first group drank a flavanol-rich cocoa mixture (17g powder) every day for 12 weeks. The second group took twice the amount every other day for 12 weeks as well.

The women were instructed to continue with their regular diet and exercise, but not to take tea or other flavanol-rich foods during the cocoa supplementation.

Improved circulation

To test arterial stiffness researchers took a measurement of aortic pulse wave energy (PWV).  When the heart contracts it generates a pulse or energy wave that travels through the circulatory system. Measurements were taken at two sites on the body – carotid–femoral pulse-wave velocity (cfPWV) and femoral–ankle pulse-wave velocity (faPWV) – at the beginning and end of the study period.

“The key finding of this study was that central and peripheral arterial stiffness decreased significantly in both groups after cocoa intake,” the researchers wrote in the journal Clinical Interventions of Aging.

“Since the same dose of cocoa was ingested by each group, although at a different frequency, this indicates that intake frequency does not affect the cocoa-induced changes in arterial stiffness.”

“Daily consumption of cocoa and/or dark chocolate has a beneficial effect in the prevention of cardiovascular events,” the study concluded.

Not just for older women

The heart healthy benefits of chocolate are not just for older women. Raw cacao in particular contains important minerals such as magnesium, iron, potassium, calcium, zinc, copper and manganese – all of which are heart healthy.

In a 2011 report in the British Medical Journal researchers analysed seven studies, with a total of 115,000 adult participants, that measured chocolate intake and heart health outcomes.

Compared with the those who had the lowest level of chocolate consumption, those with the highest intake had 37% lower risk of heart disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

Again, in 2015, a large 12-year study found that people who eat a substantial amount of chocolate every day had a lower risk of cardiovascular disease and stroke.

Compared to participants who said they ate no chocolate, those who ate between 7-100g a day had an 11% lower risk of cardiovascular disease and 25% lower risk of premature death.

• For more on healthy chocolate see our article Cocoa or cacao – what’s the difference?

The link between HRT and increased breast cancer risk is already well established but, say the researchers, this latest data published in the British Journal of Cancer reveals that we may have been underestimating the real risk.

The new research was part of the Breast Cancer Now Generations Study – a major prospective study led by scientists at The Institute of Cancer Research (ICR), London, following more than 100,000 women for 40 years to investigate the causes of breast cancer.

Out of this group some 39,000 menopausal women were identified and monitored for six years, with follow-up questionnaires gathering comprehensive data on any HRT use (type and duration) as well as their general health and lifestyle.

Tripling women’s cancer risk

During this time, 775 of these women developed breast cancer, with the researchers finding that women using combined HRT (for a median duration of 5.4 years) were 2.7 times more likely to develop breast cancer during the period of HRT use than women who had never used HRT.

This risk increased with duration of use, with women who had used combined HRT for over 15 years being 3.3 times more likely to develop breast cancer than non-users. However in women using oestrogen-only HRT there was no overall increase seen in breast cancer risk compared with women who had never used HRT.

Importantly, this increased risk level has been found to return to about normal once HRT use ends: after a year or two had gone by since women stopped taking combined HRT the scientists did not find a significantly increased risk of breast cancer, confirming the findings of previous studies.

Study leader Professor Anthony Swerdlow, Professor of Epidemiology at ICR said: “Our research shows that some previous studies are likely to have underestimated the risk of breast cancer with combined oestrogen-progestogen HRT. We found that current use of combined HRT increases the risk of breast cancer by up to three fold, depending on how long HRT has been used.

“Our findings provide further information to allow women to make informed decisions about the potential risks and benefits of HRT use.”

Previous studies

In the early 2000s two of the largest ever studies of HRT users were undertaken, one clinical randomised trial in the USA – the Women’s Health Initiative (WHI) – and one observational questionnaire study in the UK – the Million Women Study (MWS). The published results of these two studies during 2002 and 2003 raised serious concerns regarding the safety of HRT. These safety concerns revolved around the findings that that the extended use of HRT may increase the risk of breast cancer and that the use of HRT may increase the risk of stroke.

Reanalysis of both these studies in 2012 (see here, here and here) concluded that the risks had been overstated or were only specific to certain women; essentially older, more overweight women and those taking HRT for longer. Even so questions have remained.

In addition, to potential for increased stroke and breast cancer risk, HRT can also increase the risk of developing other types of cancer. Oestrogen-only HRT, for example, can increase the risk of womb cancer and is normally only used in women who’ve had a hysterectomy – women who were excluded from this study.

What can women do?

HRT is commonly prescribed to treat menopausal symptoms such as hot flushes, migraines, disrupted sleep, mood changes and depression.  Although the popularity of HRT dropped after the publication of the WHI and MWS studies, around one in ten women use HRT during their fifties, with use lessening in older age groups as menopausal symptoms reduce.

There are two main types of HRT, one containing just oestrogen (‘oestrogen-only HRT’) and the other a combination of oestrogen and a progestogen (‘combined HRT’) and it can be taken in different ways: through tablets, skin patches, a cream or a gel. A third less commonly used type of HRT known as ‘tibolone’ contains a steroid that acts like oestrogen and progestogen.

Too often the ‘informed choice’ presented to women is HRT or suffering. In factwomen’s experiecne of menopause varies tremendously and there is no universal treatment for its symptoms, which may involve a complex mixture of biological and psychological factors.

HRT is certainly not a panacea and other less risky ways of managing menopausal symptoms do exist. What is more, research suggests that women actively seek out and prefer non-medical treatment for their menopausal symptoms and want more support from their GPs – and their partners.

If you are interested in alternatives see our articles Support during the menopause and Your detox diet for menopause as well as the recommended further reading in the panel above left.

The review published in The Obstetrician and Gynaecologist outlines the advantages and limitations of both pharmacological and herbal and complementary treatments for women with postmenopausal symptoms.

The menopause – which ‘officially’ begins when a woman has not had a menstrual period for 12 months – is associated with a significant drop in estrogen production and this and can cause an increase in vasomotor symptoms (hot flushes), genitourinary symptoms (vaginal dryness, sexual dysfunction, frequent urinary tract infections, urinary incontinence), and musculoskeletal symptoms (joint pain) as well as sleep and mood disturbance.

One of the most common menopausal symptoms is hot flushes; approximately two-thirds of postmenopausal women will experience them, and 20% of women can experience them for up to 15 years, states the review.

Help for hot flushes

Low estrogen levels can also be linked to longer-term health issues such as cardiovascular disease and osteoporosis (though this is not by any means the only cause). While conventional drugs are available to treat postmenopausal symptoms, many non-pharmacological treatment options are also available.

Hormone Replacement Therapy (HRT) can effectively treat hot flushes, improving symptoms in 80-90% of women, says the review. However, the author notes, that there are serious health risks associated with HRT, such as links to breast cancer, blood clots, stroke, and cardiovascular problems.

The seriousness of these risks means that many women seek safer alternatives, many of which can be equally effective, such as behaviour modification and herbal and complimentary medicines, says the author.

According to the author, between 50-75% of postmenopausal women use herbal options to treat hot flushes, and of the complimentary therapies, soya, red clover and black cohosh have been the most investigated.

Soya contains plant estrogens and previous research has shown supplements can reduce hot flush symptoms by around 20-55%. Red clover, a legume also containing phytoestrogens, and black cohosh, a plant originating from the eastern United States and Canada, have also been reported to ease postmenopausal symptoms.

No nasty side effects

The review recommends these herbal treatments as there are no significant adverse side effects associated with them, as long as they are used in women who do not have a personal history of breast cancer, are not at high risk for breast cancer, and are not taking tamoxifen.

Iris Tong, Director of Women’s Primary Care at the Women’s Medicine Collaborative, The Warren Alpert Medical School of Brown University, Rhode Island, and author of the review said:

“Up to 75% of women use herbal and complimentary medicines to treat their postmenopausal symptoms. Therefore, it is vitally important for healthcare providers to be aware of and informed about the non-pharmacological therapies available for women who are experiencing postmenopausal symptoms and who are looking for an alternative to HRT.”

The Obstetrician and Gynaecologist‘s Editor -in-Chief, Jason Waugh added:

“Postmenopausal symptoms can be very distressing and it is important to review the advantages and limitations of the non-pharmacological treatments available as well as the pharmacological ones. Even simple behaviour modification can make a difference to postmenopausal symptoms, including keeping the room temperature cool, wearing layered clothing, relaxation techniques and smoking cessation.”

As many as 80% of women experience experience some degree of hot flashes during menopause. This new study, supported by the National Center for Complementary and Alternative Medicine, and published online in the journal Menopause, is the first controlled, randomised study of using hypnosis – a mind/body technique – to manage this difficult to treat symptom.

The first hurdle the researchers had to get over was finding a suitable placebo. Controlled, randomised studies may pit an active drug against an inactive placebo pill. But it’s hard to find a placebo for mind/body techniques.

The researchers at the Mind-Body Medicine Research Laboratory at Baylor University, Waco, Texas the school of Nursing at Indiana University in Indianapolis, Indiana and the College of Education at the University of Texas, Austin, met that challenge by randomly assigning the postmenopausal women in the trial to receive either hypnotherapy or what they termed “structured attention”.

Imagining a cool place

The women who underwent hypnosis had five weekly sessions in which they received suggestions for mental images of coolness, a safe place or relaxation, according to their preference. They also got an audio recording of a hypnotic induction and were asked to practice it daily.

The “structured attention” group had five weekly sessions in which a clinician provided discussion of their symptoms, attentive listening, interpersonal exchange, monitoring, measurement, and encouragement and avoided negative suggestions. These women also got a recording containing information about hot flashes, that they were asked to listen to daily.

Significant benefit

All the women kept diaries that tracked hot flash frequency and severity and, interestingly, they also had hot flash frequency measured objectively by a skin conductance monitor.

After 12 weeks, the women who underwent hypnosis reported 75% fewer hot flashes, compared with 13% fewer among the women given structured attention.

When combining the scores for both frequency and severity of hot flashes, the women receiving hypnosis had an overall reduction of 80% compared with 15% in the control  group.

Skin conductance showed a 57% reduction in hot flashes for the women who underwent hypnosis, compared with 10% in the controls. The hypnosis participants also reported significantly less interference with their lives from hot flashes and better sleep than controls. Moreover, their level of satisfaction with the treatment was high.

Calming the ‘rest and digest’ system

How hypnosis eases hot flashes isn’t clear. The authors of the study speculated that it may be because hypnosis may improve the function of the parasympathetic nervous system.

This system is popularly called the “rest and digest” system, which puts the brakes on the sympathetic or “fight or flight” nervous system that controls body functions that ramp up during hot flashes, such as sweating and heart rate.

Many women experience hot flashes at some point before or after menopause, as their estrogen levels naturally decline.

“While the mechanism is not completely understood, hot flashes and night sweats are thought to be caused by a complex interaction that involves fluctuating hormone levels, the hypothalamus region of the brain that regulates body temperature, brain chemicals and receptors, and the body’s blood vessels and sweat glands,” said Candyce Kroenke, ScD, MPH, a research scientist with the Kaiser Permanente Northern California Division of Research and lead author of the study.

Taking the heat out of menopause

To find out more about how diet could influence menopausal symptoms researchers at California Kaiser Permanents used data from the the Women’s Health Initiative study of the health and lifestyles of 17,473 women. The results were published in the journal Menopause.

According to the scientists, women on a diet low in fat and high in whole grains, fruit and vegetables, who had menopausal symptoms, who were not taking hormone replacement therapy, and who lost weight (4.5 kg/10 lbs or more or 10% or more of their baseline body weight) were more likely to reduce or eliminate hot flashes and night sweats after one year, compared to those in a control group who maintained their weight.

Although previous research has shown that high body weight and weight gain are associated with hot flashes and night sweats associated with menopause, this study, say the researchers, is the among the first — and the largest-to-date – to analyse whether weight loss on a diet designed to reduce fat and increase whole grains, fruit, and vegetable intake might ameliorate symptoms.

It is also among the first to examine the influence of a dietary change on symptoms that include hot flashes and night sweats and, say the researchers, this change alone may also benefit menopausal symptoms.

Losing ‘insulation’

“Since most women tend to gain weight with age, weight loss or weight gain prevention may offer a viable strategy to help eliminate hot flashes and night sweats associated with menopause,” said Bette Caan, DrPH, a research scientist with the Kaiser Permanente Northern California Division of Research and the senior author of the study.

She explained that greater body fat provides insulation that may hinder heat loss, and hot flashes and night sweats provide a way to dissipate that heat. Weight loss, then, is a straightforward way to alleviate hot flashes.

The Women’s Health Initiative Dietary Modification trial enrolled a diverse group of 48,835 post-menopausal women between 1993 and 1998 at 40 US clinical centres to evaluate the effects of a low-fat dietary pattern on heart disease, breast and colorectal cancer, and fracture in postmenopausal women.

The dietary intervention was aimed at reducing fat intake and increasing fruit, vegetable, and whole grain intake. Although weight loss was not a goal, participants assigned to the intervention group lost on average 2 kg/4.5 lbs between baseline and year one, compared to the control group.

This is the conclusion of a new study published in the British Journal of Obstetrics and Gynaecology.

The study looked at 4407 women aged 45 to 54 living in north east Scotland. The women were asked to complete a questionnaire about their menopausal symptoms and how they managed them.

The questionnaire included a symptom checklist which asked about problems such as stiff joints, aches and pains, headaches, vaginal dryness, hot flushes, night sweats, depression, anxiety, mood swings, decreased sexual interest and menstrual symptoms.

Participants were asked whether they had experienced the symptom in the last month and how bothered they were by this.

The study found that nearly half of the women (46.7%) experienced hot flushes, 46.4% night sweats and 28.2% vaginal dryness. Approximately two-fifths of women reported these symptoms as quite a bit or extremely bothersome.

Surgically menopausal women (participants who have had a hysterectomy and/or oopherectomy) reported the most bother from menopausal symptoms and the greatest frequency of bothersome symptoms.

The study also looked at the different management strategies women adopt, from HRT to alternative therapies and social support. It found that the most common management strategy used by menopausal women was social support through talking to friends or family. This was reported by more than 60% of women.

Only 8% of women experiencing a physiological ( as opposed to surgical) menopause were using HRT. Instead more women reported taking vitamins, minerals and supplements and herbal remedies rather than HRT. Around 38% of women, for example, had used herbal remedies.

In addition, one third of women thought that their GP was very supportive, however 34% wanted to have more support from them. One fifth of women wanted more support from their spouse or partner.

Dr Lisa Iversen, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen and co-author of the paper said:

“Our results provide a powerful reminder that the menopause is a time of life when women experience numerous symptoms, many of which are bothersome.

“We found that many women used non-medical approaches to help relieve the symptoms suggesting a large need for effective non-hormonal management options for menopausal women.”