What to eat and avoid during menopause? Doctor recommends dietary changes

Menopause is a natural biological milestone that every woman reaches. However, the accompanying hormonal fluctuations, along with significant physical and mental shifts, can make this period particularly challenging. Many women approach menopause with apprehension and uncertainty. Is it really something to fear? When does it typically begin, and how can women navigate its symptoms smoothly?

This Menopause Awareness Month(October), Dr Namitha Joseph, a specialist in reproductive medicine and menopausal care, dispels common myths surrounding menopause and offers expert guidance on staying healthy during this life stage.

What is menopause and when does it start?
A woman is considered to have reached menopause when she has gone 12 consecutive months without a menstrual period. This occurs because the ovaries run out of viable eggs. Globally, the average age for menopause is around 52 years. In India, however, women generally experience menopause earlier, at an average age of 46 years.

Perimenopause versus menopause
Perimenopause is the transitional phase leading up to menopause, lasting anywhere from six months to 10 years. During menopause, the ovaries completely stop producing estrogen and progesterone. In perimenopause, however, as egg counts decline, levels of estrogen and progesterone fluctuate wildly before ultimately dropping. This unpredictable hormonal roller-coaster often makes perimenopause more confusing and difficult to navigate than menopause itself, affecting everything from mood to brain function.

How to recognise the onset of menopause
Menopause is formally diagnosed after 12 continuous months without menstruation. For women who have undergone a hysterectomy or no longer have a uterus, doctors confirm menopause by testing for elevated levels of Follicle-Stimulating Hormone (FSH). Meanwhile, perimenopause reveals itself through symptoms such as sudden hot flushes, night sweats, and sharp mood swings.

Physical changes in the body
When estrogen drops during menopause, bone density begins to decline, increasing the risk of osteoporosis. Estrogen also offers protective benefits against metabolic conditions; without it, women become more susceptible to elevated blood pressure, cholesterol, high blood sugar, and abdominal fat accumulation. Reduced progesterone levels frequently lead to insomnia and sleep disturbances. Additionally, genitourinary symptoms like vaginal dryness, frequent urinary tract infections, and painful intercourse are common, alongside general fatigue and reduced vitality.

Brain fog and memory loss
Forgetfulness and difficulty concentrating are actually more pronounced during perimenopause than post-menopause. Often referred to as 'brain fog', this occurs because the brain is striving to adapt to fluctuating hormonal levels.

Does menopause affect appearance?
Beauty is subjective and should not be linked directly to menopause. While weight gain can occur during perimenopause and menopause, it can be managed effectively through lifestyle adjustments. Skin dryness is primarily a natural part of ageing rather than an isolated effect of menopause. Rather than worrying about aesthetic changes, women should focus on maintaining bone density and metabolic health.

Dietary recommendations
As metabolic risks increase, maintaining muscle strength becomes crucial for supporting bone health. Women should aim for 1.2 grams of protein per kilogram of body weight daily. Including 25–30 grams of dietary fiber, along with plenty of fresh fruits and vegetables, is essential. Processed, fried, and highly refined foods should be strictly limited to control blood sugar and cholesterol levels.

Medical treatments and hormone therapy
Lifestyle modification is the first line of management: prioritise good sleep, stress management, balanced nutrition, and regular exercise. For medical intervention, Menopause Hormone Therapy (MHT) is highly effective. Options include topical estrogen gels and oral progesterone tablets. Women without a personal history of breast cancer can safely use these therapies under medical supervision to significantly ease symptoms.

Impact on mental health
Mental health challenges—such as heightened anxiety, depression, and low irritability thresholds—are far more common during perimenopause. Women often feel unlike themselves and may consult psychiatrists without realising these symptoms stem from hormonal changes. Optimal care involves a collaborative approach between gynaecologists and mental health professionals, tailoring treatments to the woman's age and hormone levels.

Sexual health after menopause
Declining estrogen and testosterone levels lead to decreased vaginal lubrication, dryness, and discomfort, which can reduce sexual desire. This loss of libido is a biological reaction, not a personal failing. Menopause Hormone Therapy and localised estrogen treatments can dramatically improve comfort and sexual well-being.

When to seek urgent medical attention
Any vaginal bleeding that occurs after a woman has been period-free for 12 months must be evaluated by a gynaecologist immediately. Doctors will typically perform an ultrasound to measure endometrial thickness and may advise an endometrial biopsy. Post-menopausal bleeding should never be ignored.

Supplements: Calcium and Vitamin D
Women require 1,000–1,200 mg of calcium daily, ideally obtained through diet. If dietary intake falls short, supplements can bridge the gap. Daily Vitamin D requirements range from 600–800 IU. While low-dose Vitamin D supplementation is generally safe to take, women should avoid excessive self-supplementation without professional guidance.

Role of exercise and yoga
Regular physical exercise and yoga offer substantial relief during perimenopause. Yoga aids in stress reduction, while weight-bearing and resistance exercises strengthen both muscles and bones.

Importance of emotional support from family
Empathy and support from partners and family members are indispensable. During perimenopause and menopause, women navigate demanding physical and emotional changes. Misunderstandings regarding mood swings or fatigue can strain relationships. Family members who offer patience and understanding make this transition significantly smoother and less stressful.