The market is awash with dietary supplements for menopausal women, but do you really need them? Dr Haran Sivapalan takes a look.

Do my dietary needs change during menopause? It’s a question often asked – especially with the implications menopause has for skin, bones and heart health. Given that, it may surprise you that there is no specific diet required during the menopause, instead it’s advised that following a healthy, balanced diet will be enough to maintain good health as your body undergoes hormonal changes – and a bit of Vitamin D wont go astray.

Why is a healthy, balanced diet important in menopause?

Levels of the hormone oestrogen fall in menopause. Oestrogen normally has a ‘cardioprotective’ effect – this means it reduces the risk of having a cardiovascular disease such as a heart attack or stroke. Conversely, a fall in oestrogen levels during menopause can increase the risk of cardiovascular disease.

To counteract this, a balanced diet can help maintain a healthy heart and cardiovascular system and reduce your risk of heart attack and stroke.

According to The Eatwell Guide, a balanced diet includes:

• eating at least 5 portions of fruit and vegetables a day
• cutting down on salt and saturated fat
• increasing fibre and wholegrain intake
• eating two portions of oily fish per week.

Do I need calcium and vitamin D supplements?

In short, a daily supplement of 10 micrograms of Vitamin D is recommended for women during the menopause.

Oestrogen also plays a major role in keeping bones strong. Among other things, it prevents the breakdown or “resorption” of bone. A fall in oestrogen levels during the menopause can therefore lead to a loss of bone density. In fact, bone density may decline by as much as 20% in the 5-7 years after the menopause. As a result of these changes, women in the menopause are more likely to develop osteoporosis – a condition which produces fragile bones that are at risk of fracture.

Calcium

To keep your bones strong and reduce the risk of osteoporosis, it is important to get enough calcium and vitamin D in your diet. It is recommended that adults get at least 700mg of calcium per day. For post-menopausal women, the British Dietetic Association recommend an intake of 1200 mg of calcium per day.

Calcium can easily be obtained from diet alone. Foods which are good sources of calcium include:

• dairy products – e.g. milk, yoghurt and cheese
• foodstuffs fortified with calcium – e.g. most breads, certain cereals, certain soya products
• fish that is eaten with bones – e.g. sardines
• certain green, leafy vegetables – e.g. broccoli, cress and kale.

If you already have or are at greater risk of osteoporosis, you may be prescribed calcium supplements by your doctor.

Vitamin D

Vitamin D is also required to maintain healthy and strong bones. Our bodies make vitamin D using sunlight and this is the largest source of our intake. Unfortunately, adequate exposure to sunlight can be difficult, especially in the Northern hemisphere and for people with darker skin.

Vitamin D can also be obtained from foods such as: oily fish, eggs, red meat and fortified foods such as spreads and cereals. It is difficult to get enough Vitamin D from diet alone. As such, most adults (including women during the menopause) are recommended to take a daily supplement of 10 micrograms Vitamin D.

Exercise

Keeping active – with weight bearing or resistance exercises is also vital for bone health. A 30 minute walk a day will go a long way to keeping your bones in order.

Is there evidence that other supplements may be of benefit?

 There are various other dietary supplements that are claimed to help with symptoms of menopause. The most popular of these include:

• Black cohosh
• soy/isoflavones
• red clover

Black cohosh (cimifuga racemosa) is a plant extract from a member of the buttercup family. It is used to treat hot flushes and depressive symptoms during menopause. There are some clinical trials demonstrating that it is effective in this regard, but many of these studies may have been poorly conducted, and it has been associated with liver damage – however this may have been more to do with contaminated batches rather than the black cohosh itself.)

The German health system has approved a 40 mg daily supplement of black cohosh (under the trade name of Remifemin) for the treatment of menopausal symptoms. The supplement is normally taken for up to 6 months. If you are thinking of taking Black cohosh, it is advised to speak to your GP beforehand.

Soy supplements contain phytoestrogens – plant-based substances which act similarly to oestrogen in the human body. It is thought that phytoestrogens within these supplements can counteract the body’s fall in oestrogen production that occurs in menopause. Soy supplements and foodstuffs are rich in a specific class of phytoestrogen called ‘isoflavones.’

Unfortunately, there isn’t much evidence to suggest that soy consumption can help with hot flushes or other menopausal symptoms. That said, studies do show that eating 25 grams of soy per day can halp reduce cholesterol in your bloodstream.

Red Clover (trifolium pretense) supplements also contain isoflavone phytoestrogens. Although shown to be safe and well tolerated, there is not much evidence to suggest that red clover supplements can improve menopausal symptoms.

 Other herbal supplements such as ginseng, valerian root, dong quai, evening primrose and Gingko have very little evidence to support their use in treating

So what supplements should I take?

 Aside from a healthy diet and lifestyle, 10 microgram Vitamin D supplements are recommended for all adults (including women in menopause).

There are no other specific dietary requirements for the menopause, although a doctor or nutritionist may recommend other supplements (e.g. calcium, magnesium) depending on your individual health needs.

There is a small amount of evidence suggesting that soya and black cohosh supplements can help with high cholesterol and hot flushes respectively. If you decide you want to take these supplements, it is best to discuss this with your doctor beforehand.

Download our Menopause – A guide – our free e-book on everything from HRT and Bio-identical Hormones to Supplements and  skincare, so you can make informed choices about how you want to manage your Menopause.