Written by Associate Nutritionist Spela Horjak
Checked by Registered Dietitian Nishti
Menopause is a time in a woman’s life that marks the end of her menstrual cycle. The transitional period of 4-10 years prior to that, is called perimenopause. The first symptom of perimenopause is often a change in the menstrual pattern. Aside from that, hot flushes and night sweats are the most common occurrence during the female menopausal transition (1).
There are different ways of tackling these symptoms, including various forms of hormone therapy involving oestrogens and progestogens. Some women are reluctant to accept these. What about dietary interventions? This article will focus on the symptoms of hot flushes and night sweats and whether there are any dietary changes we can make to alleviate them.
Let’s dive right in.
The cause of hot flushes and night sweats
- Hot flushes are caused by hormonal changes. As the ovaries start producing less estrogen (the female sex hormone) in perimenopause, this has the ability to destabilize the hypothalamus, the part of the brain responsible for regulating body temperature. The hypothalamus is triggered to think the body is too hot and the process activates the sweat glands to cool us down which can happen both during the day and night (12). The reason for this is not completely clear.
Hot flushes can also be triggered by certain medications and hormonal therapies.
Phytoestrogens – what are they and can they help?
Soya tends to be a controversial topic for many, so let’s look at what we can learn from research so far.
Soya and soya products contain so-called isoflavones (plant-derived estrogens) that have a similar structure to estrogen hormone, which means they can mimic estrogen to some degree. Isoflavones bind to the body’s estrogen receptors and have some of the same beneficial effects of estrogen without affecting the body’s actual estrogen levels. Research has shown this can help reduce some perimenopausal symptoms by easing the sharp decline in estrogen (2).
What research says:
A randomized control trial of 38 post-menopausal women showed the group that was consuming ½ cup of cooked soybeans a day as part of a wholefood plant-based diet had their total hot flushes (the frequency as well as severity) reduced by 30% more than the control group (that didn’t consume soybeans) (3). In fact, after 12 weeks, none of the women that consumed soybeans experienced moderate-to-severe hot flushes.
A meta-analysis of isoflavone supplements showed the ingestion of soy isoflavone supplements reduced the frequency and severity of hot flushes by 20% and 26% respectively, over the course of 6 weeks to 12 months (4). Another meta-analysis study reported phytoestrogens in general (not only those found in soya) to have had a significant effect on the reduction of hot flush frequency compared to the placebo group and without any side-effects (5).
How much soya should you eat?
It is recommended women consume 2-3 portions of soya-based foods a day in perimenopause and menopause; you can choose from soya drink, soya yoghurt, soya mince, tofu, tempeh or edamame beans as part of a balanced diet. Other plants containing phytoestrogens in smaller amounts are listed below in the table below.
|
Soya products |
Other foods containing phytoestrogens |
||
|
Soya beans |
Plums |
Spinach |
Sesame seeds |
|
Tofu |
Pears |
Grains |
Green tea |
|
Tempeh |
Apples |
Garlic |
Back tea |
|
Edamame beans |
Berries |
Onion |
Cruciferous vegetables |
|
Soya mince (can be high in fat/salt) |
Apricots |
Beans |
|
|
Soya drink |
Sprouts |
Chickpeas |
|
|
Soya yoghurt |
Cabbage |
Flaxseeds |
|
It’s important to note that women with breast cancer should not take soya isoflavone supplements or any other supplements containing plant estrogens.
Whole plant foods
A study of Chinese menopausal women has shown that the inclusion of whole plant foods in the diet was associated with fewer menopausal symptoms overall (9). It’s a good idea for anyone but especially for women experiencing menopausal symptoms to base their diet on whole plant foods – fruits, vegetables, wholegrains, legumes, nuts, and seeds.
Caffeine, alcohol, and spicy foods
Coffee, alcohol, and spicy foods have the tendency to make hot flushes worse for many women (7) so definitely try to limit those or choose decaffeinated or alcohol-free alternatives. In the UK, the recommendation is to consume no more than 14 units of alcohol a week (11). In terms of caffeine, you can opt for decaf coffee or herbal tea instead if you feel that caffeinated drinks trigger hot flushes.
For some women spicy foods are also a trigger so you may want to ease off the chili.
Weight management
It is common for women to gain weight in menopause. Several studies have shown that women with a higher BMI (body mass index) and body fat percentage experience more frequent and/or more severe vasomotor symptoms compared to women with a lower BMI and a lower body fat percentage (6). Depending on the starting weight and each woman individually, it may be beneficial to look at weight loss as one of the measures to reduce menopausal symptoms. Another study showed that weight loss as part of a healthy diet intervention may help alleviate hot flushes and night sweats among postmenopausal women (10). Speak to your dietitian or nutritionist if you think this may be beneficial to you.
The link between hot flushes and anxiety
A study of 233 women (13) that were followed for 14 years found there was a significant association between the risk of hot flushes and somatic anxiety (anxiety which is experienced mainly in a physical manner). Women experiencing high levels of somatic anxiety experienced the highest rate of hot flushes in the group.
Another study of 291 women (14) showed that anxiety has an impact on the severity of hot flushes, among other factors.
What about exercise?
There is currently inconclusive evidence in relation to how different types of exercise impact the severity and frequency of hot flushes with many studies presented with several limitations so more research is needed.
One study involving 58 perimenopausal women showed resistance training (involving weight training) decreased the frequency of hot flushes by half and could therefore be considered as one of the interventions in managing this symptom (15).
A review of 13 randomized control trials found that yoga can also be effective in reducing menopausal symptoms including vasomotor symptoms (16).
An article in the Journal of Mid-Life Health suggests partaking in strength training, balance exercises as well as low impact exercise such as deep breathing exercises, yoga, and stretching is beneficial for menopausal women but advises against high-impact exercises involving running and jumping (17).
Other low-impact exercises are walking, cycling, pilates, and dancing.
There’s no solid evidence to suggest these would directly impact the severity or frequency of hot flushes, however, they will have a positive impact on bone and muscle strength, and can also help manage stress which in turn can help with anxiety and menopause-related symptoms.
Other lifestyle factors
Not smoking, drinking in moderation, and getting sufficient sleep can also help manage menopausal symptoms including hot flushes.
Conclusion
This article has summed up some of the current evidence on possible interventions in relation to hot flush alleviation. It is important to keep in mind each person is unique and it is only with trial and error that we can establish what will be beneficial for us as individuals. It is also advisable to think about balance as any extreme measure can potentially result in more harm than benefit. We can surely help you with this here. To book a no-obligation consultation please visit the booking page.
References
1
NHS Website “Menopause” [Accessed August 2022 via https://www.nhs.uk/conditions/menopause/ ]
2
Rietjens IMCM, Louisse J, Beekmann K. The potential health effects of dietary phytoestrogens. Br J Pharmacol. 2017 Jun;174(11):1263-1280. doi: 10.1111/bph.13622. Epub 2016 Oct 20. PMID: 27723080; PMCID: PMC5429336.
3
Barnard ND, Kahleova H, Holtz DN, Del Aguila F, Neola M, Crosby LM, Holubkov R. The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause. 2021 Jul 12;28(10):1150-1156. doi: 10.1097/GME.0000000000001812. PMID: 34260478; PMCID: PMC8462449.
4
Taku K, Melby MK, Kronenberg F, Kurzer MS, Messina M. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause. 2012 Jul;19(7):776-90. doi: 10.1097/gme.0b013e3182410159. PMID: 22433977.
5
Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015 Apr;18(2):260-9. doi: 10.3109/13697137.2014.966241. Epub 2014 Dec 1. PMID: 25263312; PMCID: PMC4389700.
6
Ellen B. Gold, Gladys Block, Sybil Crawford, Laurie Lachance, Gordon FitzGerald, Heidi Miracle, Sheryl Sherman, Lifestyle and Demographic Factors in Relation to Vasomotor Symptoms: Baseline Results from the Study of Women’s Health Across the Nation , American Journal of Epidemiology, Volume 159, Issue 12, 15 June 2004, Pages 1189–1199
7
BDA Website ‘Menopause and diet: Food fact sheet’ [Accessed August 2022 via
https://www.bda.uk.com/resource/menopause-diet.html ]
8
Bacciottini L, Falchetti A, Pampaloni B, Bartolini E, Carossino AM, Brandi ML. Phytoestrogens: food or drug? Clin Cases Miner Bone Metab. 2007 May;4(2):123-30. PMID: 22461212; PMCID: PMC2781234.
9
Liu ZM, Ho SC, Xie YJ, Woo J. Whole plant foods intake is associated with fewer menopausal symptoms in Chinese postmenopausal women with prehypertension or untreated hypertension. Menopause. 2015 May;22(5):496-504. doi: 10.1097/GME.0000000000000349. PMID: 25387345.
10
Kroenke CH, Caan BJ, Stefanick ML, Anderson G, Brzyski R, Johnson KC, LeBlanc E, Lee C, La Croix AZ, Park HL, Sims ST, Vitolins M, Wallace R. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative. Menopause. 2012 Sep;19(9):980-8. doi: 10.1097/gme.0b013e31824f606e. PMID: 22781782; PMCID: PMC3428489.
11
NHS Website “Alcohol advice’ [Accessed August 2022 via
https://www.nhs.uk/live-well/alcohol-advice/ ]
12
Dalal PK, Agarwal M. Postmenopausal syndrome. Indian J Psychiatry. 2015 Jul;57(Suppl 2):S222-32. doi: 10.4103/0019-5545.161483. PMID: 26330639; PMCID: PMC4539866.
13
Freeman EW, Sammel MD. Anxiety as a risk factor for menopausal hot flashes: evidence from the Penn Ovarian Aging cohort. Menopause. 2016 Sep;23(9):942-9. doi: 10.1097/GME.0000000000000662. PMID: 27433864; PMCID: PMC4993654.
14
Mitchell ES, Woods NF. Hot flush severity during the menopausal transition and early postmenopause: beyond hormones. Climacteric. 2015;18(4):536-44. doi: 10.3109/13697137.2015.1009436. Epub 2015 Mar 9. PMID: 25748168.
15
Berin E, Hammar M, Lindblom H, Lindh-Astrand L, Ruber M, Spetz Holm AC. Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas. 2019; 126: 55-60. Doi: https://doi.org/10.1016/j.maturitas.2019.05.005.
16
Cramer H, Peng W, Lauche R. Yoga for menopausal symptoms- a systematic review and meta-analysis. Maturitas. 2018; 109: 13-25. Doi: https://doi.org/10.1016/j.maturitas.2017.12.005
17
Mishra N, Mishra VN, Devanshi. Exercise beyond menopause: Dos and Don’ts. J Midlife Health. 2011 Jul;2(2):51-6. doi: 10.4103/0976-7800.92524. PMID: 22408332; PMCID: PMC3296386.