Menopause: Nutritional Considerations

Dietary approaches to menopausal symptoms have been of interest to women and their physicians for many years. Epidemiologic studies have shown that symptoms occur more commonly in parts of the world where Western dietary habits prevail, and clinical studies have found that dietary factors (fiber and perhaps fat) influence hormone concentrations and activity. However, clinical trials of nutritional interventions for menopausal symptoms have been limited. The following approaches should be considered:

• Soy products: Soy products are often prescribed for menopausal symptoms. Asian populations that frequently use soy products have a much lower prevalence of menopausal symptoms, compared with their Western counterparts, leading to the speculation that the phytoestrogens in soy (isoflavones) may be helpful.
  
  However, Asian diets vary from Western diets in many other respects (less intake of meat and dairy products and greater intake of grains and vegetables), making it difficult to attribute this difference to soy. A review of clinical studies that examined the effect of soy on menopausal symptoms found some benefit, though not enough to recommend using soy to treat hot flashes. These results may indicate that other elements of an Asian lifestyle, such as total diet, exercise, and cultural differences, account for differences.
• Low–fat diets: Some evidence suggests that a low–fat diet may be helpful. In an observational study, women following low–fat diets (about 20 percent of calories from fat) had significantly fewer hot flashes and night sweats than a control group that followed a diet containing about 30 percent of calories from fat. These women also had reductions in serum cholesterol, estrogen levels, and mammogram findings. However, a beneficial effect of a low–fat diet on menopausal symptoms has not been established in controlled clinical trials.
• Black cohosh: Evidence suggests that the botanical product black cohosh may reduce hot flashes. Several studies have revealed a significant benefit of black cohosh over placebo. Side effects of black cohosh are rare, mild, and reversible.
  
• Red clover: The botanical product red clover also contains isoflavones, and studies in postmenopausal women have found that it may increase HDL (the “good” cholesterol), bone density, mental functioning, and artery health. However, its efficacy for treating hot flashes has not been established.
  
  In contrast, two other botanicals sometimes used for menopausal symptoms, dong quai (Angelica sinensis) and chaste tree (Vitex agnus castus), have not performed consistently well in controlled clinical trials.