Vasomotor Symptoms of 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 may be considered:

Soy products are popularly prescribed for menopausal symptoms. Indeed, 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 phytoestrogens in soy (isoflavones) may be acting as estrogens.

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.¹ Other reviewers concluded that the effect of soy foods on reduction of hot flashes is modest and disappears after 6 weeks.² These results may indicate that other elements of an Asian lifestyle, such as total diet, exercise, and cultural differences, account for differences in the reporting of vasomotor menopause symptoms.

Red clover contains isoflavones as well, and studies in postmenopausal women have found increases in high–density lipoprotein (HDL), arterial compliance, bone density, and cognitive function in women using this botanical. Efficacy for vasomotor symptoms has not been established.³

Black cohosh. Evidence suggests that the black cohosh (Cimicifuga racemosa) may reduce hot flashes. Studies using the Kupperman Menopause Index (a scale of menopausal symptoms), the Menopause Rating Scale, or others that measure the frequency and severity of hot flashes and sweating have revealed a significant benefit of black cohosh over placebo. Side effects of black cohosh are rare, mild, and reversible.⁴ Unlike isoflavones that are thought to act as estrogens, black cohosh may act through dopaminergic or serotonergic pathways, or as a selective estrogen receptor modulator (SERM).²

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.⁴

Low–fat Diets. Some evidence suggests that a low–fat diet may be helpful. In an observational study, perimenopausal women following low–fat (~20%) diets scored significantly lower on the vasomotor symptoms subscale (including hot flashes and night sweats) than a control group following a diet containing ~30% fat.⁵ These women also had reductions in serum cholesterol, estrogen levels, and mammographic densities. A beneficial effect of a low–fat diet on menopausal symptoms has not been established in controlled clinical trials.

Exercise. Exercise reduces vasomotor symptoms. Physically active women reported approximately 50% fewer (and less severe) hot flashes, compared with sedentary women, although strenuous exercise may also trigger these episodes. Randomized, controlled trials have not examined the efficacy of exercise in managing hot flashes, and not all studies have reported benefits.⁶

Stress Management. Relaxation and other stress management techniques appear to reduce hot flashes and improve other menopausal symptoms. Several studies have found significant decreases (30%–100%) in hot flashes with the use of relaxation and paced respiration (slow deep breathing), and with the use of coping skills training in cognitive–behavioral interventions.³ Because norepinephrine release plays a role in the physiology of hot flashes, some have suggested that the benefit of relaxation and other stress management techniques may stem from decreased central nervous system adrenergic tone.⁷

Orders

See Basic Diet Orders.

What to Tell the Family

 It is useful for the patient and family to understand that menopause is a normal condition, not a disease or diagnosis. It can, however, be accompanied by symptoms and, in some cases, mood changes, all of which are temporary. Diet changes and exercise may reduce vasomotor symptoms, in addition to their other benefits.