Nutrition becomes increasingly important during menopause. The right diet can help manage symptoms and prevent long-term disease.

Protein — the most overlooked nutrient

Women over 40 need MORE protein than younger women, not less. The recommended intake is 1.2-1.6 g per kg of body weight per day. For a 70 kg woman: 84-112 g of protein daily. Distribute protein across all meals (20-40 g per meal) for maximum muscle protein synthesis.

Good sources: eggs, chicken, fish, Greek yogurt, lentils, tofu, tempeh, protein powder.

Calcium and Vitamin D

  • Calcium: 1,200 mg/day from diet + supplements if needed
  • Vitamin D: 800-1,000 IU/day. Most Northern-climate women are deficient — blood test can confirm
  • WHI CaD Trial (18,176 women, 7-year follow-up): small but significant improvement in hip bone density. Hip fracture reduction benefit limited to older women in subgroup analysis

The Mediterranean Diet

Strongest evidence for cardiovascular protection in postmenopausal women:

  • Abundant vegetables, fruits, legumes, whole grains
  • Olive oil as main fat source
  • Fatty fish 2-3x/week (omega-3s EPA/DHA)
  • Moderate dairy and poultry
  • Limited red meat and processed foods

Supplements — what the evidence says:

  • ✅ Vitamin D — strong evidence for bone health
  • ✅ Calcium — essential, ideally from food first
  • ✅ Omega-3 (EPA/DHA) — moderate evidence for mood and triglycerides
  • ✅ Magnesium — may help with sleep and muscle cramps
  • ⚠️ Soy isoflavones — modest 20-30% reduction in hot flashes in some women; more effective in Asian populations. Phytoestrogen supplements as a class do NOT conclusively reduce hot flush frequency or severity (Cochrane evidence)
  • ❌ Red clover (Promensil): no significant reduction vs placebo across 5 pooled RCTs
  • ❌ Black cohosh — inconsistent evidence; rare liver toxicity risk
  • ❌ Evening primrose oil — no good evidence
  • ❌ St. John's Wort — interacts with many medications

⚠️ Most 'menopause supplements' sold online lack evidence. The Menopause Society does NOT recommend OTC supplements for VMS due to lack of rigorous evidence. Spend on whole foods instead.