Tuesday, May 1st, 2018

Dietary intake and age at natural menopause: results from the UK Women’s Cohort Study


  1. Yashvee Dunneram1,
  2. Darren Charles Greenwood2,
  3. Victoria J Burley1,
  4. Janet E Cade1

Author affiliations


Background Age at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes.

Methods Study participants were women aged 40–65 years who had experienced a natural menopause from the UK Women’s Cohort Study between baseline and first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modelling, adjusting for confounders, was used to assess associations between diet and age at natural menopause.

Results During the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day (99% CI 0.8 to 5.8) and 0.9 years per portion/day (99% CI 0.0 to 1.8), respectively. Refined pasta and rice was associated with earlier menopause (per portion/day: −1.5 years, 99% CI −2.8 to −0.2). A higher intake of vitamin B6 (per mg/day: 0.6 years, 99% CI 0.1 to 1.2) and zinc (per mg/day: 0.3 years, 99% CI −0.0 to 0.6) was also associated with later age at menopause. Stratification by age at baseline led to attenuated results.

Conclusion Our results suggest that some food groups (oily fish, fresh legumes, refined pasta and rice) and specific nutrients are individually predictive of age at natural menopause.

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Monday, August 29th, 2016

Key points from the evidence on diet & activity for PMS

Dietary advice for PMS


  • Premenstrual syndrome (PMS) is cyclical and occurs during the luteal phase (1–2 weeks before menstruation) of a woman’s cycle; symptoms are relieved by the onset of or during menstruation.
  • Most women experience mild symptoms, but for 8–20% it can be severe; the severest form, affecting 3-8% of PMS sufferers, is known as premenstrual dysphoric disorder (PMD),
  • Symptoms of PMS vary between and within individuals and include mood swings, irritability, increased appetite, carbohydrate and alcohol cravings, breast tenderness, headaches and bloating
  • Women with chronic disease e g. diabetes, irritable bowel syndrome (IBS) or allergies, may have a low threshold for developing PMS so good control of chronic medical conditions may reduce the severity of symptoms.
  • Cause
  • Although not proved outright, PMS is thought to be due to an increased sensitivity to progesterone and its metabolites and/or neurotransmitter abnormalities.


  • It is difficult to diagnose PMS; the most definitive method is a symptom diary as symptoms will start in the luteal phase and cease at the start of or during menstruation

Dietary treatment

  • There is no universally recognised single treatment for PMS
  • For mild to moderate symptoms, lifestyle changes and a healthy diet can substantially reduce, if not alleviate, the symptoms.
  • For PMS sufferers who need to be treated with medication, such as anti-depressants and oral contraceptives, the success rate is no greater than 60-70% but a healthy lifestyle may make the treatment more successful (Bussell, 1998).
  • A healthy diet, regular physical activity, good sleep patterns and stress reduction techniques can help to reduce symptoms
  • Sustained dietary change is necessary for symptom relief and not just premenstrually.

Vitamin D and calcium

  • A diet rich in calcium and vitamin D is associated with a lower incidence of PMS especially lower fat versions of dairy foods.
  • Calcium (1000 mg/day) and vitamin D (10 μg) may be useful in treating premenstrual pain and emotional symptoms associated with PMS
  • Dietary vitamin D on its own has been shown to reduce the risk of PMS specifically breast tenderness and depression
  • A calcium (500mg) supplement with vitamin B6 (40mg) has also been shown to exert an effective control of PMS symptoms.

Other vitamins and minerals

  • A diet containing adequate iron and magnesium may help reduce PMS symptoms
  • Upping intakes of thiamine and riboflavin may reduce the incidence of PMS
  • Vitamin E combined with evening primrose oil has been shown to be effective for premenstrual breast pain

Dietary factors

  • Fish oil (omega 3 ) may help reduce some symptoms of PMS, including depression
  • Increasing dietary fibre can help to alleviate the constipation that may occur premenstrually.
  • Alcoholics are prone to PMS and alcohol aggravates symptoms
  • Some PMS sufferers have alcohol cravings premenstrually but alcohol metabolism may also be impaired so it has more of an effect during this time.
  • Overweight and obesity is associated with PMS
  • Many women report an increase in appetite during the luteal (PMS) phase and this may be due to the fact that the metabolic rate can rise during this time, hence allowing a little more food to be eaten without causing weight gain,


  • There is a little evidence for Jingqianping, Vitex agnus castus, Ginko biloba, ginger and Crocus sativus being effective, but more trials are needed

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Monday, August 29th, 2016

key points on diet, exercise and menopause

Key points on menopause and diet


  • The menopause occurs when ovulation ceases and oestrogen production decreases; it usually happens at an average age of 51 (range 40–58).
  • Approximately 75–80% of women suffer some menopausal symptoms; it normally lasts for 2-5 years but sometimes longer.
  • The most common menopausal symptoms include hot flushes, night sweats, vaginal dryness, sleep disturbance, mood swings, forgetfulness and lack of concentration.
  • Lean body mass and metabolic rate decrease during the menopause and this can result in weight
  • Weight is more likely to be deposited round the middle, Weight here increases the risk of diabetes, raised blood fats and heart disease,
  • Weight gain, especially abdominally, can exacerbate hot flushes and night sweats
  • Being physically active is associated with fewer menopausal symptoms and may help to reduce weight around the abdomen.
  • Following a Mediterranean style diet has been shown to reduce weight gain

The symptoms and their management

Weight gain


Heart disease and related conditions

  • Lowered oestrogen levels, which starts in the perimenopause before periods actually stop, increases the risk of heart disease, diabetes, harmful blood fats and blood pressure.
  • Consuming Soya based foods and following a more Mediterranean style of diet may help improve cholesterol levels and protect the heart
  • Reducing the glycaemic load (GL) of the diet has been shown to increase HDL (good cholesterol levels) in postmenopausal women
  • Women with Type 2 diabetes tend to have an earlier menopause and so have an even higher risk of heart disease
  • Postmenopausal women are at risk of osteoporosis because the rate of bone calcium loss is escalated during the menopause, especially if vitamin D status is low
  • The National Osteoporosis Society recommends a daily intake of 700 mg of calcium in postmenopausal women, which should be increased to 1000–1200 mg in women with
  • Women with low blood levels of vitamin D should be given a vitamin D supplement.

Bone health

New advice from public health England was released in July 2016: adults and children over the age of one should consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter.

People who have a higher risk of vitamin D deficiency are being advised to take a supplement all year round

  • Vitamin A is associated with an increased risk of osteoporosis; therefore, vitamin A or retinol supplements should be used with caution
  • Weight loss of as little as 5% of body weight is associated with increased risk of bone loss, so ideally weight loss programmes should be combined with high impact exercise.


  • There is an increased risk of developing hormone sensitive cancers, including breast cancer, during and after the menopause
  • To help reduce the risk it has been found that increased consumption of brassicas and fibre and avoiding excess weight gain can help.

Hot flushes

  • Hot flushes are one of the most common symptoms of the menopause.
  • Reducing the intake of alcohol, spicy food and caffeine, and losing weight if overweight or obese
  • Those with diabetes or at risk of it and those with high harmful blood fats may be at increased risk of hot flushes.
  • Hot flushes are less prevalent in countries where soya intake is high probably due to higher isoflavone (plant oestrogen,) soya and soya products being the most common source
  • A 20mg/d supplement of the potent isoflavone genistein, or 400ml soya milk or 80g soya mince a day, may be effective in reducing hot flushes.
  • The daily consumption of probiotic bacteria milk and prebiotic fibres may increase the bioavailability of soy isoflavones

References available on request

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