Lifestyle Support for Menopause
Nonpharmacologic Interventions for Vasomotor Symptoms
- A comprehensive approach to managing menopausal symptoms should include nonpharmacologic interventions such as acupuncture, exercise/physical activity, yoga, lifestyle modifications, weight loss if overweight, and cognitive behavioral therapy as first-line strategies before considering pharmacological treatments, as recommended by the National Comprehensive Cancer Network 1, 2
- Acupuncture has been shown to be a safe and effective option for managing vasomotor symptoms in multiple studies, with some studies finding it to be equivalent to or better than pharmacological treatments like venlafaxine or gabapentin, according to the National Comprehensive Cancer Network 1, 2
- Women who lost ≥10% of their body weight were more likely to eliminate hot flash symptoms than those who maintained their weight, according to the Women's Health Initiative Dietary Modification trial, which suggests that weight management is an effective strategy for reducing menopausal symptoms 1
- Counseling menopausal women to achieve and maintain a healthy weight is strongly recommended by the American Society of Clinical Oncology and the American Cancer Society 3, 4
- Regular physical activity is recommended, with a goal of at least 150 minutes of moderate or 75 minutes of vigorous aerobic exercise per week, and strength training exercises should be included at least 2 days per week, as recommended by the American College of Sports Medicine and the National Comprehensive Cancer Network 1, 3
- Women who quit smoking saw improvements in the frequency and severity of hot flashes compared with those who continued to smoke, according to the National Comprehensive Cancer Network 1
- Limiting alcohol intake, maintaining cool room temperatures, dressing in layers, avoiding spicy foods and caffeine, and practicing rhythmic breathing techniques may help reduce hot flashes, as suggested by the American College of Obstetricians and Gynecologists and the North American Menopause Society 1, 5, 6
- Yoga may improve quality of life associated with menopause, including improvement in the vasomotor symptom domain, and cognitive behavioral therapy (CBT) has been shown to reduce the perceived burden of hot flashes, according to the National Comprehensive Cancer Network and the American Psychological Association 1, 2
Nutrition and Dietary Approaches
- A dietary pattern high in vegetables, fruits, and whole grains is recommended by the American Heart Association and the Academy of Nutrition and Dietetics 3
Complementary and Alternative Medicine (CAM)
- Phytoestrogens, botanicals, and dietary supplements are sometimes used, but data on their effectiveness and safety are mixed or limited, according to the National Comprehensive Cancer Network 1
- Vitamin E has shown marginal improvement in vasomotor symptoms, but data are limited with mixed results, as reported by the National Institutes of Health 1
- Black cohosh has limited data showing possible benefit in the general population but no benefit in breast cancer survivors, according to the National Comprehensive Cancer Network 1
Important Considerations and Pitfalls
- Systemic hormone therapy is rarely given to patients with breast cancer to control menopausal symptoms due to safety concerns, as stated by the American Society of Clinical Oncology and the National Comprehensive Cancer Network 5, 4
- The safety of low-dose vaginal estrogen therapies in women with a history of breast cancer is not well established, according to the American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network 5
Dietary Recommendations for Managing Menopausal Symptoms
Sugar Intake Guidelines
- The American Heart Association recommends limiting added sugars to no more than 100 calories (6 teaspoons) per day for women and 150 calories (9 teaspoons) per day for men 7
- The World Health Organization recommends limiting free sugars to less than 5-10% of daily caloric intake 8
- Sugar-sweetened beverages should be avoided completely, as they're associated with increased risk of cardiovascular disease, diabetes, and other conditions that can compound menopausal health concerns 7, 8
Recommended Dietary Patterns
- A dietary pattern emphasizing vegetables, fruits, legumes, and whole grains while minimizing free sugars and red meats is recommended for managing menopausal symptoms 8
- Plant-based foods should be emphasized over animal-based foods 8
- Choose carbohydrates from vegetables, fruits, legumes, whole grains, and dairy products, with emphasis on foods higher in fiber and lower in glycemic load 9
- Avoid foods with added sugar that can displace healthier, more nutrient-dense food choices 9
- Water should be the primary beverage consumed rather than sugar-sweetened drinks 8
- Eating a diet with low glycemic load (avoiding sweets, high-sugar/low-fiber foods, and sweetened beverages) may help manage symptoms 10