In Western countries hot flushes occur in up to 80% of menopausal women and often cause significant insomnia and disruption to life. Quality of life may also be adversely impacted by changes in mental, physical, and sexual health. Hot flushes were less prevalent in countries like Japan but have increased as the diet and lifestyle has become more Westernized. This and other data points toward nutrition as playing a role in how women experience the natural life-stage transition of menopause.

Lifelong exposure to higher estrogen levels caused by the standard Australian diet and lifestyle may set women up for a more precipitous drop in estrogen levels at menopause. We can’t change our past diets but there are proven dietary strategies that can reduce or eliminate hot flushes during and after menopause. A recent study supported by PCRM (Barnard et al 2021) found that a low-fat vegan diet plus soybeans reduced moderate to severe hot flushes by 84%. Other quality of life measures also improved in this 12-week study. Many of the subjects reported complete resolution of hot flushes.

Previous studies of soy and soy-based supplements have not always shown benefits. This may be because soy isoflavones have only weak estrogen-like effects, including some estrogen blocking actions. However, the gut microbiome can convert daidzein (an isoflavone) into equol which has a stronger estrogen-like effect, but only if you have the right type of microbiome. Most vegans, but not omnivores, have gut microbes that can produce equol.

The research team assisted the study subjects to transition to a low-fat vegan diet based on fruit, vegetables, whole grains, legumes with minimal oil, nuts and avocados. In addition, they were given an Instant Pot (pressure cooker) and soybeans and instructed to consume ½ cup (86g) of cooked soybeans per day. We calculated the equivalent amount of other soy products based on protein content: 86g cooked soybeans approximates to 100g tofu, 120g tempeh or 500ml soy milk (from whole soybeans) per day. The therapeutic actions of soy may only be realised when soy consumption is combined with a whole foods, plant-based diet.

Insomnia, with or without hot flushes, is a common menopausal symptom. Personal experience has provided us with additional strategies to manage menopausal insomnia. The first is adequate hydration, not just in the evening, but throughout the day. The other is a cool sleeping environment. Sleep experts suggest a bedroom temperature of around 18ºC at night. A very lightweight doona (or lighter coverings in summer) minimizes overheating while preheating with an electric blanket in winter creates a comfortable environment for the onset of sleep.

There is a place for hormone replacement therapy. Menopausal symptoms can be severe and are not always relieved by a low fat, whole foods, plant-based diet with soy. HRT is highly effective for relieving symptoms that might otherwise be debilitating and unrelenting. It’s been well publicised, and perhaps exaggerated at times, that long-term HRT carries some risks, including breast cancer, to a variable degree depending on the type of therapy. Whether or not to take HRT, and how long to continue it, is a personal cost-benefit decision based on individual circumstances and one that should be respected by those around you. A gradual reduction in dose may soften the recrudescence of symptoms when you eventually stop the treatment.

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Peer-reviewed articles

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Page created 13 August 2021
Page last updated 6 March 2024