Lifestyle changes can ‘empower’ patients and improve menopause symptoms

Non-pharmaceutical interventions such as healthy eating and physical activity can be ‘foundational’ for managing menopause symptoms, according to a white paper highlighted as part of World Menopause Day.

The research, published in the journal of the International Menopause Society (IMS), points to how lifestyle medicine can improve menopausal symptoms, reduce chronic-disease risk and support women’s long-term health.

Among resources available for World Menopause Day on Saturday 18 October, The role of lifestyle medicine in menopausal health: A review of non-pharmacologic interventions argues that integrating lifestyle medicine into clinical guidelines and public health policy can improve quality of care, ‘empower’ patients and reduce disparities in women’s health access.

The findings are based on a literature review of PubMed, Embase, Scopus and Web of Science based on papers from January 2000 to December 2024, using a range of keywords and combinations including ‘menopause’ ‘lifestyle medicine’ and ‘healthy eating’.

The report authors stress the value of a healthy diet and regular physical exercise in reducing menopause symptoms.

‘By embracing the six pillars of lifestyle medicine – healthy eating, physical activity, mental wellbeing, avoidance of risky substances, restorative sleep and healthy relationships – women can be empowered to navigate menopause with resilience, autonomy and vitality.

‘Collaborative action among healthcare providers, policymakers and communities is essential to maximize impact,’ the report states.

The analysis found that lifestyle medicine interventions were associated with reductions in vasomotor symptoms, meaning sudden feelings of warmth, chills, or sweating, as well as improved sleep quality, enhanced mental wellbeing, healthier weight regulation, and reduced cardiometabolic and osteoporosis risk.

The research points to the power of multidisciplinary, person-centred approaches to improved adherence and patient-reported outcomes.

These approaches were also seen as ‘cost-effective’ and useful for long-term disease prevention across diverse patient populations.

The Mediterranean diet

While acknowledging that ‘high-quality evidence’ on the long-term impact of diet changes on the menopause ‘remains limited’, the review identifies the Mediterranean diet (MedDiet), characterised by high vegetable intake and limited consumption of red meat, as one dietary option that can improve women’s experience of the menopause.

‘Adherence to the MedDiet can have beneficial impacts on menopausal women’s health, including improvement in mood and depression symptoms and reductions in weight, blood pressure, blood omega-6:omega-3 ratio, triglycerides, total cholesterol and low-density lipoprotein (LDL) levels,’ the report reads.

The white paper refers to early studies which suggest that diets high in fruits and vegetables might reduce hot flashes and night sweats but says larger trials such as the Women’s Health Initiative: Changing the future of women’s health report only modest improvements.

Similar benefits have been reported for the dietary approaches to stop hypertension (DASH) diet and, to a lesser extent, for vegetarian and intermittent fasting approaches, though more targeted research on menopausal populations is still needed, the paper says.

The role of physical exercise

The review also points to studies which show that even without increased calorie intake, reduced energy expenditure contributes significantly to changes in body composition which can impact menopause symptoms.

It describes how the physical shifts associated with reduced physical exercise can also raise the risk of cardiovascular disease, with the loss of oestrogen linked to reduced vascular function and protective benefits like improved cholesterol regulation and blood flow.

Exercise, particularly aerobic and resistance training, has been shown to offer benefits for managing the menopause, the paper suggests.

Aerobic activities such as walking and cycling improve cardiovascular health, lower body fat, and alleviate menopausal symptoms like hot flashes and night sweats. Resistance training, using weights, bands, or body weight helps preserve muscle mass, is also shown to support bone density and reduce inflammation, which are both useful for alleviating menopause symptoms, according to the report.

The paper describes how combining different types of exercise may offer the best outcomes for patients, such as workouts which blend aerobic and resistance exercises that are associated with improvements in fat loss and vascular health.

The paper suggests that exercise alone, when done consistently over several months, can help alleviate menopause symptoms.

It points to research from organisations like the American Heart Association (AHA) and the International Menopause Society (IMS) which recommend at least 150 minutes of moderate aerobic activity and two days of strength training each week for optimal health during and after menopause.

Alongside its white paper, the IMS has also created six factsheets, with guidance on the benefits of healthy eating, physical activity, mental wellbeing, avoiding ‘risky substances’ and the importance of sleep and nurturing healthy relationships.

Mental wellbeing

The paper describes how stress exacerbates menopausal and points to how interventions such as cognitive-based therapy (CBT) and relaxation techniques can significantly improve symptom management and quality of life.

New digital tools, particularly mobile health (mHealth) solutions and AI-driven conversational agents, can also support patients in reducing stress, improving self-monitoring, and supporting behaviour change, the researchers suggest.

Substance use and alcohol consumption

The paper warns that substance use, and addiction are increasingly affecting women, particularly during the stages of perimenopause and menopause.

It describes how low-to-moderate alcohol consumption may delay menopause and offer limited cardiovascular benefits but also raises estrogen levels and the risk of hormone-related conditions like breast cancer and osteoporosis.

The findings reveal how stimulant drugs like cocaine and amphetamines show stronger effects during certain menstrual phases due to ovarian hormone levels, while opioids, marijuana, and nicotine show less variation, but still contribute to worsened menopausal symptoms and health risks.

The importance of sleep

Non-restorative sleep (NRS), where individuals feel unrefreshed despite adequate sleep duration, is common amongst people going through the menopause but lacks standardized measurement, the researchers explain.

They describe how sleep-disordered breathing, including obstructive sleep apnea, increases after menopause and worsens sleep quality, contributing to NRS and associated health risks.

Healthy relationships

Healthy relationships and social connections are demonstrated to improve patient’s control of chronic conditions, reduce the risk of heart disease, diabetes, osteoporosis, and lower mortality in middle-aged and older adults, the researchers state.

The researchers also describe how healthy relationships and positive social integration improves quality of life and helps reduce menopause symptoms.

‘For menopausal women, maintaining strong social support networks and nurturing healthy marital relationships can enhance quality of life, lower the risk of metabolic and cardiovascular disease, reduce the risk of osteoporosis and reduce the risk of mortality,’ the paper states.

In contrast, loneliness and social isolation are strongly associated with negative health outcomes, the researchers warn.

Revised NICE menopause guidance was published in November 2024, including updates on the use of cognitive behavioural therapy (CBT) as a treatment option, the management of genitourinary syndrome of menopause (GSM) including options for women with a history of breast cancer, and discussion of the long-term impact of HRT on health outcomes.

Nursing in Practice has previously published advice for practice nurses on managing menopause symptoms at work.

October is Menopause Awareness Month.