Menopause: Women’s health at risk due to avoidable nutrient deficiencies

The report shows that 71% of women realise a healthy diet can help ease menopause symptoms, and while 66% of those experiencing perimenopause and menopause express concern over their diet, 20% of women are doing nothing to plug nutrient gaps, according to a Perspectus Global omnibus survey of 1,526 women aged 18 to 60 years.

Various reasons include simply not thinking about it (27%), believing they don’t need a supplement (23%), or expecting to get all the nutrients they need from the diet (22%). 

HSIS dietitian, Dr Carrie Ruxton states: “Many women begin their menopause journey with inadequate intakes of many key nutrients in their diets, and still have these ongoing shortfalls when they are post-menopausal. 

“A multivitamin and multimineral will help to plug these gaps, but it’s worth considering a top-up of specific nutrients such as vitamin D, calcium, B-vitamins and omega-3 fatty acids, and investigating supplements and botanical nutrients which can target specific menopause challenges.”

Increased need for calcium ​

The report notes that calcium and vitamin D become increasingly important during the menopause, in order to slow the bone loss that typically occurs in the perimenopausal years. This is due to falling oestrogen levels​.

GP, Dr Nisa Aslam explains that humans absorb less than half the calcium in food ingested​, and without sufficient vitamin D, this plunges to 10 to 15%.

“The effect is compounded by the lack of oestrogen seen during menopause since oestrogen boosts calcium uptake.​ So, our ability to absorb calcium falls just when we need it most,” she states.

HSIS women’s health specialist, Dr Catherine Hood adds: "Given the importance of vitamin D for bone health and disease prevention, every woman who is in perimenopause, or has gone through menopause, would be wise to take supplementary vitamin D.”

Reduced nutrient absorption​

During menopause, nutrient absorption in the gut becomes less efficient​, and this inhibits the uptake of a wide range of vitamins, minerals, the amino acids that make up proteins, and lipids, including cardio-kind omega-3 fatty acids.

Aslam explains: “Malabsorption increases the risk of shortfalls​ of B vitamins, particularly B2, B6, and B12, and this may contribute to the increased risk of cardiovascular disease and dementia seen in studies of menopausal women​.”

Ruxton adds: “Since not everyone enjoys eating oily fish, taking an omega-3 supplement, or a multivitamin and multimineral which includes this important fatty acid, is a sensible step.”

Falling oestrogen​

The report explains how falling oestrogen impairs lipid metabolism which causes a surge in levels of unhealthy low-density lipoprotein (LDL) cholesterol​ and is thought to be one of several mechanisms driving the increased risk of heart disease and type 2 diabetes associated with menopause.

HSIS nutritionist Dr Pamela Mason notes, “One study​ found there was also a significant increase in the proportion of LDL cholesterol particles that were very small and high-density — the most dangerous type — with this rising from 10-13% in premenopausal women to 30-49% after menopause.

“This underlines the importance of a diet rich in antioxidant vitamins​ and polyphenols and heart-healthy omega-3 fats.”

Gut microbiome imbalance​

During ageing, the gut microbiome becomes less balanced, with fewer 'friendly' bacteria and more species that promote inflammation, and this escalates with falling oestrogen.​

Ruxton explains: “Having a less balanced gut microbiome has also been linked​ with greater risk of obesity, type 2 diabetes, and neurological problems in older adulthood.

“Beneficial gut bacteria also play an important part in the production of body chemicals including serotonin, dopamine and tryptamine which help regulate mood and sleep.

“There is huge potential around the use of prebiotics and probiotics to rebalance gut bacteria and there is already evidence that probiotic supplements can ease some menopause symptoms​.”

Increased prescription medicine use disrupts nutrient uptake​

According to research​, the use of prescription medicines increases in the perimenopausal period can disrupt nutrient uptakes.

Drugs that are known to impact nutrient status​ include metformin, commonly prescribed for type 2 diabetes; proton-pump inhibitors which reduce stomach acidity and are often used to protect against other medications such as non-steroidal anti-inflammatory drugs (NSAIDs); and diuretics used to treat heart failure. 

Mason adds: “Proton pump inhibitors can reduce blood levels of magnesium​, with this tendency increased when the patient is also taking diuretics which are sometimes used to treat heart failure. This highlights the need for nutrients such as vitamin B12 and magnesium.” 

Inflammation and antioxidant needs​

The report also notes that spiking inflammation increases antioxidant needs​, and while ageing is associated with chronic inflammation, there is emerging evidence​ that this spikes further during perimenopause.

Hood explains that oestrogen is important for regulating immunity and inflammation, but the protection it provides ebbs away with menopause, increasing the need for antioxidants​ such as vitamins A and E and anti-inflammatory omega-3 fatty acids​. 

Lower oestrogen increases choline needs​

Lower oestrogen in the blood increases the need for choline, a nutrient that the body converts into the messenger chemical acetylcholine. 

This is important for memory, mood, muscle control, and other brain and nervous system functions, HSIS nutritionist Dr Emma Derbyshire explains.

Previous studies​ have confirmed that post-menopausal women need higher intakes of choline, and shortfalls of this nutrient increase the risk of non-alcoholic fatty liver. 

The impact of menopause​

The report points out that there is a wider economic cost associated with not addressing and helping to ameliorate symptoms. 

The Women’s Health Strategy​ highlights the negative impact menopause symptoms have on productivity and staff retention, and research led by the Chartered Institute of Personnel and Development found that three out of five women dealing with menopause symptoms say this affects their performance at work​. 

In the research, 65% reported impaired concentration, 58% said they felt stressed, and 30% had to take time off due to symptoms.

Aslam adds: “Anything we can do to ease menopause symptoms and counter the increased risk of health issues associated with this drop in oestrogen and other hormones is bound to deliver benefits, not only for individual women and their families but also for the health service and the economy.”