Nutrition

Nutrition here means everyday eating: what goes on the plate, most days, over years. Not a cleanse, a plan or a list of forbidden foods.

The British Menopause Society's tool for clinicians calls good nutrition and an active lifestyle the cornerstone of a healthy menopause, whether or not HRT is part of a woman's treatment. It also says, plainly, that it is highly unlikely menopause symptoms can be controlled through diet. The BMS puts the focus on all-round health, especially the heart and bones, not on switching off a hot flush.

Bodies change in these years. The British Menopause Society's tool says many women gain weight around the perimenopause, mostly around the middle, as estrogen falls and muscle mass drops. The same tool links falling estrogen with a rise in heart disease risk and lower bone density.

The Pakistan Menopause Society lists the same later concerns in Table 1: fat around the middle, insulin resistance, cholesterol changes and bone loss. If diabetes or heart disease runs in your family, this is where what you eat now starts to count.

From the Pakistan Menopause Society

• A balanced diet of whole grains, lean protein such as dal, legumes, fish and eggs, and healthy fats such as olive or canola oil, nuts and seeds.
• Pakistani food by name: saag, methi, moong dal, chana and makkai ki roti. The table adds that the Mediterranean style of eating suits Pakistani tastes.
• Sweetened drinks and colas named as drivers of fat around the middle and metabolic risk, with doctors asked to counsel women on Pakistani eating habits in particular.
• Elsewhere in the same recommendations, a line on avoiding ultra-processed foods (section 4.2.5).

From the European Menopause and Andropause Society

The European Menopause and Andropause Society (EMAS) explains what ultra-processed means: food made with at least one ingredient rarely or never used in a home kitchen, such as preservatives, emulsifiers, sweeteners and artificial colours or flavours. Observational studies have linked these foods with obesity, high blood pressure, heart disease and stroke, though EMAS says it is not clear whether the calories or the additives are to blame.

Homemade bread and pickles sit in a different group, processed but not ultra-processed. Roti off your own tawa and achar put up at home are not what the warning is about.

From the British Menopause Society

• No food needs to be excluded because of the menopause. Cutting foods out risks missing nutrients.
• Most popular diets have very little science behind them, and weight lost on them is likely to come back.
• Carbohydrates are needed, especially when you are more active. Its lower glycaemic choices include chapati and basmati rice.
• Women's Health Concern, the patient arm of the British Menopause Society, says refined starches such as white rice and white bread can be part of a healthy diet and need not be avoided, though more wholegrain is the aim. Maida roti and naan sit in that group.
• Some foods, caffeine and spices among them, may make hot flushes worse. See chai, coffee and caffeine.

From the NHS

The NHS guide to a balanced diet covers the basics: plenty of fruit and vegetables, meals based on higher-fibre starchy foods, some dairy, some protein from beans, pulses, fish, eggs or meat, and unsaturated oils in small amounts. Have foods high in fat, salt and sugar less often. The NHS page has the portions, which Roshara leaves to it.

The NHS says people with a medical condition or special dietary needs should ask their doctor or a registered dietitian for advice. Diabetes, high blood pressure, kidney trouble and high cholesterol all count.

A menopause visit is a good time to ask for checks. The Pakistan Menopause Society asks doctors to use it for prevention: blood pressure, weight, blood sugar, cholesterol and a look at lifestyle (Table 1). See diabetes risk and heart health for more.

You probably do not cook for one. Changing what is on the table means changing it for a husband, children and sometimes in-laws who have strong feelings about how the salan should taste. The BMS tool tells clinicians that slow and steady changes are the ones that last, and that holds at the dinner table too: more dal and sabzi, a wholemeal roti in the basket, water on the table in place of cola.

Ramadan and Eid bring their own menus, and their own questions. Questions about the fast belong with a qualified scholar, and questions about eating around your medicines in Ramadan belong with whoever prescribes them.