Lifestyle strategies to manage symptoms of perimenopause/ menopause?

Dr Alison Vickers, a Sydney GP with a special interest in the care of women during perimenopause and menopause, explains

The short answer

Lifestyle is an essential part of any healthcare plan, and menopause is no different. While evidence supporting the effectiveness of lifestyle changes for managing menopausal symptoms can be limited, trying various strategies will do no harm and may improve how you feel generally. Hypnosis and cognitive behavioural therapy have both been shown to have positive effects on menopausal symptoms. Though the evidence is more limited, studies have shown benefits for exercise and weight loss (if you are overweight).

The long answer

My favourite recommendation for any medical condition is always lifestyle strategies. It is such a joy to recommend treatments with no adverse effects! The problem is that there are not always extensive studies of lifestyle treatments for menopausal symptoms. But if there is some evidence, why not try the lifestyle strategies that suit you?

Which lifestyle strategies have the most evidence for helping hot flushes and menopausal symptoms?

The 2023 non hormone therapy position statement of The North American Menopause Society considered there was good and consistent scientific evidence to recommend cognitive behaviour therapy (CBT) and clinical hypnosis for helping with hot flushes.

Do cooling techniques help hot flushes?

There are no large trials to prove that they help, but if you are trying to keep your body temperature constant, that should help, and patients do find these simple strategies do help, including:

• Hand fans and fans at night.
• Dressing in layers/wearing cool clothes/looking for natural rather than synthetic fibres.
• Cool drinks.
• Keeping cool at night (air conditioning, cold pack under the pillow).
• Forehead cooling devices.
• Avoid foods that set off flushes, like spicy foods, caffeine, alcohol and hot drinks.

Will losing weight help my hot flushes?

Women who are overweight report more severe hot flushes. Studies in overweight women have shown that losing 10% of weight significantly improves hot flushes.

Will exercise help me manage the menopause?

The evidence for exercise is very mixed. Some studies show that women who exercise regularly have fewer hot flushes, but exercise can trigger a hot flush for some women. Exercise can also improve sleep and well-being and help prevent osteoporosis or thinning of the bones. Even if the evidence for helping hot flushes is mixed, I always recommend exercise to help women manage menopause.

What about the importance of diet to help hot flushes?

Diet is always important, and having a healthy, balanced diet will always have health benefits. While the evidence is limited, studies have shown that the following diets have benefits for hot flushes:

• A low-fat plant-based diet and a half cup of cooked soybeans per day.
• Increasing fruit and vegetables.
• Vegan diet versus a diet including meat.

What other lifestyle strategies for menopause symptoms may be worth trying?

• Stop smoking – smoking makes hot flushes and night sweats worse.
• Yoga and relaxation – improve sleep and well-being.
• Acupuncture- some studies show benefits but others don’t.