The Menopause - Diet Connection: A Critical Review of Nutritional Influences on Women’s Midlife Health

Abstract

Background: Diet is a modifiable lever during the menopausal transition, yet evidence on which patterns or nutrients meaningfully affect symptoms and midlife health is heterogeneous and often observational. Objective: To critically synthesize recent evidence on associations between dietary patterns/nutrients and menopausal outcomes—vasomotor symptoms (VMS), mood/sleep, cardiometabolic markers, bone mineral density (BMD), and body composition—in peri- and postmenopausal women. Methods: We followed PRISMA. PubMed/MEDLINE, Scopus, and Google Scholar were searched (1 Jan 2020–1 Nov 2025) for randomized and non-randomized human studies assessing dietary patterns (e.g., Mediterranean, vegetarian, low–glycaemic load) or specific nutrients (e.g., omega-3, protein, vitamin D, carbohydrate quality). Two reviewers independently screened/extracted data. Risk of bias was assessed with design-appropriate tools. Pre-specified primary outcomes were VMS and cardiometabolic markers; secondary outcomes were mood/sleep, BMD, and body composition. Given heterogeneity, we used a structured synthesis-without-meta-analysis approach. Results: Of 4,144 database records and 456 manual records, 1,840 full texts were assessed and 68 studies met criteria. Across observational studies, higher-quality dietary patterns characterized by greater vegetables, fruits, and whole grains were consistently associated with lower symptom burden and more favorable metabolic profiles. Higher dietary inflammatory index scores correlated with worse menopause-specific quality of life, whereas better carbohydrate quality associated with fewer symptoms. Narrative and mechanistic reports support plausibility for Mediterranean-style patterns and omega-3 intake, though standardized interventional evidence remains limited. One randomized trial in postmenopausal women undertaking resistance training found protein intake above recommended allowances did not yield additional lean mass gains versus recommended intake. Overall certainty was low-to-moderate due to cross-sectional predominance, self-reported diet/symptoms, and variable confounding control; heterogeneity precluded pooling. Conclusion: Emphasizing a fiber-forward, minimally processed, Mediterranean-like dietary pattern and limiting added sugars is a low-risk, evidence-congruent strategy that may modestly reduce symptom burden and improve cardiometabolic profile in midlife women. Precision dietary prescriptions await well-designed trials using standardized symptom scales and objective metabolic, body-composition, and bone outcomes.