What are the recommended lifestyle support and interventions for menopause?

Lifestyle Support for Menopause

A comprehensive approach to managing menopausal symptoms should include nonpharmacologic interventions such as acupuncture, exercise/physical activity, yoga, lifestyle modifications, weight loss if overweight, and cognitive behavioral therapy as first-line strategies before considering pharmacological treatments. 1

Nonpharmacologic Interventions for Vasomotor Symptoms

Acupuncture

• Acupuncture has been shown to be a safe and effective option for managing vasomotor symptoms in multiple studies 1
• Some studies have found acupuncture to be equivalent to or better than pharmacological treatments like venlafaxine or gabapentin 1
• In a meta-analysis of randomized controlled trials among breast cancer survivors, acupuncture reduced menopausal symptoms and hot flashes 1

Weight Management

• Women who lost ≥10% of their body weight were more likely to eliminate hot flash symptoms than those who maintained their weight, according to the Women's Health Initiative Dietary Modification trial 1
• Counseling menopausal women to achieve and maintain a healthy weight is strongly recommended 1
• For those who are overweight or obese, limiting consumption of high-calorie foods and beverages while increasing physical activity is recommended to promote weight loss 1

Physical Activity

• Regular physical activity is recommended despite mixed evidence for its direct effect on vasomotor symptoms 1
• The recommended goal is at least 150 minutes of moderate or 75 minutes of vigorous aerobic exercise per week 1
• Strength training exercises should be included at least 2 days per week 1
• While physical activity may not directly improve hot flashes, it provides many other health benefits that are particularly important during menopause 1

Smoking Cessation

• Women who quit smoking saw improvements in the frequency and severity of hot flashes compared with those who continued to smoke 1
• Current smokers are more likely to experience hot flashes 1

Environmental and Behavioral Modifications

• Limiting alcohol intake if it triggers hot flashes 1
• Maintaining cool room temperatures and dressing in layers 1
• Avoiding spicy foods and caffeine that may trigger hot flashes 1
• Practicing rhythmic breathing techniques 1

Yoga and Mind-Body Practices

• Yoga may improve quality of life associated with menopause, including improvement in the vasomotor symptom domain 1
• Some studies show yoga can improve sleep, though effects on hot flash frequency may be limited 1
• Cognitive behavioral therapy (CBT) has been shown to reduce the perceived burden of hot flashes 1

Nutrition and Dietary Approaches

• A dietary pattern high in vegetables, fruits, and whole grains is recommended 1
• Diet and nutrition interventions are among the most commonly used complementary approaches for symptom management (44.3% of symptomatic women) 2
• Proper nutrition during menopause can help reduce the risk of cardiovascular diseases, osteoporosis, and metabolic syndrome 3
• Key nutrients to focus on include vitamin D, calcium, vitamin C, B vitamins, and adequate protein intake 3

Complementary and Alternative Medicine (CAM)

• Approximately 25% of postmenopausal women report using CAM therapies for menopausal symptom relief 4
• Higher education, Black ethnicity, and previous hormone therapy use are associated with higher CAM use 4
• Phytoestrogens, botanicals, and dietary supplements are sometimes used, but data on their effectiveness and safety are mixed or limited 1
• Vitamin E has shown marginal improvement in vasomotor symptoms, but data are limited with mixed results 1
• Black cohosh has limited data showing possible benefit in the general population but no benefit in breast cancer survivors 1

Important Considerations and Pitfalls

• Systemic hormone therapy is rarely given to patients with breast cancer to control menopausal symptoms due to safety concerns 1
• SSRIs that inhibit the CYP2D6 enzyme pathway (like paroxetine) may reduce the conversion of tamoxifen to active metabolites in breast cancer patients on tamoxifen 1
• The safety of low-dose vaginal estrogen therapies in women with a history of breast cancer is not well established 1
• Women should be informed that menopause is not a disease but a natural process that causes symptoms that differ individually 5
• With increased life expectancy, menopausal health care has become an important issue as women may live up to a third of their lives in the peri- or postmenopausal state 6

By implementing these lifestyle interventions, many women can effectively manage their menopausal symptoms while improving their overall health and quality of life.