As natural as it is, menopause can feel anything but straightforward, especially after bariatric surgery. The end of the menstrual cycle (menopause) and the associated decline in hormones like oestrogen and progesterone can trigger both physical and mental changes. Perimenopause, the years leading up to menopause, can bring its own rollercoaster of symptoms, from hot flushes to mood shifts and sleep disruptions. And, if you have had bariatric surgery, navigating this stage may come with unique challenges and questions.

While there is no magic menopause diet to manage symptoms and body composition changes, a thoughtful approach to your eating, lifestyle, and core bariatric nutrition foundations can help ease the journey.

In this article we will address some of the most frequently asked questions about managing perimenopause and menopause post weight loss surgery and offer practical steps for making this transition smoother.

WEIGHT GAIN

Weight gain is a common concern for women going through menopause, and while it is influenced by multiple factors, hormonal changes play a significant role in how and where the body stores fat.

On average, women between the ages of 45 and 55 gain around half a kilogram per year. This gradual increase is influenced by several factors:

• Ageing: As we age, our muscle mass naturally decreases, while fat mass increases. This combination slows down the metabolism (how many calories we burn when we are resting), meaning that even without changes to diet or physical activity, weight gain is likely.

• Menopausal Symptoms: Symptoms like sleep disturbances, mood changes, and hot flushes can make it challenging to focus on a healthy lifestyle. Disrupted sleep and mood fluctuations may lead to an increased appetite, reduced physical activity, and a change in dietary patterns which can contribute to weight gain.

• Changing Hormones: While menopause itself doesn’t cause weight gain, reduced estrogen levels can lead to an increase in weight stored centrally. Studies show that as estrogen levels drop, body fat distribution often shifts from the hips and thighs to the abdomen.

KEY STRATEGIES FOR MANAGING WEIGHT GAIN DURING MENOPAUSE

It can be extremely frustrating when, independent of any major lifestyle changes, weight regain occurs and body composition changes during perimenopause and menopause. What is essential is that you refocus on a bariatric focused balanced diet and avoid the common culprits that can escalate regain. To help regain control some key foundations to focus on include:

• Meeting Your Protein Needs: Protein plays a crucial role in maintaining muscle mass, which is essential for an optimal metabolism. Aim to meet your individual protein targets, you can calculate your targets using our protein calculator that you can find via our Protein Planner eBook. It is also packed with practical tips to help you meet your protein target with ease.

• Avoid Grazing: Structured meals and snacks are important. Meals should ideally be consumed within 10-20 minutes, while snacks should last no longer than 10 minutes. If you eat for an extended time, such as grazing on a bowl of nuts, or sipping on a smoothie all morning, it is difficult for your sleeve or pouch to give you cues that you have reached satisfied, essentially allowing you to ‘out eat’ your restriction.

• Balancing Carbohydrate: Choosing low glycemic index (low GI), high-fibre carbohydrates help stabilise blood sugar and supports both satiety and energy levels. Focus on including plenty of plant foods including whole grains, legumes, lentils, and vegetables to balance your protein intake. As a guide, try filling half your plate with protein, one third with non-starchy vegetables like green leafy vegetables and the remainder with a little low GI carbohydrate.

• Keep Food and Fluid Apart: Remember to keep your food and fluids at least 30 minutes apart to help keep you as satisfied as possible. We have a video explaining why this is so important you can view here.

• Include Regular Physical Activity: Physical activity is important for maintaining a healthy weight, supporting your bone health as well as for your mental health and improving your sleep. Aim for 2.5 hours of moderate-intensity or 1.25 hours of vigorous-intensity physical activity each week.

In addition to this, adding in some resistance exercise can assist in reducing the decline in muscle mass that naturally occurs as we age.

Break your exercise down into small, manageable sessions that your body and fitness levels can tolerate and find exercises you enjoy.

Did you know there are 21 ‘Common Culprits’ we see involved in weight regain following weight loss surgery, and understanding these becomes even more vital during menopause and perimenopause when your vulnerability to regain increases?

Our Common Culprits eWorkbook can help you identify and then manage these to help you stay in control of your post-surgery eating.

By refocusing on these bariatric principles and adopting a balanced, active lifestyle, weight management during menopause becomes more achievable, helping to mitigate the effects of hormonal changes on body composition.

MENOPAUSE SYMPTOM MANAGEMENT

Menopausal Hormone Therapy (MHT)

MHT, also known as Hormone Replacement Therapy (HRT) is the most effective option for improving symptoms for menopausal women as well as health risk factors. MHT may relieve common symptoms such as hot flushes, joint pain and vaginal dryness, it may reduce the incidence of osteoporosis, reduce cardiovascular risk as well as type 2 diabetes.

MHT is considered safe, where benefit outweighs risks for most people in their 50’s or for the first 10 years after menopause. To find the best MHT option with the lowest risks for you it requires an individualised plan developed with your medical team.

There is no evidence that MHT increases body weight.

Phytoestrogens

Phytoestrogens are naturally occurring compounds found in some plant foods that mimic oestrogen. Found in foods like soy, flaxseed, chickpeas, and lentils, phytoestrogens can weakly bind to oestrogen receptors, offering mild estrogen-like effects. For some women, especially during menopause, consuming phytoestrogen-rich foods may help ease symptoms like hot flushes. However, their effects are much weaker than those of the body’s own oestrogen or MHT

According to registered dietitian Jenn Huber, the ‘therapeutic dose’ of isoflavens (a type of phytoestrogen found in soy products) that may provide some symptom relief is to include 25 – 50 grams most days. This is easier said than done, as the amount isn’t typically listed on labels and the levels can vary across food types and brands). Jenn explains that 1 cup of soy milk or edamame provide approximately 25g, and 85g of tofu provides approximately 20g.

The Cancer Council position on the inclusion of soy and isoflavens is “the available evidence suggests that soy and other isoflavone-containing foods are unlikely to increase cancer risk and may in fact decrease the risk of developing some cancer types, although the evidence is not strong enough at this stage. Cancer Council recommends that people who already consume soy foods as part of their normal diet, including those who have been diagnosed with breast cancer, should continue to do so.”

Omega three fatty acids

Omega 3 fatty acids are associated with heart health and supporting brain health, including cognition and memory. Supplementation may help reduce the intensity of hot flushes, depressive and cognitive symptoms and joint pain although trials have had inconsistent results to provide any firm recommendations. This is a ‘watch this space’ supplement.

Vitamin E

Vitamin E may provide some relief from hot flushes, night sweats and vaginal changes, but it is important to note there are better clinical outcomes using MHT.

There is potential for vitamin E to become an addition to MHT, but more quality research is required. It is important to note that a high-quality bariatric multivitamin such as BN Healthy or FitForMe contain vitamin E levels well above the adequate intake of 7mg/day for females 51-70 years, so based on current evidence there is no need to add any additional vitamin E into your supplement regime.

WHAT CAN TRIGGER SYMPTOMS

For menopause symptom management, recommendations suggest limiting alcohol, caffeine, and spicy foods, as they may trigger or worsen hot flushes, night sweats, and sleep disruptions.

Alcohol can impact hormone levels, potentially intensifying symptoms, while caffeine may increase irritability and heart rate, affecting sleep quality. Spicy foods might raise body temperature, potentially worsening hot flushes. Moderation is key, and experimenting with reducing or eliminating these can help identify any personal triggers.

COMPLEMENTARY THERAPIES

A quick google search of “menopause supplements” brings up a wide array of beautifully marketed supplement options with bold promises, a price tag to match and a list of ingredients that can leave you scratching your head.

So are they worth the hype? Feel free to read on, but spoiler alert, there is no strong evidence to support them.

Complementary therapies encompass a range of health treatments and products that are outside the scope of conventional medicine. While some of these therapies may offer mild symptom relief, it’s essential to approach them with caution, as there’s limited evidence to support the effectiveness or safety of many popular options.

Here are some key considerations when exploring complementary therapies:

• Consult Your Doctor: Before starting any complementary therapy, discuss it with your doctor, especially if you are on other medications. Certain therapies may interact with prescription drugs, potentially affecting their effectiveness or causing unwanted side effects.

• Be Cautious with Online Products: Products purchased online often lack rigorous safety checks, so their quality cannot be guaranteed. Prioritising safety is essential, particularly when managing menopause symptoms.

• Soy and Phytoestrogen Supplements: If you’re unable to take prescribed hormone therapy for medical reasons (such as a history of breast cancer), avoid soy or phytoestrogen supplements. These concentrated compounds mimic estrogen, which may not be safe for everyone.

• Bio-identical Compounded Hormone Therapy: Bio-identical hormones are often promoted as natural alternatives, but there is currently not enough evidence to confirm their safety. For this reason, these therapies are not generally recommended.

• No Substitute for MHT: While some complementary options may help ease mild symptoms, they are not a substitute for MHT when it comes to effectively managing menopausal symptoms.

This information was adapted from the Australasian Menopause Society.

MEETING KEY NUTRIENT NEEDS DURING PERIMENOPAUSE AND MENOPAUSE

Menopause and perimenopause bring unique nutritional needs, and the great news is that the bariatric-specific goals we set for protein, calcium, vitamin D, and iron as per ASMBS Guidelines already exceed general recommendations, helping you meet the needs of this life stage. Here’s how to keep on track:

1. Protein

During menopause, getting enough protein is vital for supporting muscle mass and bone health. The daily bariatric goal of 60g or more already provides the higher protein intake your body needs through menopause. You can calculate your individual protein target using our protein calculator that you can find via our Protein Planner eBook. It is also packed with practical tips to help you meet your protein target with ease.

2. Calcium and Vitamin D

Hormonal changes during menopause can impact bone mineral density, so it’s crucial to focus on calcium and vitamin D to decrease your risk of osteoporosis. After bariatric surgery, your calcium needs are higher than the general 1000mg daily guideline for women aged 51–70, so supplementing calcium is typically necessary.

Calcium citrate is the best choice for absorption, taken in divided doses.

Vitamin D also plays a big role in bone health and can improve calcium absorption.

Most bariatric-specific multivitamins include 1000 IU of vitamin D, which already surpasses general guidelines. Depending on your individual levels, you may need to take extra vitamin D, best absorbed when paired with a meal containing healthy fats.

3. Iron

Iron needs typically decrease once menstruation stops. Many bariatric-specific multivitamins are designed to meet the iron requirements of postmenopausal women, but your exact needs will depend on factors like surgery type and history of anaemia. Regular blood tests will confirm whether you need any additional iron.

4. Stay Consistent with Supplements and Testing

A high-quality bariatric multivitamin and routine nutritional blood tests will help you stay on top of these essential nutrients. Checking your levels regularly ensures you’re meeting your needs without over- or under-supplementing.

SUMMARY

Navigating perimenopause and menopause after bariatric surgery can be challenging due to hormonal changes that affect your body and weight. By discussing MHT with your doctor, prioritising key bariatric dietary guidelines, avoiding 'common culprits' that can lead to regain, being consistent with your bariatric vitamin regime and being mindful of lifestyle factors, you can effectively manage symptoms and support your overall health during this transition.