The association between the risk of experiencing severe to moderate menopausal vasomotor symptoms and mMDS was found to have a significant negative correlation in both the unadjusted model and even after accounting for potential confounding variables, the analysis continued to reveal a noteworthy relationship. Those individuals situated in the uppermost tertile of mMDS exhibited an 83% decreased likelihood of encountering severe to moderate menopausal sexual symptoms, both prior to and subsequent to adjusting for potential confounding elements. mMDS displayed substantial prognostic capability concerning vasomotor, psychological, physical, and sexual subcategories.
The link between the Mediterranean diet and vasomotor symptoms of menopause, including hot flashes and night sweats, is garnering increased attention in the realms of nutritional epidemiology and women’s health. The Mediterranean diet is abundant in phenolic compounds and emphasizes high consumption of fruits, vegetables, whole grains, legumes, nuts, and extra-virgin olive oil as the main source of added fat, along with a moderate intake of fish and poultry. This dietary pattern has been studied for its potential advantages in managing menopausal symptoms, especially vasomotor symptoms and the age of onset28. The position paper of the European Menopause and Androgen Society (EMAS) suggests that the Mediterranean diet can alleviate vasomotor symptoms in women undergoing menopause, underscoring the potential advantages of this dietary regimen in managing symptoms associated with menopause29. Although the EMAS acknowledges the Mediterranean diet, our study provides new evidence by examining the association between mMDS and specific menopausal symptom domains in an underrepresented population, and by identifying potential cut-off points for dietary adherence. Studies indicate that following the Mediterranean Diet can lead to a reduction in the frequency and severity of menopausal symptoms, especially among women with obesity9,30. The intake of legumes and extra-virgin olive oil, specific elements of the Mediterranean diet, have been linked to a decrease in the severity of vasomotor and sexual symptoms during menopause31. Additionally, a diet rich in plants and daily intake of soybeans has been found to considerably lessen the frequency and severity of hot flashes and related symptoms after menopause. This suggests that dietary changes could be an effective strategy for managing vasomotor symptoms29,32. Conversely, the consumption of poultry and low-fat dairy products has been associated with an exacerbation of menopausal symptoms32. Thus, embracing the Mediterranean diet could be a useful approach for women looking to control vasomotor symptoms during menopause.
An Australian cross-sectional study in 2024 assessed Mediterranean Diet adherence using the MEDAS tool and menopausal symptoms with the Menopause Rating Scale in 207 peri- and menopausal women aged 40–60. The researchers found that overall adherence to the Mediterranean diet was not associated with the severity of menopausal symptoms. However, low consumption of sugar-sweetened beverages was inversely associated with joint and muscle complaints, and lower intake of red and processed meats was linked to better general health and physical function33. Another study examined the relationship between adherence to a Mediterranean diet and the severity of menopausal symptoms in women living in Ireland. A total of 304 women over age 40 (154 perimenopausal and 150 postmenopausal) participated, with dietary adherence assessed using the 14-item Mediterranean Diet Assessment Tool (MDAT) and menopausal symptoms measured by the Menopause Rating Scale (MRS). Most participants had moderate diet adherence, while high adherence was rare. The study found that lower adherence to the Mediterranean diet in postmenopausal women predicted worse menopausal symptoms, and higher BMI also correlated with greater symptom severity in both peri- and postmenopausal groups. These findings suggest that both increased body weight and lower adherence to a Mediterranean dietary pattern may contribute to a more symptomatic menopausal experience, highlighting the need for further research in this area34.
There are several proposed mechanisms through which the Mediterranean diet may influence menopausal symptoms. This mechanism has been proposed in the literature, although further research is needed to confirm its role in menopausal symptom management. The impact of the Mediterranean diet on sex hormone levels and the age of menopause suggests it could play a role in easing vasomotor symptoms. In general, adhering to the Mediterranean diet might regulate hormonal fluctuations, potentially lessening the severity of vasomotor symptoms experienced during menopause35. The Mediterranean diet’s potential to decrease the frequency and severity of menopausal symptoms is largely due to its high phytoestrogen content, particularly in foods such as soy. These phytoestrogens may exert a mild estrogen-like effect, which could help alleviate vasomotor symptoms9,30.
The Mediterranean diet has been linked to decreased inflammation, as evidenced by reduced levels of inflammatory indicators such as tumor necrosis factor (TNF-α) and interleukin 1 beta (IL-1β)36. This could aid in the relief of menopausal symptoms, given that inflammation has been associated with a rise in vasomotor symptoms31. Evidence suggests that the Mediterranean diet can reduce markers of oxidative stress, including malondialdehyde (MDA) and oxygen radical absorbance capacity (ORAC). This could potentially aid in alleviating symptoms associated with menopause37. The Mediterranean diet is associated with a more beneficial gut microbiota, which aids in maintaining the function of the gut barrier and decreasing inflammation38. This could contribute to the overall health and well-being of women going through menopause, potentially easing symptoms. Higher adherence to the Mediterranean dietary pattern can help manage weight gain and the distribution of visceral fat during menopause, which affects hormonal balance. Sticking to the Mediterranean diet has been linked to less significant increases in waist circumference over time in women post-menopause. This is crucial as an increased waist circumference and obesity are risk factors for worsening menopausal symptoms, including vasomotor symptoms. However, the diet was not linked to significant changes in overall weight or the risk of becoming overweight or obese. Furthermore, the anti-inflammatory and antioxidant properties of the Mediterranean diet, along with its impact on weight management, can help alleviate typical menopausal metabolic disorders, such as type 2 diabetes and cardiovascular diseases35,39.
The Mediterranean diet, when combined with a comprehensive lifestyle medicine strategy that encompasses regular exercise, stress management, and the avoidance of harmful substances, may collectively alleviate vasomotor symptoms. This integrated approach emphasizes the significance of maintaining a healthy lifestyle in managing symptoms associated with menopause30.
While there are some encouraging results, the evidence regarding the connection between the Mediterranean diet and vasomotor symptoms is not entirely conclusive. Some research indicates positive outcomes, but other studies advocate for more comprehensive research to formulate definitive dietary recommendations for women going through menopause.
This investigation marks the initial attempt to juxtapose and assess the correlation and prognostic capability of three distinct indicators concurrently. Within this study, diverse statistical methodologies were trialed, culminating in the documentation of the outcomes derived from two methodologies deemed more suitable, thereby affording the clinicians a comprehensive perspective on the results and their practical implications. Moreover, endeavors were made to enhance the applicability and user-friendliness of the findings at a clinical level by ascertaining the optimal cut-off point. Noteworthy strengths of this study encompass the meticulousness of the trained interviewer in data collection, thus minimizing potential reporting inaccuracies, the utilization of culturally appropriate questionnaires tailored for the [blinded] populace, comprehensive and precise inclusion criteria, as well as meticulous adjustment for numerous confounding variables.
Our investigation, akin to others, is not devoid of limitations that necessitate acknowledgment. This endeavor was executed in a cross-sectional manner, thereby precluding definitive assertions regarding causality in the observed relationships among the variables of interest. The outbreak of the coronavirus posed a constraint on the sample size. Data gathering relied on self-reports during interviews, notwithstanding the interviewer’s diligence in error mitigation, the inherent reliance on individual memory introduces an inevitable margin of error. Cultural sensitivities may lead to unrealistic responses, particularly concerning inquiries of a sexual or psychological nature. While the food frequency questionnaire was tailored for the [blinded] context, the scant representation of local cuisine peculiar to the region might impact the derived food index scores. Additionally, the cut-off values identified through ROC analysis were not validated using internal methods such as cross-validation or bootstrapping. This limits the generalizability of the proposed thresholds and should be addressed in future studies. Furthermore, the use of a modified mMDS that incorporates both MUFA and PUFA in place of only MUFA, due to limited olive oil consumption in the population, may affect comparability with traditional Mediterranean Diet Scores. This methodological adaptation, while contextually appropriate, should be considered when interpreting the results.”