Mediterranean Diet Linked to Fewer Hot Flashes and Sexual Symptoms in Postmenopausal Women

Between June 2021 and June 2022, researchers screened 452 postmenopausal women who had been referred to healthcare clinics. Each had gone at least 12 months without a period and was aged 40 or older. Only 149 made it through the inclusion criteria, and what those women reported about their eating and their symptoms is the basis of a study recently published in Scientific Reports.

The criteria were strict. The researchers excluded women with mental illness, autoimmune conditions, malignancy or other severe medical conditions, and anyone with a history of chronic smoking. Body mass index had to fall between 18.5 and 40. Women currently using hormone therapy, dietary supplements or psychiatric medications were left out, as were those whose reported energy intake was implausible, under 800 or over 4000 kilocalories a day. The women who remained were between 42 and 63 years old.

Each woman completed a validated 117-item food frequency questionnaire covering the previous year of eating, plus the General Physical Activity Questionnaire. From the food data, the team assigned every participant a modified Mediterranean diet score from 0 to 9. The modification mattered: because olive oil intake in this population was low, the score used the ratio of monounsaturated and polyunsaturated fats to saturated fat instead of monounsaturated fat alone.

Symptoms were measured with the 29-item Menopause-Specific Quality of Life questionnaire, known as MENQOL, which covers four domains: vasomotor, psychosocial, physical and sexual. A moderate to severe burden was defined as an item score of 5 or higher. The researchers then used logistic regression to compare women in the top, middle and bottom thirds of diet scores, adjusting for age, years since menopause, energy intake, BMI, physical activity, occupation, education, marital status and underlying disease.

Two domains showed a clear difference. Women in the highest-adherence group had 80% lower odds of moderate to severe vasomotor symptoms, meaning hot flashes and night sweats, than those in the lowest group (odds ratio 0.20, 95% confidence interval 0.064 to 0.658). For sexual symptoms such as vaginal dryness and low libido, the odds were 83% lower (odds ratio 0.17, confidence interval 0.068 to 0.450). Psychological and physical symptoms showed no significant association once the adjustments were made. Average MENQOL and domain scores also did not differ significantly across the three diet groups; the gap appeared in the odds of moderate to severe symptoms.

The study also reported that the diet score separated women with poor quality of life from those without almost perfectly, with an area under the curve of 0.997. The authors describe this as exploratory: the cut-points were derived without internal validation, and the figure should be read cautiously.

The backdrop is that hormone therapy works for vasomotor symptoms in many women, but some cannot take it or prefer not to, which keeps interest alive in non-hormonal options such as sleep, exercise and diet. The Mediterranean pattern, built on fruits, vegetables, legumes, whole grains and healthy fats, and tied to the traditional eating of Greece, Italy, France and Spain, has been credited with anti-inflammatory and antioxidant effects. Its role in menopause had been hypothesized and anecdotally reported but not much studied across the full range of symptoms.

Because the design is cross-sectional, it captures one moment and cannot show that the diet caused the difference. The authors say the findings support further evaluation of the diet as a non-hormonal strategy, call the evidence encouraging but inconsistent, and say prospective trials are needed.