How a Mediterranean diet helps women manage menopausal symptoms

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Sep 1 2025

New research shows that women following a modified Mediterranean diet were far less likely to report disruptive hot flashes and sexual discomfort, pointing to diet as a promising non-hormonal approach to menopausal well-being.

Study: Association between modified Mediterranean diet score and menopause-specific quality of life and symptoms: a cross-sectional study. Image Credit: Nina Jovic / Shutterstock

In a recent study in the journal Scientific Reports, researchers investigated associations between adherence to a modified Mediterranean diet and the severity of common, yet disruptive, menopausal symptoms (e.g., hot flashes, sexual discomfort). The cross-sectional study involved 149 postmenopausal women (eligible aged 40+ years; observed aged 42–63 years) and utilized a validated 117-item food frequency questionnaire.

Study findings revealed that participants who adhered most closely to the Mediterranean diet were significantly less likely to experience moderate to severe vasomotor (hot flashes; -80% lower) and mild to severe sexual symptoms (-83% lower) than those who adhered least. Mean MENQOL and domain scores did not differ significantly across Mediterranean-diet tertiles; however, the odds of moderate to severe vasomotor and sexual symptoms were lower at higher adherence.

This study suggests that diet may be a promising tool for improving menopausal well-being and may inform women and healthcare providers.

Background

Menopause refers to the natural and irreversible cessation of menstrual cycles in females, typically occurring between the ages of 40 and 55. It marks a significant physiological transition and is often accompanied by a host of disruptive symptoms, including vasomotor symptoms (e.g., hot flashes, night sweats), as well as psychological, physical, and sexual challenges.

Conventional treatment interventions involve the use of hormone therapy. Hormone therapy is effective for vasomotor symptoms for many women; however, non-hormonal strategies remain important for those who cannot or prefer not to use it. Modifiable behaviors (sleep quality, diet, and physical exercise) are increasingly recognized for their potential to meet these needs.

The Mediterranean diet (MedDiet) is a predominantly plant-focused dietary pattern closely resembling the traditional diets of countries near the Mediterranean Sea (Greece, Italy, France, and Spain) and is renowned for its anti-inflammatory and antioxidant properties.

The diet is characterized by a high intake of fruits, vegetables, legumes, whole grains, and healthy fats, and has previously been associated with scientifically validated health benefits across a range of physiological metrics. While it has been hypothesized and anecdotally documented to improve menopausal symptoms, systematic investigations of its impact on the comprehensive spectrum of menopausal symptoms have remained underexplored.

About the Study

This present cross-sectional study bridges the knowledge gap and informs women, consumers, and clinical practitioners alike by investigating the link between dietary habits and menopausal quality of life.

The study screened 452 postmenopausal women (confirmed cessation of periods for 12 months or more) aged 40 and above from June 2021 to June 2022, with participants referred to healthcare clinics.

Of these 149 participants meeting stringent inclusion criteria (e.g., no mental disease or autoimmune conditions, no malignancy or other severe medical conditions, no chronic smoking history, body mass index [BMI 18.5 to 40 kg/m2], no current hormone therapy or dietary supplements, no psychiatric medications, and exclusion of implausible energy intakes <800 or >4000 kcal/day) were identified, and their dietary intake over the preceding year was meticulously assessed using the validated 117-item FFQ.

The General Physical Activity Questionnaire (GPAQ) was used to measure participants’ activity levels, and a 117-item food frequency questionnaire (FFQ) was used to record and parameterize their dietary intake. From this data, each participant was assigned a modified Mediterranean diet score (mMDS), ranging from 0 to 9, to quantify their adherence to the dietary pattern. In this population, the modified score used the ratio of (MUFA + PUFA) to SFA in place of MUFA alone, reflecting low olive-oil intake.

Menopausal symptoms and quality of life were evaluated using the Menopause-Specific Quality of Life (MENQOL) questionnaire (29 items) to assess the severity of symptoms across four domains: vasomotor, psychosocial, physical, and sexual. A moderate to severe symptom burden was defined as MENQOL item scores of 5 or higher.

Finally, logistic regression models were leveraged to analyse the association between the mMDS (categorized into tertiles) and the odds of experiencing moderate to severe symptoms in each domain. All models were adjusted for potential confounders, including age, years since menopause, energy intake, BMI, and physical activity, as well as occupation, education, marital status, and underlying disease.

Study Findings

The study revealed a strong, statistically significant association between higher adherence to the Mediterranean diet and a lower severity of specific menopausal symptoms. Women in the highest tertile of the mMDS were observed to demonstrate substantially lower risk of moderate to severe vasomotor and sexual symptoms compared to those in the lowest tertile.

Specifically, logistic regression models revealed that women in the highest adherence group had 80% lower odds of experiencing moderate to severe vasomotor symptoms (hot flashes and night sweats) compared to those in the lowest adherence group (Odds Ratio [OR] 0.20; 95% Confidence Interval [CI] 0.064–0.658). For sexual symptoms (such as vaginal dryness and low libido), the effect was slightly more pronounced, with 83% lower odds of moderate to severe symptoms in the highest adherence group (OR 0.17; 95% CI 0.068–0.450) compared to their least-adherent counterparts.

No significant associations were observed for the psychological or physical domains in adjusted models.

Unexpectedly, mMDS demonstrated a strong ability to discriminate between women with and without poor quality of life, as shown by a high Area Under the Curve (AUC = 0.997) in a Receiver Operating Characteristic (ROC) analysis. These ROC findings were exploratory, the cut-points were derived without internal validation, and should be interpreted cautiously.

Conclusions

While the cross-sectional nature of the present study cannot establish causation, its findings support further evaluation of the MedDiet as a promising non-hormonal strategy for managing some of the most disruptive symptoms of menopause, with recognition that the evidence to date is encouraging but inconsistent, and that prospective trials are needed.