x

Introduction

Many women are interested in the potential of lifestyle and behavioural modifications to help with management of their menopausal transition and beyond. Lifestyle changes are emerging as important factors in empowering women to embrace their menopause, to optimise their health and wellbeing, and to improve some of the symptoms associated with menopause (1).

Behavioural modifications for managing menopausal symptoms

Improving cooling through environmental control

Clinical evidence to support the efficacy of cooling interventions as a treatment for menopausal vasomotor symptoms (VMS) is sparse (1); however, small increases in body temperature can trigger VMS, so it makes sense to propose environmental changes that may lower core body temperature (2,3). Suggested strategies include:

• Adjusting clothing
  • Dress in layers
  • Wear sleeveless blouses or tops
  • Wear clothing made of natural fibres
  • Using a fan as required
• Keeping cooler at night
  • Lower the room temperature, if able
  • Layering bedding
  • Put a cold pack under the pillow
  • Turn the pillow over to the cool side
  • Use dual control electric blankets
  • Use a bed fan to blow air between the sheets
• Drinking cold beverages

Avoiding potential triggers of VMS

Some women may be able to identify certain triggers for their VMS, although evidence supporting these is non-existent. Potential triggers may include:

• Spicy foods
• Alcohol
• Smoking
• Hot beverages/caffeine
• Warmer weather or environments
• Stress

Lifestyle changes for managing menopause and optimising midlife health

Healthy eating

There is no single dietary pattern that has been studied for alleviating menopausal VMS, with small studies investigating diets such as those rich in fruit and vegetables, or soy foods, yielding conflicting results (1).

For overall health benefits, the most widely-endorsed diet is the Mediterranean diet, which has been shown to have a favourable effect on cardiometabolic markers, cardiovascular disease (4,5), and possibly cognitive function and psychological wellbeing (6). There is no strict definition of a Mediterranean diet, but it can be characterised by high intake of fruit, vegetables, olive oil, nuts and fish, with limited consumption of red meat. Added to this, “healthy diets” in general would be defined by minimal intake of artificial flavouring, trans fats and added sugars (7).

For more information, the Australian Dietary Guidelines can be found at:
https://www.eatforhealth.gov.au/guidelines/guidelines

Physical activity

Physical activity may have benefits for VMS by increasing hypothalamic B-endorphins, thereby stabilising thermoregulation and has been shown to improve quality of life through the menopause and postmenopause (8, 9, 10).

Different kinds of exercise confer different health improvements. Aerobic exercise benefits body composition and cardiovascular health by reducing body fat, increasing bone mineral density and decreasing blood pressure (11, 12). In menopausal and postmenopausal women, aerobic exercise can help with menopausal symptoms, muscle strength and flexibility (11,12). Resistance training can reduce resting heart rate and blood pressure and improve lean body mass and bone mineral density (11, 12). Multi-component exercise, the combination of both kinds, provides benefits of both types of studied activity (1).

The current physical activity and exercise guidelines for all Australians, by age, can be found at:
https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years?language=en

In addition, the AMS information sheets “Exercise Recommendations for Midlife and Beyond” and “Weight management and health ageing” provide more information.

Restorative sleep

Sleep is an essential biological process that is important for cognitive functioning, mood, mental health and cardiovascular, cerebrovascular and metabolic health (13).

Sleep disturbances are extremely common around the menopause transition and postmenopause, partly due to hormonal change and vasomotor symptoms but also due to ageing in general (14). Some studies show that up to two-thirds of women self-report difficulties with sleep around this time, with frequent night-time awakenings and an inability to fall back asleep commonly reported (14). Symptoms of other medical and mental health comorbidities, and an increased prevalence of sleep disorders, also contribute to sleep disturbances as people age (15).

Menopausal VMS can contribute to sleep disturbances, so menopausal hormone therapy can provide relief for some, but it is important to realise that there are a multitude of other factors which may contribute to sleep disturbance around this time of life. Sleep hygiene strategies can help optimise quality sleep (1), and multi-component cognitive behavioural therapy is the mainstay of therapy for persistent insomnia in adults, including menopausal women (16).

For more information please see the AMS information sheet, “Menopause and Sleep”.

Avoidance of harmful substances

Long-term cigarette smoking has been shown to be associated with worse menopausal symptoms, as well as earlier onset of menopause, especially in women who smoked for over 20 years (17). Smoking is also an established cardiovascular risk factor, with baseline cardiovascular risk increasing during the menopausal transition (18), so all menopausal women who are smokers should be encouraged to quit.

Alcohol should be consumed according to established safe intake guidelines. Menopause may be a time of changing behaviours around alcohol, for example as a response to stress and mood changes (19, 20). There is conflicting evidence as to excessive alcohol intake and its effect on timing of menopause (1).

For Australian guidelines to reduce health risks from drinking alcohol, see:
https://www.nhmrc.gov.au/health-advice/alcohol

Mental and social wellbeing

Menopause and midlife can be a time of heightened stress, occurring in combination with other life stressors such as challenging life events, physical changes, and the need to care for children and elderly parents at the same time. Studies have found that increased levels of stress are associated with worse menopausal symptoms including increased frequency of VMS (21, 22); this is also seen in studies assessing job-related stress specifically (22). Regarding management of stress, programs which incorporate cognitive behavioural therapy have been found to be effective in allowing patients to improve their ability to cope with stressors, and reduce VMS and other menopausal symptoms (23, 24).

Healthy relationships are important for healthy ageing. Close relationships contribute to positive health benefits including better control of chronic diseases (1) and can improve overall quality of life in menopausal patients, specifically (25, 26, 27). Conversely, social isolation and feeling lonely are associated with poor health outcomes. Social connectedness likely improves health by fostering positive health behaviours such as physical activity and healthy eating, and by reducing mental health comorbidities (1).

Intimate partner relationships have been studied in relation to the experience of menopause, with research suggesting that satisfaction with partner relationships is associated with less severe menopausal symptoms and improved overall health (28, 29). Therefore, educating partners about the menopausal transition may improve both relationship satisfaction and wellbeing (30, 31).

For more information see the AMS information sheet, “Mood and the Menopause”.

References

1. Anekwe C, Cano A, Mulligan, J et al. The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions. Climacteric. 2025;28(5):478–496. doi:10.1080/13697137.2025.2548806
2. Freedman RR, Norton D, Woodward S, et al. Core body temperature and circadian rhythm of hot flashes in menopausal women. J Clin Endocrinol Metab. 1995 Aug;80(8):2354-8. doi: 10.1210/jcem.80.8.7629229. PMID: 7629229.
3. Freedman RR, Woodward S. Core body temperature during menopausal hot flashes. Fertil Steril. 1996;65:1141–1144.
4. Gonçalves C, Silva R, Costa M, et al. Systematic review of Mediterranean diet interventions in menopausal women. AIMS Public Health. 2024;11(1):100–129.
5. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2018;378(25):e34.
6. Cano A, Marshall S, Zolfaroli I, et al. The Mediterranean diet and menopausal health: an EMAS position statement. Maturitas. 2020;139:90–97.
7. Szoeke C. Secrets of Women’s Healthy Ageing. Melbourne: Melbourne University Press; 2021.
8. Jungmann S, Hetcher M, Kohl M, et al. Impact of 3 months of detraining after high intensity exercise on menopause-related symptoms in early postmenopausal women: results of the randomized controlled ActLife project. Front Sports Act Living. 2022;4:1039754.
9. Wasowicz A, Nowak M, Kowalska K, et al. Impact of physical exercise on menopause symptoms and health-related quality of life: a literature review. J Educ Health Sport. 2024;76:56485.
10. Luoto R, Moilanen J, Heinonen R, et al. Effect of aerobic training on hot flushes and quality of life: a randomized controlled trial. Ann Med. 2012;44(6):616–626.
11. Paluch AE, Bajpai S, Bassett DR Jr, et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation. 2024;149(3):e217–e231.
12. Schroeder EC, Welk GJ, Franke WD, et al. Comparative effectiveness of aerobic, resistance and combined training on cardiovascular disease risk factors: a randomized controlled trial. PLoS One. 2019;14(1):e0210292.
13. Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2021;17(10):2115–2119.
14. Maki PM, Thurston RC. Sleep disturbance associated with the menopause. Menopause.
15. Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics. 2018;18(2):155–165.
16. Ree M, Junge MF, Cunnington D, et al. Australasian Sleep Association position statement regarding the use of psychological/behavioral treatments in the management of insomnia in adults. Sleep Med. 2017;36 Suppl 1:S43–S47.
17. Dotlic J, Gazibara T, Rancic B, et al. Patterns of smoking and menopause-specific quality of life: smoking duration matters more. Behav Med. 2026;49(1):29–39.
18. Burnette MM, Wing RR, Kuller LH, et al. Smoking cessation, weight gain, and changes in cardiovascular risk factors during menopause: the Healthy Women Study. Am J Public Health. 1998;88(1):93–96.
19. Milic J, Glisic M, Voortman T, et al. Menopause, ageing, and alcohol use disorders in women. Maturitas. 2018;111:100–109.
20. Shihab N, Al-Safi ZA, Santoro N, et al. Alcohol use at midlife and in menopause: a narrative review. Maturitas. 2024;189:108092
21. Arnot M, Emmott EH, Mace R, et al. The relationship between social support, stressful events, and menopause symptoms. PLoS One. 2021;16(1):e0245444.
22. Matsuzaki K, Uemura H, Yasui T, et al. Associations of menopausal symptoms with job-related stress factors in nurses in Japan. Maturitas. 2014;79(1):77–85.
23. Augoulea A, Moros M, Lykeridou A, et al. Assessing the efficacy of a structured stress management program in reducing stress and climacteric symptoms in peri- and postmenopausal women. Arch Womens Ment Health. 2021;24(5):727–735.
24. Hunter MS. Cognitive behavioral therapy for menopausal symptoms. Climacteric. 2021;24(1):51–56.
25. Divya KL, Kumar N, Ramesh S, et al. Role of social support in reducing the severity of menopausal symptoms among women living in rural Mysuru, Karnataka: an analytical cross-sectional study. J Midlife Health. 2024;15(1):12–18.
26. Jalambadani Z, Garmaroudi G, Tavousi M, et al. Investigating the relationship between menopause-specific quality of life and perceived social support among postmenopausal women in Iran. Exp Aging Res. 2020;46(4):359–366.
27. Schwarz S, Völzke H, Alte D, et al. Menopause and determinants of quality of life in women at midlife and beyond: the Study of Health in Pomerania (SHIP). Menopause. 2007;14(1):123–134.
28. Kling JM, Kapoor E, Moyer AM, et al. Association between menopausal symptoms and relationship distress. Maturitas. 2019;130:1–5.
29. Lee MS, Kim JH, Park MS, et al. Factors influencing the severity of menopause symptoms in Korean postmenopausal women. J Korean Med Sci. 2010;25(5):758–765. 
30. Bahri N, Latifnejad Roudsari R, Azimi Hashemi M, et al. The effects of menopausal health training for spouses on women’s quality of life during the menopausal transition period. Menopause. 2016;23(2):183–188.
31. Parish SJ, Nappi RE, Krychman ML, et al. The MATE Survey: men’s perceptions and attitudes towards menopause and their role in partners’ menopausal transition. Menopause. 2019;26(10):1110–1116.

Authorship:

Amie Hanlon
Obstetrician and Gynaecologist
AMS Board