The Connection Between Inflammation and The Menopause Transition

As women approach arrive at perimenopause (sometime in their 30s or 40s), the body undergoes significant hormonal shifts. One of the most notable changes is a decline in oestrogen, which has well-established anti-inflammatory effects. As oestrogen levels drop, low-grade inflammation can develop throughout the body, affecting almost every cell. This inflammation can contribute to common symptoms of perimenopause and menopause (for the sake of ease I will refer to both as menopause), such as hot flashes, joint pain, and mood changes, and, if left unchecked, may increase the risk of chronic diseases later in life (McCarthy & Raval, 2020; Malutan et al., 2014).

Given this connection between oestrogen decline and inflammation, managing inflammation is an important strategy for reducing symptoms and improving health during this time. Fortunately, there are several ways to help reduce systemic inflammation through lifestyle changes, including diet, exercise, stress management, and sleep.

Diet: Nourishing the Body to Fight Inflammation

The foods we eat play a crucial role in managing inflammation, particularly through their impact on our gut microbiome. The microbiome consists of the bacteria living in our digestive system, which produce chemicals that can either promote or reduce inflammation. A diet rich in whole plant foods like fruits, vegetables, nuts, legumes, whole grains, and healthy fats (such as olive oil) helps nourish the microbiome and reduce inflammation. In contrast, diets high in processed foods—particularly those rich in sugar, fat, and salt—tend to exacerbate chronic inflammation and can contribute to weight gain, which further increases inflammation.

An anti-inflammatory diet not only helps maintain a healthy weight but also supports bone health during menopause. Studies have shown that following a nutrient-rich, whole-foods-based diet is linked to a lower risk of bone fractures during the menopause transition. For example, research from the Study of Women's Health Across the Nation (SWAN) found that a more inflammatory diet in the years leading up to menopause was associated with an increased risk of fractures both during and after menopause (Shieh et al., 2023).

Exercise: Finding the Right Balance

While regular physical activity is important for overall health, it’s essential to find a balance between exercise intensity and recovery, especially during the menopause transition when inflammation levels may already be elevated.

Moderate exercise or vigorous activity, when paired with appropriate rest, can provide the greatest benefits in reducing inflammation. For example, heavy resistance training and shorter, more intense bouts of high-intensity interval training (HIIT) have been shown to effectively lower inflammatory markers, provided they are balanced with adequate recovery periods (Cerqueira et al., 2020).

Long-term strength training has been shown to not only reduce inflammation but also offer a wide range of other health benefits. These include improved insulin sensitivity and a lower risk of developing Type 2 diabetes (Calle & Fernandez, 2010).  A study of postmenopausal breast cancer survivors found that progressive resistance training not only lowered inflammation but also improved physical strength, reduced fatigue, and enhanced overall quality of life (Serra et al., 2018). Resistance training is a highly effective strategy for managing systemic inflammation and supporting overall metabolic health, especially during the menopause transition. Just be sure to include rest days in your routine—these periods help your body recover and build strength.

Stress Management: Relax to Reduce Inflammation

Chronic stress can significantly contribute to inflammation, as the body’s stress response triggers the release of cortisol, a hormone that can elevate inflammatory markers (Knight et al., 2021). Managing stress through relaxation techniques like restorative yoga, deep breathing exercises, or spending time in nature can help reduce this inflammatory effect. Activities that promote relaxation not only improve mental well-being but also support physical health by lowering inflammation levels.

Sleep Hygiene: Prioritise Rest

Sleep plays a vital role in managing inflammation. Poor sleep quality and insufficient sleep fire up our stress hormone cortisol, can lead to higher levels of systemic inflammation, worsening perimenopausal symptoms, increasing the risk of chronic diseases and weight gain. I’ll dive deeper into sleep and menopause in a future blog post, but for now, please understand that quality rest is essential for overall health and worth prioritising.

Conclusion

During the menopause transition, understanding the connection between oestrogen decline, inflammation, and health is key. By focusing on anti-inflammatory lifestyle practices like a whole-foods-based diet, vigorous but shorter exercise, stress management, and good sleep, women can help mitigate many of the common symptoms of perimenopause and menopause while also reducing their risk of weight gain and chronic diseases in the future.

References

Calle, M. C., & Fernandez, M. L. (2010). Effects of resistance training on the inflammatory response. Nutrition Research and Practice, 4(4), 259–269. https://doi.org/10.4162/nrp.2010.4.4.259

Cerqueira, É., Marinho, D. A., Neiva, H. P., & Lourenço, O. (2020). Inflammatory effects of high and moderate intensity exercise—A systematic review. Frontiers in Physiology, 10, 1550. https://doi.org/10.3389/fphys.2019.01550

Georgiadou, P., & Sbarouni, E. (2009). Effect of hormone replacement therapy on inflammatory biomarkers. Advances in Clinical Chemistry, 47, 59-93. https://doi.org/10.1016/s0065-2423(09)47003-3

Knight, L., Jiang, Y., Rodriguez-Stanley, J., Almeida, D. M., Engeland, C. G., & Zilioli, S. (2021). Perceived stress is linked to heightened biomarkers of inflammation via diurnal cortisol in a national sample of adults. Brain, Behavior, and Immunity, 93, 206-213. https://doi.org/10.1016/j.bbi.2021.01.007

Malmir, H., Saneei, P., Larijani, B., & et al. (2018). Adherence to Mediterranean diet in relation to bone mineral density and risk of fracture: A systematic review and meta-analysis of observational studies. European Journal of Nutrition, 57(5), 2147–2160. https://doi.org/10.1007/s00394-017-1490-3

Malutan, A. M., Dan, M., Nicolae, C., & Carmen, M. (2014). Proinflammatory and anti-inflammatory cytokine changes related to menopause. Przeglad Menopauzalny = Menopause Review, 13(3), 162–168. https://doi.org/10.5114/pm.2014.43818

McCarthy, M., & Raval, A. P. (2020). The peri-menopause in a woman’s life: A systemic inflammatory phase that enables later neurodegenerative disease. Journal of Neuroinflammation, 17, 317. https://doi.org/10.1186/s12974-020-01998-9

Serra, M. C., Ryan, A. S., Ortmeyer, H. K., Addison, O., & Goldberg, A. P. (2018). Resistance training reduces inflammation and fatigue and improves physical function in older breast cancer survivors. Menopause (New York, N.Y.), 25(2), 211–216. https://doi.org/10.1097/GME.0000000000000969

Shieh, A., Karlamangla, A. S., Huang, M.-H., Shivappa, N., Wirth, M. D., Hébert, J. R., Greendale, G. A. (2023). Dietary inflammatory index and fractures in midlife women: Study of Women’s Health Across the Nation. The Journal of Clinical Endocrinology & Metabolism, 108(8), e594–e602. https://doi.org/10.1210/clinem/dgad051

Zupo, R., Lampignano, L., Lattanzio, A., Mariano, F., Osella, A. R., Bonfiglio, C., Giannelli, G., & Pergola, G. (2020). Association between adherence to the Mediterranean diet and circulating vitamin D levels. International Journal of Food Sciences and Nutrition, 71(7), 884–890. https://doi.org/10.1080/09637486.2020.1744533