The Mediterranean diet is an approach to food that centers whole grains, fruits and vegetables, nuts and seeds, beans, and healthy fats like olive oil. Thanks to its simplicity and proven health benefits, the diet has enduring popularity among consumers and researchers alike. And for people in menopause, the Mediterranean diet holds a special appeal: It may help protect against symptoms like hot flashes, depression, and cognitive issues while improving long-term bone and heart health.

Mediterranean diet basics: How it works

The Mediterranean diet is based on the traditional cuisines of Greece, Spain, Italy, and other cultures of the Mediterranean sea. It first caught the attention of public health researchers in the 1950s who noticed that heart health among rural, working class Mediterranean people was much better than that of their US counterparts. It wasn’t until the 1990s, however, that the diet exploded into public consciousness, where it has remained ever since.

For people accustomed to calorie counting and complex rules, the Mediterranean diet offers a breath of fresh air. It is nonrestrictive, meaning there aren’t hard limits on the type or amount of food you eat. Instead, the Mediterranean diet gives people a general orientation toward meals. Plant foods and healthy fats are emphasized, while other foods—meat, dairy, sweets, and refined grains—take a backseat.

The Mediterranean diet has been studied extensively and is broadly considered healthy by researchers and healthcare providers. One recent study even described it as the “gold standard in preventive medicine,” citing its many protective health benefits. But what does the Mediterranean diet have to offer people during menopause?

The Mediterranean diet & hot flashes

Hot flashes are one of the most common and uncomfortable symptoms of menopause. As your natural estrogen levels fall, a part of your brain that regulates temperature (the hypothalamus) seems to get scrambled. The hypothalamus then sends out improper signals to the rest of your body, causing intense heat and sweating..

In a study of over 6000 women, researchers found that those who ate a Mediterranean-style diet were significantly less likely to report hot flashes and night sweats than those who ate a high-fat and high-sugar diet. While we’re not entirely sure how this effect works, the study authors speculated that the diet’s higher fiber and lower fat content could help stabilize estrogen levels, while a conventional diet might do the opposite. Other investigators have suggested that the Mediterranean diet may stave off hot flashes by helping people lose excess weight (which is an established hot flash risk factor). 

It’s important to note that some research has been more ambivalent about the value of the Mediterranean diet in treating hot flashes. The gold standard treatment for hot flashes is still menopausal hormone therapy.

The Mediterranean diet & mental health

Depression, anxiety, memory issues, and brain fog are all extremely common during menopause. This is no surprise, given that the brain is rich in estrogen receptors. As your hormone levels fall, your brain function is directly impacted. 

Research in these areas suggests that the Mediterranean diet may be helpful. Multiple reviews have found that the diet is linked to lower levels of depression—possibly because it has broad anti-inflammatory properties. Similarly, a study of over 16,000 postmenopausal women found that the Mediterranean diet was linked to delayed cognitive aging and stronger verbal memory (a predictor of Alzheimer’s disease). 

A 2017 systematic review reached a comparable result: People who adhered to the Mediterranean diet were found less likely to develop cognitive disorders. This effect, the authors suggested, may be due to the diet’s reduction in inflammation and oxidative stress—as well as its focus on foods (e.g. olive oil, fruits, and vegetables) that are already known to protect brain health.

The Mediterranean diet & bone health

Estrogen plays a major role in bone maintenance. When estrogen levels begin to plummet during menopause, bones tend to become thinner and weaker. By age 80, more than a third of women have osteoporosis. This comes with a very high quality-of-life cost, as dangerous bone breaks and fractures become more common.

While there isn’t conclusive evidence showing that the Mediterranean diet improves bone health, there is some promising research. A study of 442 premenopausal Spanish women found that the diet was associated with better bone mass. Another European study found that the Mediterranean diet significantly reduced the rate of hip bone loss in people with osteoporosis. Finally, a major 2021 review found that Mediterranean-type diets are effective at preventing osteoporosis, emphasizing that the diet’s central foods are fundamental for maintaining bone health.

Other researchers strike a more cautious note. In a recent statement, the European Menopause and Andropause Society wrote that the Mediterranean diet may be appropriate for women with osteoporosis, but it “should not be used as the primary treatment strategy.” In other words, it’s important to combine a healthy diet with a bone-strengthening exercise regimen and sufficient vitamin intake (especially calcium).

The Mediterranean diet & heart health

Heart disease is the leading cause of death for women in the US. And while menopause doesn’t directly cause heart disease, it can bring about certain metabolic changes that hurt your heart health in the long run. These include shifts in your body fat, cholesterol, blood pressure, and glycemic control. There is evidence that the Mediterranean diet can help address all of these issues:

Body fat: During menopause, body fat is redistributed and “central obesity” becomes more common. This means fat tends to accumulate around your midsection, where it is much more dangerous. A 2018 study (which was not specific to menopausal people) found that the Mediterranean diet was linked to lower abdominal obesity, suggesting it might protect against this effect. A 2017 systematic review reached a similar conclusion, linking the diet with lower central obesity while noting that more research was needed.

Blood pressure: Estrogen helps keep blood vessels dilated and elastic. As estrogen falls during menopause, the blood vessels tighten up, raising blood pressure. This is a major risk factor for long-term heart disease. Multiple reviews have found that the Mediterranean diet is linked with lower blood pressure—an effect that is modest but very consistent.

Cholesterol profile: During menopause, LDL (the “bad” cholesterol) tends to increase. This is another major cardiovascular risk, as LDL can build up in your blood vessels, making heart attack and stroke more likely. A 2017 study of women before and during menopause found that the Mediterranean diet helped improve LDL and a number of other cholesterol features. Other studies have reached similar conclusions, finding moderate evidence that the Mediterranean diet is linked with better cholesterol.

Glycemic control: Estrogen and insulin are linked in complex ways that we don’t fully understand. But menopause seems to be a risk factor for insulin resistance and Type 2 diabetes. And on this front, the Mediterranean diet really shines. Multiple studies have linked it to better glycemic control and concluded that it may help prevent Type 2 diabetes. This may be due to the Mediterranean diet’s high fiber content and avoidance of processed carbohydrates, which helps prevent major glycemic spikes. The diet also seems to have a positive impact on your gut microbiome, leading to better insulin sensitivity. 

Final thoughts

The Mediterranean diet is a well-established and healthy approach to eating. It is rich in antioxidant and anti-inflammatory plant compounds, low in refined carbs, and flexible enough to accommodate many different tastes and preferences. For people approaching and experiencing menopause, the Mediterranean diet may be an effective way to reduce some symptoms and protect against long-term health issues. 

But it’s important to remember that diet is only one aspect of a comprehensive response to menopause. If you’re struggling with menopause symptoms, talk with your doctor about the medications, lifestyle adjustments, and other treatments that will best address your concerns.