Menopause can be an incredibly challenging time. Although it will affect around half of all people, it is still under-studied.

Because every woman experiences menopause differently, it can leave them confused and unsure of what to do. 

Whether it’s night sweats and hot flashes or aching joints and anxiety, everyone's journey is different.

Here, we explain how we developed the MenoScale calculator, a free online resource that helps you make sense of your symptoms.

We also investigate the important relationship between food and menopause symptoms, and how menopause can influence your metabolism. 

ZOE’s new calculator

To gather fresh insights into menopause symptoms, we first need to be able to evaluate them accurately.

Although there are other menopause symptom questionnaires, the MenoScale builds on and improves on them in a number of ways, creating a unique offering. The MenoScale calculator:

• Was developed using data from thousands of participants. 

• Uses modern, accessible language.

• Assesses the impact on quality of life in a simple, user-friendly way.

• Will be online and available for women to access for free so that they can evaluate their symptoms.

We designed a calculator that can measure the “burden” of menopause symptoms — in other words, how much your symptoms impact your life. We presented our results at the British Menopause Society’s 33rd Annual Scientific Conference and the Nutrition Society Congress 2024.

This new calculator may help clinicians and academics learn more about menopause. Importantly, it may also empower individuals by helping them understand their symptoms and how they impact their lives. 

MenoScale can help you make sense of your symptoms and understand how different interventions — like dietary changes — affect your symptoms.

How we designed the new calculator

To begin, we collected data from tens of thousands of people: 27,932 were perimenopausal, and 42,480 were postmenopausal. 

They rated the frequency and impact on quality of life of 20 common symptoms from 0 (not at all) to 5 (extremely). After adding up the score from each symptom, they got a score out of 100, where 0 is no symptoms at all, and a higher score means a greater symptom burden.

We also split the symptoms into four domains:

• Vasomotor: This includes symptoms like hot flashes and night sweats.

• Sexual: Such as vaginal dryness and loss of libido.

• Psychological: Mood swings or anxiety, for example.

• Somatic: Physical symptoms such as headaches and joint or muscle pain.

Our findings: How common are menopause symptoms?

Firstly, we investigated how common menopause symptoms are. And we found that they are very common:

• 99.8% of perimenopausal participants had one or more symptoms. 

• 92.7% of postmenopausal participants had one or more symptoms. 

• 66.0% of perimenopausal participants had at least 12 symptoms (average of 13.5 symptoms).

• 41.2% of postmenopausal participants had at least 12 symptoms (average of 10.5 symptoms).

We also found that, on average, symptoms in perimenopause were worse than postmenopause:

• perimenopause: 32.2

• postmenopause: 22

The symptoms rated most severe during perimenopause were:

• weight gain and slowed metabolism (30.7%) 

• low libido (26.2%)

• fatigue (24.3%)

Whereas during postmenopause, the most impactful symptoms were:

• low libido (23.2%)

• weight gain and slow metabolism (19.5%)

• fatigue (12.6%)

When we looked at the four domains: vasomotor, sexual, psychological, and somatic, we also found more differences between peri- and postmenopause.

Compared with postmenopausal participants, perimenopausal participants had higher average scores in the vasomotor, psychological, and somatic domains but lower scores in the sexual domain. 

The link between menopause symptoms and food

When looking at the quality of participants’ food intake, we found fascinating links between symptom scores and diet quality.

The Healthy Eating Index scores diet quality out of 100, with 0 being low quality and 100 being high quality. 

Diet quality was also linked to the number of symptoms a participant experienced. Each 20-point increase in the healthy eating score was associated with a reduced likelihood of experiencing symptoms. 

Depending on the symptoms, the likelihood of experiencing a symptom decreased by 6% to 37% for those in perimenopause and 12% to 43% for those in postmenopause.

Takeaway: The MenoScore calculator is now live

In this study, we designed and tested a novel way of measuring the “symptom burden” of menopause. We found that the majority of peri- and postmenopausal participants experience a high number of symptoms.

Our research also showed that, on average, symptoms are more burdensome for people during perimenopause than postmenopause and that the type of symptoms varies between the two groups.

Importantly, we showed that people who follow a healthier diet are more likely to report less burdensome menopause symptoms. 

However, we only found “associations” in this study — we showed that people who follow a healthier diet are more likely to be less impacted by their symptoms. But we can’t conclude that a healthy diet causes a reduction in symptoms.

In the next study, we investigate this link by following participants over time.

Can following ZOE improve how you feel during menopause?

We recently presented the results of this study at the Nutrition Society Congress 2024.

In the first study we covered above, we found that people who followed a more healthy diet experienced fewer symptoms and they tended to have less of an impact on their lives.

Following ZOE during menopause

We recruited 4,287 participants, all based in the United Kingdom. Of these, 1,000 were perimenopausal, and 3,287 were postmenopausal. 

All participants joined ZOE. This involves a testing phase, where they: 

• Use a continuous glucose monitor (CGM) to track their blood sugar responses for 2 weeks.

• Take a blood test to assess how well their body clears fat from their blood.

• Provide a stool sample so ZOE can analyze their gut microbiome.

By comparing the results of these tests to thousands of other members, we provide members with ZOE scores for each of the three tests.

Our tailored nutrition advice includes personal food scores to help people choose the right foods for their bodies, in-app recipes, and support from our Nutrition Coaches.

At the start of the study and around 30 weeks later, we assessed their menopause symptoms using version 1 of the MenoScale, our menopause symptom calculator. Participants completed food diaries using the ZOE app. From this, we calculated their diet quality.

What did we find?

In line with the results from the previous study, we found that people in perimenopause had higher menopause symptom scores than postmenopausal participants.

By the end of the study, on average, participants had increased the quality of their diet.

As we mentioned before, the score splits menopause symptoms into four broad groups: vasomotor, sexual, psychological, and somatic.

We found that in these participants, an improved diet was associated with less bothersome psychological and somatic symptoms, particularly for perimenopausal participants.

Next steps

These results are exciting: On average, in this study, a healthier diet was associated with reduced menopause symptom scores in these participants.

But we need to do more research; this is just the start. Importantly, this study didn’t have a control group, so we don’t know whether the symptoms improved because people were excited to try ZOE or because they made other changes to their health, like stopping smoking, sleeping better, or generally improving their lifestyle. 

We hope to build on this research in the future. Still, it’s becoming clearer that diet quality may be linked to menopause symptoms. 

Next, we look at the relationship between sex, menopause, and blood sugar responses.

Note: The ZOE program is intended to help you make personalized nutritional and lifestyle choices. It is for general health and wellness purposes only and is not a treatment for menopause symptoms.  

ZOE study: Menopause and blood sugar variation

The final ZOE study we’ll cover investigated blood sugar responses to food. We looked at how they fluctuate throughout the day and how these fluctuations are influenced by sex and menopause status. 

This is the first study to investigate these relationships, and the abstract was published in Current Developments in Nutrition.

Why does blood sugar matter?

When you eat food that contains carbohydrates, your gut breaks it down into glucose. This glucose then travels through your gut wall and enters your blood supply.

Glucose is your body’s primary energy source. Once in your blood, it travels around your body to be used by your cells or stored in your liver for later.

Over many years, pronounced blood sugar responses to food can increase the risk of cardiovascular disease.

ZOE’s previous research has shown that people's blood glucose levels vary greatly. Some people can eat croissants and experience just a slight uptick in their blood glucose levels. Others — even people without diabetes — have a much more pronounced blood sugar peak, and it takes their bodies much longer to clear the glucose from their blood.

After 2 weeks, we analyze data from the app and compare it with thousands of other members. Our members value this insight, as it brings the relationship between food and metabolism to life.

Variation across a day 

Different people have different blood sugar responses to the same foods. Interestingly, each individual’s blood sugar responses also vary throughout the day.

Studies have shown that, on average, people have a better (smaller) blood sugar response to breakfast than lunch. 

However, no one has investigated whether this so-called diurnal variation is the same for men and women or during the menopause transition. So, ZOE took a closer look.

The dataset also included 108 age-matched participants in pre- or postmenopause. This allowed us to compare, for instance, a 48-year-old in pre-menopause with a 48-year-old in postmenopause. 

This is important because we know that our bodies change with age. By matching participants, we can disentangle the effects of menopause from age.

What were the results?

Overall, individuals’ glucose responses to breakfast were 51% lower than responses following lunch. In other words, their blood sugar rose half as much after breakfast than after lunch. Also, responses to breakfast were similar between men and women.

However, blood sugar responses to lunch were larger in women — so the difference between breakfast and lunch responses was greater in women.

This research underscores the importance of personalization in nutrition — there is no one-size-fits-all metabolism. We are all unique.

As ZOE continues to enhance our product, we can begin folding these learnings into our membership. In the future, perhaps we can start predicting glucose responses to meals based on meal scores and time of day, sex, and menopause status.

For instance, we might suggest limiting refined carbs in the afternoon for a woman in postmenopause.

This could make a real difference to how people feel after a meal. For some, a pronounced blood sugar response can leave them feeling tired and more likely to seek energy-dense food. 

ZOE’s menopause research in a nutshell

Based on our research, we developed the MenoScale calculator. It’s free to use and may help medical professionals and researchers discover more about menopause.

Our studies have shown the power of food to support people during perimenopause and menopause: People who eat healthily have less impactful symptoms. Importantly, we’ve also demonstrated that menopause can change how our metabolism handles food.

Every woman experiences menopause differently. Our research unpacks this complexity, helping you make sense of this life stage, whether you’re in peri- or postmenopause.