The Mediterranean diet and menopause: what the evidence shows

The Mediterranean diet has some of the strongest evidence of any eating pattern for protecting the heart, and midlife is when that protection starts to matter most for women. Studies also link it to lower risk of type 2 diabetes and hip fracture. Its effect on menopause symptoms such as hot flashes is less certain: the data are observational and the benefit, if real, appears modest.

What the Mediterranean diet is

It is a way of eating based on the traditional diets of countries around the Mediterranean Sea, not a branded plan. Researchers usually score it from 0 to 9 by how much of each of these a person eats:

• More: vegetables, fruit, legumes (beans, lentils, chickpeas), whole grains, nuts and seeds, fish, and olive oil as the main fat
• Moderate: dairy, mostly yogurt and cheese, and poultry and eggs
• Less: red and processed meat, sweets, and refined and highly processed foods

Traditional descriptions include wine with meals. That part is optional, and for women in midlife there are good reasons to skip it.

What the evidence shows

Heart disease

The best evidence comes from PREDIMED, a large trial in Spain. Researchers assigned 7,447 adults aged 55 to 80 at high cardiovascular risk, 57% of them women, to a Mediterranean diet with extra-virgin olive oil, a Mediterranean diet with mixed nuts, or a control diet with advice to reduce fat. Over a median of 4.8 years, a heart attack, stroke or cardiovascular death occurred in 3.8% of the olive oil group, 3.4% of the nut group and 4.4% of the control group. After adjustment, risk was about 31% lower with olive oil and 28% lower with nuts.

One caveat: the original 2013 report was withdrawn after problems with randomization were found at some sites. The authors reanalyzed the data and published corrected results in 2018, which reached the same conclusion.

US data point the same way. In the Women’s Health Study, which followed 25,994 initially healthy women with an average age of about 55 for up to 12 years, those with the highest Mediterranean diet scores had about 28% fewer cardiovascular events than those with the lowest. Lower inflammation, better insulin sensitivity, lower body mass index and lower blood pressure each explained part of the difference. Since heart disease risk rises after menopause, this is the most important reason to consider the pattern. See menopause and heart disease.

Type 2 diabetes

In a later Women’s Health Study analysis of 25,317 women followed for about 20 years, those with the highest scores had a 30% lower risk of developing type 2 diabetes. Much of that link ran through weight: after accounting for body mass index, the reduction was about 15%. The association appeared only in women who started out with a BMI of 25 or higher, suggesting the pattern may matter most for women already at higher metabolic risk.

Bones

The Women’s Health Initiative followed 90,014 postmenopausal women for a median of 15.9 years. Women in the top fifth of Mediterranean diet scores had a 20% lower risk of hip fracture. The absolute difference was small, 0.29 percentage points, and there was no association with total fractures. It is a reasonable bonus, not a substitute for the basics in our guide to osteoporosis prevention.

Hot flashes and night sweats

The Australian Longitudinal Study on Women’s Health followed 6,040 women with natural menopause for nine years. Compared with women who ate the least of a Mediterranean-style pattern, those who ate the most were 20% less likely to report hot flashes or night sweats. A fruit-heavy pattern showed a similar link, while a diet high in fat and sugar was linked to 23% higher odds.

These are associations, and women who eat this way may differ in other ways. The Menopause Society’s 2023 position statement concluded that a healthy diet is important for long-term health but that trial evidence is too limited to recommend dietary change as a treatment for hot flashes. If hot flashes are affecting your life, effective treatments are covered in our hot flashes guide.

How to eat this way in the US

You do not need imported specialty foods. A practical version:

Eat most days	Eat a few times a week	Eat less often
Vegetables, including leafy greens	Fish and seafood, including canned salmon and sardines	Red meat
Fruit, fresh or frozen	Poultry and eggs	Processed meats such as bacon and deli meats
Beans, lentils, chickpeas	Cheese	Pastries, sweets, sugary drinks
Whole grains such as oats, brown rice, whole-wheat bread		Highly processed snacks
Olive oil as your main cooking fat
A small handful of nuts or seeds
Plain yogurt

A few habits make it easier:

• Cook with extra-virgin olive oil instead of butter for most dishes.
• Build meals around vegetables and legumes, and treat meat as a side.
• Keep canned beans, canned fish and frozen vegetables on hand for quick meals.
• Snack on nuts, fruit or yogurt instead of packaged snacks.
• Season with herbs, garlic, lemon and spices instead of extra salt.

For midlife, make sure each meal still has enough protein. Fish, eggs, yogurt, beans and lentils fit the pattern naturally.

Who should be careful

• Alcohol. You do not need wine to benefit, and even moderate drinking raises breast cancer risk. Read more in alcohol in perimenopause.
• Blood thinners. If you take warfarin, keep your intake of leafy greens steady rather than suddenly increasing it, because vitamin K affects how the drug works. Tell your clinician before a big diet change.
• Food allergies or celiac disease. Swap nuts for seeds, and choose gluten-free whole grains such as brown rice, quinoa or certified gluten-free oats.
• Kidney disease. Some kidney diets limit potassium or phosphorus, which are high in beans, nuts and some fruits and vegetables. Ask your care team.

When to see a clinician

A diet change is a good time to get a baseline check of blood pressure, cholesterol and blood sugar if you have not had one recently. See a clinician sooner if you have chest pain, shortness of breath with exertion, or symptoms of high blood sugar such as unusual thirst. A registered dietitian can help adapt the pattern to your culture, budget and health conditions. You can find a menopause-informed clinician.