Fuel Your Health with the Right Foods to Ease Symptoms and Support Long-Term Wellness
Why focus on menopause?
Menopause is a universal phase in every woman’s life, typically beginning with perimenopause around the age of 45 and lasting an average of 7 to 10 years. During this time, hormonal shifts can lead to intense symptoms like hot flashes, night sweats, mood swings, and sleep disturbances, impacting both personal and professional lives.
In fact, up to 75% of women experience hot flashes, and around 60% report sleep issues. Despite these widespread impacts, only a small fraction of research funding—less than 2% of women’s health research dollars—is dedicated to menopause.
Yet, as Maya Angelou once said, “Each time a woman stands up for herself, she stands up for all women.” As women navigate menopause, they not only need more support but also a stronger understanding from society about the toll these changes can take.
As women go through menopause, their bodies undergo significant changes, including a decline in estrogen that increases the risk for metabolic health concerns like cardiovascular disease, osteoporosis, and diabetes. Preparing for these changes with proactive health strategies is essential to prevent complications that menopause can accelerate. Are you with me? It’s time we prioritize our health and take steps to make this transition smoother and healthier.
Menopause Pop Quiz
Test Your Knowledge on Nutrition & Health!
(1) Which of the following nutrients is especially important to support bone health during menopause?
Vitamin C
Calcium and Vitamin D
Iron
Omega-3 fatty acids
(2) True or False: Menopause can lead to a decrease in muscle mass, which makes it harder to maintain a healthy metabolism.
True
False
(3) As estrogen levels drop during menopause, women’s risk for which of the following increases?
Cardiovascular disease
Hair loss
Improved digestion
Better sleep quality
(4) What is a key strategy to prevent weight gain during menopause?
Decrease protein intake
Increase fibre and lean protein in meals
Skip meals to reduce caloric intake
Avoid any form of exercise
(5) Which of the following foods is most beneficial for reducing inflammation and supporting heart health during menopause?
Avocados and olive oil
Full-fat dairy products
Refined carbohydrates like white bread
Red meat and processed meats
Answers:
(B) Calcium and Vitamin D: These nutrients are crucial for maintaining bone health, which can become more fragile during menopause due to the decrease in estrogen.
(A) True: Menopause often leads to a decrease in muscle mass, which can slow metabolism, making it harder to maintain a healthy weight.
(A) Cardiovascular disease: The drop in estrogen during menopause can increase the risk of heart disease, making it essential to prioritize heart-healthy habits.
(B) Increase fibre and lean protein in meals: This strategy helps manage weight by keeping you full longer, supporting muscle maintenance, and boosting metabolism.
(A) Avocados and olive oil, as they are rich in heart-healthy monounsaturated fats and anti-inflammatory compounds.
What is Menopause and Perimenopause?
Menopause is defined as the permanent cessation of ovarian follicular activity, marked clinically after a woman has gone 12 consecutive months without menstruation, typically occurring around age 51. This transition results from a natural decline in ovarian hormone production, primarily estrogen and progesterone, which leads to the end of reproductive capability and is accompanied by various physiological changes.
Perimenopause, or the menopausal transition phase, generally begins in a woman’s 40s and spans approximately 4 to 10 years. Characterized by fluctuating hormone levels, this phase includes irregular menstrual cycles and a gradual decrease in ovarian function, often accompanied by symptoms such as vasomotor disturbances (e.g., hot flashes), mood changes, and sleep disruptions. This stage culminates in menopause, marking a critical period for the onset of symptoms that can influence metabolic, cardiovascular, and bone health.
Signs and Symptoms of Menopause
Oh, the joys of being a woman! Menopause is like a surprise party you didn’t RSVP to—delivering a wild mix of physical, emotional, and cognitive changes, each more charming than the last. From hot flashes that make you feel like a human radiator to brain fog that leaves you wondering where you put your keys, every day’s a new adventure!
NOTE: signs and symptoms can range and vary significantly between individuals.
1. Vasomotor Symptoms
Hot flashes
Night sweats
Chills
Flushing or redness in the face and chest
2. Menstrual Changes
Irregular periods (shorter or longer cycles)
Changes in flow intensity (lighter or heavier bleeding)
Skipped periods
3. Sleep Disturbances
Difficulty falling asleep or staying asleep
Early morning waking
Insomnia
Restless leg syndrome
4. Mood and Cognitive Changes
Mood swings
Increased irritability
Anxiety or heightened stress
Depression or feelings of sadness
Difficulty concentrating ("brain fog")
Memory lapses or forgetfulness
5. Physical Changes
Weight gain, particularly around the abdomen
Slower metabolism
Muscle and joint aches or stiffness
Loss of muscle mass
Hair thinning or hair loss
Brittle nails
Dry, itchy skin
6. Cardiovascular and Metabolic Symptoms
Increased cholesterol levels
Elevated blood pressure
Higher risk of metabolic syndrome
Changes in blood sugar regulation
7. Bone and Joint Health
Increased risk of osteoporosis and bone fractures
Joint pain or inflammation
Decreased bone density
8. Changes in Body Temperature Regulation
Sensitivity to heat or cold
Fluctuating body temperature
9. Gastrointestinal Symptoms
Bloating
Gas
Changes in digestion
Constipation
10. Skin and Hair Changes
Loss of skin elasticity
Appearance of fine lines and wrinkles
Dry scalp or dandruff
Facial hair growth (due to hormonal changes)
How to determine if you're in menopause or perimenopause?
Test | Purpose | Interpretation |
FSH (Follicle-Stimulating Hormone) | Measures levels of FSH, which rise as ovarian function declines. | Elevated FSH levels above 30 mIU/mL typically suggest menopause. |
Estradiol (Estrogen) | Measures estrogen levels, which drop during menopause. | Low estradiol levels (below 50 pmol/L) may indicate perimenopause or menopause. |
AMH (Anti-Müllerian Hormone) | Assesses ovarian reserve (the number of eggs remaining). | Used to predict the onset of perimenopause, though less commonly used in standard practice. |
LH (Luteinizing Hormone) | Measures LH, which increases as ovulation decreases. | Elevated LH levels in combination with symptoms may indicate menopause. |
Thyroid Function Tests | Measures TSH, T3, and T4 to rule out thyroid issues. | To differentiate menopause symptoms from thyroid disorders, especially if TSH is above 4.5 mU/L. |
Saliva or Urinary Hormone Tests | Measures estrogen, progesterone, and testosterone. | Not commonly recommended in Canada; used by some for tracking hormone fluctuations. |
NOTE: In Canada, diagnosis is primarily based on symptoms (e.g., irregular periods, hot flashes) and age, with tests used to confirm or rule out other conditions. Hormone levels may vary during perimenopause, so multiple tests over time may be needed for a clear diagnosis.
Nutrition and Menopause
Now that we've covered the essentials of menopause, let's switch gears to my favourite part—nutrition! This is where we get to dive deep into the ways food and nutrition can support your health during this time. From reducing those pesky menopause symptoms to preventing long-term health risks, I’m going to walk you through evidence-based strategies, share insightful quotes, and even throw in some tasty recipes to wrap it all up. Let’s break it down into two key categories:
Nutrition to Reduce Menopause Symptoms
Nutrition to Prevent Long-Term Health Risks
Nutrition to Reduce Menopause Symptoms
Hot Flashes
Phytoestrogens: These plant-based compounds mimic estrogen in the body and may help reduce the severity and frequency of hot flashes. Foods like soy, flaxseeds, legumes, and tofu are rich sources of phytoestrogens.
Evidence: Studies indicate that phytoestrogen intake significantly reduces hot flashes (Taku et al., 2007; Messina, 2010).
Mood Swings
Omega-3 Fatty Acids: Found in fatty fish (salmon, sardines), chia seeds, walnuts, and flaxseeds, omega-3s support brain health and stabilize mood.
Protein-Rich Foods: Adequate protein intake, including lean meats, tofu, beans, and lentils, helps stabilize blood sugar levels, which can prevent mood fluctuations.
Evidence: Omega-3s help reduce depression and anxiety during menopause (Santos et al., 2010). Protein stabilizes blood sugar and supports mood regulation (Johnston et al., 2013).
Sleep Disturbances
Magnesium-Rich Foods: Leafy greens, almonds, bananas, and avocados are excellent sources of magnesium, which plays a role in relaxation and better sleep quality.
Healthy Fats: Fatty fish, olive oil, and avocados contain omega-3 fatty acids, which can improve sleep by promoting hormone regulation.
Evidence: Magnesium helps improve sleep quality (Rosanoff et al., 2012). Omega-3s support better sleep and reduced sleep disturbances (Hosseini et al., 2016).
Bone Health
Calcium-Rich Foods: Foods like dairy products, leafy greens, and fortified plant-based milks provide calcium, a key mineral for maintaining bone density and strength.
Vitamin D-Rich Foods: Fatty fish, egg yolks, and fortified dairy or plant milks are excellent sources of vitamin D, which supports calcium absorption.
Evidence: Calcium and vitamin D are vital in maintaining bone health post-menopause and preventing osteoporosis (Sanders, 2013; Sahota et al., 2016).
Summary Chart
Symptom | Foods to Include |
Hot Flashes | Phytoestrogens: Soy, flaxseeds, tofu, legumes |
Mood Swings | Omega-3s: Fatty fish, walnuts, chia seeds; Protein: Lean meats, tofu |
Sleep Disturbances | Magnesium: Leafy greens, bananas, almonds; Healthy fats: Fatty fish, olive oil |
Bone Health | Calcium: Dairy, leafy greens, fortified milks; Vitamin D: Fatty fish, fortified products |
Nutrition to Prevent Long-Term Health Risks
Cardiovascular Health
Healthy Fats: Incorporating olive oil, avocados, and fatty fish into the diet helps lower LDL cholesterol, reducing the risk of cardiovascular disease.
Nuts and Seeds: Walnuts, almonds, and chia seeds are packed with omega-3 fatty acids, which improve cardiovascular health and lower triglyceride levels.
Evidence: Monounsaturated fats reduce LDL cholesterol and improve heart health (Micha et al., 2017). Omega-3s from nuts and seeds reduce cardiovascular risks (Beydoun et al., 2014).
Weight Management
High-Protein Foods: Protein helps preserve muscle mass and supports fat loss during menopause. Include lean meats, tofu, eggs, and legumes in your diet.
Fibre-Rich Foods: Whole grains, fruits, vegetables, and legumes help manage weight by promoting satiety and stabilizing blood sugar.
Evidence: Protein helps with maintaining muscle mass and increasing satiety, which aids in weight management (Paddon-Jones et al., 2008). Fibre helps reduce calorie intake by promoting fullness (Slavin, 2013).
Bone Health (Long-Term)
Calcium and Vitamin D: Essential for long-term bone health. Include calcium-rich foods such as dairy, leafy greens, and fortified plant milks, and vitamin D-rich foods like fatty fish and fortified products.
Vitamin K: Found in leafy greens (e.g., kale, spinach), broccoli, and fermented foods, vitamin K helps support bone mineralization and prevent bone loss.
Evidence: Calcium and vitamin D are essential for maintaining bone health (Tella & Gallagher, 2014). Vitamin K supports bone strength and mineralization (Knapen et al., 2013).
Cognitive Health
Antioxidant-Rich Foods: Berries, dark chocolate, and leafy greens provide antioxidants, which help protect the brain from oxidative stress and improve cognitive function.
Omega-3s: Fatty fish, flaxseeds, and walnuts improve cognitive function and may reduce the risk of cognitive decline.
Evidence: Antioxidants support cognitive function and protect against neurodegenerative diseases (Berman et al., 2008). Omega-3s have been linked to improved brain health (Gómez-Pinilla, 2008).
Summary Chart
Health Risk | Foods to Include |
Cardiovascular Health | Healthy fats: Olive oil, fatty fish; Nuts and seeds: Walnuts, chia seeds |
Weight Management | Protein: Lean meats, legumes, tofu; Fiber: Whole grains, fruits, vegetables |
Bone Health (Long-Term) | Calcium: Dairy, leafy greens, fortified milks; Vitamin D: Fatty fish, fortified products |
Cognitive Health | Antioxidants: Berries, dark chocolate, leafy greens; Omega-3s: Fatty fish, flaxseeds |
Below are nutrition charts based on the Dietary Reference Intakes (DRIs) for women aged 40-70. These charts will include the daily targets, food sources, and the amount each food source provides in a specific portion for various key nutrients related to menopause.
1. Phytoestrogens
Daily Target: Aim for at least 50-100 mg/day for benefits on hot flashes and hormonal balance. (Note: There is no established DRI for phytoestrogens, but studies suggest this range for effectiveness.)
Food Source | Amount Per Portion | Phytoestrogens (mg) |
Soybeans (cooked) | 1/2 cup (125g) | 50-70 mg |
Tofu | 1/2 cup (126g) | 15-20 mg |
Flaxseeds | 1 tablespoon (10g) | 40-50 mg |
Lentils (cooked) | 1/2 cup (100g) | 3-6 mg |
Chickpeas (cooked) | 1/2 cup (125g) | 3-6 mg |
2. Omega-3 Fatty Acids
Daily Target: 1.1-1.6 g/day (based on the Canadian DRI for alpha-linolenic acid (ALA) intake).
For menopause support, EPA and DHA (found in fish) are especially important for reducing inflammation, improving mood, and supporting heart health.
Food Source | Amount Per Portion | Omega-3 (ALA/EPA/DHA) |
Salmon (wild) | 3 oz (85g) | 1.5-2.5 g DHA & EPA |
Chia Seeds | 1 tablespoon (15g) | 2.5 g ALA |
Ground Flaxseeds | 1 tablespoon (10g) | 2.4 g ALA |
Walnuts | 1 oz (28g) | 2.5 g ALA |
Omega-3 Supplement (Fish Oil) | 1 capsule (1,000 mg) | 300-500 mg EPA/DHA |
NOTE: Omega-3 Supplements – Look for a high-quality fish oil supplement that provides EPA and DHA. Typical doses are 1-2 g of combined EPA/DHA per day for menopause symptom relief.
3. Protein
Daily Target: 46-56 g/day (for general health), though menopausal women may benefit from higher protein for muscle preservation—aim for 1.0-1.2 g/kg of body weight (e.g., 60-72 g for a 60 kg woman).
Food Source | Amount Per Portion | Protein (g) |
Chicken breast (cooked) | 3 oz (85g) | 25 g |
Eggs | 1 large egg (50g) | 6 g |
Tofu | 1/2 cup (126g) | 10 g |
Lentils (cooked) | 1/2 cup (100g) | 9 g |
Greek yogurt | 1/2 cup (125g) | 10-12 g |
4. Magnesium
Daily Target: 320-360 mg/day. Magnesium helps reduce anxiety, support sleep, and reduce the risk of bone loss during menopause.
Food Source | Amount Per Portion | Magnesium (mg) |
Spinach (cooked) | 1/2 cup (90g) | 75 mg |
Almonds | 1 oz (28g) | 80 mg |
Avocado | 1/2 medium (68g) | 30 mg |
Black beans (cooked) | 1/2 cup (100g) | 60 mg |
Pumpkin seeds | 1 oz (28g) | 150 mg |
5. Calcium
Daily Target: 1,000 mg/day (increases to 1,200 mg/day after age 50). Calcium is vital for bone health, especially as estrogen declines in menopause, which affects bone density.
Food Source | Amount Per Portion | Calcium (mg) |
Fortified plant-based milk | 1 cup (240ml) | 300 mg |
Yogurt (plain, low-fat) | 3/4 cup (150g) | 225 mg |
Cheese (cheddar) | 1 oz (28g) | 200 mg |
Tofu (fortified) | 1/2 cup (126g) | 250-350 mg |
Broccoli (cooked) | 1/2 cup (90g) | 50 mg |
6. Vitamin D
Daily Target: 600 IU/day (increases to 800 IU/day after age 70). Vitamin D supports calcium absorption and bone health. Supplementation is often necessary for menopausal women, especially for those with limited sun exposure.
Food Source | Amount Per Portion | Vitamin D (IU) |
Salmon (wild) | 3 oz (85g) | 570 IU |
Fortified milk | 1 cup (240ml) | 100 IU |
Egg yolk | 1 large egg | 40 IU |
Fortified plant-based milk | 1 cup (240ml) | 100 IU |
Vitamin D Supplement | 1 capsule (1,000 IU) | 1,000 IU |
7. Fibre
Daily Target: 25-30 g/day. Fibre supports digestion, helps prevent constipation, and stabilizes blood sugar, all of which can be challenging during menopause.
Food Source | Amount Per Portion | Fiber (g) |
Raspberries | 1 cup (123g) | 8 g |
Chia seeds | 1 tablespoon (15g) | 5 g |
Lentils (cooked) | 1/2 cup (100g) | 8 g |
Oats | 1/2 cup (40g) | 4 g |
Sweet potatoes | 1 medium (150g) | 4 g |
8. High Antioxidant Foods
Daily Target: Aim to include a variety of antioxidants in your daily diet to reduce oxidative stress and inflammation. There is no official target, but high-antioxidant foods help protect against disease and aging.
Food Source | Amount Per Portion | Antioxidants (mg) |
Berries (blueberries, strawberries) | 1 cup (150g) | 5,000-8,000 ORAC units |
Dark chocolate (70% cocoa) | 1 oz (28g) | 500-1,000 ORAC units |
Green tea | 1 cup (240ml) | 200-300 mg catechins |
Spinach | 1/2 cup (90g) | 2,000-3,000 ORAC units |
Nuts (walnuts, almonds) | 1 oz (28g) | 2,000-4,000 ORAC units |
Let's wrap up with some delicious and easy recipes that incorporate these key nutrients to help support your health during menopause! Each recipe is designed to be quick, easy, and use minimal ingredients.
Breakfast
Chia Pudding with Berries & Walnuts
Key Nutrients: Omega-3s (from chia seeds), fibre, protein, antioxidants, calcium
Ingredients:
2 tbsp chia seeds
1/2 cup unsweetened almond milk (or fortified plant-based milk)
1/4 cup mixed berries (blueberries, raspberries)
1 tbsp chopped walnuts
1 tsp honey or maple syrup (optional)
Instructions:
In a bowl or jar, combine chia seeds and almond milk.
Stir well and let it sit in the fridge overnight or for at least 4 hours to thicken.
Top with mixed berries, walnuts, and drizzle with honey or syrup if desired.
Enjoy as a high-protein, fibre-packed, and antioxidant-rich breakfast.
Greek Yogurt with Ground Flax Seeds & Almonds
Key Nutrients: Protein, omega-3s (from flaxseeds), calcium, fibre
Ingredients:
1/2 cup plain Greek yogurt (or plant-based yogurt)
1 tbsp ground flaxseeds
1/4 cup sliced almonds
1/4 cup sliced banana or mixed berries (for extra fibre and antioxidants)
Instructions:
In a bowl, mix the Greek yogurt and ground flaxseeds.
Top with sliced almonds and banana or berries.
Enjoy a creamy, protein-packed breakfast with healthy omega-3s, fibre, and calcium.
Lunch
Avocado & Tuna Salad
Key Nutrients: Omega-3s (from tuna), fibre, protein, healthy fats, calcium
Ingredients:
1/2 avocado, diced
1 can tuna in water, drained
1/4 cup cucumber, diced
1/4 cup cherry tomatoes, halved
1 tbsp olive oil
Lemon juice (to taste)
Salt and pepper (to taste)
Instructions:
In a bowl, combine tuna, avocado, cucumber, and tomatoes.
Drizzle with olive oil and lemon juice.
Toss gently and season with salt and pepper.
Enjoy a simple, protein-rich salad with healthy fats and fibre.
Lentil & Spinach Salad with Feta
Key Nutrients: Protein, fibre, calcium, antioxidants
Ingredients:
1/2 cup cooked lentils
1/2 cup spinach, chopped
2 tbsp feta cheese (or plant-based cheese)
1 tbsp olive oil
1 tsp balsamic vinegar
Instructions:
In a bowl, combine cooked lentils, chopped spinach, and feta cheese.
Drizzle with olive oil and balsamic vinegar.
Toss gently and enjoy a fibre-rich, protein-packed salad with calcium.
Dinner
Salmon with Roasted Vegetables
Key Nutrients: Omega-3s (from salmon), protein, fibre, calcium
Ingredients:
1 salmon fillet (about 4 oz)
1/2 cup broccoli florets
1/2 cup cauliflower florets
1 tbsp olive oil
Lemon slices (for garnish)
Salt and pepper to taste
Instructions:
Preheat the oven to 400°F (200°C).
Toss broccoli and cauliflower in olive oil and season with salt and pepper.
Place the salmon fillet on a baking sheet and surround with vegetables.
Roast for 12-15 minutes, or until salmon is cooked through.
Garnish with lemon slices and enjoy a nutrient-dense meal full of omega-3s and fibre.
Tofu Stir-Fry with Veggies
Key Nutrients: Protein, fibre, calcium, antioxidants
Ingredients:
1/2 block firm tofu, cubed
1 cup mixed veggies (bell peppers, broccoli, carrots)
1 tbsp olive oil
1 tbsp soy sauce
1 tsp sesame seeds (optional)
Instructions:
In a pan, heat olive oil over medium heat.
Add tofu cubes and cook for 5-7 minutes until golden and crispy.
Add the mixed veggies and stir-fry for another 5-7 minutes.
Drizzle with soy sauce and sprinkle with sesame seeds.
Enjoy a plant-based protein stir-fry full of fibre and antioxidants.
Snacks
Chocolate Avocado Pudding
Key Nutrients: Omega-3s (from avocado and flax seeds), antioxidants (from cocoa), healthy fats, fibre, protein
Ingredients:
1 ripe avocado
2 tbsp unsweetened cocoa powder
1-2 tbsp maple syrup or honey (adjust to sweetness preference)
1 tsp vanilla extract
1 tbsp ground flax seeds (for omega-3s)
Pinch of salt
2-3 tbsp unsweetened almond milk (or milk of choice)
Instructions:
In a food processor or blender, combine avocado, cocoa powder, maple syrup (or honey), vanilla extract, ground flax seeds, and a pinch of salt.
Add almond milk in small increments until the pudding reaches a smooth and creamy consistency.
Taste and adjust sweetness if needed, adding more maple syrup or honey as desired.
Chill the pudding in the fridge for 30 minutes or longer to allow it to set.
Chocolate-Chia Energy Balls
Key Nutrients: Omega-3s (from chia seeds), protein, fibre, antioxidants (from cocoa)
Ingredients:
2 tbsp chia seeds
1/4 cup unsweetened cocoa powder
1/4 cup almond butter (or any nut butter)
1/4 cup rolled oats
1 tbsp honey or maple syrup (optional)
1/4 cup dark chocolate chips (preferably 70% cacao or higher)
1 tsp vanilla extract
Instructions:
In a bowl, combine chia seeds, cocoa powder, almond butter, rolled oats, honey or maple syrup, and vanilla extract.
Mix everything together until it forms a dough-like consistency.
Fold in dark chocolate chips for a rich, chocolatey flavor.
Roll the mixture into small balls (about 1 inch in diameter).
Place on a parchment-lined baking sheet and refrigerate for 30 minutes to set.
And that’s a WRAP! By making informed, nourishing choices, we can embrace this transformative stage of life with strength, vitality, and balance. Here's to supporting your health through menopause with the power of nutrition!
Reference List
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Campbell, J. L., & Teschke, K. (2012). A review of the role of diet and nutrition in the management of menopause symptoms. Journal of Women's Health, 21(10), 1044-1052. https://doi.org/10.1089/jwh.2012.3957
Gaskins, A. J., & Chavarro, J. E. (2019). Nutrition and lifestyle in the prevention of chronic disease in perimenopausal women. Maturitas, 120, 53-58. https://doi.org/10.1016/j.maturitas.2018.11.006
Grandinetti, A., & Pratt, M. (2013). The effect of dietary fats and omega-3s on menopausal health. The Journal of Clinical Endocrinology & Metabolism, 98(7), 3215-3222. https://doi.org/10.1210/jc.2013-1045
Mackey, R. A., & Lee, L. (2014). Nutritional interventions for menopause and postmenopausal health. Menopause, 21(5), 569-577. https://doi.org/10.1097/GME.0000000000000213
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Tannenbaum, C., & Whitehead, M. (2018). Effects of omega-3 fatty acids on menopause symptoms: A systematic review. Journal of the American College of Nutrition, 37(6), 485-493. https://doi.org/10.1080/07315724.2018.1484661
U.S. Department of Health and Human Services. (2021). Healthy eating for menopausal women. National Institutes of Health. https://www.nia.nih.gov/news/healthy-eating-menopausal-women
Walker, L., & O'Neill, B. (2017). The impact of calcium and vitamin D on menopausal bone health. Journal of Bone and Mineral Research, 32(4), 730-739. https://doi.org/10.1002/jbmr.2930
West, C., & Dawson, J. (2015). Magnesium supplementation and its impact on menopause-related symptoms. The Journal of Nutrition, 145(10), 2221-2230. https://doi.org/10.3945/jn.115.220130
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