From Suzanne's practice: Barbera and her fatigue during menopause

Many women I speak with are already mindful of their diet. They have read and heard a lot and often adjust their eating habits accordingly. I always appreciate this because it shows that someone is open to change. Yet, despite making healthy choices, there is often still room for personal improvement.

This was also the case with Barbera. A spontaneous 47-year-old woman, mother of three teenagers, and with a hectic job in government. She came to me because she felt she was running out of reserves. The days went on, but she no longer felt like her old self. Her energy was dwindling, her nights were becoming more restless, and during the day, she experienced more frequent hot flushes.

Barbera claimed she had been eating healthily for years. Yoghurt with fruit in the morning, mostly wholegrain products, and plenty of vegetables at dinner. At first glance, her diet seemed quite healthy. However, it turned out that her breakfast and lunch were relatively light, while she craved sweets in the evening. She consumed little protein and often snacked. While her snacks were often healthy choices like fruit, nuts, a wholegrain cracker, or rice cake, she also frequently found herself unable to resist the biscuit tin.

For Barbera, the first clue lay in the distribution of her meals throughout the day. She ate consciously and healthily, but her meals likely didn’t provide her body with enough support. If you eat too lightly during the day and snack frequently, your energy levels may become less stable. For Barbera, this was particularly evident in her strong cravings for sweets later in the day.

Her sleep also stood out. “This isn’t like me,” she said. She used to be called a “sleepyhead.” Now, she was happy if she managed six hours of sleep—and even then, it was almost always interrupted.

Barbera didn’t experience night sweats. However, she did have hot flushes during the day. And when she woke up at night, her mind would immediately start racing. Her job was very demanding. She could find herself lying awake in the middle of the night, worrying about work.

It quickly became apparent that she no longer felt comfortable in her workplace. Policies had changed, and she increasingly struggled to align with them. Everything felt too fast, too technical. The human aspect was disappearing. At this stage in her life, she craved recognition and empathy.

This created a pattern she recognised well. After a broken night, she would start the day with less energy. Cooking became harder, she was more likely to grab snacks, and real rest was postponed once again.

We started by mapping out her diet in detail. Since her protein intake seemed low, Barbera kept track of what she ate for a while. For her, approximately 1.2 grams of protein per kilogram of body weight per day was a suitable target. This amounted to about 90 grams per day.

This required some adjustment. Many people think that 100 grams of chicken breast contains 100 grams of protein. In reality, it’s about 20 grams. Barbera began incorporating a more protein-rich breakfast. She distributed her protein intake more evenly throughout the day, added healthy fats, and reduced her snacking. This resulted in fewer eating moments and more calm around meals.

We also looked at increasing the variety of vegetables in her diet. While Barbera often served fresh vegetables, the variety was limited. She started including more options like beetroot, pumpkin, carrots, and cruciferous vegetables such as cauliflower, broccoli, pak choi, and other cabbages.

As additional support, we discussed whether magnesium bisglycinate might be suitable for Barbera. This supplement can help some women with relaxation and sleep, but its usefulness and safety depend on factors such as your symptoms, diet, health, and medication. Personalised advice is therefore essential.

At SeeMe-nopause, women can receive online medical guidance for menopause symptoms. A doctor not only examines the individual symptom but also considers the woman’s overall health, medication use, preferences, and personal situation. This focus on the woman behind the symptoms is something I also recognise in SeeMe-nopause. That’s why I enjoy collaborating with them: a doctor assesses which treatment or next step might suit her situation and health.

After a few weeks, Barbera emailed to say she noticed a clear difference. Her energy levels were more stable, her cravings for sweets had decreased, and she was sleeping better. Even her hot flushes occurred less frequently and were less intense. She felt more balanced. It wasn’t always easy. She sometimes found it challenging to plan ahead for her meals and prepare more herself. But, as she wrote, “no pain, no gain.”

About ten weeks later, Barbera shared that she had also started seriously thinking about her job. She didn’t want to remain stuck in a situation that caused her stress. Ultimately, she was able to arrange a six-month sabbatical with her employer. Her husband supported her decision. This choice brought her peace of mind. She planned to use the time to reassess her life, cook more, and attend a small, personal yoga studio more often.

What I want other women to take away is that healthy eating sometimes still needs adjustment. Barbera was already doing many things right. The key wasn’t stricter eating but better distribution, more satiety, and choices that suited her life at that moment.

A practical first step is to track what you eat for a few days and how you feel afterwards. Do you get hungry quickly, crave sweets more, or sleep less soundly? This could indicate something about the distribution of your meals. Sometimes, the key isn’t in overhauling everything but in better distribution and choices that provide longer-lasting satiety.

You may not recognise Barbera’s story exactly, but perhaps you’ve noticed that your body is responding differently than it used to. What worked well for years may suddenly be less effective during menopause.

If you want to explore further, you can start with the symptom you identify with most on SeeMe-nopause, such as fatigue, hot flushes, or poor sleep. You can also read more about nutrition and lifestyle during menopause, with practical tips to take the first step yourself. If you’re unsure where to start or are still searching for what works for you, an intake session can help clarify your symptoms and possible next steps.

This article is based on the practical experiences of a specialist. To protect the patient’s privacy, names and identifiable details have been changed. The information in this article is intended for educational purposes and does not replace personalised medical advice.