Micronutrients & Prevention: Prof. Dr. Ekkehard Schleußner on Women’s Health During Menopause

Taking a Holistic Approach to Health

1. Prof. Schleußner, you have been working in the field of preventive gynecology for many years. How can a preventive approach during menopause help maintain overall well-being and provide holistic support for women during this phase of life?

Prof. Dr. Schleußner: A preventive and holistic approach to menopause aims to prepare the body and mind before severe symptoms arise. Studies show that women who maintain a healthy lifestyle not only experience fewer symptoms but may even experience menopause up to two years later.

An integrated approach based on 5 pillars of holistic prevention combines various areas of life to optimize health in the long term:

1. Physical activity: Regular exercise is essential for protecting bone density (osteoporosis prevention) and maintaining muscle mass.
2. Targeted nutrition: A diet rich in phytoestrogens (e.g., in soy, flaxseed, legumes) and micronutrients can help naturally support hormonal balance. Additionally, a heart-healthy diet (low in processed foods, high in healthy fats) protects against the rising risk of high blood pressure and cardiovascular diseases.
3. Mental Well-being & Relaxation: Techniques such as yoga, meditation, or autogenic training prevent inner restlessness and improve sleep quality.
4. Herbal Support: The use of herbal medicine can have a regulating effect early on, before drug therapy becomes necessary.
5. Medical Checkups: Regular monitoring of blood pressure, blood lipids, and bone density helps detect and counteract hormone-related changes early on.

Side Fact:

Fiber & Metabolism: A high-fiber diet (at least 30 g/day according to the DGE) not only correlates with a lower risk of cardiovascular disease but also supports the intestinal barrier. This is essential for counteracting inflammatory processes that can increase during menopause.  
⁠Source: Reynolds, A. et al. (2019). Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet, 393(10170), 434–445. Source: Reynolds et al. (2019), The Lancet. Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31809-9/fulltext 

Micronutrients During Hormonal Changes

2. What role can a balanced supply of micronutrients—within the scope of their approved effects—play during the phase of hormonal changes, for example with regard to energy, sleep, and concentration?

Prof. Dr. Schleußner: During menopause, nutritional needs change significantly due to hormonal shifts. Micronutrients play an important role in providing physiological support to the body during this transition phase and in helping to maintain important functions, such as bone strength.

Fatigue and listlessness are often consequences of hormonal changes, which can be alleviated with B vitamins (especially B2, B3, B5, B6, B12) and magnesium, which acts as a cofactor in numerous enzymatic reactions involved in energy production. Iron, on the other hand, is essential for blood formation and thus supports normal oxygen transport in the body.

Difficulty falling and staying asleep, caused by declining estrogen and progesterone levels, can be positively influenced by vitamin B6, which is involved in the formation of neurotransmitters such as serotonin and the sleep hormone melatonin. Magnesium relaxes the muscles and plays a role in regulating the sleep-wake cycle.

For difficulty concentrating and mood swings, antioxidants such as vitamin C, vitamin B6, zinc, and folic acid can be helpful.

Well-being and micronutrient balance

3. From your experience: What small but sustainable habits make the biggest difference for women in this phase of life—for example, regarding diet, exercise, sleep, or mental balance?

Prof. Dr. Schleußner: Small, consistent changes often make the biggest difference during a phase of hormonal transition, with weight gain, sleep deprivation, and mood swings. The focus is on supporting metabolism, maintaining muscle mass, and calming the nervous system.

Regarding nutrition, for example, the following tips:

• Protein with every meal: Consuming protein from fish, legumes, soy, and eggs keeps you full, stabilizes blood sugar, and supports muscle maintenance.
• Vegetables/salad on half the plate: This provides fiber and important micronutrients without excessive calories.
• Micronutrients: Pay attention to calcium (bone health) and vitamin D. Magnesium is valuable for combating fatigue and supporting nerve health.
• Drink enough water: Optimize your fluid balance, as the sensation of thirst can diminish with age.

“Small, consistent changes often make the biggest difference during a phase of hormonal transition, which is accompanied by weight gain, sleep deprivation, and mood swings. The focus is on supporting metabolism, maintaining muscle mass, and calming the nervous system. “

Immune System and Hormonal Balance

4. Research is increasingly examining how changes in the immune system or microbiome are linked to hormonal changes. What findings are there on this—and what role can micronutrients or phytochemicals play, within the scope of their approved effects, in the normal functioning of these systems?

Prof. Dr. Schleußner: The decline in estrogen and progesterone during menopause has far-reaching effects on the microbiome (especially in the gut) and the immune system. Since estrogen promotes the growth of anti-inflammatory bacteria and modulates the immune system, a decline can lead to reduced bacterial diversity (dysbiosis), inflammation, and increased susceptibility to infection.

A nutrient-rich diet that supports the microbiome (high in fiber) and provides essential micronutrients can stabilize the immune system during hormonal changes. Once again, it is primarily vitamins D, B6, B12, and folic acid, as well as zinc and selenium, that support the immune system.

Side Fact:

The Estrobolome: Research shows that a specific group of bacteria in the gut (the estrobolome) helps regulate estrogen levels in the body. A gut-healthy, fiber-rich diet thus directly influences hormonal balance and the regulation of the immune response during menopause.

Source: Baker, J. M. et al. (2017). Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53.
⁠Link: https://www.maturitas.org/article/S0378-5122(17)30650-3/fulltext 

Quality and Evidence in Supplements

5. During menopause, many women rely on dietary supplements as part of a holistic approach to health. In your opinion, what should one pay particular attention to—such as quality, composition, and scientific evidence—so that supplements can be used appropriately within the scope of their approved effects?

Prof. Dr. Schleußner: Even natural dietary supplements can have side effects. To ensure that the use of supplements is sensible and safe, the following aspects should be considered:

• Scientific evidence and efficacy: Many products promise benefits for which there is little scientific evidence. Preparations that have been tested in clinical trials (randomized, double-blind, placebo-controlled) should be used. For specific symptoms, targeted use should be employed.
• Composition and quality: Supplements should be sourced from manufacturers who have their purity, ingredients, and dosage tested by independent laboratories. The daily dose should adequately meet your needs without exceeding the safe upper limit (more is not necessarily better!). Some herbal remedies (such as black cohosh) should not be taken indefinitely.

The use of supplements should always be discussed with a doctor, as herbal remedies (e.g., St. John’s wort) can also cause interactions with other medications.

“To ensure the use of supplements is sensible and safe, the following aspects should be considered: Scientific evidence and efficacy [...]. The daily dose should adequately meet requirements without exceeding the safe upper limit.”

Micronutrients in everyday life – what matters?

6. Many women want to take a more conscious approach to their health during menopause. What recommendations do research and clinical practice offer regarding a balanced diet and the selection of high-quality micronutrient supplements?

Prof. Dr. Schleußner: Research and clinical practice agree that a balanced diet forms the basis for adequate nutrient intake. The German Nutrition Society (DGE) and international bodies recommend a varied, predominantly plant-based diet to meet micronutrient needs.

At least 3 servings of vegetables and 2 servings of fruit (preferably seasonal and colorful) should be consumed daily, with fiber-rich foods such as whole-grain bread, rice, pasta, and potatoes forming the basis of the diet. Plant-based oils (olive oil, canola oil) provide unsaturated fatty acids and vitamin E.

Protein needs can best be met with legumes (lentils, beans), nuts, dairy products, eggs, and fish. To meet iodine requirements, iodized table salt containing fluoride should be used.

“Research and practice agree that a balanced diet forms the basis for good nutrient intake. The German Nutrition Society (DGE) and international bodies recommend a varied, predominantly plant-based diet to meet micronutrient needs.”

Research Perspectives on Women’s Health

7. Which scientific developments or findings in preventive medicine do you currently find particularly exciting when it comes to healthy aging in women?

Prof. Dr. Schleußner: Particularly exciting in preventive medicine for healthy aging in women are approaches to gerontoprotection, which aim to positively influence aging processes. The focus is on addressing age-related degenerative processes (muscle/bone density) at an early stage. There is also currently a scientific debate regarding whether medications with other indications, such as antidiabetics or the “weight-loss injection” (GLP-1 receptor agonists), could influence aging markers.

Of course, lifestyle changes and the promotion of personal resilience remain particularly important, with the focus currently shifting toward optimized stress management and preventive health promotion.

Better than any therapy, however, is early detection, which allows for the early identification of disease risks through secondary prevention and the prevention of disease manifestation.

Side Fact:

GLP-1 & Lifestyle: While GLP-1 receptor agonists (weight-loss injections) are noted in research for their metabolic effects, medical professionals emphasize that they do not replace basic therapy. Without accompanying strength training and adequate nutrient intake, these medications carry a risk of disproportionate muscle mass loss (sarcopenia), which counteracts healthy aging.  

Source: Wilding, J. P. H. et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine, 384(11), 989–1002.

Link: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 

What Women Can Do Themselves

8. Many women want to actively do something for their health during menopause. What role do diet, exercise, and targeted micronutrient supplementation play in combination?

Prof. Dr. Schleußner: This combination is the key to success:

• Diet + Micronutrients: A nutrient-rich diet (e.g., plenty of vegetables, nuts) provides the foundation, while targeted supplementation (e.g., vitamin D) fills in the gaps.
• Diet + exercise: Strength training (exercise) builds muscle, which in turn requires protein (diet) to keep the metabolism active.
• Diet + exercise + micronutrients: Together, they influence inflammatory processes in the body, improve well-being, and reduce the risk of cardiovascular disease and diabetes.

A holistic approach—healthy nutrition, regular exercise (strength & endurance), and targeted nutrient intake—enables women to actively shape their menopause, alleviate symptoms, and stay healthy in the long term.

Your message to women in this phase of life

9. If you could give women entering this new phase of life one key message—what would it be?

Prof. Dr. Schleußner: Listen to your body, embrace this change as the beginning of a new, self-determined phase of life, and seek support without feeling ashamed of your symptoms. Do not hesitate to take advantage of modern treatment options for symptom relief.

Note: This interview is intended solely for general informational purposes. The assessments and statements presented reflect the personal scientific opinion and clinical experience of the interviewed expert and are based, among other things, on their own research.

The information shared reflects the expert’s personal professional experience and does not constitute official statements or claims by VitaminExpress.

The content does not constitute health claims approved under EU Regulation (EC) No. 1924/2006 and should not be interpreted as statements regarding the prevention, treatment, or cure of diseases. This interview is not a substitute for individual medical advice. For health-related questions, please consult a healthcare professional.