Managing your menopause during Ramadan

Tips on HRT, hydration and managing menopause symptoms

Ramadan is one of the holiest months in the Islamic calendar and marks four weeks of fasting, prayer, reflection and community.

From the evening of March 10 to the evening of April 9, many of the UK’s almost four million Muslims will observe the month by not eating or drinking in daylight hours.

Here Dr Hina Shahid, a GP and chair of the Muslim Doctors Association, offers advice on managing the menopause during this special month.

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What about my HRT medication?

Some medication can be affected by the Ramadan fast, so here is what you may need to change if you take HRT.

If you replace hormone levels using skin patches, skin gels, an intrauterine device such as a Mirena coil, or a vaginal pessary or cream, then you don’t need to make any changes during Ramadan.

‘Continue as normal with these forms of HRT,’ says Dr Shahid. ‘These are absorbed through the skin, they are not ingested and have no nutritional value, so they don’t break your fast.’

However, oral HRT do break your fast, so move them to before or after daylight hours.

‘Most women take their HRT tablets first thing in the morning, so just move it back earlier to your suhur, the predawn meal. If you normally have them in the evening, just wait until the sun goes down.’

These small tweaks shouldn’t disrupt their effectiveness, Dr Shahid says. ‘If you just move it by a short amount of time it won’t have an impact on your hormone levels, and as they tend to be taken once a day they are not hard to move.’

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I’m perimenopausal. What if I’m on my period during Ramadan?

Women on their periods do not fast during Ramadan, so if you’re in the perimenopause and still having periods, Dr Shahid says the exemption to not fast applies, and you can make it up at a later date.

‘If you’re having irregular bleeding, and you have already seen a doctor about this, then you may still be able to fast and it would be advisable to speak to an Islamic scholar who can give specific advice around this,’ she says.

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Don’t be tempted to skip suhur

Your menopause journey is unique to you, but many women can find their sleep is poor and they are tired as hormone levels decline.

Dr Shahid says it can be easy, especially when you’re tired, not to get up early and leave time for suhur before dawn.

‘But I would always recommend women, especially those experiencing the menopause, to get up and have a good healthy meal,’ she adds.

‘Aim for lean protein, like meat, fish or vegetarian options, wholegrains and fruit and vegetables. These will help give a continuous, steady supply of energy that stabilise your sugar levels. Oatmeal is a good option. Make conscious choices about what will work best for your body and provide the nutrients you need.’

Read more articles on nutrition on the balance menopause library

Drink plenty of water at night

Keeping hydrated is important for energy and wellbeing and can be tricky for those observing Ramadan as the fast includes not drinking any liquid.

Ensure you drink two litres of water during non-fasting hours so you are topped up for the day and eat plenty of hydrating foods, such as fruit and salad vegetables, before dawn and after sunset, Dr Shahid says.

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Choose evening foods that won’t aggravate menopausal symptoms

When breaking the fast after sunset, it can be easy to be drawn to a large, rich options for iftar, which can be geared towards unhealthy food.

‘You might really want a samosa, but try and avoid fried and fatty foods,’ Dr Shahid says. ‘They can disrupt your energy levels, give you heartburn, make it harder to sleep and worsen night sweats. It’s really important to pay attention to your nutrition, especially if you are going through the menopause. Again, focus on lean protein, wholegrains and a balanced diet.’

Try to stick to a routine

Find a new routine during Ramadan, keeping your meals at similar times every day and following the steps that usually help you manage your symptoms, like not getting too hot in bed.

Many women will go to the night prayers at a mosque, which are often busy and warm. Wear layers of cool natural fabrics to these sessions to minimise hot flushes, Dr Shahid says.

‘You are not going to be perfect every day of the month, but try and have some structure,’ she says. ‘Ramadan is meant to challenge you but within limits. If you can get a day time nap, and some people take time off during Ramadan to really concentrate on it, then this can help.’

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Focus on the positives and joy that Ramandan brings

A month of fasting can bring emotional up and downs, and when mixed with menopause, when declining levels of hormones can affect your mood, this can be a difficult combination.

While some days will be harder than others, there are many positives to take from Ramadan, says Dr Shadid.

‘For women experiencing fluctuating moods due to the menopause, it may become more noticeable during Ramadan when you are hungry and tired,’ she says.

‘This is when lifestyle measures are really important, and Ramadan is a really supportive month with a focus on community and family. A lot of people do extra prayers, it is a spiritual time with an emphasis on gratitude. This can lead to an amazing positive synergy between Ramadan and mood.’

Reaching out into the community and talking to other women who are going through the menopause during this time can be a great source of support, says Dr Shahdid.

And if you are really struggling on some days and break your fast, don’t feel you have failed.

‘There are all sorts of reasons that people need to break their fast, and people are encouraged to stop if they need to,’ says Dr Shahid.

‘You can make it up at another time. It is important for women not to feel bad and beat themselves up, it is absolutely fine.’