Here's what you should really be eating during the perimenopause
While people often use the terms perimenopause and menopause interchangeably, it’s important to note that ‘perimenopause’ actually marks the transitional phase leading up to menopause, while ‘menopause’ specifically refers to the point when a woman has gone 12 consecutive months without a period.
Perimenopause affects everyone differently, so understanding what to expect and how to be proactive at this time in our lives is really important.
Some women may blissfully pass through perimenopause without much notice, but for many women, perimenopause brings a whole host of symptoms like hot flashes, irregular periods, vaginal dryness, and even weight gain. The good news? Making some small changes to your diet can help manage these symptoms. Why? Because so many menopausal symptoms are connected to your gut health.
Meet the experts: leading pelvic health physiotherapist and author of Strong Foundations, Clare Bourne. Joanna Lyall, nutritional therapist and founder of The Better Menopause. Functional hormone nutritionist Pippa Campbell. Emma Bardwell, registered nutritionist and co-author of The Perimenopause Solution.
Can a healthy, balanced diet help with menopausal symptoms?
Tweaking what you eat and drink during perimenopause can do more than just alleviate specific symptoms – your dietary choices can also contribute to your long-term well-being.
In fact, researchers from George Washington University found that women who cut out all animal products and up their intake of legumes – including half a cup of cooked soybeans, daily – suffered 88% fewer hot flushes twelve weeks later.
The results, published in the journal Menopause, made headlines globally, with some outlets suggesting a vegan diet could be a stand-in for hormone replacement therapy (or HRT) – which is, lest we forget, the most effective way to manage menopause symptoms and support women's health as we age.
Other studies, such as research by PREDICT and run by Zoe, the personalised nutrition company, found that menopausal women had worse blood sugar responses and greater levels of inflammation after eating, which was thought to be down to changes in the gut microbiome that occur as a result of menopause.
‘Perimenopause ... is a time when thinking about what we are eating could not be more important,’ writes leading pelvic health physiotherapist Clare Bourne in her book Strong Foundations.
‘Flipping our focus onto the power of nutrition and what it can do to help fuel us can be really helpful: focusing on what will benefit us and what we should be eating more of, rather than what we should restrict.’
Joanna Lyall, nutritional therapist and founder of The Better Menopause, agrees; ‘it’s all about getting into a mindset of addition rather than reduction.’
Of course, while we certainly wouldn't want to suggest that healthy eating is a *replacement* for medication, it's true that knowing what's up when it comes to menopause nutrition can help us feel and function better during a notoriously challenging life stage.
‘Ideally, I want women to make sure they’re well prepped in advance, rather than waiting until their symptoms are impacting their wellbeing,' says Emma Bardwell, registered nutritionist and co-author of The Perimenopause Solution: Take Control of Your Hormones Before They Take Control of You. ‘Forewarned is definitely forearmed.’
Going through perimenopause puts your body under stress, stress causes inflammation, and chronic inflammation is linked to diseases including arthritis, Alzheimer’s and heart disease.
The best way to eat to dial that down is by eating a Mediterranean style diet, based around vegetables, fruit, legumes, grains, olive oil, nuts and seeds, herbs and spices, some fish and seafood, moderate dairy and a limited amount of meat.
‘It’s a way of eating, not a written-in-stone diet, and can be adjusted according to taste, budget and preferences,’ says Bardwell. One study even found that a high intake of oily fish and fresh legumes was associated with delayed natural menopause, while refined carbs brought it on earlier.
The average age to reach menopause is 51, with perimenopause kicking in in your 40s. It lasts four to seven years, and can include various symptoms, from mood changes to sleep problems to joint pain – all of which can be eased by getting your food intake sorted.
Question is: how do we navigate menopause nutrition in a mindful and healthy way, and what can we do now to prevent severe symptoms later on?
What to eat during perimenopause
Half the battle is knowing where to direct your menopause nutrition efforts in a world where everyone seems to be an expert. While personalised nutrition advice can be hugely helpful during this time of change, educating and empowering yourself to take control of your menopause experience – and understanding that this could be a 10-14-year period of your life – is really important.
‘During this period of hormone decline, if you allow your gut to be affected by that, you’re going to predispose yourself to a higher chance of bone density loss, to cardiovascular disease and to ill bone health. Whereas, if you make changes to your diet during the perimenopause phase, you are much more likely to have a healthier second half of your life,’ explains Lyall.
‘In a nutshell, all women over 40 really need to be thinking about eating for their heart, brain and bone health,’ says Bardwell.
Here, then, are some key foods to include in your perimenopause diet – and why...
Perimenopause diet: 6 foods to include in your diet
1. Fruit and veg
While eating the rainbow may sound rather cliche, a 2021 study found positive links between plant-based diets and fewer hot flashes, so focus on increasing your intake of fruit and vegetables – and do aim to eat a wide variety of colours.
Bourne suggests trying for a minimum of 30 different plant-based foods a week. ‘It can be quite an exciting challenge and makes our food a lot more pretty to look at.’
If 30 different plant-based foods seem like a lot, Lyall reminds us that herbs and spices also count: ‘If you make a meal from scratch, it’s actually quite easy to fit at least six plant-based ingredients in that. You might have a couple of different vegetables, some kind of herb or seasoning, and then add some kind of carb or protein on top.’
2. Fibre
Good sources of fibre include vegetables, fruit, whole grains and legumes – but you’d probably be surprised how many people miss out on this essential nutrient.
A 2023 study from The University of Nottingham shows the link between fibre and various health benefits. These include a healthier gut, reduced risk of ovarian cancer, as well as reduced symptoms of depression.
‘In perimenopause, the hormones start to change, and we are likely to start suffering from slower movement in the gut, which can lead to constipation,’ explains Lyall. ‘And if you become constipated, that puts pressure on your pelvic floor, which can then lead to other symptoms later on in life, like prolapse, weakened bladder and incontinence.’
Another reason why fibre is so important during perimenopause is that it really helps slow down the blood sugar release, ‘this can help prevent some of the issues that many women in perimenopause and menopause face – such as metabolic conditions and insulin resistance, which can then lead to weight gain,’ she says.
Including fibre-rich foods in your diet can also keep you feeling satisfied for longer, giving your cholesterol levels a positive nudge, and, according to a 2022 study, reducing the likelihood of heart disease. Bourne suggests aiming for 30g of fibre in your diet every day.
3. Protein
As you navigate through perimenopause, you may notice a decline in your lean muscle mass and an increase in body fat. But, by upping your daily protein intake, you can help manage your appetite, potentially reduce body fat, improve cholesterol levels, maintain your lean muscle mass, and reduce the risk factors associated with heart disease. Various clinical trials have found that consuming more protein than the recommended dietary allowance not only reduces body weight but also enhances body composition by decreasing fat mass while preserving fat-free mass.
‘Protein also works on regulating blood sugar levels as well. So it’s going to make you feel fuller, and you’re less likely to get those spikes and slumps in the afternoon, which is a pretty common menopause symptom,’ says Lyall. ‘And it’s a leaner fuel to take energy from, so rather than fueling on carbs, which convert to sugar, fueling on protein takes longer for your body to break down and absorb.’
‘Protein is a powerhouse and needed for so many of our body’s functions,’ adds Bourne. The best sources of protein? Fish, lean meat, tofu, beans, eggs, nuts, seeds, oats, chickpeas and lentils. ‘Think about how you can incorporate it into each meal and snack that you eat,’ she says.
4. Calcium
As we age, our risk of developing osteoporosis – a condition that weakens and makes your bones brittle – naturally increases. ‘Although it’s worth bearing in mind that someone’s risk of osteoporosis is also genetically linked, so not everybody has the same risk. I think this is the big thing for menopause, in general – everyone’s experience of it is individual,’ says Lyall.
But looking after bone health is important, especially as perimenopause can make you more vulnerable to specific vitamin and mineral deficiencies. So incorporating calcium and vitamin D-rich foods into your diet can be a boon for your immune system and promote the health of your bones and muscles.
‘We often think of dairy as providing the calcium we need, for example, milk, cheese and yoghurt, however, calcium can be found in other sources as well,’ explains Bourne. ‘These include tinned fish, for example, sardines, fortified cereals, fortified plant-based milks and some leafy green vegetables.’
‘For calcium absorption, we also need vitamin D, which we get from food such as eggs, oily fish and mushrooms, as well as from sunlight,’ she adds.
This goes back to your gut health, explains Lyall, ‘it’s not only a case of making sure you’re having a diet rich in calcium and vitamins, it’s also a case of digestion and absorption. If your gut is not healthy, you’re not going to maximise your absorption, you’re going to have high levels of inflammation and having inflammation in the body directly impacts bone density.’
5. Omega-3 fatty acids
While fats have often been portrayed as the ‘enemy’ in many a diet, fats are essential for our body. ‘They help us to make our hormones, as well as supporting the absorption of essential fat-soluble vitamins A, D, E and K,’ explains Bourne.
Oily fish – such as salmon, mackerel and sardines – nuts, seeds and avocados are all great examples. They may help manage some symptoms of perimenopause such as night sweats and one 2018 study suggested fatty acids could also help ease symptoms of depression during menopause, too.
‘Essential fats are great for brain health, they’re involved in hormone production, and they make you feel fuller so that’s going to stop the cravings. And, having essential fats in your diet nourishes your skin and your hair,’ adds Lyall.
‘Healthy Omega-3 intake is associated with decreased inflammation and improved mood,’ says functional hormone nutritionist Pippa Campbell. ‘During perimenopause, the body is in a state of inflammation, so I recommend eating fish such as sardines, anchovies, mackerel, salmon, and herring. Just remember the acronym "SMASH"’.
Another excellent source of Omega-3, she says, is flaxseed. ‘Another word for linseed, flaxseeds are brilliant for balancing our hormones as they contain something called lignans and isoflavones which are "phytoestrogens". Consumption of these have been shown to control levels of oestrogen in the body.’
6. Magnesium
Magnesium is just so important. ‘We need a lot of magnesium as women in general, and as we go into menopause, we seem to need more,’ says Lyall. ‘Magnesium is important for sleep, and for our muscles and joints. So when we can get really achy and low energy or struggle with sleep, magnesium is really a really powerful remedy for that.’
Of course, you can have magnesium in lots of different ways. You can eat it – it’s found in dark green leafy vegetables, almonds even cacao nibs (which Lyall recommends adding to a smoothie in the morning, or popping on top of a granola bar) – you can take it as a supplement and you can have magnesium in a bath.
‘Absorbing magnesium through your skin means you haven’t got to go through the process of absorbing it through the gut, which makes it faster and is why it can have a real knock-on effect on sleep. And you can buy pastes and butters and sprays as well,’ she says.
‘However you want to take magnesium, chances are you are not currently getting enough – and magnesium would help make anyone struggling to sleep feel better.’
And the foods to avoid during perimenopause...
Want to know what to avoid? Avoidance. ‘The keto and paleo diets mean many women avoid carbs and grains,’ says Bardwell. ‘Headaches, irritability, fatigue, constipation, sugar cravings, high cholesterol and bloating can all be down to a lack of complex carbs in your diet. Yet, despite the fact these common perimenopause symptoms could potentially be improved so easily, carbs are still plagued by controversy and often shunned.’
She cites the annoyingly pervasive notion that carbs make you bloated, inflamed, sluggish and unable to lose fat; ‘This isn’t true, carbs contain just 4 calories per gram, they fuel our muscles, pack in fibre and, when chosen wisely, are an excellent source of vitamins and minerals,’ she says.
If nothing else, think of your brain! ‘It’s the hungriest organ in your body, using up around 20 per cent of the energy you consume in a day in its resting state, and carbs are its favourite food.’
Research suggests our brains use the equivalent of over 400 calories of glucose a day, which goes some way to explaining why low-carb diets can blunt your mental acuity, make your mood swing wildly and give you brain fog,’ explains Bardwell. So welcome good-quality complex carbs, mostly derived from plants, back into your diet.
Then there’s the trend for dodging dairy or gluten, with no medical need. ‘Dairy is a widely available and relatively cheap form of calcium and protein, plus it provides iodine which is crucial for thyroid health,’ says Bardwell.
‘Plant milks can match the calcium if they’re fortified but it’s hard to find one that contains iodine and because they’re predominantly water, they’re not a good source of protein, unless we’re talking about soy.’
According to Campbell, managing perimenopause effectively may signal that it’s time to reevaluate your relationship with alcohol.
‘Alcohol burdens the liver and whilst it’s focused on detoxing that, it can’t focus on getting rid of other things like used oestrogen,’ she says. ‘Additionally, alcohol typically makes perimenopause symptoms worse.’
The bottom line: We’re all different, and our experience of menopause will all be different, but if you can try to eat well 90% of the time, then it’s fine to still have the odd bit of chocolate or a glass of wine – because life is too short not to be joyful.
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