How to Combat the Peri-Scaries (Tips for Perimenopause)
By Faith Haney, PostGlo Student Intern
Hot flashes, mood swings, and trouble sleeping are just a few of the possible nuisances that may crop up during perimenopause, and the Internet is rife with advice on how to treat them. Recently, using nutrition to counter the symptoms of perimenopause has become a trending topic – but can what you eat actually make a difference? Read on to find out!
What is Perimenopause?
Perimenopause is a period of hormonal shifts in which the body transitions to menopause, or the cessation of menstruation. While it varies widely between individuals, perimenopause typically begins in your mid-40s and lasts an average of four years, though its duration can range from a few months to 8-10 years.
During perimenopause, decreased production of estrogen and progesterone leads to irregular periods and a range of physical and emotional symptoms, including hot flashes, night sweats, sleep disturbances, joint and muscle pain, weight gain and redistribution (particularly around the midsection), loss of muscle mass, mood swings, low libido, and brain fog. Additionally, those entering perimenopause experience an increased risk for conditions such as osteoporosis, hypertension, and heart disease, as estrogen (which decreases during perimenopause) plays a protective role in maintaining bone and heart health (Cleveland Clinic, 2024).
What is a Healthy Diet for Perimenopause?
The type and quantity of food you eat can have profound implications on perimenopause symptoms and health outcomes. Focus on consuming more whole, plant-based foods such as a variety of fruits and vegetables, whole grains, nuts and seeds, legumes, and olive oil. Eating patterns like the Mediterranean diet have been shown to help with weight management, improve cardiovascular health, and decrease intensity and frequency of hot flashes and other symptoms (Barnard et al., 2021). Plant-based foods are especially important for providing fiber, which feeds the healthy bacteria in our gut and keeps you fuller for longer. A healthy gut has also been linked to an improvement in heart health, reduced depression, and a decrease in risk of certain cancers like ovarian cancer (Huang et al., 2018).
Getting enough protein is crucial for those experiencing perimenopause, which is generally accompanied by a decrease in muscle mass. Protein can assist in maintaining muscle mass and preventing weight gain by increasing satiety. In fact, recent research suggests that the enhanced muscle breakdown observed during perimenopause can increase your appetite for protein, which will not be satisfied until enough protein has been consumed, regardless of overall caloric intake (Simpson et al., 2022). Protein recommendations for perimenopause typically range from 1.2-1.6 grams/ kg of body weight per day, though you can speak with a dietitian to determine your individual needs. Prioritize consumption of lean and plant-based proteins like lentils, beans, eggs, nuts and seeds, and fish. Soy products like tofu, tempeh, edamame, and soy milk are particularly great sources of protein and have additional benefits beyond their protein content (see below).
Due to the increase in bone loss and risk of osteoporosis that results from declining estrogen levels, those entering perimenopause should be mindful of consuming enough calcium and vitamin D to protect bone health. Aim for 2-3 servings of calcium-rich foods per day, such as leafy greens like kale or collard greens, dairy products or fortified dairy alternatives, and nuts and seeds. For most people living in areas that do not get year-round direct sunlight, daily vitamin D supplementation is recommended in addition to consumption of fortified foods like dairy/ dairy alternative products and orange juice or fish like tuna or salmon (British Dietetic Association, 2019).
In addition, omega-3 fatty acids have been found to improve health and wellbeing during perimenopause. Research shows that omega-3 fatty acids can help to reduce inflammation, night sweats, heart disease risk, and depression symptoms (Krupa et al., 2024 and Mohammady et al., 2018). Omega-3 fats are found in fatty fish like salmon or mackerel as well as flax seeds, chia seeds, hemp seeds, and walnuts.
During perimenopause, it is possible that your daily basal metabolic rate (BMR) – the amount of energy needed to maintain essential bodily functions at rest– will decrease by 200-300 calories due to hormonal changes and loss of muscle mass. However, it is still important to ensure you are eating enough (above your BMR), as diets too low in calories increase risk of micronutrient deficiency and do not bring long-term benefits or sustainable weight loss (Erdélyi et al., 2023). Consider working with a dietitian who can help you figure out your unique needs.
What About Soy?
Soy and some other plant foods like flax seeds contain a chemical called phytoestrogen that has a similar structure to estrogen. Studies have shown that regular consumption of phytoestrogen-containing foods is effective in reducing certain menopausal symptoms like hot flashes, night sweats, sleep disturbances, and high cholesterol. Furthermore, soy consumption has not been shown to increase breast cancer risk and may actually have a tumor-reducing effect (Erdélyi et al., 2023). Incorporating more soy into your diet during perimenopause may help to alleviate some of the intensity of symptoms and improve overall health outcomes.
What Else Should I Consider During Perimenopause?
Aside from consuming a healthy diet, it is important to participate in regular exercise throughout perimenopause. In particular, regularly incorporating weight bearing and muscle strengthening activities can help to maintain muscle mass and preserve bone health. Make sure to keep moving throughout the day, whether it’s taking a short walk around the block or a stretch break at your desk.
Additionally, ensuring adequate sleep can improve mental health, cardiovascular health, and symptom management during perimenopause, which is easier said than done considering the high prevalence of sleep disorders associated with this time period. Melatonin is a hormone that is important for regulating the body’s sleep-wake cycle (also known as its circadian rhythm) and can be found in certain foods. Consuming foods that contain melatonin, such as tart cherries, goji berries, eggs, and nuts, has been shown to assist with sleep while providing additional benefits for immunity and disease prevention (Meng et al., 2017). In addition, maintaining a regular eating schedule and consuming enough of the vitamins and minerals used in melatonin synthesis (vitamin B6, vitamin B12, folate, magnesium, and zinc) can help to improve sleep quality (Erdélyi et al., 2023).
Lastly, adequate water intake and hydration is necessary for maintaining electrolyte balance and relieving certain hormonal symptoms like headaches and hot flashes. In contrast, caffeine and alcohol should be limited, as they have been shown to trigger hot flashes and exacerbate sleep disturbances (Faubion et al., 2015).
While perimenopause can feel overwhelming, you may be able to ease some of the symptoms through simple nutrition and lifestyle changes. Instead of accumulating more stress by taking a million supplements or attempting various restrictive diets recommended online, it is important to take care of yourself and practice self-compassion during this time. If you feel you need extra support, reach out to a registered dietitian who can help you nourish your body while navigating these changes. You’ve got this!
References
Barnard, N. D., Kahleova, H., Holtz, D. N., Del Aguila, F., Neola, M., Crosby, L. M., & Holubkov, R. (2021). The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause, 28(10), 1150-1156.
British Dietetic Association. (2019, May). Menopause and Diet. www.bda.uk.com. https://www.bda.uk.com/resource/menopause-diet.html
Cleveland Clinic. (2024, August 8). Perimenopause: Age, stages, signs, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2023). The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients, 16(1), 27. https://doi.org/10.3390/nu16010027
Faubion, S. S., Sood, R., Thielen, J. M., & Shuster, L. T. (2015). Caffeine and menopausal symptoms: what is the association?. Menopause (New York, N.Y.), 22(2), 155–158. https://doi.org/10.1097/GME.0000000000000301
Huang, X., Wang, X., Shang, J., Lin, Y., Yang, Y., Song, Y., & Yu, S. (2018). Association between dietary fiber intake and risk of ovarian cancer: a meta-analysis of observational studies. The Journal of international medical research, 46(10), 3995–4005. https://doi.org/10.1177/0300060518792801
Krupa, K. N., Fritz, K., & Parmar, M. (2024). Omega-3 fatty acids. In StatPearls. StatPearls Publishing.
Meng, X., Li, Y., Li, S., Zhou, Y., Gan, R. Y., Xu, D. P., & Li, H. B. (2017). Dietary Sources and Bioactivities of Melatonin. Nutrients, 9(4), 367. https://doi.org/10.3390/nu9040367
Mohammady, M., Janani, L., Jahanfar, S., & Mousavi, M. S. (2018). Effect of omega-3 supplements on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology, 228, 295–302. https://doi.org/10.1016/j.ejogrb.2018.07.008
Simpson, S. J., Raubenheimer, D., Black, K. I., & Conigrave, A. D. (2022). Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage. Bjog, 130(1), 4.