If you’re a woman in her late 30s or 40s, listen up: You are either in or approaching perimenopause, the time leading up to menopause. Perimenopausal hormone fluctuations can bring hot flashes, irregular cycles, sleep issues, mood changes, and unwanted weight gain and body composition changes. Fun times. But you do not have to suffer through this phase.
There are over 100 symptoms associated with perimenopause. They range from the most common (listed below) to some of the more surprising ones: frozen shoulder and bleeding gums.
Here are just a few symptoms and physiological changes that can occur due to hormone fluctuations in perimenopause:
- period changes in flow, length, frequency
- weight & body composition even without making any dietary changes
- elevated cholesterol levels
- an increase in inflammation (you can test your hsCRP to gauge your level of inflammation)
- hot flashes & night sweats
- rage, irritability (not kidding; rage is one of the first noticeable symptoms. I speak from experience.)
- depression and mood swings
- muscle loss
- vaginal dryness
- UTIs
- low libido
- brain fog
Some women can begin hormone replacement therapy (HRT) in perimenopause to replace waning estrogen, progesterone, and testosterone. Others may find relief with a hormone support supplement like this one for hot flashes and this one for estrogen and progesterone support (I typically recommend this formula to women in late perimenopause or early menopause).
The average age of menopause is 51 but can happen in your 40s, so perimenopause may begin as early as your mid-30s. This is an important time to make some diet shifts to support hormone fluctuations, keep inflammation and cholesterol in check, and maintain healthy body composition.
Top Three Diet Changes for Perimenopause
These foods/macronutrients will support gut health, healthy lipid levels, inflammation management, and estrogen levels. They may not get rid of all your perimenopausal symptoms, in which case HRT combined with the modifications can be a game changer. Start with one food at a time and work up from there. For example, work on increasing protein, then focus on adding more fiber, then add in phytoestrogenic foods.
Protein: key in perimenopause to maintain muscle mass, balance blood sugar and help with appetite regulation, and provide the raw materials to support skin and hair health. Protein breaks down into the amino acids that are necessary to support hair and skin health.
Recommendations vary between .08 grams to 1 full gram of protein per pound of bodyweight. This is not always an easy task. Your protein needs depend on your activity level, but lifting heavy weights in perimenopause, which is a recommendation that combats muscle loss, calls for more protein. You need protein to build muscle.
I do some kind of strength training every week, whether it’s weights or a barre class, but I have seen so much research lately about the importance of lifting heavy in perimenopause, so I’ve started focusing more on that also. I used to use 5-8 pound hand weights, but now I do anywhere from 10 – 25 pounds. The rec is to go as high as you can without putting yourself at risk for injury.
Emerging research highlights that women in perimenopause and beyond need to consume 30-50 grams of protein at breakfast or their first meal of the day to build muscle effectively. I rely heavily on protein smoothies (25-30 grams of protein) to help meet the goal. Here’s the protein I use (21 grams!). Sorry, but the classic 2 egg breakfast only has 14 grams of protein. Pair with smoked salmon or sausage to bump it up to ~40 grams! Add spinach for folate and iron.
Fiber: most women are only getting 13 grams of protein per day when you need at least 25. Fiber has a number of benefits including the following:
- gut health support: feeds your beneficial probiotic bacteria that digest your food for you
- blood sugar management: blood sugar rises in perimenopause, and that can cause weight gain
- satiety: helps keep you full
- cholesterol management: fiber binds up excess cholesterol in the colon and helps excrete it from the body
Bacterial diversity is so important for immune and overall health, and fiber is what increases your probiotic bacterial colonies. In turn, the bacteria ferment the fibers and produce short chain fatty acids as a byproduct which feed your colon cells. Short chain fatty acids are super important for colon health.
It’s not as difficult as you think to meet daily fiber needs. Simply follow the “cereal bowl” diet: eat a bowl full of veggies at lunch and dinner. This can be a side salad, roasted veggies, sauteed greens, or any way you like. The highest fiber foods I include and recommend are broccoli (5g per cup), lentils (a whopping 16g per cup), raspberries (8g per cup), avocado (10g), apple (3-4g). All legumes are great sources of fiber. A salad has about 10 grams of fiber. My morning smoothie has 10 grams of fiber with the berries (including raspberry), banana, almond butter, and this fiber supplement I use to beef up my fiber goals.
Phytoestrogenic foods: estrogen levels decline in perimenopause, and this may cause hot flashes and night sweats, among other unpleasant symptoms. You can support estrogen by including foods that contain plant-based dietary estrogen that may function similarly to the estrogen the human body produces.
Phytoestrogens bind to estrogen receptors and have a modulating effect. In early perimenopause, where estrogen levels are fluctuating, phytoestrogens have a balancing effect. During high estrogen periods, the phytoestrogens displace some estrogen at the receptors and lessen the cellular response. Conversely, when estrogen levels are low (as in late perimenopause and post-menopause), phytoestrogen binding promotes more of a cellular response. (source)
The most popular phytoestrogenic food is soy. Wonder if that’s why Asian women report fewer menopausal symptoms than American women? Soy used to get a bad rap because of its estrogenic properties, but the concerns are a bit unfounded. Read my article on soy here.
Include unprocessed forms of soy like tofu, tempeh, edamame, and miso. Avoid hydrolyzed soy and soy isoflavones (typically found in protein powders and processed vegetarian/vegan products).
Conclusion
Perimenopause is a time to make certain diet and lifestyle adjustments to support fluctuating hormone levels. The top three main considerations should be increasing protein, fiber, and phytoestrogenic foods.
A couple other nutrition habits to keep in mind: watch the coffee and booze. Alcohol can affect estrogen and disrupt sleep. Caffeine can trigger hot flashes and also affect sleep.
Read my other post on supplements to include for perimenopause here.
Reach out to me if you would like support in navigating the perimenopausal transition.
Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.