Perimenopause, the time in life when a woman or person with ovaries begins to transition away from reproductive years to menopause, is not talked about enough. So many women come to me confused about their changing bodies—periods are suddenly irregular, the weight creeps up, and their mood is all over the place. They are entirely unaware that these are typical signs of shifting hormones.
Think about the years leading up to your first period. Most of us are familiar with the tumultuous early teenage years and recognize that this is a time of major hormonal and physical change. Perimenopause is the same, but women are left in the dark since there are fewer conversations about it.
The frustrating and sometimes life-altering symptoms of difficulty losing weight, heavy irregular periods, insomnia, hot flashes, and impaired sexual function associated with perimenopause are related to declining progesterone and estrogen levels. These symptoms can start as early as your late 30s, so that’s ten-plus years until menopause — much too long to suffer. Add on an increased risk of osteoporosis and heart disease with declining estrogen, and you’ll see that it’s essential to act now.
You can take steps to feel like yourself again, and a healthy diet can make a significant difference. Let’s take a closer look at how nutrition can help make the perimenopause transition smoother and more manageable.
Easing Perimenopause Symptoms & Preventing Weight Gain Through Diet
Before examining perimenopause diet specifics, let’s discuss why food can help or hinder perimenopause symptoms. Our hormones are closely interconnected with our metabolic health, which means as hormones decline, the way we utilize and store nutrients and energy changes.
Menopause increases the risk of metabolic syndrome, heart disease, and osteoporosis, primarily because of the decline in estrogen. The risk of heart disease jumps for women after menopause, partly because estrogen protects against inflammation, oxidative stress, and blood vessel damage.
Estrogen also protects against osteoporosis, so our bone health is affected once levels drop. As a result, a heart-protective and bone-supporting diet before menopause can help prevent age-related disease, while during perimenopause, it can help mitigate symptoms.
Perimenopause Weight Gain and Body Image
Weight gain is also a concern for women in the perimenopause transition, so diet also can support weight management. A recent population-based study found that women in menopause experience a higher rate of fat gain and lean mass losses until two years after their final period. At the same time, participants’ weight continued to climb until menopause and then stopped once they hit menopause.
Part of the reason for the weight gain,lean body mass loss, and perimenopause connection is due to the relationship between sex steroid hormones and metabolism. Estrogen can influence how well your cells can switch from fat burning during fasting (like overnight or between meals) and carb utilization for energy after meals.
Alterations in fat metabolism affect cholesterol levels and even increase inflammation and free radicals in the body. As estrogen declines, blood sugar spikes may increase as insulin regulation is also impacted, which means the body is less efficient at utilizing and storing energy—resulting in more fat storage.
A lot of women struggle with body image and weight concerns in this period.
In fact, some research suggests that women may be especially vulnerable to developing an eating disorder during perimenopause because of these hormonal changes and challenges associated with mood and body.
Making diet changes within this perimenopause window may help, but this doesn’t mean restricting calories or spending countless hours in the gym
Instead, focus on foods that nourish you and eating patterns that highlight essential nutrients for hormones, bone health, and metabolic regulation. For example, one study found that consuming more antioxidants is linked to fewer perimenopausal symptoms like hot flashes, sleep problems, and difficulty concentrating.
Best Diet for Perimenopause
There’s no single best diet for perimenopause, but here are the food and nutrient choices that can relieve symptoms and support a healthy weight.
Protein-rich foods are so helpful for perimenopause because they help preserve lean body mass (and more lean mass means a higher metabolism) and help regulate blood sugar. Protein is essential for maintaining a healthy body weight because it can help with satiety between meals (meaning you won’t feel hungry or deprived).
What does high protein mean? Each person’s needs vary depending on body size, activity level, and eating pattern, but generally speaking, aim for 20-30 grams of protein per meal.
Bumping up protein also doesn’t mean you need to only eat animal-based products. Plant proteins can contribute to your protein intake, too. A mix of lean proteins like fish, poultry, beans, legumes, grass-fed meats, and pastured eggs can top up your protein requirement and keep your meals interesting.
If you were going to make one single change for perimenopause symptoms and weight management, it should be to focus on eating more fiber-rich foods. Fiber does so many things for our bodies: it helps with digestion, helps to maintain healthy blood sugar, and feeds beneficial microbes in your gut.
Taking care of your gut is essential for hormone balance. The metabolic byproducts of bacterial fermentation (called short-chain fatty acids or SCFAs) can even help regulate insulin sensitivity and improve your metabolic health.
Studies suggest that fiber, especially viscous fiber found in fruits, veggies, and legumes, can improve body weight even without caloric restriction. Fiber is also an essential nutrient for cholesterol and a healthy heart. High fiber foods include beans, legumes, vegetables, fruit, nuts, seeds, and whole grains.
I've created a free hormone-balancing starter kit. In it, I break down the most important diet and lifestyle changes you can make to help improve your hormones You can grab it here.
Nutrient-rich foods are those rich in vitamins, minerals, and antioxidants. Eating a variety of nutrient-rich foods may help calm inflammation and possibly regulate hormones. Foods that contain the following nutrients can be beneficial for perimenopausal women:
- Omega-3s: Omega-3 fatty acids keep inflammation in check by balancing the production of pro-inflammatory compounds. They help protect delicate blood vessels and the brain against inflammation and damage that increases the risk of heart disease and dementia. These fatty acids may also help with mood swings, sleep disturbances, and hot flashes.
You can find omega-3 fatty acids in fatty fish like salmon, flax seeds, chia seeds, and walnuts, but often a supplement can provide higher doses.
- Calcium: Calcium is an essential nutrient for bone building, but interestingly studies on whether supplementing with calcium prevents fractures later in life show mixed results. This may be because calcium needs other nutrients, like vitamin D and magnesium, to work effectively.
Sometimes supplements can be necessary to get the recommended daily values, but focusing on a steady supply of calcium-rich foods like almonds, leafy greens, or sardines is a good place to start.
- Vitamin D3: Calcium needs vitamin D to be absorbed properly, and low vitamin D levels can make a person more prone to bone loss. Vitamin D is also critical for blood sugar, immune health, and mood.
How much you need depends on baseline levels, but I usually suggest starting with 2,000 to 4,000 IU of vitamin D3 daily. Food sources of vitamin D are less available, so supplements are often needed, especially if you don’t eat dairy or spend time in the sun. I recommend pairing vitamin D with vitamin K to promote better calcium absorption.
What Should You Limit in Your Diet?
That glass (or two or three) of wine after a long day probably isn’t doing you any favors. I’m not here to judge anyone’s choices about alcohol, but I’m here to give you the facts about alcohol and perimenopause.
While some research suggests that drinking could help with hot flashes, alcohol can worsen insomnia and increase anxiety and depression. Plus, it adds extra calories that aren’t metabolized as efficiently by the body as food, making it even harder to lose weight during perimenopause.
Sweets may feel like comfort or a treat, but they probably aren’t helping you feel better. Women who eat more sugar during perimenopause are more likely to have hot flashes. Plus, with blood sugar dysregulation and the increased risk of insulin resistance, eating more sugar can actually make you crave it even more, creating a cycle that’s hard to break.
Caffeine has a lot of benefits, including improved memory, alertness, and mood, but some people don’t tolerate it well. It can worsen anxiety, hot flashes, and sleep disturbances—all things you don’t need more of during perimenopause.
If you love your coffee or matcha in the morning, try switching to decaf or experimenting with cutting down on how much you have and see if it helps. Or, try an alternative like an herbal coffee or tea with adaptogens.
Processed foods aren’t great for us at any age, but if you struggle with symptoms of perimenopause, you’ll definitely want to limit them. Studies suggest that higher intakes of processed foods are linked to more symptoms, while eating more fruits and veggies may help you feel better.
Processed foods include packaged white bread, frozen dinners, packaged chips and cookies, fast food meals, microwave-ready foods, candy, and others. Not only are these foods nutritionally void, but they are also linked to heart and blood sugar issues.
The Bottom Line on Perimenopause and Your Diet
Eating whole foods packed with nutrients and limiting highly-processed items is vital for promoting overall health during perimenopause. Focus on healthy fats, lean protein, and fiber while ensuring you eat enough calcium and other essential vitamins and minerals for bone and heart health.
It can take time to feel like yourself again, and self-compassion goes a long way. With a balanced diet and healthy lifestyle, it’s possible to manage the physical and emotional symptoms of perimenopause naturally.
KEEPING IT REAL, WHILE KEEPING YOU EDUCATED
Featuring a 28 day plan to take back your cycle and dozens of charts, checklists, and diagrams to help along the way.
- Davis SR, Lambrinoudaki I, Lumsden M, et al.. Menopause. Nat Rev Dis Primers. 2015. 1. 15004.
- Silva TR, Oppermann K, Reis FM, Spritzer PM.. Nutrition in Menopausal Women: A Narrative Review.. Nutrients.. 2021. 13. 2149.
- Nappi RE, Simoncini T.. Menopause transition: a golden age to prevent cardiovascular disease. Lancet Diabetes Endocrinol. 2021. 9. 135-137.
- Baker JH, Runfola CD.. Eating disorders in midlife women: A perimenopausal eating disorder?. Maturitas.. 2016. 85. 112-116.
- Ko SH, Kim HS.. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women.. Nutrients. 2020. 12. 202.
- Gregorio L, Brindisi J, Kleppinger A, et al.. Adequate dietary protein is associated with better physical performance among post-menopausal women 60-90 years.. J Nutr Health Aging.. 2014. 18. 155-160.
- Jovanovski E, Mazhar N, Komishon A, et al.. Can dietary viscous fiber affect body weight independently of an energy-restrictive diet? A systematic review and meta-analysis of randomized controlled trials.. Am J Clin Nutr.. 2020. 111. 471-485.
- Soleymani M, Siassi F, Qorbani M, et al.. Dietary patterns and their association with menopausal symptoms: a cross-sectional study.. Menopause.. 2019. 26. 365-372.
- Abshirini M, Siassi F, Koohdani F, et al.. Dietary total antioxidant capacity is inversely related to menopausal symptoms: a cross-sectional study among Iranian postmenopausal women.. Nutrition. 2018. 55-56. 161-167.
- Iorga A, Cunningham CM, Moazeni S, Ruffenach G, Umar S, Eghbali M.. The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy.. Biol Sex Differ.. 2017. 8. 33.
- Ji MX, Yu Q.. Primary osteoporosis in postmenopausal women.. Chronic Dis Transl Med.. 2015. 1. 9-13.
- Westerterp-Plantenga MS, Lemmens SG, Westerterp KR.. Dietary protein - its role in satiety, energetics, weight loss and health.. Br J Nutr.. 2012. 108. S105-S112.
- Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO.. The Health Benefits of Dietary Fibre. Nutrients.. 2020. 12. 3209..
- Fan, Y., Pedersen, O.. Gut microbiota in human metabolic health and disease.. Nat Rev Microbiol. 2021. 19. 55–71.
- Ciappolino V, Mazzocchi A, Enrico P, et al.. N-3 Polyunsatured Fatty Acids in Menopausal Transition: A Systematic Review of Depressive and Cognitive Disorders with Accompanying Vasomotor Symptoms.. Int J Mol Sci.. 2018. 19. 1849..
- Derbyshire E.. Derbyshire E.. Nutrients.. 2018. 10. 1094.
- Mason RP, Libby P, Bhatt DL.. Emerging Mechanisms of Cardiovascular Protection for the Omega-3 Fatty Acid Eicosapentaenoic Acid.. Arterioscler Thromb Vasc Biol.. 2020. 40. 1135-1147.
- Bailey RL, Zou P, Wallace TC, et al.. Calcium Supplement Use Is Associated With Less Bone Mineral Density Loss, But Does Not Lessen the Risk of Bone Fracture Across the Menopause Transition: Data From the Study of Women's Health Across the Nation.. JBMR Plus.. 2019. 4. e10246.
- Martens PJ, Gysemans C, Verstuyf A, Mathieu AC.. Vitamin D's Effect on Immune Function.. Nutrients.. 2020. 12. 1248.
- Sunyecz JA.. The use of calcium and vitamin D in the management of osteoporosis.. Ther Clin Risk Manag.. 2008. 4. 827-836.
- Jehan S, Masters-Isarilov A, Salifu I, et al.. Sleep Disorders in Postmenopausal Women.. J Sleep Disord Ther.. 2015. 4. 212.
- Gallicchio L, Miller SR, Kiefer J, Greene T, Zacur HA, Flaws JA.. Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women's Health Study.. Menopause.. 2015. 22. 1098-1107.
- Gerrie-Cor M Herber-Gast, Gita D Mishra,. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. The American Journal of Clinical Nutrition. 2013. 97. 1092–1099,.
- Mason RP, Libby P, Bhatt DL.. Emerging mechanisms of cardiovascular protection for the omega-3 fatty acid eicosapentaenoic acid.. Arteriosclerosis, Thrombosis, and Vascular Biology.. 2020. 40. 1135-1147.
- Juul, F., Deierlein, A.L., Vaidean, G. et al.. Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice.. Curr Atheroscler. 2022. 24. 849–860.