Perimenopause is the transitional phase leading up to menopause, when a woman’s body begins to produce less estrogen. It typically starts in our 40’s but can begin earlier, and may last several years. During this time, menstrual cycles may become irregular, and symptoms like hot flashes, mood swings, sleep disturbances, and weight changes can occur. Perimenopause ends when a woman has gone 12 consecutive months without a period, marking the start of menopause.
As women live longer, more are spending a significant portion of their lives in and beyond menopause. Menopause, which typically occurs between the ages of 45 and 55, marks the end of menstruation and fertility. But it also brings a wave of physiological changes, driven largely by a decline in estrogen levels.
But this hormonal shift affects far more than reproductive health. Estrogen plays a powerful role in metabolism, insulin sensitivity, fat distribution, and even appetite regulation.
As estrogen levels fall, many women notice weight gain, especially around the abdomen, along with symptoms like hot flashes, mood swings, and trouble sleeping. These changes also increase the risk for chronic diseases such as type 2 diabetes, cardiovascular disease, osteoporosis, and hormone-sensitive cancers.
While menopause is a natural transition, how you eat can dramatically shape your experience. In fact, small, consistent changes in nutrition and lifestyle can help ease symptoms, reduce long-term disease risk, and improve overall well-being.
Let’s explore the science behind the metabolic changes of menopause, the impact of nutrition, and how you can find evidence-based strategies for symptom relief and long-term health.
The Role of Nutrition in Menopause
Did you know the quality of your diet can help ease the transition into menopause?
The quality of your diet plays an important role in overall health and the prevention of chronic diseases during the transition into menopause. A healthy diet can ease symptoms of perimenopause and menopause while reducing the risk of conditions like cardiovascular disease, type 2 diabetes, obesity, and hormone-sensitive cancers. Research shows that higher intakes of fruits, vegetables, and healthy fats are associated with lower visceral fat mass (the hidden fat beneath the abdominal muscles)—a common concern during menopause.
Menopause and Metabolism
As estrogen levels decline, your basal metabolic rate decreases by 250–300 calories per day, leading to weight gain (as much as 4.4 pounds per year and an average of 1.5 pounds per year!!) and increased abdominal fat. And that’s if you don’t change anything and keep the same lifestyle as before.
That means that to maintain your weight with all other things being equal, you would have to have an energy deficit of 250-300 calories per day. (Either by consuming 250-300 less calories per day, or burning off 250-300 calories more per day.)
You’re Not Crazy…You’re Gaining Weight Without Doing Anything Differently
Obesity rates rise significantly during midlife, with about 55% of women being overweight or obese by age 60.
Also, the decline in estrogen causes changers that directly impacts carbohydrate metabolism and energy balance:
Increased visceral fat (fat stored deep in the abdomen)
Reduced insulin secretion by the pancreas (insulin is needed to shuttle sugar in the bloodstream into our cells for energy)
Lower insulin sensitivity in muscle, liver, and at tissue (so insulin isn’t doing the same job that it used to do in these tissues)
Menopause Timing and Diabetes Risk
Interestingly, when you enter menopause also matters. A large Chinese study found the lowest diabetes risk occurred with menopause between ages 45–49. Women who experienced menopause before 40 had the highest risk, and those with menopause later than 50 were also more vulnerable.
One major driver? Weight gain and changes in body composition (i.e., more fat, less muscle), which often accelerate after menopause.
Strategies To manage Weight During Menopause:
If you’re aiming for weight loss, do so slowly to improve insulin sensitivity (your first goal can be a loss of 5-10% of your current weight)
Ideal weight loss is gradual—0.5 to 1 kg per week—with a total target of 5–10% of body weight.
Reduce your daily calories by ~500-700 calories per day but not below your basal metabolic rate
Focus on smart carbs
Eat at least ~120-130 grams of carbohydrates daily (don’t be scare by that number…this is the minimum amount of carbohydrate necessary for the brain to run optimally…and it runs 24 hours per day. (The brain only runs on carbs and ketones.)
Prioritize whole grains and lower glycemic index carbs like:
Vegetables, fruits, whole grains (quinoa, oats, brown rice, bulgar wheat, barley, wheat berries, bran)
Increase fiber to 30-45 grams daily
This will help support the gut microbiome, which can have a positive effect on metabolism, insulin sensitivity, and insulin secretion.
Research has shown that certain healthy gut bacteria with beta-glucuronidase activity can increase levels of biologically active estrogen in the body, helping to slow estrogen loss and ease menopause symptoms.
Limit added sugars
To <10% of daily calories
Hormonal changes may reduce thirst, so consistent hydration (around 33 mL/kg/day) supports metabolism, thermoregulation, digestion, and skin health. Aim for ~2 liters per day (or around 33 ml/kg/day, per the research).
Menopause and Cholesterol
You didn’t know it, but all those years, estrogen was protecting your heart. It kept your cholesterol, triglyceride levels and blood pressure at bay, kept your blood vessels nice and elastic, helped maintain better blood flow, and quelled inflammation.
That all changes now.
Well, it started to change as soon as estrogen started declining and your risk of cardiovascular disease increased. And the steeper the drop in estrogen, the more your risk increases.
Good news – strict adherence to a healthy diet can reduce the risk of cardiovascular death by 14-28%. So, what does that mean?
Focus on Healthy Fats
-Limit saturated fats to <10% total calories (from red meat, palm oil, butter)
-Replace with PUFAs (polyunsaturated fatty acids) like those found in
- Nuts and seeds (walnuts, almonds, pecans, pistachios, peanuts)
- Olive oil and other vegetable oils
- Fatty fish (sardines, herring, mackerel) – include twicer per week to decrease inflammation and support heart health.
-Fill up on Fiber
- Aim for 30-45 grams of fiber per day to help manage cholesterol levels and support gut health.
- Soluble fiber helps you feel fuller longer, it lowers the amount of cholesterol your liver makes, and it helps your body get rid of cholesterol and bile through bowel movements. Some examples of soluble fibers are:
- psyllium (under brand names, Metamucil, and Konsyl)
- pectin
- wheat dextrin (Benefiber)
- Beans (especially navy, pinto, and black beans)
- Lentils, nuts, and oat products
- Fruits and vegetables – Aim for 5 total servings per day
- Swap out refined gains for whole grains
- Proteins
- Enjoy fatty fish 2-3 times per week
- Swap out animal protein for tofu when possible
Can Soy Help with Menopause Symptoms?
I often get asked if soy is safe to eat during menopause and, if so, how much is safe to eat.
In short, there are many studies for and against soy and other phytoestrogens in the diet. While the isoflavone content of soy can reduce hot flashes and other menopausal symptoms, phytoestrogens can have a negative effect on the treatment of hormone-sensitive breast tumors.
Menopausal symptoms are rarer in countries that eat a lot of soy.
A daily intake of 20-42 mg of soy isoflavones may help reduce menopausal symptoms and may offer protective effects. (That’s about 400 ml of soy milk (a little more than 1 ½ cups) or about 1 cup of tofu/tempeh.
Speak to your physician if have a hormone-sensitive cancer (like breast cancer) or are undergoing anti-estrogen treatment, like Tamoxifen.
The Gut Microbiome and Menopause
I mentioned earlier that the enzyme, beta-glucuronidase, can increase levels of estrogen in the body.
Menopause and perimenopause are often linked to changes in gut health and dysbiosis in the gut (an imbalance of good and bad bacteria). Estrogen levels influence the gut microbiome and then those bacteria reactivate estrogens and phytoestrogens. This helps support hormonal balance.
Dysbiosis can disrupt this process, potentially reducing active estrogen levels and worsening menopausal symptoms. Some symptoms of dysbiosis may include gas, bloating, diarrhea, constipation, frequent colds and infections, yeast infections or UTIs.
How Can You Have a Healthy Gut?
Eat a diet rich in fibers (as mentioned above, aim for 30-45 grams of dietary fiber daily) which will be rich in prebiotic fibers.
Eat fermented foods like sauerkraut, kimchi, yogurt
Probiotics can help strengthen the gut bacteria, reduce inflammation, and promote short-chain fatty acid production. These SCFAs may positively affect metabolism and hormone balance.
Ultimately, we probably aren’t eating enough live cultures daily to enact a benefit on our gut. You’d have to be very strategic in the types and amounts of probiotic-rich foods you consume each day and, even then, it’s not a guarantee that the amount of live cultures originally in the product have survived the trip from production all the way to your gut.
So, taking a probiotic supplement isn’t a bad idea.
Here is a link to my probiotic recommendations
(I receive commission on supplements purchased through Fullscript)
Menopause and Bone Health
As if we didn’t have enough to worry about, osteoporosis and osteopenia are critical concerns during menopause. Osteoporosis is the progressive condition that weakens bones and increases the risk of fractures.
Osteopenia is where the bone mineral density is lower than normal, which means your bones are weaker than they should be and can increase your risk of fractures.
Bone loss begins 1-3 years before menopause and can last 5-10 years. The average rate of bone loss per yea is about 2%, which can result in a 10-12% decrease in bone mineral density in the spine and hip.
Nutrition Prescription for Menopause and Prevention of Osteoporosis
Ensure adequate intake of vitamin D. We get most of our vitamin D from sun exposure, but if you’re fully covered in the sun, wear sun protection (which you should) or aren’t outdoors during the prime sun months, supplementation is essential, especially as the body’s ability to convert vitamin D decreases with age.
And about 80% of dietary vitamin D is absorbed in the small intestine, so those with digestive diseases.
Clinical studies show that osteoporosis treatments are up to 30% less effective without proper vitamin D levels.
- Vitamin D: 2,000 IU daily during months of low UV-B exposure (will likely need from a supplement as it’s difficult to get this much with food alone).
- Foods sources: egg yolks, dairy products, liver and fortified foods, like Vitamin D fortified orange juice.
- Calcium should come from a balanced diet and not supplements, as supplements can affect cardiovascular risk.
- Calcium is absorbed better when your vitamin D levels are adequate, but it can be improved by acidic foods (like orange juice fortified with calcium), or other foods eaten together with calcium-rich foods.
- Calcium: the RDA for menopausal women (from the age of 51) is 1,000-1,200 mg per day.
- Food sources: dairy products (the most absorbable form), mineral-rich water (and hard water), canned fish with soft bones (like sardines or anchovies), calcium-fortified foods, leafy greens and seeds.
- Protein: adequate, but not too much, is recommended for muscle mass preservation and metabolism.
- .8 – 1.2 grams of protein per kg of body weight per day. (That’s about 55-80 grams of protein per day for a 150-pound woman)
- Vitamin C: Supports collagen formation in bones.
- You can easily get the 100 mg/day needed through foods like citrus fruits, berries, bell peppers
- B vitamins: support the nervous system and reduce homocysteine levels, which are linked to stroke and osteoporosis
- Gut microbiome: a healthy gut microbiome can enhance vitamin absorption.
Sleep and Nutrition During Perimenopause and Menopause
We finally get some sleep after our babies grow up and then you start popping up at 4:30 am when everyone else in the house finally sleeps! (Or is that just me?)
Well, it’s not just me because roughly 50% women experience sleep disturbances during perimenopause and menopause.
Inadequate sleep (less than 7 hours) (really, only 7 hours?!) is linked to increased risk of cardiovascular disease, obesity, diabetes, and even early mortality.
Sleep deprivation affects energy intake, glucose uptake, and leptin resistance. Sleep and the circadian rhythm affect appetite, nutrient absorption, metabolism, and upset digestion.
Menopause-related sleep challenges are tied to hormonal shifts, but diet can play a big role in improving sleep quality. Foods that contain melatonin can directly affect sleep. Tryptophan is a precursor of melatonin and foods high in tryptophan can help improve your sleep. And conversely, the quality of sleep deteriorates with a reduced intake of tryptophan.
- Tryptophan: found in eggs, fish, soy, sesame and pumpkin seeds, spirulina, cheese, and shellfish.
- Melatonin: found in tart cherries, strawberries, grapes, nuts, and fish.
- Vitamins and trace elements that act as cofactors in melatonin synthesis: folic acid, vitamins B6 and B12, magnesium, and zinc. Adequate (not more) intake of these is necessary for good sleep.
A regular eating schedule (every ~4 hours or so) and good sleep hygiene practices, along with smart tools, like sleep trackers, can help you get better rest!
Navigating perimenopause and menopause involves significant hormonal shifts, primarily a decline in estrogen, which impacts metabolism, weight, and chronic disease risk. Strategic dietary choices can alleviate symptoms like hot flashes and mood swings, mitigate weight gain, and reduce the risk of conditions such as type 2 diabetes, cardiovascular disease, and osteoporosis. By focusing on smart carbohydrates, healthy fats, ample fiber, and key nutrients, women can proactively support their well-being, manage metabolic changes, enhance gut health, strengthen bones, and improve sleep quality throughout this natural life transition.