A good diet for the perimenopause can help you through the symptoms and risk of menopause. Going through the menopause is a serious life event that 50% of us will go through, and yet there is much less of a conversation around the menopause and perimenppause than puberty and pregnancy. The menopause can bring altered health risks for a variety of conditions that we should be aware of. Many of these risks can be managed with lifestyle measures, alongside medical support and screening, where necessary. Moreover, the menopause can come with some less-than pleasant side effects that you may wish to find relief from. Starting work on this during perimenopause will help.
Before reading on, why don’t you take my Food Freedom Quiz to help you understand your relationship with food and where to focus your work.
What are the symptoms of the peri/menopause?
The perimenopause comes with a variety of symptoms, working on a good diet for perimenopause can help . Some you may experience only briefly, others may last for longer time periods. Symptoms include:
- Gradual loss of periods, periods need to have been absent for 1 year for the menopause to have been reached.
- Mood changes, including mood swings
- Brain fog
- Headaches and/or migraines
- Heart palpitations
- Muscle aches
- Hot flashes
- Issues with sleeping
- Dry skin
- Vaginal dryness and itching
- Changes to your pelvic floor
- Loss of sex drive
You may experience different symptoms at different times, and you won’t necessarily experience all of these symptoms either. Knowing what to expect may help you to feel more in control.
What risks change with the menopause?
Going through the menopause means a change in the way certain hormones operate. Notably, oestrogen levels drop. This starts occurring during the peri menopause and continues for some time afterwards. Oestrogen performs a variety of functions, including having a protective effect against heart disease and supporting bone health. Cholesterol levels can be managed by oestrogen, which is why the risk of cardiovascular disease increases as oestrogen levels decrease. The risk of developing high blood pressure also increases with age, which also increases heart disease risk.
From around our mid-thirties, calcium levels in the bones can start to decrease. The decrease in oestrogen leads to calcium levels dropping more quickly. Because of this, osteoporosis risk increases.
Your body may also require less calories each day. This may mean that if you continue to eat your normal amount of food that you see some weight gain. This isn’t a risk factor on it’s own, but it may be worth being aware of changes in your body to help work out the amount of food that feels right for you.
What is a good diet for the perimenopause?
When considering a good diet for the perimenopause, you need to make sure you’re getting all the right nutrition. Your body starts going through many changes during the perimenopause, and so it needs a little extra of things like protein, omega-3 fatty acids, calcium and fibre. Caffeine and alcohol may both exacerbate symptoms, so try adjusting your intake to see if it reduces your symptoms at all.
Increasing protein intake can help prevent the loss of muscle mass, which starts to decrease during perimenopause. It can also help in regulating appetite, blood sugar levels, and maybe even in balancing your hormone levels. Eat protein rich foods across the day (in all three meals and a snack) for best effect – try nut-butters on toast, beans or lentils added to your dinners, or chicken salad for lunch.
Omega-3 fatty acids are important for perimenopausal health. They include EPA and DHA, found in fatty fish. Omega 3’s may help regulate your hormone levels and reduce some symptoms such as mood swings, hot flashes. Omega 3’s can also reduce the risk of heart disease, reduce inflammation (which could help with any joint pain) and aid blood pressure control. Further benefits of omega 3’s include helping the body to absorb calcium, great for those bones. Also they can reduce the risk of cognitive decline, which can be a concern in perimenopause.
Perimenopause can also increase your risk of heart disease and osteoporosis. Let’s take a look at bone and heart health in a bit more detail.
Bone health and a good diet for the perimenopause
At about 35 years of age, it is common to slowly lose calcium from our bones, and the loss of oestrogen during menopause increases the loss rate. This can increase the risk of osteoporosis. A well-balanced diet can support bone health, especially sources of vitamin D and calcium. Calcium is one of the main minerals that is used to make our bones. It is recommended to have 2-3 sources of calcium each day, such as:
- 200ml milk and calcium-fortified alternatives
- 30g cheese
- 150g yoghurt and calcium-fortified alternatives
- Tofu, especially “calcium-set” forms (e.g. certain non-organic firm tofu brands)
- “Bony” fish, like sardines
- Leafy greens
Although vitamin D can be found in food sources, such as egg yolks and some mushrooms, sunlight and supplementation is recommended. Between October and March, it is recommended to take a daily vitamin D supplement as UV levels in the UK are too low during winter for us to be able to synthesise vitamin D ourselves. If you have a darker skin tone, wear modest clothing or spend most of your time indoors then you may also wish to supplement during the summer months. Vitamin D works alongside calcium to support bone health.
Additionally, taking weight-bearing or resistance exercise can support bone health. This includes walking, dancing, running, yoga and weight lifting.
Heart health and a good diet for the perimenopause
After the menopause, women lose the protective benefit of oestrogen against heart disease, so a heart-healthy lifestyle can help to protect your health. A good diet for the perimenopause can help to lower cholesterol levels as well as your blood pressure, which can reduce your risk of developing heart disease.
- Reduce your intake of saturated fats and swap them for unsaturated. This includes butter, coconut oil, fatty and red meat and baked goods. Instead, choose lean cuts of meat, use an unsaturated fat to cook with (like olive oil) and try grilling instead of frying.
- Include sources of omega-3 fatty acids. The main recommendation is to have two portions of oily fish per week. If you are vegetarian you might wish to include an algal omega-3 supplement and/or plant based omega-3s, such as flaxseed, chia seeds and walnuts.
- Include sources of fibre. This includes fruits and vegetables, nuts and seeds, pulses and wholegrains. Aim for around 30g per day.
- Reduce salt intake. I have lots of tips on how to do so on my blog and Instagram. You can also buy my book, The DASH Diet for a 21-day plan to reduce your blood pressure. Easy wins are aboiding processed foods like ready meals. Cooking from scratch helps you know exactly how much salt is in your food.
- Reduce your intake of refined sugars – less sweets, cakes and sugary soft drinks
- Eat more fruit and vegetables, for all the vitamins, minerals, fibre, and other nutrients such as antioxidants. All these help protect your heart. Make sure you’re getting at least 5-a-day, with a good mix of fruit and veg or different colours. Remember, all types can count, whether its fresh, frozen, canned, dried or juiced.
Phytoestrogens and the menopause
Phytoestrogens are plant compounds similar in structure to oestrogen. They may have a mild oestrogen-like effect if eaten in sufficient quantities. Sources of phytoestrogens include flaxseeds and soy products.
In countries where soy products are consumed daily, menopause symptoms such as hot flashes are reported at significantly lower rates than in the UK (1). However, the evidence on the effectiveness of phytoestrogens against menopause symptoms is limited, with a meta-analysis finding that multiple studies showed limited benefit of using phytoestrogens over a placebo.
Many sources of phytoestrogens can be consumed as part of a balanced diet, and so if you enjoy them, then they can be a good choice to include regardless of any phytoestrogen benefit. Soy is a source of lean protein, which can support muscle mass. It may also reduce cardiovascular disease risk, and as a source of calcium, can support bone health.
Flaxseeds contain omega-3 fatty acids, which are also supportive of heart health.
Herbal remedies for the menopause
There are a number of supplements and herbal remedies recommended for the menopause. However, these have limited evidence behind them. Although herbal remedies are considered “natural”, this does not mean risk-free. You may with to speak to your GP, dietitian or a pharmacist first, especially if you are on any medication.
- Black Cohosh: Black cohosh is a herb widely used to relieve hot flashes, night sweats, mood swings, and sleep disturbances commonly experienced during menopause.
- Red Clover: Like flaxseeds, red clover contains compounds similar in structure to oestrogen and so is thought to have oestrogen-mimicking effects. A meta-analysis (2)found a slight improvement in hot flashes but reported that most studies on red clover and menopause symptoms were poor quality.
- Dong Quai: Also known as Angelica or female ginseng. Dong quai has been used in traditional Chinese medicine for centuries for a variety of uses including menopause symptoms. It is thought to enhance blood flow to the pelvis and have an oestrogen-like effect.
- Evening Primrose Oil: Evening primrose oil is rich in gamma-linolenic acid (GLA), an omega-6 fatty acid. This supplement may help reduce breast pain, irritability, bloating, and other physical symptoms associated with menopause.
Although many of the foods and supplements listed contain compounds that may act like oestrogen, this does not mean they can replace HRT. Foods and supplements will contain varying amounts of these compounds and will not be able to have a guaranteed or regulated level of phytoestrogens. Choosing to go on HRT (or not!)
Disordered Eating in the Perimenopause
A good diet for the perimenopause needs an emphasis on nutritious foods but this should not come at the expense of food enjoyment. The menopause can lead to some changes in body shape and weight distribution. As in puberty, when the body changes, this can cause anxiety and provoke a response of wanting to diet or restrict certain food. In the Dietitian UK clinic we have seen this lead to a rise in disordered eating patterns and even eating disorders.
Following the below tips can help with the changes you may notice in your body composition and help your relationship with food:
- – Build in more resistance based exercise. Using resistance bands and light weights along side body weight exercises such as squats and lunges can help build muscle. This benefits your metabolism. So try switching your exercise routine.
- Follow the tips for a good diet for perimenopause as outlined in this blog. Switching from saturated fats to unsaturated, increasing your protein intake and fibre and including plenty of diversity in your meals will help.
- Take time to work on your relationship with your body and food. This could be in the form of writing in a journal, having some talking therapy and nutrition sessions or learning more through books and podcasts.
The bottom line
Regular movement and exercise, especially resistance-training is easily overlooked, but can be an important part of wellbeing after the menopause. Finding movement that you enjoy can help to make this more sustainable and something you look. forward to! With a few adjustments towards balanced eating habits and an active lifestyle, women can navigate through the challenges of perimenopause with greater ease.
At Dietitian UK we can help support you through this stage of life. You can work with Priya or Elle, get in touch and we would love to help.
- Li L, Lv Y, Xu L, Zheng Q. Quantitative efficacy of soy isoflavones on menopausal hot flashes. British journal of clinical pharmacology. 2015 Apr;79(4):593-604.
- Ghazanfarpour, M., Sadeghi, R., Roudsari, R.L., Najmabadi, K.M. and Khadivzadeh, T. Effects of red clover on hot flash and circulating hormone concentrations in menopausal women: a systematic review and meta-analysis. Avicenna journal of phytomedicine, 2015