Nutrition During Perimenopause: What You Should Know

When most people hear the word perimenopause or menopause they think of declining estrogen and the end of fertile years. While yes, this is a big part of the menopausal period, menopause is a whole-body transition not just a reproductive shift. Today we are going to unpack what goes on during the transition into menopause and nutrition and lifestyle interventions to support overall health, prevent disease, and help you thrive in midlife. 

The Menopausal Transition: Perimenopause To Menopause (1) 

Age 40-44: 

Menstrual Patterns: Periods may be regular or start to become irregular.

Hormonal Changes: Decline in progesterone; symptoms may be mild or absent. 

Age 45-50: 

Menstrual Patterns: More pronounced irregularity in periods. 

Hormonal Changes: Continued decline in progesterone and erratic estrogen levels. 

Symptoms: Common symptoms include hot flashes, painful sex, UTIs, anxiety, brain fog, depression, and insomnia. 

Early 50s: 

Hormonal Changes: Both estrogen and progesterone levels are very low. Health Considerations: Potential decline in metabolic health. 

Mid-50s: 

Health Impact: Worsening metabolic health; risk to overall health span.

What Do I Mean By Worsening Metabolic Health (1)? 

Metabolic health is the state of your body’s metabolic processes and how well they function. Several factors are taken into account such as: 

A waist circumference of less than or equal to
35 inches (89 cm) for women and less than or equal to 40 inches (102 cm) for men

Fasting blood glucose of less than or equal to 100 mg/dL

Systolic blood pressure less than 120 mmHg & diastolic blood pressure lower than 80 mmHg

Triglycerides less than 150 mg/dL

HDL (good) cholesterol of 50mg/dL in women and above 40mg/dL in men

A 2019 study found that only 12% of Americans are metabolically healthy (2), meaning 88% of us check 3 or more of these factors. 

Note: you can be skinny and still be metabolically unfit! 

Why Are Perimenopausal Women More Likely To Deal With Poor Metabolic Health Compared To Pre-menopausal Women (1)? 

The answer: Declining sex hormones (estrogen, testosterone, progesterone)! 

When someone says estrogen most of us automatically think of reproduction but estrogen also has many other roles in the body, for example: 

Estrogen plays a role in energy production. As estrogen levels drop during perimenopause, mitochondrial function is impaired (going back to high school biology, mitochondria is the powerhouse of the cell), which leads to reduced energy flow to the brain and muscles. This decline can result in brain fog, and decreased muscle mass and strength.

Lower levels of estrogen affect insulin sensitivity, making it harder for the body to regulate blood sugar. This can lead to increased cravings and a higher risk of weight gain and risk of diabetes. On top of this, declining estrogen can lead to worsened inflammation and a weakened immune response.

Estrogen is essential for maintaining healthy cholesterol levels and supporting a balanced gut microbiome, which is important for digestion and overall health. A decrease in estrogen can disrupt this balance, contributing to digestive problems and further weight gain.

After learning about some of the various roles estrogen plays in the body, you might think, “I should just replace the sex hormones I'm losing with hormone replacement therapy.” While hormone replacement therapy can be beneficial and should be considered when possible, it shouldn’t be the only strategy implemented for women who want to optimize their health during midlife. Hormones do not act in a vacuum, yes, hormones support your body’s health but they need a healthy body to do so. The foundations of nutrition, movement, stress reduction, and other areas need to be addressed before or with starting any medical approaches to hormones. 

Let’s Get Into The Basics (1) 

During perimenopause, many women see changes like a thicker waist or weight gain, or they might feel weaker and less energetic. They start to notice that the diet and lifestyle choices that once worked to keep weight in check are suddenly not as effective anymore. 

In response to these unwanted changes, many women adopt a "less is more" approach to food, reducing calorie intake and sometimes cutting back on food groups, most commonly fats. Simultaneously, they often increase exercise, particularly cardio, hoping to "burn off" calories. The combination of eating less and exercising more can lead to exhaustion and intense cravings for quick energy sources, such as caffeine and processed carbs. Ultimately, this cycle leads to harm by breaking down muscle, promoting fat storage, and tanking energy. To improve health, support weight, and keep lean muscle mass during perimenopause, women need to switch the focus from counting calories to meeting macronutrient needs!

Nutrition: The Specifics (1) 

Nutrition is the biggest lever you can use to promote good metabolic health.  

Let’s get into macros! 

Carbohydrates: as women's estrogen and hormonal rhythms decline and change, their ability to process carbohydrates, even from healthy sources such as unprocessed or minimally processed whole grains, vegetables, fruits, and beans, is affected.

To combat this change we need to find your carb threshold: 

The average American eats around 300 grams of carbohydrates per day. Based on this number, a "low-carb" diet would be anything less than 150 grams per day. Although this may be a good place to start, the actual amount of carbs you eat needs to be tailored to you as an individual and based on your metabolic flexibility, body composition, and activity level. 

Protein: As we age, our body's ability to synthesize protein and make muscle drops (called anabolic resistance). On top of this, hormonal fluctuations during perimenopause cause our body to favor fat storage over muscle growth. So how do we support muscle growth and repair? We need to eat more protein than we did when we were younger. 

Women often tend to eat less protein at breakfast, slightly more at lunch, and the largest amount at dinner. This uneven distribution can lead to anabolic resistance and negatively affect appetite control, satiety, gut health, and weight management. 

Our muscles are most receptive to protein in the morning after an overnight fast. To maximize the benefits of dietary protein, midlife women should aim to distribute their protein intake evenly across meals. It's recommended to consume at least 30-35 grams of protein at each meal to meet increased needs.

Fat: Consider fat as a lever you can tweak up or down as your health, needs, and goals require. As a guideline try to get around 60% of your protein goal in fat. So if you eat 100 grams of protein eat 60 grams of fat. Note: fat does not make you fat, dietary fat is super important for health! The body needs fat to make hormones! 

Okay so now that we are eating a balanced diet, what about lifestyle? 

Sleep & Stress

Perimenopause is notorious for causing sleep disruptions and an increased stress response. As progesterone declines, the quality of sleep seems to disappear, and anxiety and mood shift increase. Progesterone is a natural mood stabilizer that increases the production of GABA, a neurotransmitter that promotes sleep and mood by increasing feelings of relaxation and well-being. Here are some basic ways you can support quality sleep and lower your stress response.

Sleep Support: balance blood sugar, turn off screens close to bedtime, get sunlight in the morning, stop eating 3 hours before bed, sleep in a dark cool room, and practice a wind-down routine. 

Stress support: eat enough calories, do not overtrain, practice a mindfulness routine (journal, prayer, meditation, yoga, walking), get outside, take deep breathes, limit caffeine and sugar, stay hydrated   

Exercise (1) 

As we talked about earlier, aging and fluctuating hormones cause an increase in the loss of muscle mass and strength. Even if you are meeting your dietary protein goal, if you are not exercising you are still going to lose muscle. Basically, if you do not use and maintain your muscle you will lose it! 

While walking is great for stress reduction and mood support, during midlife to protect muscles and support muscle growth and bone health women need to lift weights! 

Working with a personal trainer or joining a group class geared towards weight lifting is a great way to build community and muscle! 

TLDR:

Perimenopause is not just a shift in reproductive health but a whole-body transition. To best support overall health, prevent disease, and thrive in midlife the foundations of nutrition, exercise, stress, and sleep need to be addressed.

References: 

1. Johnson, Kristin, et al. The Great Menopause Myth: The Truth on Mastering Midlife Hormonal Mayhem, Beating Uncomfortable Symptoms, and Aging to Thrive. Fair Winds Press, 2024. 

2. Araújo, Joana, et al. “Prevalence of optimal metabolic health in American Adults: National Health and Nutrition Examination survey 2009–2016.” Metabolic Syndrome and Related Disorders, vol. 17, no. 1, 1 Nov. 2019, pp. 46–52, https://doi.org/10.1089/met.2018.0105.