Best Diet for Perimenopause: What Foods Should You Eat?

Written by: Jennifer Chesak, MSJ
Medically reviewed by: Nesochi Okeke-Igbokwe, MD, MS

Perimenopause, aka the menopause transition, can usher in symptoms ranging from hot flashes and night sweats, to changes in body composition, to mental health and cognitive concerns. What you eat can influence how you feel, help ease symptoms, and support overall health. But an effective perimenopause diet should be sustainable and nutrient dense, not restrictive.

If you’re in your 40s, you might be missing ’90s grunge, spending time on AOL Instant Messenger, and maybe even a life without smartphones. And, oh yeah, you might also be in perimenopause, the time leading up to menopause (when you’ve had an absence of a period for a full year).

Perimenopause, though it usually starts in one’s mid-40s, might show up earlier. It lasts anywhere from four to 14 years. And it may bring about symptoms—such as weight changes (including around the abdomen), hot flashes, and mood swings, just to name a few—that impact your quality of life. Several treatments can help address menopause symptoms, as can lifestyle changes, such as diet.

But a diet for perimenopause should never involve restriction, deprivation, or unsustainable practices; none of these things are effective. So what’s the best diet for perimenopause? 

No singular eating strategy is perfect for this midlife trajectory, as everyone has individual needs. However, some key nutritional tenets that support your metabolic health can help you build the perimenopause eating strategy that’s right for you. Let’s dive in.

HOW DIET SUPPORTS YOU IN PERIMENOPAUSE

We all generally know the basic benefits of eating a healthy diet, such as potentially living longer while feeling good and having more energy. But what’s less clear is what eating a healthy diet means and why and how certain nutrients can support you through perimenopause. Here are a few considerations.

Stabilize blood sugar for reduced cravings and energy dips

In response to food intake, glucose (blood sugar) increases. A glucose rise in the bloodstream triggers the pancreas to release insulin, a hormone that signals your cells to uptake glucose to either be used for energy or stored for later.

The specific nutrient makeup of the foods you consume dictates how much and how fast glucose enters the bloodstream, and therefore the extent of the glucose rise you experience. Frequent glucose elevations (blood sugar spikes) trigger the need for more insulin. The body can then overcorrect with an insulin surge, causing your blood sugar to drop (aka crash) within hours of eating, leading to an energy slump. 

Postprandial reactive hypoglycemia, the clinical term for blood sugar crashes that occur after eating, can lead to cravings for more blood-sugar spiking foods to make you feel better quickly. A crash can also lead to mood swings and fatigue and even contribute to additional menopause symptoms, including hot flashes and weight changes. (See the next two sections, respectively.)

Eating for more stable blood sugar helps prevent the vicious cycle of spikes and crashes, leaving you feeling better in the long run. It also helps counteract insulin resistance, which is when frequent insulin surges and hyperinsulinemia (high insulin) make your cells resistant to insulin’s signal. Over time, insulin resistance leads to high blood sugar, which can cause prediabetes and type 2 diabetes. 

Your estrogen level declines significantly by the time you reach menopause. This puts you more at risk for insulin resistance, and dietary strategies can help you maintain your insulin sensitivity. 

Manage vasomotor symptoms 

Vasomotor symptoms—those related to the constriction or dilation of blood vessels—include hot flashes and night sweats. These symptoms affect about 85% of people who go through the menopause transition. Your brain’s hypothalamus regulates your body temperature. But hormonal changes, specifically fluctuating and then eventually declining estrogen and increasing follicular stimulating hormone (FSH), may disrupt the brain's ability to adjust to minor temperature changes.

Although more research is needed, studies suggest that hyperglycemia (high blood sugar) and hyperinsulinemia can contribute to worsened vasomotor symptoms—yet another reason to eat  for more stable blood sugar, which may help.

Counteract visceral fat gain

The hormonal changes during the menopause trajectory can also impact your body composition, leading to adiposity (fat tissue) gain and muscle loss, often with fat accumulating in the midsection. Body composition changes in this life stage can be frustrating—and not just because they might impact self-esteem.The type of adipose tissue people tend to gain in perimenopause is visceral fat, which surrounds and insulates your internal organs. The result is often referred to as “menobelly” or “cortisol belly.”

Although you need some visceral fat to support overall health, an excess amount puts you at risk for type 2 diabetes, cardiovascular disease, and more. Meanwhile, the menopause trajectory itself can put you more at risk for these conditions. Dietary strategies can help reduce or counteract visceral fat increases.

Preserve lean muscle and your metabolic rate

In addition to increases to adiposity, perimenopause can also put you at risk for muscle loss. Unless we do something about it, such as resistance training, we naturally lose muscle mass as we age. Hormonal changes during the menopause trajectory hasten this muscle loss. Specifically, the loss of estrogen may contribute to declines in skeletal muscle development and regeneration, and the loss of progesterone may impair protein synthesis, which is necessary for boosting muscle mass. 

Additionally, fat gain and lean mass loss can lower your metabolic rate, how many calories you burn at rest. And the opposite is true: More muscle mass can increase your metabolic rate. You can help build and preserve muscle via resistance training and adequate protein intake.

Support bone, heart, and gut health

Dietary changes also help support several other aspects of health that can become compromised during the menopause transition.

• Bone health: People can lose up to 20% of bone mass by the time they reach postmenopause. But optimal nutrition and physical activity can help us maintain strong bones.

• Heart health: Cardiovascular health can also take a hit during menopause, putting you more at risk for high cholesterol, high blood pressure, and heart diseases. Eating a heart-healthy diet can support your cardiovascular health.

• Gut health: You may not think of perimenopause as playing a role in your gastrointestinal (GI) tract, but hormonal changes directly affect gut health, which can put you more at risk for GI symptoms, such as bloating, constipation, diarrhea, gastroesophageal reflux disease (GERD), and more. However, nutritional changes can support your gut health.

6 CORE NUTRITION PRINCIPLES FOR PERIMENOPAUSE

Again, no specific diet is the right one for perimenopause, because needs and tastes vary. But certain core nutrition tenets can serve as the foundation for any perimenopause diet strategy.

1: Prioritize protein

“I would recommend eating a well-balanced and well-rounded diet that is heavy on protein,” says Jaime Knopman, MD, board-certified reproductive endocrinologist, and member of the Veracity doctor team. “As women age, we lose muscle and therefore we need extra protein.”

Protein, in combination with resistance training, helps build and preserve muscle and even supports hormonal health, since you need protein to make hormones. 

Protein needs vary, but the minimum amount the body requires to function is about 0.4 grams of protein per pound of body weight per day. But experts say that may not be enough and that aiming for 0.6 to 1 gram of protein per pound of body weight is more ideal.

A good rule of thumb is to try to consume about 30 to 40 grams of protein per meal and at least 10 to 20 grams per snack to meet your protein goals for the day.

2: Make friends with fiber

When considering foods for perimenopause, those with fiber are key. Fiber delivers multiple benefits during perimenopause and beyond. Eating fiber helps slow the absorption of glucose into the bloodstream, which can blunt potential blood sugar spikes. It’s also filling, helping you stay satisfied for longer after eating.

Much of the fiber you eat passes through your GI tract largely undigested or absorbed. This has several benefits, including bulking your stool for more regularity. But also, once fiber reaches your large intestine, it feeds your microbiome, the community of microbes living in your gut. 

Certain gut bacteria then ferment fiber, producing beneficial compounds called short-chain-fatty acids (SCFAs). SCFAs then activate cells that produce glucagon-like peptide-1, a hormone that aids with stabilizing blood sugar, counteracting insulin resistance, and helping you feel fuller longer. Fiber also helps keep cholesterol levels in check.

Aim for at least 30 to 45 grams of fiber per day by consuming a variety of fruits, vegetables, and whole grains.

3: Heap on the healthy fats

Outdated nutrition advice, especially from before the new millennium, often vilified fat. But not all fat is created equal. Healthy fats are necessary for hormonal health, heart health, and overall health. 

Omega-3 fatty acids, for example, are polyunsaturated fatty acids (PUFAs) with anti-inflammatory properties. Dr. Knopman recommends going heavy on anti-inflammatory foods. “They can help reduce inflammatory mediators that are frequently elevated in the body as women age,” she says.

Consumption of omega-3s during the menopause trajectory is also associated with reduced symptoms of depression, a mental health condition that can worsen or develop during perimenopause.

4: Increase calcium and vitamin D

“We need to maintain a well-balanced diet and take in enough calcium and vitamin D,” Dr. Knopman says. These micronutrients are crucial for bone health.

Experts recommend increasing calcium intake from 1,000 milligrams per day to 1,200 milligrams, especially in postmenopause. As for vitamin D, aim for 600 IU per day until age 70, when you should increase to 800 IU.

5: Abstain from alcohol

Alcohol can have a negative impact on your health for numerous reasons. For one, it shares links to cancer development, including breast cancer, for which aging already increases risk.

“Additionally, alcohol can disrupt cell cycles and increase chronic inflammation,” Dr. Knopman says. “Alcohol can also lead to sleep disturbances, and sleep disturbances are a big problem during perimenopause.”

Although the occasional drink is unlikely to cause lasting harm, reducing alcohol consumption is a good idea.

6: Limit ultra-processed foods

You may be wondering which foods to avoid in perimenopause. “Ultra-processed foods are linked to many serious health problems that become more prevalent when women are perimenopausal,” says Dr. Knopman. “They can also increase inflammatory mediators in the body which fuels inflammatory disorders.”

Although the occasional favorite snack or treat isn’t a concern, overconsumption of ultra-processed foods is linked to heart issues, sleep issues, and worsened menopause symptoms, such as hot flashes and night sweats. Stick to whole foods and minimally processed items as much as possible.

SMART MEAL TIMING AND STRUCTURE 

Some meal-timing strategies can also help you build a diet that’s right for you while navigating perimenopause. Consider the following:

• Aim for a protein-rich breakfast: Try to get 20 grams or more of protein to start your day. 

• Pair carbohydrates with key nutrients: Protein, healthy fats, and fiber can all help slow the absorption of glucose into your bloodstream, mitigating blood sugar spikes and crashes.

• Avoid late-night eating: Eating your last meal a bit earlier in the evening and then fasting throughout the night can give your pancreas a break from producing insulin, which can help you maintain insulin sensitivity. Aim to stop eating two to three hours before bed.

• Try intermittent fasting: If you want to give your pancreas even more of a break, intermittent fasting can help. One method is to eat your daily meals within an eight- or 10-hour window and fast for the remaining 16 or 14 hours.
  
  

SAMPLE 3-DAY PERIMENOPAUSE DIET PLAN

To give you an idea of a perimenopause diet plan, we built a three-day sample menu of three meals and one snack per day.

Day 1:

• Breakfast: Greek yogurt, berries, 1 tablespoon ground flax and walnuts

• Lunch: Lentil-quinoa bowl, roasted broccoli, tahini-lemon drizzle

• Snack: Edamame or cottage cheese

• Dinner: Salmon, farro, sautéed greens
  
  

Day 2:

• Breakfast: Veggie omelet, avocado, whole-grain toast

• Lunch: Tofu stir-fry, brown rice, mixed vegetables

• Snack: Apple and peanut butter

• Dinner: Turkey chili with beans, side salad
  
  

Day 3:

• Breakfast: Overnight oats (chia, soy milk, cinnamon)

• Lunch: Sardine salad on whole-grain crackers, cucumber and tomatoes

• Snack: Hummus and carrots

• Dinner: Chicken thigh, roasted Brussels sprouts, sweet potato
  
  

EVIDENCE-INFORMED SUPPLEMENTS FOR PERIMENOPAUSE

Some nutritional supplements can also be beneficial in perimenopause. Here are a few to consider under the guidance of your healthcare provider. They’ll help you navigate any potential medication interactions or concerns with underlying conditions.

General supplements

• Vitamin D and calcium: Both are crucial for bone health. So if you aren’t getting enough from diet, supplementation may be necessary to correct deficiency.

• Omega-3 fatty acids: If your diet is low on nuts, seeds, and fatty fish, a supplement can help you meet your needs.

• Magnesium glycinate: This form of the essential mineral can help improve sleep quality and reduce muscle tension.

• Iron or B12: If your provider finds that you are low on either of these micronutrients, supplementation may help, which can then help reduce fatigue.

Options from Veracity

Veracity has several supplements for supporting you through perimenopause. These include:

• Perimenopause Support: An antioxidant-rich formula to promote estrogen balance and ease menopause symptoms

• Metabolism Ignite: Formulated to boost your natural production of the hormone GLP-1 and to support metabolic health

• Perimenopause Protocol: Four supplements that help relieve symptoms and support overall metabolic health
  
  

TRAINING AND MOVEMENT TO PAIR WITH DIET 

Diet is a strong tool for navigating perimenopause, but nutritional changes work best in combination with other healthy lifestyle habits, such as engaging in physical activity.

“I am a huge fan of exercise,” Dr. Knopman says. “And what I have learned as a woman who is perimenopausal herself, and has gone through many different exercise regimens, is that strength training is where it is at. Hardcore cardio all day every day is not the way to stay fit at our age.”

She emphasizes that it’s a myth that lifting heavy weights will make you bulky. Instead, she says, “It will build lean body muscle, increase your metabolism, and protect your bones. Additionally it helps prevent falls and builds stability.” Fall risk increases with age.

KEY TAKEAWAYS

• No one particular diet is best for perimenopause.

• However, some key nutritional strategies can help support you through this midlife transition and beyond.

• Prioritizing fiber, protein, healthy fats, and adequate levels of micronutrients, and eating mostly whole foods can help.

• Some supplements can help support your metabolic health so you can maintain your energy levels and mitigate perimenopause symptoms.
  
  

FREQUENTLY ASKED QUESTIONS (FAQS)

What is the best diet for a perimenopausal woman?

No one particular diet is best for perimenopause. However, some key nutritional strategies can help support you through this midlife transition and beyond. Prioritizing fiber, protein, health fats, and adequate levels of micronutrients, and eating mostly whole foods can help.

What foods should be avoided during perimenopause?

A diet during perimenopause should feature a sustainable eating pattern that prioritizes adequate nutrition. However, reducing or eliminating intake of ultra-processed foods, refined carbohydrates, and alcohol helps support your health through the menopause transition and beyond.

What is the best way for a perimenopausal woman to lose weight?

If you’re trying to lose weight in perimenopause, eating a healthy diet, upping protein intake, and prioritizing strength-training can all facilitate healthy body composition changes, such as fat loss and muscle gain.

What vitamin deficiency is associated with perimenopause?

Several vitamin and mineral deficiencies, including magnesium and calcium and vitamin B12, are common during perimenopause.