Written by Sandra Mikhail, Founder and Director of Nutrition A-Z
Perimenopause is the transitional period before menopause when a woman’s body gradually begins producing less eostrogen and progesterone, leading to hormonal fluctuations.
It typically begins in a woman's 40s but can start as early as the mid-30s, lasting anywhere from a few months to over a decade, with an average duration of around four years. To be completely frank, I may be entering this new chapter and I feel it may be a long one...
Symptoms of perimenopause are many, but ones that are features include irregular periods, hot flushes, mood changes, sleep disturbances, and weight gain. If I had to cluster other symptoms based on what I've seen in clinic and what the research shows, they would include:
Since hormone levels fluctuate day-to-day, it can be tricky for doctors to pinpoint exact changes. Lab tests aren’t always conclusive, so they often rely on symptoms to guide diagnosis.
Instead of pathologising perimenopause as a problem to be fixed, I believe it’s about reconnecting with your body during this transitional phase and equipping yourself with the knowledge to manage any challenges that arise along the way. Where do I come in? Let's break down the nutritional and lifestyle considerations you should take note of:
Look at your "Macros" differently
Your Micronutrient Needs
Phytoestrogens
Isoflavones in Soy and Flaxseed: These plant-based compounds mimic oestrogen in the body and may help regulate extreme hormonal fluctuations. Though evidence is mixed, moderate soy consumption (tofu, edamame, miso) might reduce hot flushes and improve bone density. However, effects are generally mild. Nevertheless, including soy is definitely worth a try!
Gut Health and Fibre
If you've missed our blog post about the Female Gut, then head on over and have a read because it explains a lot when it comes to fibre. You will need to adjust your fibre intake depending on your gut symptoms and general digestive health. Also, since the gut microbiome plays a role in oestrogen metabolism, a diet rich in fruits, vegetables, and whole grains contributes to both gut and hormonal health. A practical way to ensure fibre diversity is to use the "30 plants per week" approach, which is illustrated here.
Diversify your movement with a focus on strength training
Regular movement helps manage weight, reduce hot flushes, improve mood, and support bone density. A combination of aerobic exercise, strength training, and flexibility exercises is ideal:
Sleep Hygiene
Hormonal shifts can disrupt sleep. Establishing a consistent sleep routine, reducing screen time, and practicing relaxation techniques can promote restful sleep. Additionally, avoiding caffeine and alcohol, particularly in the evening, may improve sleep quality.
Alcohol and Caffeine Moderation
Both can worsen symptoms like hot flushes, anxiety, and sleep disturbances. Moderation or avoidance may help in managing these symptoms.
Supplement with caution
While some supplements like black cohosh, evening primrose oil, and red clover are popular for managing perimenopausal symptoms, scientific evidence on their efficacy and safety is limited or inconsistent. It’s essential to consult a healthcare provider before starting any supplement, particularly as these can interact with other medications.
Consider this your blueprint to managing understanding and managing perimenopause. For perimenopause, an overall lifestyle strategy that includes balanced nutrition, physical activity, stress management, and sleep hygiene shows the most evidence for symptom relief and health maintenance. Most importantly, when in doubt, consult a gynaecologist or endocrinologist and not an internet-certified hormone coach that is guaranteed to cause an imbalance of your bank account.
Alternatively, you can join the Female Edition of our Rebalance Programs to ensure you get personalised support.
Symptoms of perimenopause are many, but ones that are features include irregular periods, hot flushes, mood changes, sleep disturbances, and weight gain. If I had to cluster other symptoms based on what I've seen in clinic and what the research shows, they would include:
- Fatigue
- Brain fog & forgetfulness
- Anxiety, or irritability
- Low libido & vaginal dryness
- Sore breasts & headaches
- Bloating & gut issues
Since hormone levels fluctuate day-to-day, it can be tricky for doctors to pinpoint exact changes. Lab tests aren’t always conclusive, so they often rely on symptoms to guide diagnosis.
Instead of pathologising perimenopause as a problem to be fixed, I believe it’s about reconnecting with your body during this transitional phase and equipping yourself with the knowledge to manage any challenges that arise along the way. Where do I come in? Let's break down the nutritional and lifestyle considerations you should take note of:
Look at your "Macros" differently
- Protein: Prioritising protein intake (around 1.2-1.5g per kg of body weight daily) helps prevent muscle loss, which accelerates with declining oestrogen. Sources like poultry, fish, legumes, eggs, and dairy are beneficial.
- Healthy Fats: Focusing on omega-3-rich fats (found in fatty fish, flaxseed, and walnuts) can reduce inflammation and potentially ease symptoms like mood swings.
- Complex Carbohydrates: Focus on complex, high-fibre carbohydrates (whole grains, vegetables, legumes) to stabilise blood sugar levels, which can reduce irritability and fatigue. Redefine your relationship with carbohydrates and work with a specialist to help you establish how much carbs you require on sedentary vs active days.
Your Micronutrient Needs
- Calcium and Vitamin D: Oestrogen's decline can lead to bone density loss, increasing osteoporosis risk. Calcium (1000-1200 mg/day) and adequate vitamin D (600-800 IU/day) support bone health. Good sources include dairy, leafy greens, and fortified foods.
- B Vitamins: Vitamin B6, B12, and folate are linked to mood regulation, energy, and cognitive function. Foods like whole grains, fish, poultry and leafy greens are a starting point. Try to include these 4 foods daily (unless there is a medical reason for avoidance): Sunflower seeds, spinach, mushrooms and legumes.
- Magnesium: Known to support sleep, mood, and bone health, magnesium-rich foods (nuts, seeds, leafy greens) can also help alleviate muscle cramps associated with hormone fluctuations.
Phytoestrogens
Isoflavones in Soy and Flaxseed: These plant-based compounds mimic oestrogen in the body and may help regulate extreme hormonal fluctuations. Though evidence is mixed, moderate soy consumption (tofu, edamame, miso) might reduce hot flushes and improve bone density. However, effects are generally mild. Nevertheless, including soy is definitely worth a try!
Gut Health and Fibre
If you've missed our blog post about the Female Gut, then head on over and have a read because it explains a lot when it comes to fibre. You will need to adjust your fibre intake depending on your gut symptoms and general digestive health. Also, since the gut microbiome plays a role in oestrogen metabolism, a diet rich in fruits, vegetables, and whole grains contributes to both gut and hormonal health. A practical way to ensure fibre diversity is to use the "30 plants per week" approach, which is illustrated here.
Diversify your movement with a focus on strength training
Regular movement helps manage weight, reduce hot flushes, improve mood, and support bone density. A combination of aerobic exercise, strength training, and flexibility exercises is ideal:
- Strength Training: Reduces the risk of osteoporosis and sarcopenia (age-related muscle loss).
- Cardio Exercise: Walking, cycling, or swimming can improve cardiovascular health and reduce hot flashes.You can also incorporate fasted stead-state cardio if you're struggling with stubborn body fat loss. Learn more here.
- Mind-Body Practices: Yoga, meditation, and tai chi may reduce stress and improve sleep.
Sleep Hygiene
Hormonal shifts can disrupt sleep. Establishing a consistent sleep routine, reducing screen time, and practicing relaxation techniques can promote restful sleep. Additionally, avoiding caffeine and alcohol, particularly in the evening, may improve sleep quality.
Alcohol and Caffeine Moderation
Both can worsen symptoms like hot flushes, anxiety, and sleep disturbances. Moderation or avoidance may help in managing these symptoms.
Supplement with caution
While some supplements like black cohosh, evening primrose oil, and red clover are popular for managing perimenopausal symptoms, scientific evidence on their efficacy and safety is limited or inconsistent. It’s essential to consult a healthcare provider before starting any supplement, particularly as these can interact with other medications.
Consider this your blueprint to managing understanding and managing perimenopause. For perimenopause, an overall lifestyle strategy that includes balanced nutrition, physical activity, stress management, and sleep hygiene shows the most evidence for symptom relief and health maintenance. Most importantly, when in doubt, consult a gynaecologist or endocrinologist and not an internet-certified hormone coach that is guaranteed to cause an imbalance of your bank account.
Alternatively, you can join the Female Edition of our Rebalance Programs to ensure you get personalised support.
