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  • Taylor Richter, RDN, LD

Cracking the Code: The Adventure Through the Perimenopause and Menopause

Alright, ladies, let's talk about something we're all going to face at some point – perimenopause. Entering this midlife phase where our bodies decide to shake things up a bit. You know, the hot flashes, the mood swings, and all the other surprises no one really warned us about. But fear not! We're diving deep into the world of perimenopause, breaking it down because understanding perimenopause is the first step to owning it.

Menopause, defined as the absence of menstruation for 12 consecutive months, typically occurs around the age of 51. However, this timing can vary, and before reaching menopause, women undergo perimenopause, a gradual transition lasting two to ten years, usually initiating in the mid-to-late 40s (1).

Perimenopause: A Gradual Shift

Perimenopause unfolds through two stages:

Early Transition (Around Age 47)

During early transition, menstrual cycles become irregular, deviating by seven or more days. Biochemically, an increase in follicle-stimulating hormone (FSH) signals the ovaries to produce follicles, while a decline in progesterone alters the endometrium preparation. This hormonal shift shortens the follicular stage and the menstrual cycle (1).

Late Transition (Around Age 49)

In the late transition period, menstrual cycles further deviate, with intervals exceeding 60 days. FSH continues to rise, and noticeable symptoms, commonly linked with menopause, may emerge (1).

Symptoms of Perimenopause

Perimenopause introduces various symptoms, often associated with menopause (6):

  • Hot Flashes: Result from hormone level changes, particularly estrogen deficiency, leading to feelings of heat, sweatiness, and possibly anxiety (7).

  • Vaginal Atrophy: Manifests as dryness, burning, itching, pain during urination, and painful intercourse due to estrogen deficiency.

  • Insomnia: Trouble falling asleep, not feeling rested, or difficulty staying asleep, attributed to hormonal changes and, in some cases, mood changes like depression (8).

  • Weight Gain: Decreasing estrogen levels contribute to central fat deposits, especially around the waistline. Factors include reduced physical activity and psychological distress.

  • Depression: Perimenopausal women are two to five times more likely to experience depression, with the risk declining two to four years after the final menstrual period. Depression is associated with night sweats.

  • Anxiety: Women with low anxiety before perimenopause may be at a higher risk of high anxiety during and after perimenopause. Anxiety is also linked to trouble falling asleep and early awakening, common in perimenopausal insomnia.

Risks and Considerations

Beyond symptoms, the transition to menopause comes with an increased risk of heart disease and osteoporosis. Post-menopausal women face a higher risk of heart disease, as indicated by the American Heart Association. Additionally, the decline in estrogen during menopause contributes to bone loss, elevating the risk of osteoporosis. Statistics reveal that one in two women over 50 will experience a bone fracture due to osteoporosis (3).

Navigating Perimenopause: A Holistic Approach

Nutrition Strategies

  • Anti-inflammatory diet: A diet high in vegetables, fruits, nuts, seeds and protein, may reduce hot flashes and weight gain. The anti-inflammatory diet also emphasizes decreasing sugar, ultra-processed foods and inflammatory oils. A study published in JAMA Internal Medicine found that adhering to an anti-inflammatory diet was associated with a 20% lower risk of developing depression (2).

  • Alcohol and Caffeine Management: Limiting alcohol and caffeine intake can alleviate hot flashes and improve sleep. Research published in Menopause: The Journal of The North American Menopause Society indicates that excessive alcohol intake can exacerbate menopausal symptoms (4, 9).

  • Soy and Flax Seeds: Rich in phytoestrogens, soy protein, and flax seeds may help reduce hot flashes and night sweats. A study in Menopause demonstrated that soy isoflavones significantly reduced the frequency and severity of hot flashes.

  • Meal Timing: Eating earlier in the day and incorporating regular fasting periods can reduce inflammation, improve circadian rhythm, and support overall health. Research published in Cell Metabolism suggests that time-restricted eating can positively impact metabolic health.

Lifestyle Practices

  • Exercise Routine: Maintaining a regular exercise routine, such as walking, is crucial for strengthening your bones to aid in avoiding osteoporosis and improving mood. The Journal of Clinical Sleep Medicine published a study revealing that regular physical activity improves sleep quality in postmenopausal women.

  • Mental Health Care: Approaches like cognitive-behavioral therapy (CBT) can help manage depression and anxiety, potentially impacting hot flashes and sleep. A 2019 study published in Menopause indicated that CBT may reduce hot flashes and sleep problems.

Supplement Recommendations

Before starting any supplement regimen, consult with a licensed health professional. Here are some detailed supplement recommendations (13):

  • Black Cohosh: Widely used in Europe, it may help reduce hot flashes, sleep disturbances, and improve mood. A Cochrane review suggested that black cohosh may be effective in reducing the frequency and severity of hot flashes.

  • 5-Hydroxytryptophan (5-HTP): Natural production may improve sleep, depression, anxiety, and aid in weight loss. Research published in the Journal of Psychiatric Research indicates that 5-HTP supplementation may have antidepressant and anxiolytic effects.

  • Maca: Known to improve anxiety, depression, protect against bone loss, and reduce hot flashes and night sweats. A study in Climacteric found that maca supplementation reduced psychological symptoms, including anxiety and depression, in postmenopausal women.

  • Sage: Can help reduce hot flashes, night sweats, anxiety, and depression, while improving concentration and memory. A systematic review published in Advances in Integrative Medicine reported positive effects of sage extract on menopausal symptoms.

  • Red Clover: May reduce hot flashes while also improving vaginal atrophy. Research published in Menopause: The Journal of The North American Menopause Society suggests that red clover may have a positive impact on hot flashes.

Putting it All Together

Managing perimenopause is a highly individualized journey that requires a comprehensive approach. Seeking guidance from a Registered Dietitian can provide detailed support, considering nutrition, lifestyle, and supplementation for a holistic approach to navigate these transitional periods. If you are interested in working with one of our dietitians at The Functional Kitchen please fill out a quick application here to schedule your complimentary call.


  1. American College of Obstetricians and Gynecologists. (2018, December). The Menopause Years. Retrieved from

  2. Medscape. (2018, November 6). Diet Rich in Fruits and Vegetables Tied to Fewer Menopause Symptoms. Retrieved from

  3. Medscape. (2017, June 8). Heavy Drinking Increases Postmenopausal Sarcopenia Risk. Retrieved from

  4. NIH National Institute on Aging. (n.d.). Menopause: Tips for a Healthy Transition. Retrieved from

  5. NIH National Institute on Aging. (2017, June 27). What is menopause? Retrieved from

  6. NIH National Institute on Aging. (2017, June 16). What Are the Signs and Symptoms of Menopause? Retrieved from

  7. NIH National Institute on Aging. (2017, June 26). Hot Flashes: What Can I Do? Retrieved from

  8. NIH National Institute on Aging. (2017, May 13). Sleep Problems and Menopause: What Can I Do? Retrieved from

  9. NIH National Institute on Aging. (2017, May 16). Facts About Aging and Alcohol. Retrieved from

  10. NIH National Institute on Aging. (2019, April 29). Choosing Healthy Meals As You Get Older. Retrieved from

  11. NIH National Center for Complementary and Integrative Health Clinical Digest. (2016, February). Menopausal Symptoms and Complementary Health Practices:

  12. Nye, Haylee. “Managing Menopause Symptoms Naturally...Where to Begin.” Women's HealthNutrition Academy. 

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