• Marie Belzile-Davidson, MS, Dietetic Intern

Nutrition for Perimenopause and Menopause

Menopause is defined as 12 months after a woman’s last period. On average, this happens around the age of 51 but can vary from person to person.


You may have heard of menopause before but did you know that before menopause, there is a period known as perimenopause or the menopause transition? This stage in a women’s life can last anywhere from two to ten years and usually begins in the mid-to-late 40s. While perimenopause and menopause can come with significant challenges, they are not illnesses nor problems. Rather, they are normal, biological transition periods in a woman’s life. That being said, the health needs and risks of women do shift during perimenopause and after menopause but more on that in a bit.


So what is perimenopause? It is broken down into two stages: early transition and late transition. For the average woman, early transition begins around age 47 and late transition begins around age 49. Keep in mind though that this will vary from woman to woman.


During early transition, menstrual cycles may start to become irregular by seven or more days. You may also notice your first missed menses during this stage. From a biochemical perspective, you are experiencing an increase in follicle-stimulating hormone (FSH – the hormone that tells your ovaries to produce follicles), a decrease in progesterone (a hormone produced by your ovaries to help prepare your endometrium for a fertilized egg/potential pregnancy), your follicular stage shortens, and your menstrual cycle also shortens. All that to say that your hormone levels are shifting from what they once were, before perimenopause.


In the late transition period of perimenopause, your cycle becomes even more irregular and you may experience greater than 60 days between cycles. Your FSH continues to increase and you may also notice the onset of symptoms. Many of these symptoms are commonly associated with menopause when they should really be tagged to perimenopause. These include:


Hot flashes: You may feel hot, sweaty, and possibly even anxious for one to a few minutes as a result of hormone level changes, particularly estrogen deficiency.


Vaginal atrophy: This can come in the form of vaginal dryness, burning, itching, pain when urinating, and painful intercourse. The main factor in these symptoms is estrogen deficiency.


Insomnia: You may experience trouble falling asleep, not feeling rested, or difficulty staying asleep for several months. This can be due to hormonal changes but may also be due to mood changes, such as depression.


Weight gain: Decreasing estrogen levels increase central fat deposits in a woman’s body, leading to weight gain around the waistline. Other contributing factors can include a decrease in physical activity and psychological distress.


Depression: During perimenopause, women are two to five times more likely to experience depression. Then, the risk declines two to four years after a woman’s final menstrual period. Depression is also associated with night sweats.


Anxiety: Interestingly, women with low anxiety before perimenopause are at a higher risk of high anxiety during and after perimenopause. Anxiety is also associated with trouble falling asleep and early awakening, which can happen with the insomnia one may experience during this period.


In addition to these symptoms that often begin in perimenopause and may continue through menopause, a woman’s risk of heart disease and osteoporosis increases when menopause begins.


This can all seem quite overwhelming for stages of life that women inevitably go through. It is also important to acknowledge that while perimenopause and menopause are natural biological stages that bring on hormonal shifts and symptoms, they do not occur in a silo. They often happen around an age where women may be experiencing other major shifts in their lives – children leaving the home, older adult relatives needing more care, changes in social support, shifts in physical conditions, etc.


This interplay of so many factors means your approach to supporting your body and minimizing these symptoms should be multi-faceted. Let’s take a look at some nutrition, lifestyle, and possibly even supplementation strategies that may help you through perimenopause and menopause.


Nutrition


Studies have shown that the Mediterranean Diet may reduce hot flashes and weight gain while also lowering the risk of developing depression by 20 percent! The Mediterranean Diet is high in vegetables and fruit, cold-water fatty fish, nuts and seeds, legumes, olives and olive oil, herbs and spices, and whole grains. It minimizes added sugar, ultra-processed foods, and inflammatory fats. It is also low in dairy, which is a good source of calcium (remember the increased risk of osteoporosis?) so if you do well with dairy, you may benefit from incorporating some grass-fed dairy options. There are lots of non-dairy foods that are rich in calcium too, such as fish with bones (like sardines).


Limiting alcohol and caffeine may also be beneficial. Alcohol can worsen hot flashes and make it harder to stay asleep. It can also take the place of valuable nutrient-dense foods in our diet and contribute to weight gain. Too much caffeine may also trigger hot flashes. If you are a big caffeine drinker, you could consider cutting back and incorporating some alternatives like green tea or herbal teas.


Soy protein can also reduce hot flashes. Soy contains phytoestrogens – these are plant compounds that our bodies see as similar to estrogen. Eating phytoestrogens may help reduce some of the symptoms caused by declining estrogen levels, such as hot flashes. Flax seeds may also help reduce hot flashes and night sweats. Bonus: flax seeds may also reduce cholesterol and fasting blood sugar levels. Eating soy and flaxseeds will not necessarily make things better overnight – it could take several weeks to see the benefit so if you give these a try, give them some time.


Meal timing can also help support your body through perimenopause and menopause. Studies have shown that eating earlier in the day and incorporating regular fasting periods (nothing crazy here, think a typical 12-hour overnight fast between dinner and breakfast) can help reduce inflammation, improve our circadian rhythm to help with insomnia, improve our gut microbiota, and increase stress resistance. On the flip side, skipping meals and eating the majority of our calories later in the day has been associated with an impaired stress response, imbalances in our circadian rhythm, weight gain, and more.


Lifestyle


While perimenopause and menopause come with several symptoms and possibly other life changes, it is important to maintain an exercise routine. This can help minimize unwanted weight gain and can improve your mood, among other benefits.


Now please do not confuse exercise with absolutely annihilating yourself at the gym, only to collapse in a puddle of sweat. If that is what you love to do and your body responds well to it, go for it! However, there are so many different ways to exercise – find a way to move your body that you enjoy and could see yourself doing multiple times a week! For example, walking is an excellent way to add intentional movement to your routine. In fact, studies have shown that walking 12.5 miles a week (that’s just under two miles a day), for 12 weeks can help reduce anxiety and depression while also improving sleep!


Just like exercise is important in all stages of life, so is taking care of our mental health. Approaches, such as cognitive-behavioral therapy (CBT), can assist in minimizing or managing the depression and anxiety that may come with perimenopause and menopause. CBT focuses on changing thinking patterns and a study in 2019 even showed that it may help reduce hot flashes and sleep problems, in addition to the mental health benefits.


Supplements


There are so many supplements on the market so we are just going to highlight a few. Please remember that not all supplements are created equal and many can interact with other medications and have an impact on existing medical conditions. Always consult with a licensed health professional (like a Registered Dietitian), before beginning any supplements.


Soy isoflavones: Like we previously discussed, phytoestrogens can help reduce hot flashes. Bonus: soy isoflavones have also been shown to improve insulin resistance, may slow bone mineral density loss, may improve vaginal atrophy, and can reduce weight gain.


Black Cohosh: This supplement is widely used in Europe and may help reduce hot flashes, sleep disturbances, and improve mood.


5-Hydroxytryptophan (5-HTP): Our bodies naturally produce 5-HTP and convert it to serotonin. Supplementation with 5-HTP may help improve sleep, depression, and anxiety, and may also help with weight loss.


Maca: Maca can help improve anxiety and depression, protect from bone loss, and also

reduce hot flashes and night sweats.


St. John’s Wort: This plant can help decrease anxiety and depression. Some studies have shown that it may be as effective as some selective serotonin reuptake inhibitors (SSRIs). It has also been shown to improve sleep and mood, along with reducing hot flashes.


Sage: Like some of these other supplements, sage can help reduce hot flashes, night

sweats, anxiety, and depression. It has also been shown to increase concentration and memory.


Red Clover: This supplement may reduce hot flashes while also improving vaginal atrophy.



Putting it all together


There is no perfect way to manage what perimenopause and menopause can bring on – your approach should be unique to you, your symptoms, and your needs based on the other factors in your life (pre-existing conditions, other life factors, your goals, you name it!). If you need help navigating these transition periods in your life, reach out to a Registered Dietitian to help you from a nutrition, lifestyle, and supplement perspective!




References


American College of Obstetricians and Gynecologists. (2018, December). The Menopause Years. Retrieved from https://www.acog.org/Patients/FAQs/The-Menopause-Years


Mayo Clinic Healthy Lifestyle Women’s Health (2016, April 21). Menopause weight gain: Stop the middle-age spread. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058


Medscape. (2018, July 27). Weight Effects of Plant-Estrogens May Vary After Menopause. Retrieved from https://www.medscape.com/viewarticle/899858


Medscape. (2018, March 19). Mediterranean Diet May Help Protect Bones in Postmenopausal Women. Retrieved from https://www.medscape.com/viewarticle/894109


Medscape. (2018, November 6). Diet Rich in Fruits and Vegetables Tied to Fewer Menopause Symptoms. Retrieved from https://www.medscape.com/viewarticle/905407


Medscape. (2017, October 10). Docs Call Attention to Women Piling on Pounds in Midlife. Retrieved from https://www.medscape.com/viewarticle/886795


Medscape. (2017, June 8). Heavy Drinking Increases Postmenopausal Sarcopenia Risk. Retrieved from https://www.medscape.com/viewarticle/881339


NIH National Institute on Aging. (n.d.). Menopause: Tips for a Healthy Transition. Retrieved from https://www.nia.nih.gov/health/infographics/menopause-tips-healthy-transition


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

https://www.nia.nih.gov/health/what-menopause


NIH National Institute on Aging. (2017, June 16). What Are the Signs and Symptoms of Menopause? Retrieved from https://www.nia.nih.gov/health/what-are-signs-and-symptoms-menopause


NIH National Institute on Aging. (2017, June 26). Hot Flashes: What Can I Do? Retrieved from https://www.nia.nih.gov/health/hot-flashes-what-can-i-do


NIH National Institute on Aging. (2017, May 13). Sleep Problems and Menopause: What Can I Do? Retrieved from https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do


NIH National Institute of Diabetes and Digestive and Kidney Diseases. (2017, March). Treatment for Bladder Infection (Urinary Tract Infection—UTI) in Adults. Retrieved from

https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults/treatment


NIH National Institute on Aging. (2017, May 16). Facts About Aging and Alcohol. Retrieved from https://www.nia.nih.gov/health/facts-about-aging-and-alcohol


NIH National Institute on Aging. (2019, April 29). Choosing Healthy Meals As You Get Older. Retrieved from https://www.nia.nih.gov/health/choosing-healthy-meals-you-get-older


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

What the Science Says. Retrieved from https://nccih.nih.gov/health/providers/digest/menopause-science


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



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