Does Intermittent Fasting Help With Perimenopause (or Make It Worse)?

Menopause and perimenopause bring on a host of changes—hot flashes, unexpected mood swings, or the nights when sleep feels like a distant memory. But the struggle to zip up your favorite jeans? That one really hits hard. Social media posts, friends, and even some doctors say intermittent fasting (IF) can ease some of the curve balls your body is throwing your way during the “change of life.” 

Intermittent fasting has gained traction among midlife women as part of the Galveston Diet, a menopause-focused nutrition program created by menopause specialist Mary Claire Haver, M.D. The idea? Limit eating to set hours or days and fast the rest.

But not all experts are on board. Some think IF is the secret to handling the weight and metabolic changes that come with menopause (including the dreaded meno belly). Others think it’s just another diet fad and not a one-size-fits-all solution. (Spoiler: Nothing about menopause seems to be a one-size-fits-all, right?). 

About the Experts

Elizabeth Ward, M.S., R.D.N, is a registered dietitian who specializes in menopause and women’s nutrition. She’s the co-author of The Menopause Diet Plan, A Natural Guide to Managing Hormones, Health, and Happiness.

Megan Ramos is a medical researcher, Co-Founder of The Fasting Method with Jason Fung, M.D., NYT., and author of The Essential Guide to Intermittent Fasting for Women.

Greg Brannon, M.D., F.A.C.O.G., is the medical director and founder of Optimal Bio, a bioidentical hormone therapy replacement (BHRT) medical practice.

What Is Intermittent Fasting?

“Intermittent fasting isn’t about what you eat, it’s about when you eat,” explains registered dietitian Elizabeth Ward, M.S., R.D. It’s less about the kale and more about the clock: You eat within a certain time window, then hit pause until the window opens again. And studies show that IF can lead to weight loss (1). “The idea is that going for long periods without eating encourages your body to burn more of its fat stores,” says Ward.

There are several approaches to IF. The most popular include:

• 16:8 protocol: This method is the one promoted in the Galveston Diet. You eat during an 8-hour window and fast the other 16 hours of the day (2).
• 18:6 protocol: Like 16:8 but with a tighter eating window. With 18:6 intermittent fasting, you get  6 hours to eat, and fast for 18 hours.
• 5:2 protocol: This popular approach is more flexible. For five days of the week, you eat normally without restricting calories. Then, on two non-consecutive days, you limit your calories to 500-600 (3).
• Alternate-day fasts: During an alternate-day fast, you fast for one day and eat unrestricted the next. 
• 48-hour fasts: A 48-hour fast means exactly what it sounds like: no eating for two consecutive days (4). It’s often touted for anti-aging, but it’s not for the faint of heart. 
• Fasting-mimicking diet: A fasting-mimicking diet skips fasting altogether. Instead, you eat 700 to 1,100 calories for three to five days a month and follow a balanced diet for the rest (5). 
• Circadian rhythm fasting: With circadian rhythm fasting you start eating when the sun rises and stop when it sets. This approach aims to work with hormones like insulin and cortisol and restore metabolic balance (6).

How Intermittent Fasting Can Help With Perimenopause

Proponents of intermittent fasting during perimenopause point to research suggesting it helps with common perimenopause concerns like weight gain, insulin resistance, inflammation, and brain fog. Here’s what IF might do: 

Weight loss 

One of the most talked-about perks of Intermittent fasting is its potential for weight loss. A 2021 review study published in JAMA found that certain types of IF, like alternate-day fasts and 5:2,  can lead to significant weight loss, especially in overweight or obese people (1). 

It also seems to help pre- and postmenopausal women manage their weight. Perimenopause weight gain is real, so this is a big deal. On average, most women gain about one to one and a half pounds per year during the menopause transition (7). 
A 2022 study published in Obesity found an 8-week IF plan that limited eating to four to six hours a day, helped obese pre- and post-menopausal women lose six to nine pounds (8). The women lost more fat than muscle, improving body composition.

Lower insulin resistance

Insulin is a hormone that moves glucose (sugar) from your blood to your cells, where it’s used for energy. Levels increase after you eat and decrease when you fast. Insulin resistance is when your cells are less responsive to insulin, causing glucose to build up in the blood. Insulin resistance is a key risk factor for type 2 diabetes. 

Menopause hormone changes increase the risk of developing insulin resistance, making women more prone to type 2 diabetes, says Megan Ramos, co-founder of The Fasting Method with Dr. Jason Fung. “IF is used to reverse type 2 diabetes but it can also prevent type 2 diabetes and other metabolic disease.”One small study found that IF improved insulin sensitivity in pre- and post-menopausal women (9). Still, more studies are needed to confirm these results and to determine how IF helps prevent chronic health issues like diabetes.

Decrease inflammation

Estrogen has anti-inflammatory properties. Levels of the hormone decline in perimenopause, which can lead to chronic inflammation, the hidden enemy behind so many health problems like perpetual fatigue, heart disease, metabolic syndrome, and more (10). Some studies suggest IF curbs inflammation (11). 

However, the research isn’t clear-cut. Other studies show that time-restricted eating may not impact chronic inflammation (12). 

Decrease heart risks

Intermittent fasting improves heart disease risk factors, like body weight and cholesterol levels, in women during menopause (13). However, it’s not clear if the improvements in heart health are due to time-restricted eating specifically or some other factor, like the weight loss that occurs when you limit eating time to 4, 6, or 8 hours a day.

Boost memory, mood, and energy

Intermittent fasting offers brain health benefits like improved memory and focus, says gynecologist Greg Brannon, M.D. “Anecdotally, women experience less brain fog, more energy, and a boost in sex drive,” adds Ramos. 

The research is less conclusive. Early studies that aren’t specific to menopause show no change in mood, energy, or memory among intermittent fasters (14, 15). However, small clinical trials and animal studies suggest that intermittent fasting may lower the risk of dementia and Alzheimer’s disease (16). When it comes to IF and brain health, more research is needed to confirm any potential benefits.

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Can Intermittent Fasting Make Perimenopause Symptoms Worse?

Experts like Stacy Sims, M.D., caution that IF may have unexpected consequences for women in perimenopause. Some research shows intermittent fasting might increase oxidative stress that leads to cell damage and inflammation (17) and negatively impact hormones. Studies show IF may:

Lower estrogen

Early research suggests IF doesn’t impact key sex hormones like estradiol, estrone (two types of estrogen), or progesterone in perimenopause or menopause (8). But, it may lower dehydroepiandrosterone (DHEA), a hormone that contributes to estrogen production (8). DHEA levels naturally decline after menopause. Low DHEA is linked to osteoporosis, heart disease, and breast cancer (18). 

Ramos notes that no studies have looked at the hormonal impact of fasting for 24 hours or more. “Our clients never see their DHEA-S levels drop due to fasting. We also do not observe any declines in estrogen levels during therapeutic fasting as well.”  These observations debunk the concerns that IF worsens hormone balance, wreaking havoc on your body. However, we need larger clinical studies to confirm Ramos’ findings.

Increase stress

Researchers also worry that intermittent fasting increases cortisol, the body’s primary stress hormone. Cortisol naturally increases in the morning and decreases throughout the day, aligning with your circadian rhythm—a 24-hour cycle that regulates processes like sleep and metabolism (19). 

Cortisol levels increase when you fast. Research suggests that IF may disrupt the natural cortisol cycle, leading to higher-than-normal levels throughout the day (19). The circadian rhythm affects how we react to food, says Ward, and plays a role in weight control.

On top of that, declining estrogen levels during menopause further increase cortisol levels (20). Chronically high cortisol may also be responsible for your menopot, which is the unhealthy visceral fat that surrounds the abdominal organs and one of the health issues that raises your risk of heart disease (21). 

Lower bone density

Some studies show that IF lowers DHEA levels (18). DHEA is strongly linked to bone health, likely due to its role in supporting bone-building activity (22). Given that the risk for osteoporosis increases after menopause due to estrogen loss, a drop in DHEA could further heighten that risk (23).
Ramos says clients who follow her IF protocol see significant boosts in human growth hormone (HGH) levels. HGH may protect against bone loss and osteoporosis, so could help counterbalance the potential reduction in DHEA while fasting (15, 24).

Who Should Fast During Perimenopause?

Fasting is safe for most healthy women during perimenopause. But if you’re considering trying it to lose weight and upgrade health markers, talk to your doctor about which protocol might work best for you. 

Ramos says women with a body mass index (BMI) of 18 or less, those with nutrient deficiencies, or those being tested for a medical condition should avoid intermittent fasting. 

IF may not be the best choice for women with diabetes or those who need to take prescription medication with food, adds Ward. She also advises very active women and women with a history of disordered eating to avoid intermittent fasting.

The Best Intermittent Fasting Method for Perimenopause

When it comes to IF during perimenopause, experts differ on the best approach. Two popular styles are below but ultimately, the best for you should be based on lifestyle, activity level, personal preference, and health. 

Ward prefers the 16:8 protocol since it gives you the most time to eat (and get the nutrition you need) and may help limit snacking at night, “which is when women tend to overdo it on high-calorie foods.” Brannon also prefers this IF pattern, made popular by the Galveston Diet. 

Another approach is The Fasting Method, recommended by Ramos. The plan involves alternate-day fasting, where you fast for 24 to 36 hours, three days a week. On fasting days, you can drink water, coffee, and tea and take a fasting supplement that provides electrolytes, fiber, and amino acids. 

According to Ramos, this particular fasting schedule increases growth hormone production and protects against muscle loss and bone weakening (20). Some people swear by these all-day fasts, but they’re not for everyone—especially those who have a tendency to binge after going too long without eating.

Maximizing Intermittent Fasting During Perimenopause

No matter which IF plan you choose, give yourself enough time to eat, suggests Ward. Intermittent fasting helps you lose weight by reducing calorie intake. “It also means you get fewer vitamins and minerals, and less protein and fiber.” 

To make the most of your eating window, focus on nutrient-dense foods like fiber-rich fruits and veggies, and lean protein to keep you feeling full. Include foods rich in calcium and vitamin D—like Greek yogurt, dark leafy greens, and chia and flax seeds—for bone health. 

If you’re following a 16:8 protocol, start eating earlier in the day, suggests Ward. “Consuming the majority of your calories at breakfast and lunch could make it easier to control your weight and help your body burn fat.” Some research suggests eating earlier might enhance fat burning compared to eating later, even when calories remain the same (25).

To get the most out of IF, Dr. Brannon suggests a multi-pronged approach: strength training, stretching for flexibility and balance, frequent walks, and sufficient sleep.