Some foods tame weight gain and hot flashes, others make them worse.
Whoever said, “The more things change, the more they stay the same,” never went through perimenopause (we Googled it, and it was indeed a dude.) Everything about us seems to change during this time, from the erratic behavior of our internal thermostats to sleep patterns to body shape to how much of a damn we give about other people’s opinions (that one is ok). Our nutritional needs also shift, something many of us aren’t aware of. Following the right diet during perimenopause can yield big dividends: fewer symptoms, reduced risk of diseases, and better overall health.
But like everything in perimenopause, nutrition can be complicated. So, we tapped experts about the best diet for perimenopause, which foods to eat (and avoid), and why a specialized perimenopause diet can help.
Neha Lalani, M.D., an Austin-based board-certified endocrinologist and obesity medicine specialist practicing at Bluebonnet Diabetes & Endocrinology.
Lauren Slayton, M.S., R.D., is a registered dietitian, founder of Foodtrainers in New York City, and host of The Food Trainers podcast.
Imashi Fernando, M.S., R.D., CDCES is a registered dietitian who works in a large hospital system as a clinical dietitian and provides one-on-one nutrition counseling.
There are a bunch of reasons you’d potentially want to revisit how and what you eat during perimenopause (the years leading up to menopause, aka being period-free for a full year) (1). Decreasing levels of estrogen and progesterone can cause physical symptoms like hot flashes as well as emotional symptoms such as anxiety and depression, and your nutritional choices can minimize some of these, or make them worse. In the meantime, most women lose muscle mass as they age, and we’re likely to gain about 1.5 pounds a year through our 50s, even if we eat the same exact way, according to the Mayo Clinic and every single middle-aged woman in your gym’s locker room.
The hormonal changes you experience during perimenopause can have health impacts that outlast these symptoms: Women in menopause are at higher risk for a range of problems including obesity, high blood pressure, diabetes, cardiovascular disease, and osteoporosis (2) as well as breast, colon, and endometrial cancers (3).
All of this adds up to the need to pay attention to good nutrition and follow a proper perimenopause diet. “Many perimenopausal clients come to me saying, “My old tricks aren’t working,” says Lauren Slayton, M.S., R.D., founder of Foodtrainers, a nutritional consultancy in New York City and host of The Foodtrainers Podcast. “And it’s true, for this chapter of our lives, we need new tricks. Actually, it’s more than tricks because it’s for the duration.”
Broadly speaking, says Slayton, women need a lot more protein, fewer carbs, and “targeted supplementation.” While getting nutrients from whole foods is always ideal, “supplements also help with the changes in the body,” says Neha Lalani, M.D., an Austin-based board-certified endocrinologist and obesity medicine specialist practicing at Bluebonnet Diabetes & Endocrinology.
Midlife hormone shifts often bring weight gain during perimenopause and menopause. In fact, excess pounds are one of the most common symptoms of perimenopause.
During this phase, your body produces less testosterone, estrogen, and progesterone. Not having these hormones is detrimental. They mitigate muscle loss, regulate mood and metabolism, and reduce sleep issues—factors that impact your ability to lose weight.
That said, a sedentary lifestyle, poor diet, and unmanaged stress are more likely to cause menopause weight gain than hormone shifts. So, eating a better diet can help you keep things under control.
Before we jump into the best foods to eat during perimenopause and what foods to avoid during perimenopause, there’s one popular diet trend that you should be cautious about right now: intermittent fasting (IF).
Fasting overnight for 12 to 18 hours or following a 5:2 diet (that is, eating very little two days out of the week) has been shown to be as effective for weight loss as other diets (4). Magazines, websites, books, and newsletters aimed at midlife women regularly discuss the potential benefits of IF, with menopause-age celebrities like Jennifer Aniston, Halle Berry, and Grey’s Anatomy’s Kate Walsh reportedly singing its praises (5). It’s known to improve metabolic function and reduce inflammation and potentially the conditions that are worsened by it, such as heart disease, stroke, and other serious illnesses (6).
Still, intermittent fasting may not be the best idea for women in the menopause transition. Research with obese pre- and post-menopausal women who ate only during a 4-hour period (the so-called “warrior diet”) showed that DHEA, a primary component of estrogen, decreased, albeit remaining within the normal range (7). Since DHEA drops naturally in menopausal women (and IF made it drop more), researchers said that any weight loss benefits should be weighed against the negative effects of these hormonal changes.
Your best bet: See a doctor before doing intermittent fasting.
Now to the good stuff: What to eat and what to avoid during perimenopause.
Your mom made you drink milk for stronger bones, but calcium is especially important right now because of the decline in estrogen. “As estrogen is dropping, the bone density is going to go down because estrogen helps with maintaining bone density,” says Lalani. When bones become porous and brittle, you can develop osteoporosis (8).
In the US, around 8 million women have osteoporosis, and 1 in 3 women will break a bone in their lifetime due to osteoporosis, according to the Office on Women’s Health. If you’re lactose-intolerant, you may be at even higher risk.
Enter the mineral calcium, which hardens and strengthens bones (9). When loading up on calcium-rich foods, little and often is the best approach: Calcium is absorbed best when you consume 500 mg or less at a time, according to the National Institutes of Health (10). It recommends women aged 51 to 70 get 1,200 mg per day, and no more than the maximum of 2,000 mg.
Consuming calcium alongside vitamin D aids absorption so combine it with sources like salmon, canned sardines, tuna, mackerel, fresh shiitake mushrooms, and egg yolks.
High-calcium foods include:
A well-functioning gut microbiome is essential to overall good health: It communicates with our immune system and how it responds to infection, helps us digest food and fiber properly, promotes heart health and brain health, affects blood sugar, and may prevent diabetes, just to name a few benefits.
The gut microbiome also plays an important role in regulating hormones. When hormones in our bloodstream reach the liver, they get metabolized. Instead of acting on our tissues, they get sent to the intestine and then excreted. When there’s a healthy, diverse microbiome in the gut, some of the hormones get reabsorbed to be used in the body, which is a good thing (11).
Unfortunately, research indicates that menopause might be associated with lower gut microbiome diversity (12). More studies are needed to determine how the gut microbiome specifically impacts menopause-related disease risks. But given the potential for gut health to influence menopausal health, scientists say, and the modifiable nature of the gut microbiome, eating to encourage a healthy gut should be a key component during perimenopause.
Gut-friendly foods for a perimenopause diet include:
Whole grains help the gut function properly, reduce spikes in blood sugar which contribute to insulin resistance, and promote healthier fat-to-lean body composition during perimenopause (9, 16). Women should aim for 21 grams of fiber a day, but some other studies have found that the benefits are even greater if you aim for between 25 and 29 grams (17).
High-fiber foods to get into your perimenopause diet include:
Changes during perimenopause can cause the body to secrete proinflammatory molecules. Low-grade inflammation can accelerate vascular damage as well as promote the proliferation of cancer (18). An anti-inflammatory diet such as a Mediterranean diet helps combat that effect. In addition to avoiding foods that promote inflammation—the usual suspects of saturated fats, added sugar, refined carbohydrates, and sodium—we should get an ample amount of foods known for their active anti-inflammatory properties (19).
Some of these, like tomatoes and fatty fish, have anti-inflammatory properties themselves. Others, like fiber, are converted into the anti-inflammatory substance butyrate in our guts. Focus on eating these (19, 20, 21):
While our need for iron goes down post-menopause, research shows that perimenopausal women are at risk of iron deficiency and anemia (22), particularly if they have very heavy periods. Menopausal women should aim for three servings of iron-rich foods every day. Good sources include:
Protein helps your body maintain muscle mass and strength – important because around perimenopause you begin to lose muscle at a higher rate. It also balances appetite and blood glucose, which can combat perimenopause weight gain. Add protein to carbs to avoid blood sugar spikes (top that bagel with some smoked salmon), bulk out salads with chicken, tofu, or beans, or consume it throughout the day.
How much protein you need for a perimenopause diet depends on who you ask, and lifestyle factors such as whether you’re doing CrossFit and running marathons. Recommendations generally range from 0.8g – 1.0g to 1.2g for every kilogram of body weight. For a 150-pound woman (68kg), that translates to 68g to 81.6g of protein per day, spread across meals throughout the day. When you reach 40 or 50, your protein intake should be on the higher end of that range, to prevent sarcopenia, or muscle wasting (23).
Getting that much can be tricky, says Slayton, if you don’t eat any meat. “It doesn’t have to be huge slabs of chicken (maybe not super appetizing) but ideally you don’t want to be plant-based in perimenopause. To get the protein you need, in this stage, you’ll end up with an excess of carbs,” if your only protein comes from plants, as legumes and the like also contain carbs, albeit healthy ones. “Cultured cottage cheese, Greek yogurt, fish and shellfish, grass-fed beef are some go-to protein sources,” she says. Slayton also says protein powders can help you reach your protein mark if you’re not down for heaps of fish or poultry: “A grass-fed whey protein powder and collagen peptides work well for perimenopause.” Working them into a fruit smoothie or blended coffee is a good option.
Great sources of protein include:
Magnesium can help knock out a surprising number of unwanted menopause symptoms, including risk of osteoporosis, insomnia, and anxiety.
When you think of eating for strong and healthy bones, calcium comes to mind. But magnesium also plays a role. In fact, magnesium deficiency contributes to osteoporosis (24). Low magnesium intake is also associated with fewer hours of sleep and overall lower sleep quality (25). Plus, magnesium has been shown to boost muscle relaxation and reduce anxiety, which may help alleviate symptoms like muscle cramps and mood swings (26).
Good sources of magnesium include:
While the myth that soy can mess with men’s testosterone levels (it doesn’t) has long persisted, studies suggest that soy and other foods packed with phytoestrogen may help women in this phase. Phytoestrogens are plant compounds that can mimic estrogen in the body. Because estrogen is decreasing during this time, some research suggests that phytoestrogen foods may help clear up some symptoms of hormonal fluctuations including hot flashes and night sweats (27).
Foods with phytoestrogens include:
In general the foods to avoid during perimenopause are the ones we should be avoiding anyway … except it’s a bit more important to look after our nutritional needs during this time, as many of these can make the symptoms of perimenopause and menopause worse. It doesn’t mean we can’t ever have these—just curb your intake and focus on the tasty good stuff above.
Some sources suggest they can set off or worsen hot flashes (28, 29).
Women who eat more ultra-processed foods have worse hot flashes, research shows (30). These foods also upset the balance of intestinal bacteria and tend to be more calorie-dense which can lead to weight gain.
These promote insulin resistance which may make hot flashes and night sweats worse. Plus they put us more at risk of diabetes.
Foods high in saturated fats (the kind that are typically solid at room temperature and prevalent in meat and dairy products) are associated with high blood pressure, which can exacerbate perimenopausal symptoms. The most common sources of saturated fats in Americans’ diets are foods that combine meat and dairy and are all familiar: sandwiches, burgers, tacos, and burritos, according to the Mayo Clinic. Other foods to watch out for: baked goods made with butter, full-fat ice cream, and other desserts.
It spikes blood sugar and adds extra calories without adding nutrients. Alcohol also interferes with sleep, causes inflammation (31) and can adversely affect your gut microbiome.
Caffeine has a lot of benefits, including improved memory, alertness, and mood, but some people don’t tolerate it well. It can worsen anxiety, hot flashes, and sleep disturbances—all things you don’t need more of during perimenopause (32). Regardless of your tolerance, “caffeinated beverages like coffee should be limited to no more than 2-3 cups a day,” says registered dietitian Imashi Fernando, M.S., R.D. If coffee is giving you problems, consider black tea. It has less caffeine than coffee.
Want to get a better idea of exactly what you can eat? Browse through a full week of Fernando-approved perimenopause meals:
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