Thriving Through Perimenopause: Simple Nutrition and Lifestyle Changes for Symptom Relief

Guest post written by Chiara Toscano, 4th-year dietetics student, University of Ottawa

Change is scary. In particular, changes in our bodies can be really scary. So, it can be distressing when around ages 40-50, your body starts going through significant changes. First, you notice your periods are more frequent, maybe lighter, maybe heavier, then they get more infrequent. You start getting hot flashes and night sweats. You start having trouble sleeping and find yourself feeling a bit moodier than usual. Eventually, your periods stop altogether, among many other symptoms. Welcome to perimenopause!

We know that there are countless treatments for perimenopausal symptoms, but is there something to be said about nutrition and lifestyle? If we believe everything we read on the internet, then yes, we can drastically improve our perimenopause symptoms through exercise and nutrition. But how much of that is truly accurate versus someone trying to sell you something? In this post, we’ll look at what the science has to say about managing perimenopausal symptoms through simple changes to our habits, behaviours, and nutrition.

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A word on the use of gender-binary language

Many of the studies cited in this post refer to those with a uterus as ‘women’ or ‘females’. We recognize that not all those born with a uterus identify as women and that not all women have a uterus, for a variety of reasons. Those assigned females at birth will experience symptoms related to the menopausal transition and could benefit from the information presented in this blog post. We also recognize that those taking gender-affirming hormonal therapies have differing and complex experiences when it comes to perimenopause, which is under-studied and beyond the scope of this post. 

What is perimenopause?

Perimenopause is the transitional phase between menstruation and menopause - it literally means the ‘time around’ menopause. Perimenopause ends with the cessation of your periods (menopause). Most women will enter perimenopause during their forties - although some may start feeling symptoms as early as their thirties, or as late as their fifties. There are two phases of perimenopause: early stage and late stage perimenopause. During the early stage, women will start to experience symptoms, and will occasionally miss periods. Late-stage perimenopause involves greater menstrual irregularity. You may go between 6 - 12 months without a period. Menopause itself officially starts when you have gone more than 12 months since your last period.

How do our hormones change during the perimenopausal period? The main hormones involved are estrogen, progesterone, follicle-stimulating hormone (FSH) and LH (luteinizing hormone). Estrogen levels fluctuate at first but overall will decrease during perimenopause and eventually menopause. These fluctuations in estrogen are the main driver for the symptoms you might experience during this phase. The drop in estrogen will also cause an increase in FSH and LH, a normal sign of menopause. Your progesterone and melatonin levels will also decrease during perimenopause. 

Adapted from the September 1999 issue of the Harvard Women’s Health Watch, 1999. President and Fellows, Harvard College [digital illustration].

Can you manage perimenopause symptoms through food?

Your experience of perimenopause is as individual as you are. But is there something to be said about the role of food in how you experience symptoms? We’ll dive into the science and share some simple ways to manage common perimenopause symptoms through nutrition. 

Trouble sleeping

Having a harder time getting a good night’s rest is a core symptom of menopause. As mentioned before, your levels of melatonin decrease during perimenopause, meaning it can be harder to get to sleep, get good quality sleep, and stay asleep as long as you used to. You might also find yourself turning into more of an ‘early bird’, and waking up more frequently during the night. So is there anything we can add to our day in terms of food that might help? Well, studies show that isoflavones have a promising effect on subjective sleep quality. Isoflavones are a form of phytoestrogen found in plants - basically they are molecules shaped similarly to estrogen that bind to estrogen receptors in your body, which may reduce perimenopausal symptoms. Where can we find isoflavones in food? Things like soybeans, edamame, soy-based beverages, tofu, tempeh, flax seeds, sesame seeds, broccoli, cabbage, and collard greens (to name a few) are all a rich source of isoflavones. 

Another nutrient to watch out for is tryptophan, a building block of proteins that is used by the body to produce serotonin and melatonin. It is abundant in foods like poultry, fish, eggs, pumpkin seeds, beans, peanuts, cheese, and leafy green vegetables. Studies have shown that relatively small doses of tryptophan (as little as 250 mg) can positively impact sleep. It can help increase sleep efficiency and subjective sleep quality, and decrease the amount of times you wake up at night. 

Finally, the benefits of melatonin supplementation are well observed, so it’s reasonable to say it might help with sleep during perimenopause. Melatonin supplementation carries little risk, but it’s always best to check with your doctor or pharmacist to see if supplementation would be recommended for you. 

TLDR; isoflavones, tryptophan-rich protein sources and melatonin supplementation seem to help with sleep and could be a helpful tool during the perimenopausal period.

Hot flashes and night sweats

Hot flashes and night sweats are incredibly uncomfortable symptoms that many women go through during perimenopause. So what can we do to help? You may have heard that caffeine can make hot flashes worse. Studies do support this, although there are some inconsistencies in the findings. If you are a coffee lover and are experiencing hot flashes, the best advice would be to monitor your symptoms. If you seem to get more episodes when you have caffeine, this may be a sign to find some caffeine-free alternatives you enjoy, or simply cut back a little. You can always experiment with amounts and timing to see how much caffeine is ok.

There are many promising, recent studies about the effects of soy-isoflavones (like we mentioned above) on hot flashes. They suggest that consuming them leads to fewer and less severe hot flashes. Some also looked at soy-isoflavone supplements and showed positive effects. On the other hand, the official position of the North American Menopause Society is that soy products can’t be recommended as a treatment for hot flashes, due to lack of evidence. So the best advice would be to include these types of foods in your meals if you enjoy them - and if you notice they help with your hot flashes, all the better. But if you don’t, that’s fine too. You might also be worried about how eating soy products might affect your risk of breast cancer, especially if you’ve had it in the past. The current position of the American Institute for Cancer Research and the general scientific consensus is that consuming soy products is safe for women who have had estrogen-receptor-positive breast cancer. Outside of this fact, the health benefits of soy products are well documented in the literature. 

TLDR; caffeine might make hot flashes worse, so you can pay attention to your symptoms or even experiment with drinking more or less caffeine to see if that’s the case for you. Soy products and other isoflavones show promise to help with hot flashes and have many other health benefits. If you enjoy them, give them a try and see if they help.

Bone health

An overlooked aspect of the changes occurring in your body during perimenopause is the changes to your bones. Women’s bone density peaks during young adulthood, and slowly decreases over time, with a sharp drop observed during menopause. This can lead to the development of something known as osteopenia, and eventually osteoporosis. This is essentially very low bone density and increases your risk of fractures.

So what can be done to help keep your bones healthy during this stage of life? Well, making sure you are getting enough vitamin D and calcium daily is an important first step. Vitamin D supplementation, specifically vitamin D3 can help you maintain healthy bones. So, try incorporating sources of vitamin D into your day,  like eggs, fatty fish, fortified milk and fortified plant-based beverages. While your skin can produce vitamin D, it’s important to keep in mind that about 40% of Canadians will have low vitamin D levels in the winter, and people with more melanin in their skin won’t produce as much vitamin D from the sun, so it may be worth discussing supplementation with your doctor, pharmacist, or dietitian.

Combining your sources of vitamin D with a source of calcium will supercharge your absorption. Things like dairy products, tofu, dark green veggies (okra, bok choy, kale, arugula, etc.), fish, and fortified plant-based beverages are all good sources of calcium. 

Another underrated nutrient for bone health is vitamin C. Studies suggest that the anti-inflammatory and antioxidant effects of vitamin C-rich foods can help protect you against bone loss associated with perimenopause. Luckily, getting enough vitamin C is fairly easy, as it is found in a lot of foods. Great sources include broccoli, sweet peppers, cabbage, leafy greens, kiwis, mangos, berries, and citrus fruits. 

Finally, recent studies have shown that melatonin supplementation may have the added benefit of helping to minimize bone density loss during perimenopause. More studies are needed, but if you are already taking this supplement, you may be happy to hear about this added benefit. 

TLDR; talk to a trusted healthcare professional about vitamin D supplementation. Focus on getting enough calcium, vitamin D and vitamin C from the foods you eat.

Muscle and body changes

During perimenopause, weight changes, fat distribution, and muscle loss can occur due to hormonal shifts and changes to your metabolism. You might have seen ads encouraging you to try some new ‘miracle diet plan’ to shed belly fat, since the change in estrogen that occurs at this time may result in more fat mass around your middle. The truth is that changes to your body at this stage are completely natural, and may be out of your control. This can be an uncomfortable truth to come to terms with, but it’s important to remember that so many things affect body size, not just nutrition and exercise. The best thing you can do for your body is to try and refocus on cultivating health. If you’ve been stuck in the diet cycle, you may feel like you need to restrict what you eat to prevent your body from changing. It’s important to keep in mind, however, the importance of maintaining your muscle mass during this phase of life.

Studies show that extremely restrictive diets lead to nutrient deficiencies and excessive muscle loss. Having more muscle mass can actually help to improve metabolism and can mitigate issues from bone density loss. Losing muscle increases your risk of fractures, and decreases your ability to function in your day-to-day life. So how can we maintain muscle mass through what we eat? Firstly, focus on eating enough food. I know it’s tempting to diet when you notice body changes, but it’s very difficult to preserve or build muscle mass when you aren’t eating enough. Then focus on nourishing your body and honouring your hunger and fullness cues. If you’re not sure how to do that, we highly recommend working with a weight-inclusive Registered Dietitian (book a free discovery call here!). 

Focus on eating balanced meals as much as possible. Meals that contain a source of protein, a source of carbohydrates, and fruit or vegetables can help provide a wide variety of nutrients and keep you feeling full and satisfied. Try to incorporate sources of protein at each meal and snack - not only will they help keep you satisfied, but they will also help you preserve your muscle mass. In terms of supplementation, studies do show that creatine supplementation can benefit perimenopausal women in a few ways. It is well documented that it can help with building and maintaining muscle if you are resistance training. Interestingly, it may also help with some of the emotional symptoms of perimenopause, like depression, brain fog, and cognition changes. 

When it comes to body changes, it’s really important to remember that bodies are supposed to change over time. You don’t necessarily have to like the changes, but focusing on body respect rather than trying to change your body often results in better long-term health. Don’t sacrifice long-term health and wellness for short-term weight loss that is unlikely to last.

TLDR; your body may change during perimenopause, and that’s ok. Focus on eating enough food, and getting enough protein to maintain muscle mass and strength. While you don’t have to love your body every day, you should focus on respecting it. 

Lifestyle changes to manage perimenopause symptoms

Now that we’ve covered how the foods we eat can help with perimenopause symptoms, let’s dive into some simple lifestyle changes that can help as well. 

Movement 

Physical activity has many benefits, at every stage of life. But let’s break down why it can be especially beneficial during perimenopause. Movement acts as a signal, encouraging your muscles to grow. This can help you maintain your strength and ability to function at this age. Studies also show it can decrease certain perimenopause symptoms, in particular hot flashes. It also has well-documented benefits in terms of mental health. During perimenopause, it is particularly important to incorporate weight-bearing or resistance movements. What does that look like? Things like walking, dancing, low-impact aerobics, gardening, running, lifting weights or using resistance bands, jumping and racket sports are all great options. This is because these sports create a higher strain on your bones and muscles through the effect of gravity. This in turn helps to maintain your bone density. The best advice is to choose a form of movement you enjoy, that way you’ll want to keep coming back for more. If your ideal movement isn’t weight-bearing, incorporating some weight-bearing or resistance exercises a few times a week would also be beneficial. 

TLDR; movement helps preserve your muscles, strength, and ability to function. Weight-bearing or resistance exercise is important for your bone health at this stage. Exercise may also help with hot flashes and other perimenopause symptoms. 

Sleep hygiene

As mentioned before, trouble sleeping is one of the core symptoms of perimenopause, and most people going through perimenopause will experience it. We know that lack of sleep can be detrimental to our health, so trying to maintain good quality sleep is important. Studies show that things like cognitive-behavioural therapy (CBT), mindfulness, relaxation and physical activity help improve sleep in perimenopausal women. Otherwise, trying to improve your sleep hygiene can go a long way. That means going to bed and waking up at roughly the same time every day, avoiding caffeine and other stimulants before bed, sleeping in a cool, dark room, and getting exposure to sunlight earlier in the day. The Harvard Stress & Development lab has created a helpful checklist which can be found here that can help guide you. Lastly, acupuncture has been shown to significantly lower the odds of sleep disturbances in perimenopausal and menopausal women. If it’s something accessible to you and you are open to trying it, it may be worth a shot. 

TLDR; CBT, mindfulness, relaxation, acupuncture, physical activity, and working on your sleep hygiene can help improve your sleep quality. 

Self-compassion in the face of change 

The physical and psychological changes happening during perimenopause can profoundly affect your body image. Interestingly, some studies find that body dissatisfaction increases during perimenopause, while others find that it remains unchanged. Studies also show that the worse your symptoms are, the more likely you are to have poor body image, which highlights the importance of caring for yourself during this time. It can be so difficult to navigate the changes happening in your body during this phase. In light of this, self-compassion becomes an essential tool. It’s not necessary to love your body every single day - but it still deserves to be treated with respect and compassion, especially when going through this transitional phase. Things like affirmations, mindfulness and gratitude practices can all be helpful tools to cultivate self-compassion. If you need support on how to nourish your body, and cultivate self-compassion and body respect during perimenopause and beyond, feel free to check out the different ways you can work with Nutrition IQ here.  

Video: Thriving Through Perimenopause: Nutrition and Lifestyle Changes for Symptom Relief

The bottom line on thriving through perimenopause

Managing perimenopause symptoms through nutrition and lifestyle can help you navigate this transition phase with greater ease. The science shows that certain foods can help you get adequate sleep, manage hot flashes, and maintain your strength and function. Small habits like movement, sleep hygiene and most importantly self-compassion can further help you alleviate your symptoms. It’s important to note that symptoms and their severity will vary from one person to the next - and what works for you might not work for someone else. If your symptoms are starting to affect your quality of life, we encourage you to reach out to a healthcare professional. We hope that the information shared in this post will help support not only your health but your emotional well-being, helping you to not just survive, but thrive during this transformative time in your life. 

Looking for a helpful cheat sheet to help you manage your perimenopause symptoms through food and lifestyle? Check out our handy guide that includes additional tips and the top sources of nutrients to help manage symptoms.

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