Getting the Best Nutrition During Perimenopause

Perimenopause is a natural stage in life that half of the population experiences, yet it’s often misunderstood. It is the time leading up to menopause, when the body begins to change due to a decline in egg supply with resulting hormone fluctuations. Perimenopause can start seven to 10 years before menopause, which is officially defined as going 12 months without a period.

During perimenopause, your hormones — especially estrogen and progesterone — shift, and these changes can affect your whole body. Jackie Vannuyen, MD, with ProMedica Physicians Obstetrics/Gynecology explains, “Perimenopause is an inflammatory state. Hormones are master anti-inflammatory agents, so when they decline, inflammation rises.”

Common Symptoms

Perimenopause can feel different for everyone, but some common symptoms include:

• Irregular periods and more intense PMS symptoms.
• Hot flashes and night sweats.
• Sleep problems and fatigue.
• Mood changes like anxiety or irritability.
• Breast tenderness.
• Vaginal dryness or pain during sex.
• Low libido.
• Urinary issues
• Headaches.
• Weight changes, including stubborn belly fat.
• Cognitive changes like brain fog or trouble focusing.

There is no single test for perimenopause, which can make it challenging to diagnose. “Perimenopause is a clinical diagnosis, but it’s a diagnosis of exclusion,” explains Dr. Vannuyen. “That means we need to make sure there are no other underlying health conditions that could be contributing to these symptoms.”

Testing hormones may seem like the answer, but this isn’t very informative. Hormone levels can change based on the day or time of month. The focus for diagnosis should be symptoms. That’s why it’s important for patients to advocate for themselves when working with doctors to determine the root cause.

Managing Perimenopause Symptoms with Nutrition

There is no magic pill to help relieve all perimenopause symptoms. However, nutrition can play a big role in healing inflammation from changing hormones. Lab tests that inform you of your cholesterol, thyroid levels, iron levels and more can help determine how your body is currently functioning. From there, women can work with a health care provider or dietitian to optimize their nutrition to support them in perimenopause.

Registered dietitian and licensed therapist Jennifer Gilliland says it’s also important that women trust their own experiences when it comes to food. “Notice if you’re more tired or have better energy when eating certain foods. We know our bodies; paying attention to how we feel and how our bodies respond can give us valuable insight,” she says.

The timing of certain foods can also make a difference in how we feel. For instance, focusing on protein intake at the start of the day and introducing carbohydrates later in the day can be helpful for those with insulin resistance.

Everyone’s body is different, but here are some essential nutritional elements that women in perimenopause should keep in mind:

• Protein. We lose muscle mass as we age, which makes protein an important ingredient for those in perimenopause. Strength training tears the muscle fibers and protein helps build them back up to build muscle mass.
• Fiber. Fiber helps promote digestion and prevent constipation. It also helps prevent heart disease, diabetes and some cancers.
• Bone-building nutrients. Calcium, vitamin D, zinc and magnesium all help promote bone health, which is essential as we get older. Dairy products, Greek yogurt and lactose-free milk are all good sources of these nutrients.
• Water. Getting enough water helps prevent dehydration and supports the function of our organs.
• Supplements. It’s always best to get the nutrients we need from food, when possible. That’s because we’ll absorb more of the nutrients and benefit from additional nutrients in the food. However, supplements can give us a helpful boost when needed.

“If we’re putting a lot of nutrient-dense foods into our bodies, we’re going to have a better output,” Jennifer shares. She highlights the importance of paying attention to your unique food sensitivities and how we feel from the foods we eat. The goal is to feel better, be more energetic and give our bodies the nutrients they need. Being too strict will overwhelm us.

Jennifer recommends easing into change with manageable steps, rather than trying to make multiple nutritional changes at once. Opt for convenient, nutrient-dense foods, like pre-cooked chicken or pre-cut vegetables from the grocery store, if needed. Convenient foods like this from a grocery store will almost always be a healthier option than a restaurant because of the ingredients and portion sizes.

Exercise, Sleep and Stress

Along with nutrition, other lifestyle changes and medication can be helpful in managing perimenopause symptoms.

Dr. Vannuyen recommends 150 minutes or more of moderate intensity exercise per week, plus strength training three times per week. “The goal is to be strong and healthy, not necessarily skinny. We want to avoid being frail, prevent bone fractures and optimize health through activity,” she explains.

Focusing on movement can also help with weight gain that tends to happen around this time. Declining estrogen and testosterone, and the loss of muscle mass, tend to slow metabolism. Of course, sleep plays a vital role in ensuring we have the energy to even think about exercise. Getting enough quality sleep reduces cortisol (our stress hormone) levels. Elevated cortisol can negatively affect our metabolism, energy, mental and physical health. “We tend to push through without even realizing how tired we are. If you’re waking up several nights or several times a night — even just to throw the covers off — that’s going to disrupt your sleep,” Jennifer explains.

Working with a health care professional can be helpful if you are feeling tired during the day or experiencing sleep disruptions. They can also help you manage feelings of anxiety or depression, which may be affecting your daily life.

Your mental and emotional state could affect your energy level, your overall well-being and even how your body absorbs and digests nutrients.

The Role of Medications in Perimenopause

When it comes to medications, women in perimenopause may have more options than they think. There are hormonal and nonhormonal medications. There are also symptom-specific medications or overall medications that can help with multiple symptoms.

Some medications that could help include:

• Menopause hormone therapy (MHT, formerly known as hormone replacement therapy):
  • Combined bioidentical FDA-approved forms of estrogen/estradiol and progesterone (for women with a uterus).
  • Estrogen (for women without a uterus).
  • Vaginal estrogen, used locally for genitourinary syndrome of menopause.
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SSNRIs) for hot flashes.
• Antianxiety or antidepressant medications for mood changes and/or hot flashes.

“We always want to consider the risks and the benefits of any medication we’re considering,” says Dr. Vannuyen. “Your health care provider can discuss which medications may be best for you depending on your symptoms, health status and other factors.”

It’s important to understand that not all hormones are equal. Dr. Vannuyen compares hormones to citrus fruit. They are all in the same family, but different types of hormones have different functions and different side effects. Some hormones can even be beneficial in helping to prevent osteoporosis, colon cancer, and possibly dementia and heart disease.

Seeking Help for Perimenopause Symptoms

Perimenopause is a normal part of life, but it deserves more attention and understanding. If you’re experiencing symptoms, don’t hesitate to seek help.

Dr. Vannuyen reminds us, “Go to your health care appointment informed, and don’t be afraid to advocate for yourself. Many women may think their perimenopause symptoms are normal, but once they are treated, they realize how bad those symptoms were.”

With the right information and support, you can navigate this transition by feeling strong and informed.

Jackie Vannuyen, MD

Dr. Vannuyen is an OB-GYN with ProMedica Physicians Obstetrics/Gynecology. She practices in Sylvania, Ohio. View her profile.

Jennifer Gilliland

Jennifer is a registered dietitian with ProMedica and a licensed therapist.