What To Eat In Perimenopause: The Foods To Focus On As Your Hormones Begin To Change

For many women, perimenopause is the moment when the body they thought they knew starts behaving differently. Sleep becomes less predictable, energy fluctuates, weight begins to settle in different places and maintaining muscle suddenly requires more attention. The temptation is often to respond by eating less. Less carbohydrate, less fat, fewer calories, perhaps skipping breakfast altogether. I think we need to turn that conversation around.

Perimenopause isn’t simply about managing weight. As oestrogen begins to fluctuate and eventually decline, we need to protect muscle and bone, support cardiovascular and metabolic health and nourish the gut. So rather than asking what should I cut out?, a more useful question is: what does my body need more of now?

Start with protein

If protein wasn’t something you thought much about in your thirties, perimenopause is a good time to start. Maintaining muscle becomes increasingly important as we age, and particularly through the menopause transition. Muscle isn’t simply about looking toned. It supports strength and mobility, and it is metabolically active tissue that plays an important role in glucose regulation and metabolic health.

I encourage women to spread protein across the whole day rather than eating most of it at dinner.1 A simple guide is to include a portion of protein roughly the size of your fist at every meal. Breakfast is the obvious place to start. Eggs, Greek yoghurt or a smoothie with added protein, rather than toast or cereal alone, can make a significant difference to the day’s total. At lunch and dinner, think fish, chicken, tofu, tempeh, beans or lentils, alongside plenty of vegetables. Protein also works best alongside resistance exercise. If there is one form of exercise I would prioritise increasingly through midlife, strength training is high on the list.

Feed the gut with plants

We hear a great deal about the gut microbiome in menopause, and it is a genuinely fascinating area of emerging research. But before reaching for an expensive probiotic, start with what is on your plate. Our gut microbes feed on the fibres found in vegetables, fruit, beans, lentils, nuts, seeds and whole grains. When it comes to plants, diversity matters.

I encourage women to think in colour. Berries at breakfast, leafy greens, cruciferous vegetables such as broccoli and cauliflower, herbs, nuts and seeds, beans and lentils. Fermented foods such as kefir, live yoghurt, sauerkraut and kimchi add another dimension if you tolerate them. This is one reason a Mediterranean way of eating makes so much sense in midlife. It brings together vegetables, fruit, legumes, nuts, seeds, whole grains, fish and extra virgin olive oil, a dietary pattern with good evidence for cardiovascular and metabolic health.2

Don’t automatically ditch the carbohydrates

Carbohydrates are often the first casualty when women notice their body composition changing. They don’t need to become the enemy. Quality matters far more. Oats, buckwheat, quinoa, beans, lentils and sweet potatoes bring fibre and micronutrients with them. Combine them with protein, vegetables and healthy fats and you have a very different meal metabolically from a bowl of refined cereal or a pastry grabbed with coffee.

What I would reduce are the refined carbohydrates and added sugars that quietly accumulate through the day: biscuits, pastries, sugary cereals, sweetened drinks and heavily processed snacks. This isn’t about never having dessert again. It is about what makes up most of your diet.

Bring in the good fats

Cardiovascular health becomes increasingly important as we move through menopause, so this is a good time to look at the fats we eat most often. Extra virgin olive oil, nuts, seeds, avocado and oily fish are the foods I would bring in regularly. Salmon, sardines, mackerel and trout deserve particular attention because they provide protein alongside the omega-3 fats EPA and DHA. Walnuts, chia and flaxseed provide ALA, the plant form of omega-3.

Think less about eliminating fat and more about changing the everyday default: olive oil rather than butter most of the time, a handful of nuts instead of a processed snack, and oily fish regularly through the week.

What about phytoestrogens?

Phytoestrogens have become something of a menopause buzzword, but they are worth understanding. These naturally occurring plant compounds are structurally similar to oestrogen and can interact with oestrogen receptors in the body. Soy foods such as tofu, tempeh and edamame are rich in isoflavones, while flaxseed contains lignans. The research on whether soy meaningfully reduces symptoms such as hot flushes remains mixed,3 so I wouldn’t present these foods as a way to “balance your hormones”. I would, however, include them.

Tofu, tempeh, edamame and ground flaxseed bring protein, fibre and useful plant compounds to the diet. A tablespoon of ground flaxseed stirred into yoghurt, porridge or a smoothie is one of the simplest additions you can make.

Eat for your bones before you think you need to

Bone health can feel like something to worry about later. It isn’t. Declining oestrogen accelerates bone loss around menopause, which makes this an important time to get enough calcium, vitamin D and protein. Natural yoghurt, kefir and cheese provide calcium and protein. Tofu set with calcium, tahini, sesame seeds and tinned sardines eaten with their bones are useful alternatives.

Vitamin D is harder to obtain from food alone, particularly in the UK, although oily fish and eggs provide some. NHS guidance is for everyone to consider a daily 10 microgram supplement through autumn and winter. Nutrition also works alongside movement. Bones respond to being challenged, so resistance training and exercise that puts load through the bones, such as brisk walking, jumping, and climbing stairs, are an important part of the picture.

Don’t respond to perimenopause by eating less and less

Perhaps the most important thing I tell women entering perimenopause is not to panic and start removing entire food groups. When weight begins to redistribute around the middle, restriction can feel like the obvious answer: fewer carbohydrates, less fat, smaller portions, skipped meals. But this is also a period when we need to preserve muscle, protect our bones and pay closer attention to cardiovascular and metabolic health. That requires nourishment.

So instead of beginning with what can I remove?, start with what you can add. More protein. More plants. More fibre. More oily fish. More calcium. Better fats.

Our nutritional needs evolve as we do. Perimenopause isn’t a reason to eat less food. It is a very good reason to become more intentional about the food we eat.

References

1. Bauer J, et al. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, 14(8), 542–559.

2. Estruch R, et al. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine, 378(25), e34.