Perimenopause and Menopause
- Mansi Shah
- Jul 3
- 6 min read
If you’re in your late 30s or 40s and suddenly you donʻt feel like yourself, you may have entered perimenopause or menopause. While both are natural transitions, they are not the same thing. Let’s break down what happens, when it happens, and—most importantly—how to manage the symptoms.
What They Mean & Age of Onset
Perimenopause means “around menopause.” It is the months or years leading up to your final menstrual period, as your ovaries begin to slow down. Perimenopause typically starts between ages 40 and 44, though some women notice changes as early as their mid-30s.
Menopause is a single point in time: the 12 consecutive months without a period. The average age is 51 (normal range: 45–55). After this, you are postmenopausal.
What Happens in the Body: The Hormone Rollercoaster
Before perimenopause, estrogen and progesterone rise and fall in a predictable monthly rhythm. During perimenopause, that rhythm becomes chaotic:
· Estrogen spikes and drops erratically.
· Progesterone falls more consistently, creating a relative estrogen dominance.
· FSH rises as your brain tries harder to stimulate ovulation.
By late perimenopause and menopause, both estrogen and progesterone remain chronically low.
The Domino Effect: Mood, Appetite, and Metabolic Health
Mood Changes
The erratic swings in estrogen also affect the levels of serotonin (the feel good hormone) leading to anxiety, irritability, brain fog, and depression. Sleep disruption from night sweats worsens everything.
Appetite
During your reproductive years, estrogen helps regulate hunger and fullness hormones. When estrogen levels decline and fluctuate during midlife, this regulation is disrupted. The hunger hormone, ghrelin, can become more pronounced or feel stronger during this time. Meanwhile, signalling to the brain from leptin (the fullness hormone) may become less effective, making it harder for you to sense the feeling of fullness. Many women experience stronger cravings for sugar and refined carbohydrates and feel hungry soon after meals.
Hot flushes and night sweats
Hot flushes are the most widely reported symptom during perimenopause and are caused by declining estrogen levels. Your may suddenly start feeling hot and sweaty and this may last for several minutes. It may be accompanied by palpitations or anxiety.
Sleep Disruption
During menopause, hormonal changes can cause sleep disturbances. Hot flushes are one of the most frequently reported reasons for waking up at night. Additionally, women in perimenopause have a higher risk of developing conditions like sleep apnea and restless leg syndrome, which can further disrupt sleep.
General Metabolic Health (Deep Dive)
This is the biggest sleeper issue. Lower estrogen changes three core metabolic systems:
1. Weight gain (and why it’s not your fault)
During perimenopause, the average woman gains 1.5–2 pounds per year. Women tend to gain fat mass and lose lean mass during this transition period. Additionally, the decline in estrogen levels prompts redistribution of fat to the abdomen. Visceral fat (the deep belly fat around your organs) fat releases inflammatory chemicals that can contribute to other metabolic conditions.
2. Insulin sensitivity & blood sugar
Estrogen helps your cells respond to insulin. As estrogen falls, cells become more insulin resistant. Blood glucose stays higher longer after meals which can eventually cause prediabetes or type 2 diabetes. Even normal-weight women can develop insulin resistance during menopause.
3. Cardiovascular health
The shifts in fat distribution and insulin resistance that take place during perimenopause are also associated with increased cardiovascular risk factors such as elevated blood pressure, elevated low-density lipoprotein (LDL), and obesity. Additionally, estrogen which protects the health of your blood vessels is on the decline, further contributing to an increased cardivascular risk.
How to Manage Symptoms (Beyond “Just Deal With It”)
Seek advice about Hormone Therapy (HT) from your doctor, it can help alleviate some of the symptoms
Stress management – High cortisol worsens hormonal chaos. Try 10 minutes of deep breathing, morning sunlight, or yoga.
Sleep hygiene – sleep in a dark and cool bedroom to 65–68°F (18–20°C)
Strength training – 2–3 times weekly to preserve muscle and bone density.
Keep an eye on nutrition, try to eat
What to Eat to Improve Metabolic Health (Plant-Based First)
You cannot “eat your way out of menopause,” but you can dramatically reduce visceral fat, stabilize blood sugar, and protect your heart. Aim to reduce intake of refined carbohydrates and sugar and focus on increasing whole grains, fruits and vegetables.
These strategies start with plant foods; where animal protein is an option, it’s noted in italics.
1. Prioritize Protein at Every Meal (25–40g)
Plant base: Tofu, tempeh, edamame, seitan, beans, lentils, chickpeas, black beans, pumpkin seeds, hemp hearts, pea or soy protein powder.
Optional add (meat/fish): Eggs, Greek yogurt, cottage cheese, chicken, turkey, salmon, sardines, or whey protein.
Why: Protein increases satiety, keeping you fuller for longer and preventing the blood sugar spikes from carbs. Itʻs also important for preserving muscle.
2. Eat Carbs in a “Sequence” to Flatten Blood Sugar
Eat vegetables first → then protein/fat → then starches/sugars. Always pair carbs with protein, fat, or fiber. Example: Apple with almond butter → lower glucose rise than apple alone.
Best plant carb sources: Non-starchy vegetables (broccoli, spinach, zucchini), berries, cherries, whole fruits (not juice), steel-cut oats, quinoa, barley, beans, and lentils.
Optional add: Same meal works with added grilled chicken or salmon on the side.
3. Target Visceral Fat with Fiber & Resistant Starch
Visceral fat responds well to soluble fiber and resistant starch. Aim for 25–35g total fiber daily.
Plant sources:
· Soluble fiber: Oats, flaxseeds (ground), chia seeds, Brussels sprouts, beans, lentils, apples, citrus.
· Resistant starch: Cooked and cooled potatoes or pasta, green bananas, plantains, barley, beans.
Optional add: Resistant starch is plant-only by definition, so no animal addition needed. But a meal of beans + greens works with or without a small piece of fish.
4. Switch to Heart-Protective Fats
Replace butter and coconut oil with unsaturated fats. Limit saturated fat to <10% of calories.
Plant sources: Olive oil, avocados, nuts (walnuts, almonds), seeds (flax, chia, hemp), and tahini. For omega-3s (lower triglycerides, reduce inflammation): ground flaxseeds, chia seeds, hemp seeds, walnuts, and algae-based omega-3 supplements.
Optional add (fish): Fatty fish 2x/week (salmon, mackerel, sardines, anchovies) provides DHA/EPA omega-3s directly. If adding fish, you can reduce algae supplement.
5. Balance Sodium & Potassium for Blood Pressure
As cardiovascular protection declines, blood pressure becomes salt-sensitive.
Plant sources for potassium (helps balance sodium): Sweet potatoes, spinach, Swiss chard, white beans, kidney beans, bananas, avocados, tomatoes, coconut water, and potatoes with skin.
Reduce sodium: Cook with herbs, spices, citrus, and vinegar instead of salt. Avoid processed plant meats that can be high in sodium (check labels).
Optional add: Same potassium-rich vegetables pair well with any animal protein; just don’t salt the meat heavily.
Bonus: Time Your Meals
Many women find that stopping eating by 7pm reduces night sweats and improves fasting glucose. A 12-hour overnight fast (e.g., 7pm to 7am) gives insulin levels time to fall between days.
A Sample Plant-First Day (with optional additions)
Breakfast: Tofu scramble with spinach, mushrooms, and half an avocado + 1 slice sourdough.
Optional add: 2 eggs instead of tofu, or a side of smoked salmon.
Lunch: Large salad with 1 cup chickpeas, quinoa, cucumber, tomatoes, hemp hearts, and olive oil vinaigrette.
Optional add: 4oz grilled chicken or sardines.
Snack: Coconut yogurt (plain) with ground flaxseeds, walnuts, and a few dark chocolate chips.
Optional add: 1 hard-boiled egg or small Greek yogurt.
Dinner: Baked tempeh or tofu, roasted broccoli and sweet potato, with tahini drizzle.
Optional add: Baked salmon instead of tempeh.
Evening: Chamomile tea or magnesium glycinate (check with your doctor).
The Takeaway
Perimenopause and menopause are major metabolic transitions in womenʻs lives. During this phase you are likely to need a different diet, different exercise, and sometimes different medication. Listen to your body, eat plenty of plants, prioritize protein, lift heavy things, and do not suffer in silence. You’ve navigated every other decade of womanhood—you’ve got this one too!
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Disclaimer: This post is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting a new supplement, diet, or exercise program, especially regarding hormone therapy.
References
https://my.clevelandclinic.org/health/diseases/21608-perimenopause
https://www.hopkinsmedicine.org/health/wellness-and-prevention/perimenopause-and-anxiety
Yang JL, Hodara E, Sriprasert I, Shoupe D, Stanczyk FZ. Estrogen deficiency in the menopause and the role of hormone therapy: integrating the findings of basic science research with clinical trials. Menopause. 2024 Oct 1;31(10):926-939. doi: 10.1097/GME.0000000000002407. Epub 2024 Jul 30. PMID: 39081162; PMCID: PMC12072814.
Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.
https://www.sleepfoundation.org/women-sleep/perimenopause-and-sleep
Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5):e124865. doi: 10.1172/jci.insight.124865. PMID: 30843880; PMCID: PMC6483504.
Kodoth V, Scaccia S, Aggarwal B. Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review. Womens Health Rep (New Rochelle). 2022 Jun 13;3(1):573-581. doi: 10.1089/whr.2021.0119. PMID: 35814604; PMCID: PMC9258798.
Alemany M. Estrogens and the regulation of glucose metabolism. World J Diabetes. 2021 Oct 15;12(10):1622-1654. doi: 10.4239/wjd.v12.i10.1622. PMID: 34754368; PMCID: PMC8554369.
https://www.health.harvard.edu/diet-and-nutrition/is-food-sequencing-worth-a-try
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