Nutrition for Perimenopause and Menopause


Sharon Sun


June 17, 2022

The 40s and 50s. It is the near mid-life time where many changes are happening and the thought of experiencing and preparing for menopause may be weary for some. In the midst of questioning life choices, creating meaningful routines and battling chronic health conditions, it’s valid to feel that our health does not appear as bulletproof as our earlier years.

Before we get into nutrition for menopause, I want to express that growing older can be seen as a privilege. While weight gain and weight loss are experiences of perimenopause and menopause and can take up our attention in these years, it is far more valuable to nurture our nutrition holistically so that we can be healthy, have endurance and enjoy living our life. Here are some inspirational words of wisdom from the American talk show host herself:

“ Of course, I want to look my best. I want to feel strong and vibrant. But I know for sure that the pathway to your best life isn’t the route of denial. It’s owning every moment. Staking claim in right now. And with gratitude, embracing the age you are.” -Oprah Winfrey

With that in mind, let’s shift the thinking on healthy eating and healthy aging to how we can best nurture our bodies to live the life we desire. This means including emotional, social, psychological and spiritual health. Today, we will cover:

  • What is menopause and perimenopause?
  • What changes happen to our bodies in our 40s and 50s?
  • How does our nutrition change in these years?
  • What can we do and eat to stay healthy during menopause?
  • Resources for menopause

A woman closing her eyes and practicing meditation

What is menopause and perimenopause?

Menopause is a natural occurrence for women between the ages of 45-55. It is defined as starting at 12 months after the last menstrual period. While most women experience menopause during this time, any history of chemotherapy, smoking, autoimmune conditions as well as having low body fat is linked to experiencing early menopause (1).

The time up to this point is called perimenopause and can vary in the start date, from the late 30s to the early 50s (1). During perimenopause, an important hormone called estrogen starts to decline and women will start to have periods which are on and off. Eventually, the drops in estrogen alongside progesterone causes the menstrual cycle to come to a stop. The decline in estrogen levels is the culprit of some undesirable symptoms. You may have heard of women experiencing hot flashes, poor concentration, headaches, joint pain and irritability during this time (2). There is also significant variation in the severity and duration of these symptoms depending on the person meaning they can last from months to years! Are there ways to manage some of these through food? That’s where you’ll find out more next.

Midlife nutrition changes

As we age into the years of perimenopause and menopause, it is not uncommon to experience the above symptoms while running into other complications. Thankfully, there are a few roles that balanced nutrition can play in maintaining good health to prepare us for these years. But first, what are some common changes that can arise in the years leading up to menopause when estrogen levels start to drop off?

Osteoporosis risk and decreased bone mass

Even in the years before menopause, women start experiencing changes to organs and functions of the body. At around the age of 30 is the time when women can obtain their highest bone mineral density (9) with the help of calcium from the diet. Up to the 40s, bone loss gradually occurs and after which new bone can no longer be built (2). Why does this happen? Before menopause occurs, estrogen is a key helper, protecting our bones in the process of building it. That means it’s not a surprise that a decline in estrogen as women age leads to an increased risk of osteoporosis (2). In fact, 5 to 7 years after menopause the loss in a women’s bone density can be as much as 20% (3). This is heightened with inadequate intake of the bone- building nutrients such as calcium and Vitamin D.

A doctor's sample model of a bone structure
What nutrients are important for bone health?

Think of our bones as a ‘calcium bank’ much like the money in our savings account. We save money in our earlier years so that we can prepare for a potential rainy day. The key is that we have deposits/funds to take from. The same idea applies to the calcium that we get from our food. We aim to save calcium in our bones over the early years so that we don’t run into trouble later. However, if we don’t save enough and we’ve already reached the peak age, our body still needs some calcium for essential functions like regulating muscle cells and brain cells (that’s right, not just for bones!). Our body can then start to take away from an already low storage of calcium in the bones. This is what gradually leads to softening of the bones (osteoporosis risk), resulting in the formation of pores and overall, increases the risk of fractures and falls.

While calcium is often seen as the hero for optimal bone function (for good reasons), let’s not forget about the other players which also support the building of our bones including Vitamin D, Magnesium, Zinc, Protein, Vitamin K and Vitamin C.

What can I do to reduce the risk of osteoporosis before menopause?
#1 Have a balance of supporting foods containing these nutrients:
  • Calcium: For all the reasons above! Aim to have 2 to 3 servings of calcium rich foods per day. Experiment with adding tofu (check the label for calcium sorbate), canned salmon (which contain calcium-rich edible bones), dark leafy greens, milk, cheese and yogurt to your dishes.
  • Magnesium: Magnesium helps build the structural matrix of the bone together with calcium and phosphorus.  It can be found in a variety of foods and is abundant in halibut, whole grains, leafy greens, some fruits, nuts and seeds, edamame and even dark chocolate and espresso coffee (mocha anyone?)
  • Vitamin K: This vitamin supports specific proteins that help with forming bone. The richest sources come from dark leafy green vegetables (think spinach, kale, collards, swiss chard), dried prunes/plums and plant oils.
  • Vitamin D:  Vitamin D helps with activating certain proteins which help with absorbing calcium. Despite this significant role, Vitamin D is limited in the food supply and is usually found in fortified milk/soy beverages, egg yolks, fortified orange juice, fortified cereals, fatty fish and variable amounts in mushrooms. You can support your skin’s natural ability to make Vitamin D from sunlight by going for a 30-minute walk on a sunny day! Meeting these needs can be a challenge and a Vitamin D supplement is usually recommended. Speak with a dietitian or doctor to see if it is right for you.
#2 Be mindful of sodium intake.
  • Nutrients can enhance the functions of others or reduce these. Sodium is one which prevents absorption of calcium. The kidneys will excrete both sodium and calcium when the diet is high in sodium.
#3 Weight bearing exercise.
  • One of the best practices to preserve the bone mineral density is to do regular weight-bearing exercise. Although it seems counterintuitive at first, the stress that weight-bearing exercise exerts on the bones ultimately makes the bone deposit more calcium and create more bone cells (4).
#4 Consult about additional risk factors.
  • Even with a supportive diet, additional factors will contribute to increased osteoporosis risk. This includes low BMI, medication use (ie. PPIs for acid reflux, SSRIs for depression, some diabetes medications) and co-existing conditions such as diabetes (5). Consult a doctor about taking a bone density test during perimenopausal years.

The key here is to be as best prepared as possible with adequate bone density before entering menopause with the help of nutrients above and then supporting what we have as we enter menopause.

Changes in Weight

As women reach over 40 years of age, they can experience changes in weight. Similar to the other changes, the decline in estrogen levels play a role here. The changes in hormones changes how the body stores and metabolizes fat (particularly visceral fat which surrounds the abdomen and subcutaneous fat) (6). When this happens, the body’s insulin response and sugar metabolism switches, increasing the risk of cardiovascular disease and diabetes (7). However, weight gain is also a result of loss of lean body mass along with decreased physical activity in the older years. Naturally, our lean body tissue uses more energy (are more metabolically active) compared to our fat tissue. Therefore, a change in tissue body tissue composition changes the energy balance in our body and can show up as a change in weight. This is where the balancing acts of both good nutrition and physical activity come in handy.

An important note on weight

While weight gain and weight loss are experiences of perimenopause and menopause, which can help one become more mindful of our nutrition, it is just as important that it does not take up significant attention to pull us away from our overall health.  Our bodies do so much more than what one might be receptive of, however the privilege of aging and finding ways to nurture what we have now is far more valuable towards living a joyous and healthy life.

How can I support my lean body tissue and muscle mass?
#1 Physical Activity

There’s no surprise here. Loss of the lean body tissue can begin in the early 30s and 40s, with gradual loss of 1% each year without physical activity (8). To combat this and preserve muscle mass, engage in regular physical activity and at least 150 minutes per week. An average of 60 minutes of activity per day has been shown to help with weight maintenance for the average adult (9). All types of exercises count to support bone density including walking, running and resistance training. These are also beneficial in maintaining steady blood sugar levels and insulin response and reduce risk of developing metabolic disease (10).

A woman on a yoga mat doing exercise crunches
#2 Protein and nutrition:

Just as many of us know it to be true, protein is important for optimizing the building of muscle. For adults of all ages, a daily recommendation of 1g per kg of body is used to prevent muscle loss with age (11). It’s just as important to have this amount spread evenly over the meals and snacks in a day. Contrary to belief, more protein in one meal (any more than 30g/meal) is not better and has the same muscle building effect as 3 times as much protein in the same meal (12). In fact, spreading out your protein intake can actually improve building of muscle by 25% (12).

Need some protein rich meal ideas? See our recipe page here!

Hot flashes and sleep and appetite disturbances

A notable occurrence with the decline of estrogen is the experience of hot flashes and sleep disturbances. Fluctuating estrogen and progesterone over the later years impacts our body temperature leading to sweating at night and unpleasant waking, disrupting our sleep. Hot flashes can occur at anytime before, during and after menopause with symptoms lasting between 1 to 5 years (13) which can lead to insomnia. In The National Sleep Foundation has found that 61% of women who past their menopause years report having insomnia for 30 days (13).

Not only does this impact one’s mood the next morning, but poor sleep is tied to appetite disruption and imbalance in our hunger hormones. Two of these hormones are ghrelin (which signals our hunger) and leptin (which signals fullness). Regularly having poor sleep raises ghrelin levels and lowers leptin levels which impacts how much we eat in a day and subsequent appetite control and weight.

What are some things that help with hot flashes or improve sleep?
#1 Limit alcohol, coffee and spicy foods

Caffeine can worsen hot flash symptoms (2) and accelerate our heartbeat leading to a hot flush experience. Caffeine also stimulates excretion of calcium in the urine (which would counteract the function of the calcium bank earlier!). Aim for no more than 2 to 3 cups per day.

#2 Build healthy sleep habits.

This includes:

  • Reduce drinking caffeine beverages 4-6 hours before bed and alcohol 3 hours before (14)
  • Have a regular sleep routine
  • Some people may find that exercising early on in the day helps (14)
#3 Do not smoke

Absence of smoking can alleviate hot flash symptoms and reduce long-term health risks (1)

#4 Engaging in mind and body relaxation activities

Engaging in mind and body activities may help with reduce stress and provide some relief from menopause symptoms (1)

Does eating soy help with menopause symptoms?

A common question is whether eating soy foods helps with managing menopause symptoms. Soy contains plant estrogens called phytoestrogens (specifically the isoflavone group) which are structurally similar to human estrogen when it is broken down in the body. This leads some individuals to believe that the phytoestrogens have the same effect as human estrogen but the effects are not mimicked quite exactly. Thus, relying on soy and soy products to retrieve estrogen to improve menopause symptoms can be questionable. Studies usually indicate either mixed or inconclusive results. In some cases, soy intake has been shown to reduce hot flashes with modest soy intake (15) without any adverse side effects. Others note that since isoflavone metabolization happens relatively fast in the body before having a chance to stay, daily and consistent consumption may be needed before improvement to hot flashes can be seen (15). Overall, the evidence is not conclusive and soy intake may or may not work to reduce hot flash symptoms for some individuals.

That being said, soy is a nutritious option in nature, offering fibre, protein, magnesium and calcium (all of which were discussed earlier!) and can’t be neglected for its contributing health benefits such as blood sugar management and heart health.

Photography with soy and soy milk

Photography with soy and soy milk

Gut Changes

Just as how our guts can be sensitive to changes in our diet, changes happening in our parts of our body can also cause a host of gut changes. The changing levels of ovarian hormones and estrogen strike again, presenting with unpleasant gut symptoms for this round. This includes bloating, bowel change and discomfort in the gut. Constipation is particularly common as one ages as a result of menopause, stress and a changing gut microbiota.

What should I watch out for?
#1 Medications

Usual culprits for microbiota changes include chronic antibiotics. As always, speak with your doctor to discuss impacts of specific medications on gut health.

#2 Support a healthy gut through fibre-rich foods and probiotics.

There’s no shortage of foods that the bacteria in our guts thrive on . Particularly having adequate fibre and incorporating probiotics promotes good gut flora balance. Despite not being a ‘nutrient’ that we would absorb, the role of fibre can not be stressed enough. The recommendation of having 25g per day for women is usually not met by most but the benefits of regular intake are plenty: stabilizing blood sugars, lowering cholesterol levels, regulating bowels, regulating the appetite and of course, supporting the gut microbiota. Fiber-rich foods are abundant in the fruits and vegetables, grains and meat alternative food groups (pulses like chickpeas, lentils, beans). If you live on bread like I do (and other foods), I would highly recommend Silver Hills sprouted grain bread abundant in fibre and micronutrients for an easy swap. If you enjoy plant sources of protein such as chickpeas and lentils in dishes, those are also bonus sources of fibre. Insoluble fibres are particularly helpful for alleviating constipation symptoms.

#3 Opting for less gassy foods

Gas is a normal part of every day especially with adequate fibre intake from foods. However, if bloating is a significant issue, try specific fibre-containing foods such as chia seeds, pumpkin seeds, strawberries, bananas, berries, baked potatoes with skins which are less gassy.

#4 Stress levels

The gut and brain are closely connected and stress can trigger undesirable gut symptoms. Check in to see if you are experiencing consistent stress and make a plan to navigate this.

Heart Health /Cardiovascular Health

By now, you’ll probably recognize that estrogen has multiple influences on the body systems, especially when it starts to fluctuate and drop in the later years of life. Another area it affects is cholesterol and heart health. Earlier on, estrogen has a protective role in maintaining a healthy heart by regulating cholesterol levels. During menopause, the decline in estrogen is associated with higher cholesterol and blood lipids (triglycerides) (16). This puts on a greater risk of heart disease but thankfully we can take an active part in reducing this risk through a heart healthy diet.

Holding a handful of blueberries in the shape of a heart

What makes for heart healthy eating?

Keep in mind some of these best practices for heart healthy eating:

  • Choose lean meats
  • Switch from saturated fats to unsaturated fats. Enjoy fried foods only occasionally.
  • Choose lower fat dairy options
  • Include heart healthy proteins such as fish, unsalted nuts, beans, legumes. The Canadian Food Guide recommendation for 2 servings of fish (ie. canned sardines, mackerel, salmon, trout, herring) per week helps meet Omega 3s important for heart and brain health.
  • Limit intake of refined sugars such as in soft drinks
  • Limit salt intake from highly processed foods.
  • Include fruits and vegetables everyday containing antioxidants. All frozen, fresh, and canned varieties count!
  • Limit refined grains
  • Include fibre-rich foods everyday!

Changing Nutrient needs

As we age, our body requires more or even less of some nutrients. Here is the quick run down of key nutrient changes for women in perimenopause and menopause.

What nutrients do I need less of?
  • Iron: As menopause approaches and menstruation (with loss of blood) declines, iron needs decrease. The RDA reduces from 18 to 8mg/d for women over 50 years of age.
  • Folate: After menopause, pregnancy is no longer a consideration and the additional folate safety net needs to prevent neural tube defects in newborns is no longer accounted for.
 What nutrients do I need more of?
  • Calcium and Vitamin D: For calcium, women’s needs increase from 1000mg to 1200mg at the start of age 50. We covered that this would be critical among maintaining bone health, brain function and muscle function! Vitamin D is essential to support in the process as well as the additional supporting micronutrients.
  • Vitamin B6: An essential B vitamin for a healthy immune system and good brain function, the needs for Vitamin B6 increases from an RDA of 1.3mg/day to 1.5mg/day after the age of 50. This is due to the decreased absorption and increased breakdown of the nutrient in the body’s processes (17) especially in the elderly ages. The good news is that this nutrient is abundant in foods such as potatoes, beans, meat, chicken and fish. Consider speaking to a doctor or dietitian regarding a supplement if these are not frequent in your diet.
  • Vitamin B12: This vitamin is commonly found in animal and milk products and is critical for cognitive function among many others. As adults age into their 50s and beyond, there can be difficulties with absorbing B12 from decreased acid production in the stomach and certain proteins that are needed to help absorb Vitamin B12. Blood tests can verify a person’s B12 status and followed with appropriate supplements and vitamin injections if needed.

Nutrition is important, but so is everything else

If you've gotten this far, congratulations! You’re one step closer to supporting a healthy lifestyle in the perimenopausal and menopause years. Remember, nutrition is just one part of holistic health and we need to take care of ourselves physically, spiritually, emotionally, socially and psychologically especially when many changes are happening. Always reach out to a dedicated professional on the topics or consult a doctor regarding additional therapies during this time.

A beautiful layout of nutritious foods and flowers

Additional Resources

At Fuel Life, we’re on a mission to integrate health services and empower individuals to find their version of healthy. We believe in embodying the pillars of Body, Mind, Nutrition and Community at the core of our retreats, programs and events. Through the provision of interprofessional care and health, our vision is to pass along a legacy of positive health for all Canadians. Not sure where to start? Book a free discovery call today!

Connect:  | Instagram | Facebook Fuel Life Canada


1.       Menopause and Perimenopause, Health Link BC.(2022).

2.       Menopausal Symptoms: In Depth. National Center for Complementary and Integrative Health. ( 2017).

3.       Hormones and Healthy Bones, Washington, D.C.: National Osteoporosis Foundation.(2009).

4.       Slowing bone loss with weight-bearing exercise. Harvard Health Publishing. Harvard Medical School. (2021).,bone%2Dforming%20cells%20into%20action.

5.       NIH Osteoporosis and Related Bone Diseases National Resource Center .What People With Diabetes Need To Know About Osteoporosis.,The%20diabetes%E2%80%93osteoporosis%20link,have%20the%20highest%20fracture%20risk.

6.       Santosa, S., & Jensen, M. D. (2013). Adipocyte fatty acid storage factors enhance subcutaneous fat storage in postmenopausal women. Diabetes, 62(3), 775-782.

7.       Keller, C., Larkey, L., Distefano, J. K., Boehm-Smith, E., Records, K., Robillard, A., ... & O'Brian, A. M. (2010). Perimenopausal obesity. Journal of women's health, 19(5), 987-996.

8.       Jacobsen, M. (2014). Midlife Nutrition - Helping Women Over 40 Overcome Nutrition Challenges." Today's Dietitian.

9.       Sternfeld, B., Wang, H., Quesenberry Jr, C. P., Abrams, B., Everson-Rose, S. A., Greendale, G. A., ... & Sowers, M. (2004). Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation. American journal of epidemiology, 160(9), 912-922.

10.   Sternfeld, B., & Dugan, S. (2011). Physical activity and health during the menopausal transition. Obstetrics and Gynecology Clinics, 38(3), 537-566.

11.   Yanai, H. (2015). Nutrition for sarcopenia. Journal of clinical medicine research, 7(12), 926.

12.   O'Connor, D. L., Blake, J., Bell, R., Bowen, A., Callum, J., Fenton, S., ... & Nutrition Working Group. (2016). Canadian consensus on female nutrition: adolescence, reproduction, menopause, and beyond. Journal of Obstetrics and Gynaecology Canada, 38(6), 508-554.

13.    Sleep Foundation. (2022) Menopause and Sleep.

14.   Harvard Medical School Division of Sleep Medicine. (2007).Twelve Simple Tips to Improve Your Sleep.

15.   Chen, M. N., Lin, C. C., & Liu, C. F. (2015). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, 18(2), 260-269.

16.   Harvard Health Publishing (2022). Take control of rising cholesterol at menopause.,(fat)%20known%20as%20triglyceride.

17.   Kjeldby, I. K., Fosnes, G. S., Ligaarden, S. C., & Farup, P. G. (2013). Vitamin B6 deficiency and diseases in elderly people–a study in nursing homes. BMC geriatrics, 13(1), 1-8.