Perimenopause

About Perimenopause

Perimenopause literally means “around menopause”. It refers to the natural transition between a woman’s reproductive years and the cessation of her periods. Perimenopause usually begins in our 40s but can begin as early as our mid-30s. It can last from two to ten years. Hormone levels including oestrogen and progesterone fluctuate throughout the month. Often progesterone decreases initially, followed by oestrogen which dips sharply in the last one to two years. These hormonal changes can result in a variety of signs and symptoms:

• A change in your periods is often the first sign. Your periods can become lighter or heavier and your cycle length may fluctuate from one month to the next.
• Weight gain, especially around the middle.
• Symptoms similar to PMS including breast tenderness, low mood/anxiety, headaches.
• Hot flushes.
• Night sweats.
• Vaginal dryness.
• Urinary tract infections.

Thankfully, diet and lifestyle can play a key role in supporting a healthy perimenopause.

Eat to Balance Blood Glucose Levels

Blood glucose refers to the amount of sugar in your blood. When the level of glucose in the blood is unstable it can impact mood, weight, sleep, energy and concentration. It can also interfere with your sex hormones and therefore worsen perimenopausal symptoms. 

To balance your blood glucose levels:

• Include a portion of protein with all meals. Protein helps to slow the absorption of sugar into the blood stream.  Protein also helps to maintain muscle mass, which starts to decline during perimenopause (this is known as sarcopenia).  Maintaining muscle mass as we age can support our strength and also increase our metabolic rate.  Good plant sources of protein include tofu, tempeh, pulses, nuts and seeds (and their butters). Animal sources include chicken, turkey, fish, shellfish, eggs, Greek yoghurt, cottage cheese and feta cheese.
• Limit starchy carbohydrate such as bread, rice and pasta. Ideally, your plate should consist of no more than 25% starchy carbohydrates.  
• Opt for wholegrain starchy carbohydrates (brown rice, quinoa, jumbo oats, rye bread) instead of refined carbohydrates (white bread, white pasta or white rice).
• Movement such as going for a walk after a meal may reduce blood glucose levels.
  
• Reduce stimulants such as caffeine. As well as affecting blood glucose, caffeine can exacerbate anxiety and bladder issues. 
• If you eat something sweet, consume it after a meal rather than on an empty stomach.

Consume Phytoestrogens

Phytoestrogens are compounds found in certain plant foods which can balance oestrogen levels. Studies have found that they can relieve perimenopausal symptoms especially hot flushes and vaginal dryness. Research has also shown that they may help reduce age-related bone loss. Studies show that only 10% of Chinese women experience hot flushes compared to approximately 75% in Western countries. This may be due to their higher intake of soya, a source of phytoestrogens.

Sources of phytoestrogens include:

• Ground flaxseeds (also known as linseeds): Flaxseeds are one of the richest sources of the phytoestrogens lignan. Aim for 1-2 tablespoons each day of ground flaxseeds. Add to porridge, yoghurt, smoothies or baked goods.
• Soya: Soya contains phytoestrogens known as isoflavones. Sources include tofu, miso, tempeh and soya beans (edamame beans). Swap regular yoghurt for soya yoghurt. Try scrambled tofu instead off eggs. Snack on edamame beans with soya sauce or sesame seeds.
• Less potent sources include beans and pulses (chickpeas, butterbeans, kidney beans, lentils), sesame seeds, pumpkin seeds, alfalfa sprouts and rye.  Add to soups and salads, pasta dishes and casseroles. Snack on hummus.

Consuming phytoestrogens several times a day appears to be more effective compared to one large dose so aim to spread your intake over the day. They appear to work better in some women. This may be due to differences in our gut bacteria. Therefore, to maximise their effectiveness it’s worth  supporting your gut bacteria through eating adequate fibre and eating fermented foods (yoghurt, kefir, sauerkraut, kimchi etc.).  They also seem to be more effective in those following a more plant-based diet. This may be due to the fact that plant-based diets tend to support a healthy bacteria in the gut.

Eat Cruciferous Vegetables

Cruciferous vegetables contain compounds called glucosinolates which can help balance oestrogen by supporting oestrogen detoxification. Good sources include cabbage, brussels sprouts, cauliflower, kale, broccoli, collard greens, radishes and watercress.  Avoid boiling them as the beneficial compounds leak into the water. Steaming or microwaving is best. They should also be chewed well as this activates the beneficial compounds. Another sources of glucosinolates are broccoli sprouts which you can buy or make at home. These contain between 10 and 100 times more glucosinolates per gram than broccoli.

Ensure Adequate Omega 3

Many perimenopausal women experience low mood and anxiety. The fatty acid Omega-3 may support mood. Good plant sources protein include walnuts, pumpkin seeds, hemp seeds, chia seeds and ground flaxseeds. Animal sources include oily fish such as salmon, herring, sardines, and fresh tuna (not canned), mackerel.

Eat for Bone Health

Because oestrogen supports bone health, declining levels of oestrogen in perimenopause can accelerate bone loss. Ensure you consume a regular intake of calcium-rich foods. Good plant sources protein include calcium-set tofu, green vegetables, chickpeas, sesame seeds and almonds. Animal sources include dairy foods and canned fish containing bones (such as sardines). Vitamin D supports the absorption of calcium. Supplementation may be beneficial.  However, I always test my clients’ levels to tailor their dose as the amount needed is highly individual.

Eat Fermented Foods

The vaginal microbiome changes during menopause. These changes are linked with urogenital symptoms of the menopause – vulval and vaginal atrophy, and vaginal dryness. Lactobacillus bacteria appear particularly relevant in maintaining vaginal homeostasis. Eating fermented foods such as sauerkraut, yogurt, kefir milk and kimchi may support the vaginal microbiome. 

Hydrate

Staying hydrated can support several perimenopausal symptoms. It can reduce constipation. Constipation can exacerbate pelvic floor problems. It can also help to avoid your urine becoming too concentrated, which can irritate your bladder.

Herbs and Supplements

Several herbs have been shown to be beneficial in supporting perimenopausal symptoms. Always seek the advice of a nutritionist before supplementing.

Feel free to get in touch if you would like to find out more about my personalised perimenopause programme.