Dietary changes for peri-menopause

Peri-menopause is a significant period of transition in a woman’s life, marked by changing hormone levels and onset of new health conditions. While perimenopause and menopause is a natural process, transitioning through peri-menopause often requires concerted effort and dedication to improving diet and lifestyle to better suite the hormonal changes for this stage of life.

There are four stages to perimenopause:

1. Stage 1: early perimenopause. Progesterone production drops due to lower ovarian reserve and poorer egg quality.
2. Stage 2: early menopause transition. An increase in follicle stimulating hormone (FSH) leads to fluctuating levels of estrogen. Estrogen levels increase drastically and also fall drastically, leading to irregular and unpredictable cycles.
3. Stage 3: late menopause transition. Estrogen levels steadily decrease and cycles become long.
4. Stage 4: late peri- menopause. The period of time between the last menstrual period and menopause, identified as 12 months after the last menstrual period.

To read more about the four stages of peri-menopause, the hormonal changes that occur at each stage as well as potential symptoms, please read my article here.

Dietary changes for Stage 1 of Perimenopause:

Stage 1 of peri-menopause is marked by declining progesterone levels. This occurs primarily due to a decline in oocyte quality and number. Science has not yet figured out how to increase oocyte number (the current theory suggests that women are born with all the eggs they will have and menopause is a state of running out of eggs) but diet and lifestyle changes have been proven to help improve oocyte quality (5). Good oocyte quality leads to stronger and more robust ovulation with better quality corpus luteum for adequate progesterone production. Dietary changes to support this initial stage of peri-menopause are similar to dietary changes that help support fertility. An accumulation of oxidative stress over time has been proposed to be one of the main causes of declining oocyte quality (6). Diet changes should reflect the addition of foods that help fight oxidative stress, mop up free radical damage, as well as offer anti-inflammatory effects.  Example of such foods include all berries, pomegranates, dark chocolate, nuts and seeds, particularly pecans, walnuts, pistachios and peanuts (1), red cabbage, beetroots, spinach, kale and all beans, especially pinto beans which contain kaempferol, an antioxidant flavanoid that is useful in fighting oxidative stress and preventing cancer (2). Inunh addition to high antioxidant foods, foods and nutrients that boost progesterone can also be incorporated in this phase. These includes foods that are high in magnesium, vitamin b6, vitamin c, zinc and beta carotene. Examples of foods rich in these nutrients include bananas, almonds, dark chocolate, most fruits which are naturally high in vitamin c, sunflower seeds, pumpkin seeds, cashews and any orange coloured food like pumpkin, sweet potatoes, capsicums and carrots. Omega 3 fats found in seafood, algae, walnuts, flax and hemp seeds are also beneficial to lowering inflammation which contributes to poor egg quality.

Dietary changes for Stage 2 of Perimenopause

Stage 2 of peri-menopause occurs when the brain senses low levels of progesterone and increases FSH to stimulate the ovary to release more oocytes and increase hormone production. This leads to wildly fluctuating estrogen levels. During this stage estrogen can rise up to three times higher than normal levels within reproductive years leading to a state of severe relative estrogen dominance and associated symptoms (4). The drastic rise in estrogen is often followed by large drops in estrogen leading to oscillating symptoms of either estrogen dominance or low estrogen. Dietary changes to help transition through this phase of perimenopause should focus on supporting estrogen detoxification pathways. These include supporting the liver, gut/digestion and lymph systems. Top estrogen metabolising foods include cruciferous vegetables such as broccoli, kale, cauliflower, cabbage, brussel sprouts and radish. Broccoli sprouts can be particularly beneficial as they are up to 10 x stronger than broccoli, offering a decent serving of sulforaphane which is a potent antioxidant with anti-cancer properties. Sulforphane is especially beneficial in detoxifying the more toxic estrogen metabolites that are associated with breast cancer during this stage of peri-menopause and beyond. In addition to cruciferous vegetables, bitter foods like dark leafy greens, dandelion, and dark chocolate help to support liver function for better estrogen metabolism.

Fibre intake becomes increasingly important during the second phase of perimenopause. Fibre helps to modulate the gut microbiome and increase microbial diversity in the gut. Beyond this, fibre attaches to toxic estrogen metabolites and helps to excrete them through the stool. High fibre diets have been shown to excrete up to three times more estrogen through the stool when compared to low fibre diets (7). Constipation or irregular bowel movements contribute to the re-absorption of estrogen from the gut back into the blood stream, further increasing the estrogenic load on the body. While fibre is crucial in removing unwanted estrogen from the body, care should be taken to increase fibre intake slowly alongside adequate water intake and movement. A sudden increase in fibre can lead to temporary constipation which only worsens estrogen dominance symptoms.  The recommended daily intake for women is 25-30g of fibre a day, however this is considered a minimum. There is no established upper limit to fibre intake and women should increase fibre to an extent that is tolerable to them. Higher fibre diets, upwards of 50g a day are shown to help improve many health parameters (8). Unfortunately only about 20% of the adult population in Australia hits the minimum fibre recommendations (9).

Foods containing phystoestrogens such as soy, flaxseeds and dried fruits are and important addition during this stage of perimenopause.  There is much confusion over phytoestrogen rich foods. These foods are often thought to increase unhealthy estrogen in the body, but in reality, phystoestrogens are friendly compounds that are useful in both high and low estrogen states. Phytoestrogens act like weak adaptogens to estrogen, helping to either increase or lower estrogen as needed by the body. In the estrogen dominant state of peri-menopause, phytoestrogens weakly bind to estrogen receptors in tissues like the breast and uterus, essentially blocking more harmful estrogen metabolites from attaching to these receptors and worsening symptoms of estrogen dominance and risk of estrogenic cancers. This is why phytoestrogen rich foods have been associated with cancer prevention (10). To read more about phytoestrogens read my article here

The lymph and urinary systems are also important in helping to eliminate water soluble estrogen metabolites from the body. Aside from adequate hydration, supporting lymph detoxification through movement and lymphatic drainage massage can also be important. Avoidance of alcohol is recommended in this phase. High estrogen states are greatly associated with breast cancer and other estrogenic cancers. Alcohol greatly inhibits estrogen metabolism and excretion and to date has been proven to be the most potent dietary carcinogen associated with breast cancer and other estrogenic cancers (11).

Dietary changes for Stage 3 and 4 of Perimenopause

During stage three and four of peri-menopause, the body moves into a low estrogen state. Cycles become long and eventually stop. These stages are the ones most commonly associated with peri-menopausal symptoms such as hot flashes, vaginal dryness, low mood, brain fog and weight gain.  Dietary changes in these two phases of peri-menopause as well as post-menopause should focus on two aspects: firstly eating in a way to increase estrogen in the body and ease symptoms of low estrogen and secondly, to eat in a way that addresses the potential health conditions that occur due to the loss of estrogen and progesterone. These changes include insulin resistance, high cholesterol and weight gain as well as an increased risk of chronic health conditions such as diabetes, cardiovascular disease and alzheimers disease.

Phytoestrogen rich foods such as soy and flax seeds are shown to help assist with symptoms of low estrogen. In the case of low estrogen, phytoestrogens weakly attach to estrogen receptors, where there otherwise would not be enough estrogen to support the tissue that needs it. This can ease some symptoms of low estrogen, particularly hot flashes (12). Calorie needs drop by bout 200 calories a day after age 50. This is because with age, basal metabolic rate decreases due to a loss of muscle mass. Furthermore, the energy required for the operations of the reproductive system is no longer necessary, leading to a potential calorie surplus around the time of menopause. In order to mitigate the likelihood of weight gain, women should adjust their calories accordingly and ensure adequate strength/resistance training to improve metabolic function and increase muscle and bone mass. Estrogen is an insulin sensitising agent. A loss of estrogen can therefore lead to insulin resistance, increased fat accumulation around the midsection and increased risk of metabolic syndrome, diabetes and cardiovascular disease (13). This is especially true in women with a history of PCOS as they transition into menopause. Blood sugar management becomes crucial in the peri-menopausal period. To read more about blood sugar management please read my article here.

Dietary changes can be a powerful means to supporting the body and mind through the menopausal transition, however these changes alone are not enough for many women. For a smooth transition into menopause, many aspects of lifestyle need to be addressed, including sleep, exercise and stress. Depending on the severity of symptoms many women also find relief in employing mental health strategies, medical interventions such menopausal hormonal therapy (MHT) and/or natural and alternative remedies such as herbal medicines, nutritional supplementation and acupuncture etc.

References:

1.Blomhoff, R., Carlsen, M. H., Andersen, L. F., & Jacobs, D. R., Jr (2006). Health benefits of nuts: potential role of antioxidants. The British journal of nutrition, 96 Suppl 2, S52–S60. https://doi.org/10.1017/bjn20061864

4.Prior J. C. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts, views & vision in ObGyn, 3(2), 109–120.

5.Skoracka, K., Ratajczak, A. E., Rychter, A. M., Dobrowolska, A., & Krela-Kaźmierczak, I. (2021). Female Fertility and the Nutritional Approach: The Most Essential Aspects. Advances in nutrition (Bethesda, Md.), 12(6), 2372–2386. https://doi.org/10.1093/advances/nmab068

6.Zaha, I., Muresan, M., Tulcan, C., Huniadi, A., Naghi, P., Sandor, M., Tripon, R., Gaspar, C., Klaudia-Melinda, M., Sachelarie, L., & Stefan, L. (2023). The Role of Oxidative Stress in Infertility. Journal of personalized medicine, 13(8), 1264. https://doi.org/10.3390/jpm13081264

7.Goldin, B. R., Adlercreutz, H., Gorbach, S. L., Warram, J. H., Dwyer, J. T., Swenson, L., & Woods, M. N. (1982). Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. The New England journal of medicine, 307(25), 1542–1547. https://doi.org/10.1056/NEJM198212163072502