As we now know, perimenopause refers to the years that precede menopause, when women can experience unwelcome symptoms of hormones changing like night sweats, mood swings, irritability, depression, missed or heavy periods, and vaginal dryness. These symptoms are no walk in the park! Most women start experiencing perimenopause in their mid-40s, but for some women it will begin as early as their 30s.
So what’s happening to your hormones during this time? During perimenopause, estrogen and progesterone hormones start to decrease. Progesterone tends to drop first, and estrogen can fluctuate up and down until it settles. You can’t avoid these hormonal changes altogether, but you can do a lot to empower yourself with specific dietary and lifestyle choices that help you feel more like yourself. Here are some important foods I tell women to focus on during this time in your life:
1. Load up on cuciferous vegetables.
In the early stages of perimenopause, progesterone drops faster than estrogen. This can lead to estrogen dominance, or a higher estrogen level compared to progesterone. During this phase, it’s important to support the body’s ability to metabolize estrogen properly, and vegetables from the cruciferous family are best at that. “Rich in indole 3-carbinol and chlorophyll, cruciferous vegetables promote estrogen metabolism and detoxification in the liver, shifting ‘dirty’ estrogens to ‘clean’ estrogens,” explains Paula Carper, R.D., registered dietitian and women’s health strategist, who recommends eating cruciferous vegetables on a daily basis during perimenopause.
If you’re not used to consuming this type of vegetable and need some inspiration, try sautéing and incorporating broccoli, Brussels sprouts, and bok choy into omelets and stir-fries. You can also mix raw shredded broccoli, cabbage, or Brussels sprouts into your salads. One of my favorite substitutes is to make mashed cauliflower instead of mashed potatoes and cauliflower rice instead of white rice for more fiber and fewer carbs. Or, simply snack on cruciferous veggies alone or dipped in guacamole or hummus. If they cause gas or bloating, start slowly and stick with cooked forms, as cooking these cruciferous veggies makes them easier for your digestive system to tolerate.
2. Eat protein-rich foods at every single meal (even breakfast).
Blood sugar issues during perimenopause will worsen your mood swings, increase irritability, and stress your adrenals. Eating protein at every meal will stabilize blood sugar and reduce the spikes and crashes, which will also help you lose weight, prevent weight gain, and reduce your risk for insulin resistance, diabetes, and metabolic syndrome. Protein also helps you stay full and burn more calories without feeling deprived or constantly hungry. Your muscle mass and bone density take a hit as you enter menopause, and getting enough protein in your day, along with resistance training or weight-bearing activities, will preserve them and reduce their decline.
The best high-protein foods to incorporate into your diet are pastured eggs, wild-caught fish, lean poultry, grass-fed meats, and legumes (if you can tolerate them). Aim for 21 to 28 grams of protein at each meal, including breakfast. Skip the morning pastry and have a savory breakfast like a vegetable omelet or organic, preservative-free turkey or chicken sausage with some broccoli or cauliflower. If you like oatmeal, add high-protein nuts and seeds like almond butter, hemp, or pumpkin seeds for a delicious and high-protein treat.
3. Incorporate flaxseed into your routine.
Flaxseed can be one of the most supportive superfoods throughout perimenopause. Carper frequently recommends it in the later perimenopause stages as it contains lignans, which are phytoestrogens, weaker plant-based estrogens that provide gentle estrogen support when estrogen is waning. Conversely, she adds, “it can act adaptively and block estrogen when estrogen dominance is present in the earlier stages.” That said, if adding flaxseed worsens your periods, mood swings, breast tenderness, or other symptoms you’re experiencing, it may be amplifying your estrogen dominance, and you should discontinue use.
Expert tip: Always grind flaxseeds to reap the benefits, as we don’t have the digestive enzymes needed to break down the outer shell. If possible, buy them whole, grind them in small batches every few days, and store in the fridge to maximize freshness. Flaxseeds can be enjoyed in smoothies, as an egg replacement in vegan or egg-free recipes, or simply added to casseroles or Greek yogurt. If you’re into healthy baked goods, you can also use ground flaxseed to replace white or processed flours in muffins and other baked goods to increase fiber and protein.
4. Focus on foods that support bone health.
Estrogen protects against bone loss, so when it starts to drop, women are at an increased risk for osteoporosis. This means that perimenopause is a very important time to support your bone health to prevent osteoporosis and its complications. You can do this in a few ways, but this first is by eating calcium-rich foods. If you can tolerate dairy, eat two to three servings per day and choose organic or grass-fed varieties. Plain or Greek yogurt are great options as they also contain live bacteria that support the gut. Skip sweetened and fruit-flavored yogurts and mix in chopped cucumber and fresh herbs instead of fruit as a savory snack. Plain cottage cheese and aged cheeses without additives or colorings are good sources of calcium and protein as well.
If you don’t tolerate dairy, there are many nondairy calcium-rich foods to choose from. Try broccoli, bok choy, collard greens, kale, almonds, and canned salmon and sardines with bones. Many of these foods contain vitamin D, which helps your body absorb the calcium, but I find that most of my patients are deficient in vitamin D and need to supplement for optimal bone health—especially during perimenopause. To continue to support your bone health during perimenopause, ask your doctor to test your vitamin D levels and take a dose that’s right for you.
Two other often overlooked nutrients critical for bone health are magnesium and vitamin K2. Magnesium, found in nuts, legumes, leafy greens, and dark chocolate, is another mineral that makes up your bones. Vitamin K2, found in natto (fermented soy), egg yolks, cheese, and butter, tells your body to deposit the calcium in your bones, not your arteries or other organs. Just like vitamin D, food doesn’t typically provide an adequate amount of vitamin K2. Because of the emerging research on its role in bone health—as well as heart disease and diabetes—I recommend that women during and after perimenopause add a high-quality vitamin K2 supplement to their daily routine.
5. Don’t forget omega-3-rich foods.
During the transition to menopause, try to eat 4 ounces of omega-3-rich fish like salmon, sardines, tuna, mackerel, cod, and trout twice a week. Research shows that EPA and DHA, the two omega-3 fatty acids found in fish, reduce inflammation, improve mood, and reduce depression. They also reduce the risk for heart disease, another condition that women become at higher risk for after perimenopause.
But what about plant-based omega-3s like walnuts and flaxseed? These foods contain the plant-based omega-3 ALA, which needs to be converted to EPA and DHA in order for you to receive the benefits. This means that nut-based omega-3s don’t replace fish-based ones, but they are still a great source of healthy fats and fiber. If you’re at an increased risk of heart disease or don’t like eating fish, ask your doctor about starting a high-quality fish oil supplement.
6. Eat more high-fiber complex carbohydrates (because not all carbs are bad).
Cutting out simple and processed sugars and replacing them with high-fiber complex carbohydrates will help balance your blood sugar during perimenopause. Healthy carbohydrates can also reduce mood swings, irritability, and depression because they increase the production of serotonin, one of the happy, feed-good hormones.
I find that the best types and amounts of carbohydrates will vary from one person to another, as several things must be factored in like your medical history, activity level, and digestive health. If tolerated, beans, lentils, oats, quinoa, buckwheat, and other whole grains a few times a week are good options. Starchy vegetables like sweet potatoes, carrots, beets, winter squashes, and other root vegetables are great choices because they are rich in nutrients and fiber.
By focusing on these foods—which can help decrease inflammation, support a healthy mood, and balance hormones and insulin levels—perimenopause doesn’t have to be something we dread. In fact, entering perimenopause is a great excuse to prioritize cooking at home, learning to love healthy foods and exercise, and generally taking a little extra care of yourself. That doesn’t sound like anything we should be afraid of!