Perimenopause and Menopause Nutrition

Perimenopause and menopause: eating and training for the body you have now

Perimenopause is one of the biggest transitions in a woman’s life, yet it’s often the least talked about. Many women reach their mid-forties feeling well prepared for very little of it, and some don’t realise that the changes they’re noticing are part of the transition at all.

The good news is that nutrition, movement and a better understanding of your own biology can make an enormous difference to how you feel and function through these years.

This article explains:

What perimenopause actually is

Menopause is officially confirmed after twelve consecutive months without a period. The transition towards it, however, begins years earlier. Perimenopause means “around menopause” and describes the run-up, when symptoms often first appear. It typically lasts around four years, though this varies considerably from woman to woman.

It can help to think of it as a kind of second puberty — only in reverse. Rather than ovulation beginning, it becomes more sporadic and less predictable until it eventually stops altogether. Because the symptoms are so varied, many women don’t immediately connect them to the transition, and recognising them isn’t always straightforward.

Some women pass through with few symptoms; others experience a unique mix of many, which can also include irregular periods, joint pain, vaginal dryness and low sex drive. Hot flushes are the most recognised sign, but they’re far from universal — which is part of why perimenopause is so easily missed.

Why weight and body composition change

A very common experience is eating the same foods as always but gradually gaining weight, or feeling hungry after meals that used to be satisfying. After years of knowing what works for your body, it can be unsettling when the rules seem to change.

This isn’t a sign you’re doing something wrong. The menopausal transition is associated with shifts in body composition — more abdominal and visceral fat, and a reduction in lean muscle. Importantly, these changes aren’t driven by hormones alone: ageing, activity levels, diet and sleep all play a significant part.

The shift tends to come from a cascade of overlapping changes rather than any single cause:

Muscle is metabolically active tissue, so as lean mass declines — a process called sarcopenia that accelerates with age — the body burns slightly less energy at rest. If food intake and activity stay exactly the same, it becomes easier to gain fat over time. Oestrogen’s role in appetite-regulating hormones such as leptin and ghrelin also means some women simply feel hungrier, or find that meals no longer keep them full for as long.

Core dietary principles for this stage of life

Supporting a healthy body composition through perimenopause comes down to a handful of consistent, achievable habits. None of them require an extreme diet — the focus is on quality, protein and variety.

A useful bonus: cooking and then cooling starchy foods such as potatoes, rice and pasta increases their “resistant starch”, which can be gentler on post-meal blood sugar and beneficial for the gut microbiome.

Aim for variety, not restriction

Different plants deliver different vitamins, minerals, polyphenols and antioxidants, so variety matters as much as quantity. A simple, motivating target is to eat thirty or more different plant foods across a week — rotating your vegetables rather than defaulting to the same few.

Why strength training matters more than ever

If there’s one habit worth prioritising during perimenopause, it’s resistance training. The goal is to preserve — and ideally build — muscle, which supports metabolism, strength, bone health and blood sugar control. It is never too late to start.

Combining regular resistance work with enough protein is one of the most effective things you can do for muscle mass and metabolic health at this stage. Adding some cardiovascular exercise supports heart health and helps with the shifts in cholesterol and insulin sensitivity that can accompany the transition.

How your genetics shape your nutrient needs

Nutrition isn’t one-size-fits-all, and genetics is one reason why. The StrideDNA test looks at the PEMT gene, which offers insight into how efficiently your body produces and uses choline — a nutrient that becomes particularly relevant during and after menopause.

Here’s the connection: oestrogen stimulates the PEMT pathway, which allows the body to produce phosphatidylcholine from phosphatidylethanolamine. As oestrogen declines, this pathway may become less active, potentially increasing your reliance on choline from food. Choline also supports methylation, because it can be converted into betaine, which helps recycle homocysteine back into methionine.

Certain PEMT variants may therefore mean you need more dietary choline, especially when intake is low. Choline-rich foods include eggs, fish, soy, chicken and beef — and understanding your own genetics can help you personalise these choices rather than relying on population averages.

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