Start Now for a Better Menopause
Certain habits support wellbeing in this new stage of life, although it’s never too late to improve your health.
Women are often blindsided by perimenopause. A 2023 BMC Women’s Health survey found that most women said they were completely uninformed or only had some knowledge of the menopause transition. To fill the knowledge gap, perimenopausal women turned to the internet and friends for information.
What you do during perimenopause, and before, contributes to your future health and wellbeing, but if you don’t know the facts about menopause, it’s difficult to take action.
In the U.S., women can live up to 40% of their lives after their last menstrual period. (The average age of menopause in the U.S. is 52.) If you’re like me, you want to stay energetic and avoid chronic conditions to the best of your ability for as long as possible. That requires an awareness of what’s happening to your body during the menopause transition and how diet and lifestyle can help counteract those changes and help you feel more in control.
Declining estrogen levels starting in perimenopause increase the risk for several conditions including heart disease, stroke, and osteoporosis. Positive health habits before – and after - menopause can offset the risk for these and other chronic problems and help you live your best life.
Perimenopause is a good time to start practicing the lifestyle habits that are associated with greater wellbeing. Here’s what to work on now, and at any point, including after menopause occurs.
Follow a plant-based eating plan.
You’ve probably heard the advice to eat a plant-based diet a thousand times, and for good reason. Plant foods, including grains, soy products, lentils, beans, seeds, nuts, fruit, and vegetables, provide myriad nutrients that support health during perimenopause and beyond.
Depending on food choices, diets rich in plants tend to be higher in fiber, a nutrient that just 5% of people in the U.S. consume in adequate amounts, which is about 30 grams daily for women. According to a 10-year study of 1,600 people ages 49 and older in The Journals of Gerontology, those who ate the most fiber had the fewest chronic diseases, such as heart disease, type 2 diabetes, and cancer, less disability and depression, and better brain function that those who consumed the least.
Soluble fiber is a type of fiber that helps to keep you fuller for longer and may aid in weight control, helping to prevent weight gain around your middle, most of which tends to be visceral fat, also called belly fat. Evidence suggests that adding soluble fiber to your eating plan can result in weight loss independent of calorie restriction. In one study, increased intake of soluble fiber slowed belly fat gain over a 5-year period.
Soluble fiber helps to better manage blood cholesterol levels, which is noteworthy because cholesterol tends to rise after menopause occurs. Soluble fiber helps stabilize blood glucose levels, which often increase with estrogen loss. And fiber is essential to gut health. It prevents constipation and provides food for the beneficial bacteria in the gut that supports health in numerous ways.
According to the American Heart Association, even if don’t regularly eat enough healthy plant foods, including more at any point is associated with a lower risk of dying from cardiovascular disease. Although most of your food should be plants on a plant-based diet, you don’t have to cut out animal foods, such as lean meat, poultry, eggs, dairy products, and seafood.
Eat adequate protein.
Protein gets a lot of attention and there’s no shortage of information on the internet about how much protein women “should” consume. Protein is required to make nearly every compound in the body that keeps you alive and it plays a key role in muscle and bone health. Adequate protein as part of a balanced diet can help you feel fuller for longer and can make weight loss and long term weight control easier by increasing eating satisfaction.
It's a good idea to become accustomed to eating about 25 to 30 grams of protein at each meal for many reasons. This post explains protein in depth and helps you figure out how much you need every day.
Start moving and making muscle.
As estrogen declines, muscle changes, too. Lower estrogen levels promote sarcopenia, which is muscle tissue loss. Skeletal muscle mass makes up about 30% to 40% of your entire body mass.
During perimenopause, women tend to gain fat and lose lean mass, which includes the skeletal muscle in your arms, legs, and other places, according to the Study of Women’s Health Across the Nation. This change in body composition may not be reflected on the scale, although many women will gain body fat during the menopause transition.
Even when your weight is stable, losing lean mass is never good. Research shows that women with more lean mass and less fat have greater leg strength and can walk and climb stairs faster than those with less lean mass.
The trick is to do everything you can to build and preserve skeletal muscle now and in the future. Muscle supports your bones, keeps you strong and independent for longer, and is a metabolic machine that helps reduce the risk for insulin resistance, which is linked to several conditions including type 2 diabetes, overweight and obesity, high blood pressure, and cardiovascular disease. And, according to The Journal of Nutrition, Health, and Aging, two studies published in 2023 found an association between greater muscle mass and a lower risk for cognitive decline and dementia.
A combination of adequate protein and regular, challenging resistance exercise, such as weight training at least twice weekly, supports skeletal muscle mass. Check out this post for more on why muscle matters so much.
Boost your bones.
Estrogen protects bone mass by slowing the breakdown of bone cells, and declining estrogen levels means you lose bone tissue faster than you can make it. In SWAN participants, bone loss was greatest from one year before the last menstrual period through two years after. Bone mass declines steadily but more slowly after that initial loss.
The good news is that regular physical activity, including exercise, housework, and yard work is associated with greater bone density and bone strength in premenopause and early perimenopause, which helps reduces the risk of bone fractures later on.
It’s best to have as much bone tissue as possible before perimenopause starts, and that requires a combination of physical activity and nutrition. Include 1,000 milligrams of calcium in your diet every day before perimenopause starts and 1,200 milligrams daily once menopause occurs. Vitamin D improves calcium absorption, and adult women require 15 micrograms every day. In the SWAN population, women with adequate blood levels of vitamin D levels had fewer fractures than women with low levels.
Snap out of poor sleep habits.
Sleep suffers when life gets busy, hot flashes hit in perimenopause, or you’re feeling stressed. Regular sleep deprivation can make you cranky, interfere with concentration and alertness, and contribute to so called “brain fog” during perimenopause. It also makes weight control more difficult.
Your sleep patterns may change when perimenopause starts. About half of all women report sleep problems starting early in perimenopause. However, for those with good sleep before perimenopause, sleep may not get worse during this time.
It’s important to get into good sleep habits now to help head off any potential issues down the road. Here are some suggestions to get more slumber.
• Go to sleep and get up at the same time each day, including on weekends.
• Avoid social media and TV before bedtime.
• Avoid napping in the late afternoon or evening, as it may interfere with nighttime sleep.
• Keep your bedroom at a comfortable temperature and as quiet as possible.
• Exercise on a regular basis.
• Avoid going to bed with a very full stomach, and don’t drink too much fluid before bed, including alcohol. Alcohol disrupts sleep later on in the night.
• Limit caffeine, especially later in the day.
• Discuss all of the medications and dietary supplements you take with your doctor, nurse practitioner, or pharmacist to see if they may be interfering with sleep.
• Avoid nicotine. Nicotine is a stimulant that can affect sleep.
The Bottom Line
Perimenopause is a time of change, but it’s possible to minimize the health effects of lost estrogen with positive health habits. If you need help, check out the book I wrote with Hillary Wright, M.Ed, RDN called The Menopause Diet Plan, A Natural Guide to Managing Hormones, Health, and Happiness.
Very helpful distillation of your book recommendations (which I enjoyed, btw)! Wondering if we can crowd source websites and cookbooks that people recommend for plant-based meals. Thanks!