For women in their mid-30s and up, perimenopause is a huge life transition that can last up to a decade. While hormonal fluctuation is a normal part of most women’s lives, the changes that occur during this period can bring extra challenges.
Perimenopause is the period that leads up to the end of menstruation (menopause), when the ovaries begin to produce less estrogen. For most women, it starts in the 40s, but can begin as early as the mid-30s.
Perimenopause lasts until the ovaries stop releasing eggs and menstruation ceases (technically after 12 straight months without a period). While perimenopausal symptoms can last up to a decade, there’s often a “ramping up” in the final years as estrogen levels plummet. This dramatic change in hormone levels leads to a number of symptoms.
While each woman experiences perimenopause differently, there are a number of symptoms that are common to most, including:
• Worsening of premenstrual syndrome (PMS)
• Longer or shorter than normal menstrual cycles
• Hot flashes and night sweats
• Mood swings
• Bone loss
• Difficulty sleeping
• Lower sex drive
• Breast tenderness
• Urine leakage when sneezing or coughing
• Discomfort during sex due to vaginal dryness
It’s overwhelming just to read this list of symptoms, let alone get through them with grace and humor. Luckily, there are a number of lifestyle changes you can make to lessen the disruption perimenopause causes in your day-to-day life.
Among the best ways to naturally manage perimenopause, doctors often recommend regular exercise, getting more sleep (and higher-quality sleep), drinking less alcohol, maintaining a healthy body weight and, perhaps most importantly, attention to a healthy diet.
There are number of good food choices that can help you survive. Let’s look at the top three!
#1 – Plant estrogens from soy
Isoflavones are plant chemicals found in certain foods, particularly soybeans, chickpeas and other legumes. While much less powerful than actual estrogen, these isoflavones have an estrogen-like structure and can work in the body as a phytoestrogen (plant-based estrogen).
While emerging research indicates isoflavones may help to protect bone and heart health, some of the more exciting research points to the benefit of isoflavones for hot flashes.
One study, published in 2015 by the North American Menopause Society, looked at the effects of isoflavones from soy in the diet for perimenopausal women.
Previous research indicates that about half of all women are able to convert soy into an estrogen (equol).
Researchers surveyed women (ages 45 to 55) who weren’t on any type of hormone therapy and who ate soy products at least three times a week. Participants kept a log of how many and how severe and their hot flashes and night sweats were, and they had their hot flashes measured with a skin monitor.
Next, urine samples were studied to determine who of the participants were able to produce equol from soy isoflavones. Of the 357 participants, 34% were equol producers. And among that group, those who ate the most soy were over 75% less likely to report a higher than average number of hot flashes and night sweats than those who had the least soy in their diet.
For the women unable to produce equol, the soy in their diet made no difference. As equol testing is not a standard protocol for most doctors, the best course of action is to try a high-soy diet for six weeks and keep track of your own benefits.
A second, more in-depth research review from the North American Menopause Society looked at the overarching benefits of isoflavones for perimenopausal women. Overall, the review board of 22 clinicians found that “use of soy isoflavones for hot flashes is reasonable and that soy food consumption is associated with lower risk of breast and endometrial cancer.”
#2 – Omega-3 fatty acids from salmon and other fatty fish
Omega-3 fatty acids from salmon and other fatty fish can help with perimenopausal symptoms even beyond hot flashes.
Research shows that omega-3s can first help curb out-of-control inflammation in the body, which can seriously worsen menopausal changes to bone health, heart health and mood (and hot flashes to boot).
A 2013 study found that omega-3 fatty acids were linked to perimenopausal bone health. Scientists looked at red blood cell samples from women with and without a history of hip breaks. They found that higher levels of omega-3 fatty acids (either from fish or from plants such as flax) were associated with a lower likelihood of fracturing a hip (the most common age-related bone fracture).
While the study didn’t identify a direct mechanism for omega-3s improving bone health, the researchers hypothesize “that inflammation may contribute to bone resorption, the breaking down of bone caused by the release of cells called osteoclasts.”
A second study on perimenopausal Korean women with osteoporosis found similar results. Looking at bone loss levels and fish in the diet, the team found that the more fish in the diet, the less bone loss the women experienced.
Studies show that omega-3s can also help to improve the mood swings and changes that come with fluctuations in estrogen levels. A 2009 study from Université Laval in Quebec found that omega-3s ease mental distress and symptoms of depression common to menopausal and perimenopausal women.
For the study, the team recruited 120 women (ages 40 to 55) and divided them into two groups. Women in the first group took one gram of EPA (a marine-based omega-3 fatty acid) every day for eight weeks. Those in the second group took a placebo.
At the end of the trial period, the women taking omega-3s experienced a significant improvement to their mood and feelings of mild depression. As a bonus, women with hot flashes also experienced an improvement taking the omega-3 supplement.
Finally, menopause can have a significant impact on heart health. Estrogen is believed to have a positive effect on the inner layer of artery wall, helping to keep blood vessels flexible. In addition, for many women the hormonal changes of menopause cause the blood pressure to rise, “bad” LDL cholesterol levels to rise as “good” HDL cholesterol declines, and triglycerides to rise.
There is a growing body of evidence that omega-3 fatty acids from salmon and other fish can provide cardiovascular protection for women as they age. One particular study from 2014 found that omega-3s were linked to sharply lower heart risk among post-menopausal women.
Researchers examined blood tests and medical records from 2,448 postmenopausal women between the ages of 50 and 79 who participated in the Women’s Health Initiative study. Of those women, half had heart disease and half did not.
By comparing the women’s heart health status and omega-3 blood levels, the team found that higher levels of the three seafood-source omega-3 fatty acids (EPA, DHA, and DPA) were linked to a significant reduction in heart disease.
#3 – Calcium and vitamin D from food or supplements
Like omega-3 fatty acids from salmon, calcium and vitamin D offer a wide-range of benefits for perimenopausal women. To start, it shows promise in lowering cholesterol (which often rises as hormone levels change).
A 2014 study found that calcium and vitamin D were able to improve cholesterol profiles. Over 600 women in the trial took either a supplement containing 1,000 mg of calcium and 400 IU of vitamin D3 or a placebo. The women who took the supplement were more than twice as likely to have normal vitamin D levels, as well as lower “bad” LDL levels and higher “good” HDL levels. Test subjects also experienced lower levels of triglycerides.
Of course, vitamin D and calcium are well-documented as key nutrients for the prevention of osteoporosis. In fact, in 2007 the FDA approved a health claim for these two supplements.
According to the FDA: “Osteoporosis is a significant public health problem, especially for women. This new labeling should assist consumers to select foods—and women especially since women do the majority of food shopping in the US—that provide adequate calcium and Vitamin D intake and hopefully prevent the occurrence of osteoporosis in themselves and their family members.”
Interestingly, another study found that calcium and vitamin D levels were linked to lower risk of early menopause, so it’s important to start early with increased dietary intake and/or supplementation.
The 2017 study from epidemiologists at the University of Massachusetts Amherst’s School of Public Health and Health Sciences evaluated how vitamin D and calcium intake was associated with early menopause by looking at data from over 100,000 women ages 25-42.
According to Alexandra Purdue-Smithe, lead researcher: “We found that after adjusting for a variety of different factors, vitamin D from food sources, such as fortified dairy and fatty fish, was associated with a 17 percent lower risk of early menopause when comparing the highest intake group to the lowest intake group.”
Food and Drug Administration, HHS. Food labeling: health claims; calcium and osteoporosis, and calcium, vitamin D, and osteoporosis. Final rule. Fed Regist. 2008 Sep 29;73(189):56477-87. PubMed PMID: 18985959.
Lucas M, Asselin G, Mérette C, Poulin ML, Dodin S. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 641–651, https://doi.org/10.3945/ajcn.2008.26749.
Matthan NR, Ooi EM, Van Horn L, Neuhouser ML, Woodman R, Lichtenstein AH. Plasma phospholipid fatty acid biomarkers of dietary fat quality and endogenous metabolism predict coronary heart disease risk: a nested case-control study within the Women’s Health Initiative observational study. J Am Heart Assoc. 2014 Aug 13;3(4). pii: e000764. doi: 10.1161/JAHA.113.000764. PubMed PMID: 25122663; PubMed Central PMCID: PMC4310362.Messina M. (2016). Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients, 8(12), 754. http://doi.org/10.3390/nu8120754
Moon HJ, Kim TH, Byun DW, Park Y. Positive correlation between erythrocyte levels of n-3 polyunsaturated fatty acids and bone mass in postmenopausal Korean women with osteoporosis. Ann Nutr Metab. 2012;60(2):146-53. doi: 10.1159/000337302. Epub 2012 Apr 14. PubMed PMID: 22507833.
Newton KM, Reed SD, Uchiyama S, Qu C, Ueno T, Iwashita S, Gunderson G, Fuller S, Lampe JW. A cross-sectional study of equol producer status and self-reported vasomotor symptoms. Menopause. 2015 May;22(5):489-95. doi: 10.1097/GME.0000000000000363. PubMed PMID: 25380274.
Orchard, T. S., Ing, S. W., Lu, B., Belury, M. A., Johnson, K., Wactawski-Wende, J., & Jackson, R. D. (2013). The association of red blood cell n-3 and n-6 fatty acids to dietary fatty acid intake, bone mineral density and hip fracture risk in The Women’s Health Initiative. Journal of Bone and Mineral Research : The Official Journal of the American Society for Bone and Mineral Research, 28(3), 505–515. http://doi.org/10.1002/jbmr.1772
Purdue-Smithe AC, Whitcomb BW, Szegda KL, Boutot ME, Manson JE, Hankinson SE, Rosner BA, Troy LM, Michels KB, Bertone-Johnson ER. Vitamin D and calcium intake and risk of early menopause. Am J Clin Nutr. 2017 Jun;105(6):1493-1501. doi: 10.3945/ajcn.116.145607. Epub 2017 May 10. PubMed PMID: 28490509; PubMed Central PMCID: PMC5445672.
Schnatz PF, Jiang X, Vila-Wright S, Aragaki AK, Nudy M, O’Sullivan DM, Jackson R, LeBlanc E, Robinson JG, Shikany JM, Womack CR, Martin LW, Neuhouser ML, Vitolins MZ, Song Y, Kritchevsky S, Manson JE. Calcium/vitamin D supplementation, serum 25-hydroxyvitamin D concentrations, and cholesterol profiles in the Women’s Health Initiative calcium/vitamin D randomized trial. Menopause. 2014 Aug;21(8):823-33. doi: 10.1097/GME.0000000000000188. PubMed PMID: 24594863; PubMed Central PMCID: PMC5234488.