How to Build a Personalized Nutrition Plan for Your Perimenopausal Patients

Menopause is a much anticipated time for women. It defines the moment when reproduction ends and marks a new phase of life. But did you know there is a time leading up to menopause? It's called perimenopause.

Perimenopause is when numerous shifts happen due to the decline of reproductive hormones. For example, the risk factor for certain conditions like osteoporosis increases, the body's metabolism slows, and unpleasant symptoms, like hot flashes, begin to arise. Luckily, there are specific dietary changes that women can make during this time to prevent certain conditions and stay on top of the metabolism changes.

The Perimenopause Diet ensures that nutrient-dense foods, including vitamins and minerals, fill each plate so that women have the building blocks required for this new adventure in life.

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What is Perimenopause?

The time immediately preceding menopause is known as perimenopause. It is typically around four years and is a transitional time between the fertile years and menopause. The ovaries begin to discontinue to produce hormones, which leads to hormonal changes. Full menopause does not start until there have been 12 consecutive months without a menstrual period.

Some notable symptoms during these years involve declining reproductive hormones like estrogen and progesterone. Menstrual periods will become shorter and more irregular, and ovulation will occur less regularly, leading to fertility decline.

Hormonal imbalances lead to various symptoms. For example, hot flashes or night sweats may occur when estrogen is low. When estrogen is high, though, PMS-type symptoms may be experienced. These imbalances have also been shown to lead to brain and mood changes.

Why Do Women in Perimenopause Need to Focus on Nutrition?

Risk factors for certain conditions increase significantly in the menopausal phase. However, because perimenopause is a transitional time leading up to menopause, it's the perfect time to focus on preventing those conditions and preparing the body for further hormonal drops. Nutrition is an area where we can hugely impact that prevention and preparation.

The following are common conditions that are more likely during menopause and respond well to nutritional interventions:

• Osteoporosis - 20% of bone loss can occur during perimenopause and menopause, and ½ of postmenopausal women have osteoporosis due to declining estrogen. Nutrients, including magnesium, potassium, vitamin C, vitamin K, several B vitamins, and carotenoids, are necessary to prevent osteoporosis.
• Heart Disease - decreasing hormones lead to changes in cholesterol, insulin secretion, hypertension, and vascular changes, all contributing to cardiovascular disease (CVD). The Mediterranean Diet and DASH Diet have both been studied and shown to reduce the risk of CVD.
• Mental Health Conditions - plant foods and phytoestrogens have been shown to be able to balance some of the hormone fluctuations that cause depression, anxiety, and rage during perimenopause.
• Dysbiosis - the gut microbiome is quite different during menopause than during pre-menopause. The microbiome shifts as we age leading to various digestive symptoms, yet nutrition can help balance a dysbiotic microbiome.

What Foods Are Important to Add in to Perimenopause Diet

Certain nutrients are vital during perimenopause and should be the focus of The Perimenopause Diet.

According to research, increasing protein in the diet could lessen or even prevent weight gain and muscle loss during perimenopause. The researchers suggested that women's protein requirement rises at this time because of hormonally-induced tissue protein breakdown and that women are less likely to overconsume calories if their protein intake is adequate.

Omega-3 fatty acids, most commonly associated with fish oils, are essential precisely for their ability to improve mental health struggles and hot flashes that coincide with perimenopause and menopause. This effect is likely because of the anti-inflammatory properties abundant in these fatty acids. Omega-3s are so supportive that they yield equivalent results to hormone therapy and antidepressants.

Increased fiber intake, including eating more fruits, vegetables, whole grains, and beans, was shown to reduce hot flashes and night sweats by close to 20% in postmenopausal women. Fiber also helps women stay full longer and lose weight easier.
Calcium is recommended for its important role in helping to maintain bone health by preventing bone loss, an issue prevalent in peri and postmenopausal women. However, it is also an essential nutrient for preventing other health conditions, such as hypertension, colorectal cancer, obesity, and kidney stones. Calcium-rich foods include dairy, canned sardines and salmon (with bones), almonds, winter squash, edamame, and leafy greens, such as collard, mustard, turnip, kale, bok choy, and spinach. Vitamin D intake must also be adequate since it is required for the absorption of calcium.

Probiotic-rich foods (as well as probiotic supplements) can help rebalance the microbiome and balance out imbalanced hormones that many women experience during perimenopause. Some examples of probiotic-rich foods are yogurt, sauerkraut, pickles, kimchi, and kefir.

Foods to Avoid?

Some foods may also contribute to common perimenopausal symptoms and should be reduced and avoided in the diet.

For example, spicy foods, alcohol, and caffeine can all trigger hot flashes, so these may be foods to avoid if hot flashes are a symptom you are experiencing.

Diets rich in refined (processed) grains, such as white bread, pasta, and white rice, should be avoided since they are associated with increased physical and psychological symptoms of menopause. Whole grains have been shown to help those symptoms, so they should be consumed instead.

Saturated fats may be another category of food to be mindful of during perimenopause since they can contribute to higher cholesterol, which is already a condition that perimenopausal women are prone to.

Functional Medicine Labs to Test for Perimenopausal Women

At the onset of perimenopause, there are typically three distinct hormonal changes occurring. There are increased estrogen levels (which are responsible for many unpleasant symptoms), decreased progesterone levels, and disruptions in the communication pathways within the hypothalamic-pituitary-ovarian (HPO) hormonal circuit controlling female reproduction.

Thoroughly testing reproductive hormones is a great idea when determining if you are in perimenopause and how imbalanced your hormone levels are. The DUTCH Complete test is an excellent choice since it tests several markers. Not only are reproductive hormones tested, but also adrenal hormones. The adrenal glands are responsible for producing sex hormones during menopause when the ovaries have officially discontinued functioning, so understanding adrenal health is crucial during perimenopause. This test also analyses melatonin and cortisol to better understand your sleep patterns and organic acids to screen for various nutritional and neurotransmitter deficiencies.  

Because specific nutrients are required to prevent certain conditions such as osteoporosis and heart disease, a Micronutrient Test helps detect the current status of those nutrients to see if there are any present deficiencies.

Since the microbiome can play a role in hormonal health, a Comprehensive Stool Analysis would be beneficial. This test examines the stool and can assess the status of the microbiome. It can also show the level of the body's inflammation and ability to absorb nutrients.

Summary

Perimenopause is a transitional period leading up to menopause, a life-changing phase for a woman. Many experience hormonal imbalances and unpleasant symptoms during this time. Because of those hormonal imbalances and eventual hormonal decline, there is an increased risk for many other health conditions.

Luckily, dietary changes can help ease this transition. Consuming certain nutrients during perimenopause can help to prevent health conditions associated with menopause. Functional medicine testing can also be helpful at this time to analyze your perimenopausal status and associated symptoms to create a diet plan individualized to your hormones and nutritional needs.