Perimenopause and menopause can bring changes to menstrual cycles, sleep, mood, appetite, digestion, body composition and overall wellbeing.
This is also a stage of life when many people are exposed to conflicting advice about fasting, carbohydrates, supplements, hormone-balancing diets and rapid weight loss. Restrictive diets can make it more difficult to meet nutritional needs and may contribute to fatigue, food preoccupation, loss of muscle and an unhealthy relationship with food.
There is no single menopause diet. Personalised nutrition can, however, help protect your bones, maintain muscle, support cardiovascular and metabolic health, manage gastrointestinal symptoms and make regular eating feel more achievable.
What happens during perimenopause and menopause?
Perimenopause is the transition leading up to menopause. During this time, hormone levels fluctuate and menstrual cycles may become less predictable. Menopause is reached after 12 consecutive months without a menstrual period when there is no other medical explanation.
Experiences vary considerably. Some people have few symptoms, while others experience several physical and emotional changes.
- Hot flushes or night sweats
- Disrupted sleep and fatigue
- Changes in mood or concentration
- Heavier, lighter or irregular periods
- Changes in appetite or food cravings
- Reduced muscle mass or strength
- Changes in body composition or fat distribution
- Joint discomfort
- Constipation, bloating or other digestive symptoms
- Changes in cholesterol, blood pressure or blood glucose
Nutrition cannot prevent every symptom or replace medical treatment when it is needed. It can support health through these changes and help reduce longer-term health risks.
Practical nutrition guidance
Seven important nutrition priorities
1. Eat regularly enough
Long periods without eating can leave some people feeling tired, irritable, overly hungry or more likely to eat past comfortable fullness later in the day.
A regular pattern might include three meals, with snacks added according to appetite, activity and medical needs. Each meal does not need to be perfect.
- A source of protein
- A carbohydrate food
- Vegetables or fruit
- A source of healthy fat
2. Include protein throughout the day
Muscle mass and strength become increasingly important during midlife. Protein provides the building blocks needed to maintain and repair muscle.
Try to include a meaningful source of protein at breakfast, lunch and dinner rather than relying on one large protein-rich meal at the end of the day.
- Eggs
- Milk, yoghurt and cheese
- Calcium-fortified soy milk
- Tofu, tempeh and edamame
- Beans, chickpeas and lentils
- Fish and seafood
- Chicken, lean meat or other poultry
- Nuts and seeds
Important: Your ideal protein intake depends on your body size, activity, health conditions and overall dietary intake. People with kidney disease or other medical conditions may require individual advice before increasing protein.
3. Protect your bones
Changes in oestrogen levels around menopause can contribute to faster bone loss. Calcium, vitamin D, adequate protein and resistance or weight-bearing activity all play a role in maintaining bone health.
Calcium needs increase after the age of 50. Meeting these needs may require deliberate planning, particularly when dairy foods are avoided or poorly tolerated.
- Milk, yoghurt and cheese
- Calcium-fortified soy milk
- Calcium-set tofu
- Tinned sardines or salmon with edible bones
- Selected calcium-fortified foods
Important: When choosing a plant-based milk alternative, check the nutrition panel and look for approximately 100 mg or more of calcium per 100 mL. Calcium supplements are not automatically necessary and should be considered according to dietary intake, medications, medical history and bone-health risk.
4. Support heart and metabolic health
Ageing and the menopause transition can affect cholesterol, blood pressure, glucose regulation and where body fat is stored.
Rather than concentrating on a single superfood, focus on an overall eating pattern that is satisfying, nutritionally adequate and sustainable.
- Vegetables and fruit
- Wholegrain breads and cereals
- Beans, chickpeas and lentils
- Nuts and seeds
- Fish
- Extra virgin olive oil and other unsaturated fats
- Minimally processed protein foods
Important: Supporting heart health does not require eliminating carbohydrates. Wholegrain bread, oats, rice, pasta, legumes, potatoes and fruit can provide energy, fibre and important nutrients.
5. Pay attention to fibre and digestive symptoms
Fibre supports bowel regularity, the gut microbiome, cholesterol management and blood glucose regulation.
Increase fibre gradually and drink enough fluid, particularly when your current fibre intake is low. A sudden large increase may worsen bloating, gas or abdominal discomfort.
- Vegetables
- Fruit
- Oats and other whole grains
- Beans, chickpeas and lentils
- Nuts and seeds
Important: Persistent constipation, diarrhoea, reflux, abdominal pain or bloating should not automatically be attributed to menopause. These symptoms may require assessment for another gastrointestinal condition.
6. Check iron when periods are heavy
Iron requirements generally decrease after menstruation stops. During perimenopause, however, periods may become heavier or more frequent and increase the risk of iron deficiency.
Possible signs include fatigue, weakness, headaches, reduced exercise tolerance, shortness of breath or difficulty concentrating.
- Lean red meat
- Chicken and fish
- Eggs
- Beans, chickpeas and lentils
- Tofu
- Iron-fortified cereals
- Nuts and seeds
Important: Plant-based iron is absorbed more effectively when eaten with vitamin C-rich foods such as capsicum, citrus fruit, kiwifruit, berries or tomato. Speak with your GP before beginning a high-dose iron supplement.
7. Be cautious with symptom triggers and supplements
Some people notice that alcohol, caffeine, hot drinks or spicy foods appear to trigger hot flushes, night sweats, reflux or sleep disturbance. Other people notice no connection.
There is no need to remove several foods just in case. Observe your own pattern and make targeted changes only when they are helpful.
Soy foods such as tofu, tempeh, edamame and calcium-fortified soy milk can contribute protein and other nutrients. Evidence that concentrated soy isoflavone supplements consistently relieve hot flushes remains mixed.
Important: Natural does not necessarily mean effective or safe. Herbal products and concentrated supplements can interact with medications and may be unsuitable for some medical conditions. Seek medical advice before using menopause supplements, particularly with a history of breast cancer, another hormone-sensitive condition or liver disease.
What about weight changes?
Changes in sleep, activity, appetite, muscle mass, stress and hormone levels can all influence body composition during midlife. Some people notice that their weight changes or that weight is distributed differently, particularly around the abdomen.
This does not mean you have failed or need to begin an extreme diet.
Repeated restriction can increase hunger, reduce dietary variety, contribute to muscle loss and make eating feel more chaotic. A more sustainable approach may focus on:
- Regular and satisfying meals
- Adequate protein across the day
- Fibre-rich carbohydrate foods
- Resistance and weight-bearing activity
- Sleep and stress support
- Realistic and individual health goals
Improvements in nutrition, strength, blood pressure, cholesterol, blood glucose and wellbeing can be meaningful even when weight changes slowly or does not change.
When can a dietitian help?
An Accredited Practising Dietitian can provide individual support for:
- Unexplained weight or appetite changes
- Difficulty meeting protein or calcium requirements
- Elevated cholesterol, blood pressure or blood glucose
- Insulin resistance or type 2 diabetes
- Iron deficiency or heavy menstrual bleeding
- Osteoporosis, osteopenia or increased fracture risk
- Constipation, bloating, reflux or irritable bowel symptoms
- Food intolerances or coeliac disease
- Vegetarian or vegan dietary requirements
- Emotional eating, binge eating or a history of disordered eating
- Confusion about supplements or conflicting menopause advice
Dietetic care should be collaborative and tailored to your symptoms, preferences, culture, medical history and relationship with food.
When should you speak with your doctor?
Arrange a medical review when symptoms are severe, interfere with daily life or have not previously been assessed. Seek prompt medical advice for:
- Bleeding after menopause
- Very heavy or prolonged menstrual bleeding
- Unexplained weight loss
- Persistent vomiting or difficulty swallowing
- Blood in your bowel motions
- Severe or persistent abdominal pain
- Symptoms of significant iron deficiency
- Major changes in mood or mental wellbeing
Menopausal hormone therapy and other medical treatments may be appropriate for some people. Nutrition can complement medical care but should not be presented as a substitute for effective treatment.
Personalised nutrition support
You do not need to follow a rigid menopause diet
Small, practical changes that protect bone, muscle, heart and digestive health are usually more helpful than restriction or expensive supplements. Dr Kellie Millard provides evidence-informed and respectful nutrition support during perimenopause, menopause and beyond.
References
- 1. NSW Health Agency for Clinical Innovation — Menopause Care Clinician Toolkit: Wellbeing and lifestyle
- 2. NSW Health Agency for Clinical Innovation — Musculoskeletal health and menopause
- 3. Australasian Menopause Society — Complementary medicines and therapies
- 4. Australian Government Eat for Health — Milk, yoghurt, cheese and alternatives
- 5. Australian Government Eat for Health — Recommended number of serves for adults
- 6. Healthy Bones Australia — Calcium and bone health
- 7. Healthy Bones Australia — Vitamin D and bone health
This information is general in nature and is not a substitute for individual medical or dietetic advice. Speak with your GP, dietitian or treating healthcare team about symptoms, medications, supplements and your individual health needs.
Resource prepared by Dr Kellie Millard, Accredited Practising Dietitian and Credentialed Eating Disorder Dietitian.