Perimenopause Without the Hype: What Women Really Need

By Lane Edwards, Accredited Practising Dietitian

Perimenopause is a natural but often disorienting transition. Hormonal fluctuations can bring on a cascade of changes — from disrupted sleep and mood shifts to brain fog, fatigue, and changes in how the body feels and functions.

In the midst of all this, it's completely understandable to feel overwhelmed. When energy is low and emotions are high, reaching for quick fixes can feel like the only option — especially when planning meals or finding time to move your body feels like too much.

But beneath the noise of wellness trends and miracle cures, there is a quiet truth: your body is adapting, not failing. And there are simple, evidence-based ways to support it — gently, sustainably, and without overhauling your life.

When Does it Start — and What's "Normal"?

There is no single "normal" when it comes to perimenopause. For some women, symptoms begin in their late 30s; for others, not until their 50s. The transition is shaped by genetics, health history, and individual hormone patterns — and it doesn't follow a predictable timeline (Huang et al., 2004; Davis et al., 2025).

Perimenopause is the lead-up to menopause, marked by fluctuating estrogen and progesterone. Menopause — defined as 12 months without a period — usually occurs around age 51-52, but some women experience it earlier due to genetics, medical conditions, or surgery (Erdélyi et al., 2024).

Some of my patients begin noticing changes in their mid to late 30s. Many are still hoping to start a family and fear that door has closed. But I’ve seen those same women go on to have children, build thriving careers, and start talking more openly about menopause. Early onset isn’t a sign something’s wrong — it’s just different. And it’s still entirely possible to live fully.

Neurodivergence and Perimenopause: A Double Challenge?

Emerging research suggests that neurodivergent women — including those with ADHD or autism — may experience more intense symptoms. Estrogen enhances dopamine signaling, which affects attention and mood. As estrogen declines, ADHD traits like forgetfulness and emotional dysregulation can worsen (Young et al., 2020). Many neurodivergent women also report heightened sensory sensitivity and burnout during this transition (Mahdi et al., 2022).

What Actually Helps: Nutrition That Supports You

Forget the detox teas and hormone-balancing powders. Here's what the science supports — and how it looks in real life.

Carbohydrate Quality and Fibre: Fuel for Hormones and Gut Health

Carbohydrates are your brain's preferred fuel and influence serotonin production, which supports mood and sleep (Elibol & Yildiz, 2025). Fibre also supports gut health and helps the body eliminate excess estrogen, which may ease symptoms like bloating, mood swings, and breast tenderness (Partula et al., 2022). The key is quality: whole grains, legumes, fruits, and vegetables offer steady energy, fibre and antioxidants — helping to stabilise blood sugar and reduce inflammation. Think oats for breakfast, chickpea salad for lunch, and roasted vegetables as an accompaniment for dinner.

Protein: Supporting Muscle and Energy

Estrogen plays a role in maintaining muscle mass and strength. As levels decline, the body's ability to build and preserve lean tissue can shift — which may affect energy, recovery, and physical resilience (Hao et al., 2022).

Including protein-rich foods across the day helps support these changes. Animal-based sources like eggs, fish, and dairy provide complete proteins and key nutrients like iron and B12. In line with the Planetary Health Diet — which supports both personal and environmental wellbeing (a whole other article coming soon) — it’s recommended to limit red meat to 1-2 serves per week and focus more on plant-based proteins such as legumes, tofu, tempeh, nuts, seeds, and whole grains, and if you do eat meat, prioritise white meats like chicken, turkey and fish.

Calcium & Vitamin D: Bone Builders

As estrogen levels decline, bone remodeling becomes less balanced — with more bone being broken down than rebuilt. This can gradually reduce bone density and increase the risk of fractures over time. Supporting your bones through food is one of the most effective long-term strategies (Méndez-Sánchez et al., 2023).

Calcium-rich foods like dairy or dairy alternatives, fortified almond, oat or soy milks, tofu, almonds, and leafy greens can be included across the day — think yogurt with breakfast, a handful of almonds as a snack, or tofu stir-fry for dinner. Vitamin D can be synthesized from sunlight, but sunscreen and limited sun exposure may reduce absorption — so dietary sources and supplements are often recommended (Méndez-Sánchez et al., 2023).

Omega-3s: Mood & Brain Support

Omega-3 fatty acids help regulate inflammation and support brain function — both of which can be affected during perimenopause. They've also been linked to improved mood and reduced cognitive fog in midlife women (Bettencourt & Bhatnagar, 2025).

Fatty fish like salmon, sardines, and mackerel are excellent sources, and including them a few times a week can make a meaningful difference. Whenever you can, opt for sustainably sourced fish to support ocean-friendly practices and protect marine ecosystems. Plant-based options like flaxseeds, chia seeds and walnuts also contribute, especially when sprinkled over breakfast bowls or salads or blended into smoothies.

While seeds and walnuts are great sources of ALA (alpha-linolenic acid), the plant-based precursor to omega-3s the conversion rate to EPA and DHA (the active forms of omega-3 fatty acids used by the brain and body) is quite low — often less than 10%. This is why dietitians often recommend algal oil supplements for vegans and vegetarians. Algal oil is derived from marine algae and provides a direct, vegan-friendly source of EPA and DHA — without relying on fish.

Lifestyle Matters Too

Nutrition is just one piece of the puzzle. Movement, sleep, connection, and stress management all shape how you experience perimenopause. But you don’t need dramatic overhauls — small, consistent habits can make a meaningful difference.

Here’s what helps:

• Exercise: Resistance and aerobic training help preserve bone density, muscle mass, and mood stability. Even short walks or bodyweight workouts can support hormonal balance.

• Sleep: Prioritise sleep hygiene — cool, dark rooms, consistent bedtimes, and limiting alcohol and caffeine in the evening can improve sleep quality.

• Stress: Chronic stress can amplify symptoms. Mindfulness, yoga, deep breathing, and regular rest are powerful tools for emotional regulation.

• Connection: Social support buffers stress and improves resilience. Whether it’s a friend, therapist, or community group, connection matters.

A Mediterranean-style diet — rich in whole foods, healthy fats, and plant diversity — complements these lifestyle shifts and may reduce symptom severity (Erdélyi et al., 2024).

Hope, Not Hype

Perimenopause isn't a disease — it's a transition. You don't need to overhaul your life or buy into pseudoscience. You need evidence-based strategies and support. As a dietitian, I see women thrive when they're given the right tools — not fear.

Let's stop marketing to women's insecurities and start empowering them with facts.

References

Bettencourt, A., & Bhatnagar, A. (2025). Omega-3 fatty acids, brain health and the menopause. Women's Health Reports, 3(1), 205336912513417. https://doi.org/10.1177/20533691251341701

Davis, S. R., et al. (2025). Prevalence and severity of symptoms across the menopause transition. The Lancet Diabetes & Endocrinology. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(25)00138-X/fulltext

Elibol, E., & Yildiz, E. (2025). Carbohydrate quality index and menopausal symptoms. BMC Women's Health, 25(1), Article 3822. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-025-03822-z

Erdélyi, A., et al. (2024). The importance of nutrition in menopause and perimenopause—A review. Nutrients, 16(1), 27. https://www.mdpi.com/2072-6643/16/1/27

Hao, S., et al. (2022). Dietary and exercise interventions for perimenopausal women: A systematic review. Frontiers in Nutrition, 8, 752500. https://www.frontiersin.org/articles/10.3389/fnut.2021.752500/full

Huang, Z., et al. (2024). Exploring heterogeneity of perimenopause with application of multivariable analysis approaches. BMC Women's Health, 24, Article 638. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03483-4

Mahdi, S., et al. (2022). The lived experiences of adults with attention-deficit/hyperactivity disorder: A qualitative meta-synthesis. PLOS ONE, 17(9), e0274365. https://doi.org/10.1371/journal.pone.0274365

Méndez-Sánchez, L., Clark, P., Winzenberg, T. M., Tugwell, P., Correa-Burrows, P., & Costello, R. (2023). Calcium and vitamin D for increasing bone mineral density in premenopausal women. Cochrane Database of Systematic Reviews. https://www.cochrane.org/evidence/CD012664_calcium-and-vitamin-d-improving-bone-health-healthy-premenopausal-women

Partula, V., Deschasaux-Tanguy, M., Schnurbein, J., et al. (2022). Dietary fiber and health outcomes: An umbrella review of systematic reviews. The American Journal of Clinical Nutrition, 116(3), 769–786. https://ajcn.nutrition.org/article/S0002-9165(22)02813-1/fulltext

Young, S., Adamo, N., Ásgeirsdóttir, B. B., et al. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach. BMC Psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9