What should I eat during perimenopause?

As a women's health dietitian and performance nutritionist I always get asked the question – if there was one piece of food you would tell women to eat give women what would it be.

This is always a tricky one to answer as I know all to well, that we don’t just eat nutrients – we eat food which is a mix of nutrients and phytonutrients in the food matrix so its more about the pattern of nutrition.

But if I was to single out one nutrient it would be fibre.

Not protein.. but fibre.

Let me explain.

The menopause story

To understand how to fuel women through the menopause transition, we first need to understand what is happening physiologically.

Perimenopause is essentially puberty in reverse — a time of profound hormonal fluctuation as the ovaries gradually reduce production of the two main sex hormones: oestrogen and progesterone. Progesterone is usually the first hormone to decline, often quietly, while oestrogen levels fluctuate erratically before eventually falling too. Rather than a smooth transition, hormones rise and fall unpredictably, which is why symptoms can feel so inconsistent and confusing.

There are more than 40 recognised menopause symptoms, yet many of the cognitive and psychological effects remain understated and under-discussed. Menopause is not simply a reproductive transition — it is a major biological shift with widespread effects on the brain, metabolism, gut, immune system and stress response.

The four physiological shifts shaping performance in midlife

1. A metabolic story

One of the biggest shifts happening during menopause is metabolic. Declining oestrogen changes how women metabolise carbohydrates and regulate blood glucose levels — the cornerstone of sustained energy, focus and performance. This can lead to more energy crashes, increased cravings, changes in body composition and reduced resilience to stress if nutrition and lifestyle habits are not supportive.

3. An inflammatory story

Women in perimenopause also tend to experience higher baseline levels of inflammation. We do not fully understand why, but hormonal fluctuations, changes in gut bacteria and lifestyle behaviours that often accompany feeling chronically unwell — such as increased sugar intake, poorer sleep and more alcohol consumption — are all thought to contribute. This heightened inflammatory state can affect mood, cognition, joint health, gut health and long-term disease risk, including diabetes and certain cancers.

4. A stress story

Menopause often collides with one of the most stressful periods in a woman’s life. Symptoms frequently coincide with growing caregiving responsibilities, which disproportionately fall on women. Many women in the “sandwich generation” are simultaneously caring for ageing parents while raising children and managing demanding careers. The result can be chronic stress, burnout and elevated cortisol levels, all of which reduce resilience and amplify menopause symptoms such as anxiety, insomnia, hot flushes and weight gain.

And you know what underpins this all?

Your gut health.

There is also a gut health story that happens in the menopause.

 A gut health story

Research suggests that the gut microbiome also changes during menopause. Without proactive support, women can experience a shift from a rich and diverse microbiome to one that is less varied and more inflammatory in nature. A less diverse microbiome is associated with poorer metabolic health, greater inflammation and increased risk of chronic disease.

Eating for success for the menopause starts with eating in a way that nourishes your gut microbiome.

The one nutrient that does that the most?

Fibre.

Supporting your body through perimenopause starts with understanding what is changing and giving your body the right foundations.

Nutrition is not about following another restrictive diet or chasing the latest trend. It is about creating a sustainable approach that supports your hormones, metabolism, gut health and long-term wellbeing.

If you're navigating perimenopause and want personalised support, Dr Linia Patel's evidence-based nutrition programmes can help you understand what your body needs and build strategies that work for your lifestyle.

Explore Linia's menopause nutrition programmes or book a consultation to start your personalised nutrition journey.