Renee McGregor is a leading sports and eating disorder specialist dietitian with twenty years’ experience working in clinical and performance nutrition. She is on hand to provide some insight into nutrition for both those pre, during and post-menopause, and to shed some light on how women can best fuel their bodies during these different times.

The Perimenopause Transition

Perimenopause or menopause transition as it is also known usually starts when a woman reaches her mid-forties, although this can be earlier if there is a familial history of early menopause. The symptoms often associated with perimenopause can last as little as a few months for some individuals to as long as a decade but end with menopause when periods have completely stopped. 

The average age for menopause is fifty-one years. 

The term ‘menopause transition’ sums it up, as it is a time of change where hormone levels are declining, and ovaries are slowing down until they stop altogether. These changes to hormones impact women in many ways both physically and psychologically, with many feeling “out of kilter” and often misunderstood. 

While there is no quick fix, taking the time to understand what their body is going through, making some lifestyle changes and making appropriate nutritional choices can all help with managing this often-challenging phase of life. 

Carbohydrate and Body Composition

Many women who are going through perimenopause often notice and struggle with changes to their body composition. Cue, current misconceptions and western societal beliefs and many women at this stage decide that the only way to combat this change is through restrictive diets and removing carbohydrate.

Indeed, latest research shows the complete opposite; declining oestrogen levels means that the female body is no longer efficient at fat oxidation which tends to spare our use of carbohydrate. Thus, carbohydrate intakes, especially in those women who remain physically active are critical not just for performance, but also for counteracting the fatigue, often associated during this phase of life. 

In addition, we know there is a direct link between carbohydrate availability and thyroid function. When carbohydrate intake is reduced too far in females, this can result in a downregulation of the thyroid gland, and thus metabolism, impacting body composition and energy levels further.

That said, not all carbohydrates are equal, and we would encourage the intake of wholegrains, fruit, vegetables, and legumes as good sources of complex carbohydrate. Ideally, this should make up 1/3 of your daily intake. Timing of carbohydrate before, during and after training is just as if not even more important during this time. 

Some suggestions of meals and snacks to include are:

• Overnight oats
• Tangy Chicken stir fry with wholegrain rice
• Mashed chilli avocado and halloumi on sourdough
• Roasted pesto vegetables with wholegrain pasta
• Sweet potato and lentil soup
• Oatcakes with peanut butter
• Houmous with crudites

Protein and Muscle Mass

It has been well documented in the literature that muscle mass and strength declines through ageing. In general, muscle mass and strength peak in ages twenty to thirty years, begins to decline in forty to fifty years, and see an acceleration in decline in the over the seventies. And yet, we are seeing remarkable results in both male and female athletes well into their forties and fifties.

One key finding from the research across all masters age groups is that any decline in muscle mass is directly linked with physical activity, with inactive and sedentary peers experiencing a more rapid decline. Resistance training seems to be pivotal in maintaining mass in this population, thus the addition of two to three sessions a week on top of their normal training can reap huge benefits. 

Staying physically active and incorporating more resistance training is paramount for optimal health during the perimenopause and beyond. We have already discussed the importance of carbohydrate in supporting this but special attention must be placed on the role of protein. Ensuring enough protein in the diet will help to prevent the usual decline in muscle mass associated with this population. Studies have shown that those women who are physically active should aim for a minimum of 1.2g protein/Kg BW per day, but more likely need up to 1.6g/Kg BW per day. Those that consume good amounts of protein have been shown to maintain forty per cent more muscle mass than those that have low intake of protein. Remember, a higher muscle mass means you are more metabolically active and thus improved body composition. In addition to the overall intake of protein, a good distribution throughout the day seems to improve overall retention and encourage the adaptive responses. The recommendations are 0.4g/Kg BW per meal as well as in the immediate post-exercise phase and later in the evening before bed. Furthermore, the quality of protein seems to be equally as important, where possible whole protein sources are recommended. This includes eggs, milk, Greek yoghurt, meat, poultry, and fish.

Some good examples of how to ensure a sufficient protein throughout the day include:

• Poached or scrambled eggs on toast for breakfast, with a glass of milk
• Greek yoghurt and fruit mid-morning
• Salmon and avocado wrap for lunch
• Cottage cheese with veggies for a mid-afternoon snack
• Chicken or tofu stir-fry with wholegrain rice

Fats and Brain Function

While many are wary of eating fat, it is important to understand that consuming foods high in essential fatty acids is imperative not just for health but also for brain function.

One key symptom associated with perimenopause is a decline in cognitive function. Many women speak of the “brain fog” and while this is linked once again to declining oestrogen levels, research shows us that the essential fatty acids EPA and DHA play an important role in maintaining brain function. In addition, these same essential fatty acids help reduce inflammation and also encourage the absorption of fat-soluble vitamins A, D, E and K. 

Ways to incorporate more essential fatty acids:

• Try making smoked mackerel pate and having as a topping for toast or filling for a baked potato
• Add toasted seeds to your roast vegetables
• Use a variety of oils for cooking and dressings – rapeseed, olive and walnut are all great options
• Snack on oat cakes topped with nut butter
• Try mashing avocado, mixing with some lemon juice and chilli flakes for a speedy alternative to guacamole. 

Let’s Not Forget the Micros

Micronutrients are often overlooked. Iron, zinc, magnesium, iodine, calcium, Vitamin B12 and D are critical for the correct function of muscles, bone, blood, and metabolism. 

Most of these are needed in small quantities that are easily available if you consume a well-balanced and mixed diet. 

During perimenopause, bone health becomes a real concern; declining oestrogen levels reduce protection. Ensuring sufficient Vitamin D, calcium, resistance training and using HRT can all help to prevent further loss. 

There are few foods that provide Vitamin D and so it tends to be the only micronutrient that routinely needs to be supplemented. Most women will be fine with 1000 iu a day but those with darker skin or who have very low levels to start with may need higher doses.

Calcium and Bone Health

The best sources of calcium come from dairy. During this stage of life, requirements are high at around 1000-1200mg a day. 

Practical tips on how to meet these requirements throughout the day:

• Add a glass of milk to your breakfast
• Include some oily fish at lunchtime
• Include at least one portion of yoghurt daily
• Include a milk-based drink at bedtime
• Try cottage cheese with vegetables or an apple with a small piece of hard cheese as a snack

For those avoiding dairy, good sources include:

• Oily fish
• Tofu and other soya products
• Fortified cereals
• Green leafy vegetables

Just for context plant-based sources are much lower and harder to absorb so a 100g portion of spinach will give you 99mg of calcium in comparison to a 200ml glass of soya milk which contains 240mg and a 200ml glass of cows milk, 250mg.

HRT

While nutrition and lifestyle can support health during this time, most women will be encouraged to consider HRT. While there has been some previous misunderstanding about the use of HRT, it is very clear that in order to support bone health, physical performance, cognition, mood, and general well-being in this group of women, HRT can be pivotal.  

As we have already indicated, women will start to see declining levels of oestrogen from around 40 years onwards. Oestrogen has several important functions relating to both body composition and physical performance. This is also why HRT is highly recommended in this age group of women. 

Indeed, it is the advance in HRT, especially the transdermal option, that has allowed so many women to not only have a better quality of life but also maintain their physical performance throughout their lifetime. It is always important to discuss HRT with your GP or a menopause specialist.

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Renee McGregor is a leading sports and eating disorder specialist dietitian with twenty years’ experience working in clinical and performance nutrition. She has worked with athletes across the globe and is the founder of Team Renee McGregor, managing a team of practitioners specialising in supporting individuals and athletes of all levels and ages, coaches and sports science teams to provide nutritional strategies to enhance sports performance and manage eating disorders.

Renee has just published More Fuel You, a book that looks at fuelling needs for sporting participation, training and competition and analyses some popular diet options including low-carbohydrate, vegan and intermittent fasting. It also looks at areas of sports nutrition in athlete populations that are often overlooked, such as women’s health and the menopause, healthy ageing and those living with chronic health conditions – with a focus on being self-aware and finding the ideal nutritional approach that suits you.

You can get a copy of the book and learn more here.