female_health

Perimenopause

Perimenopause lasts ~4-8 years before final menstrual period. Mediterranean diet + resistance training + (if appropriate) menopausal hormone therapy reduces vasomotor symptoms 75% and protects bone + heart.

Nutrition

Pattern

Mediterranean + phyto-oestrogen support

Foods to emphasise

Fatty fish 2-3×/wk
Flaxseed (lignans)
Soy foods (whole — tofu, tempeh, edamame)
Leafy greens (calcium, vitamin K)
Berries
EVOO
Nuts/seeds

Foods to limit

Alcohol (worsens hot flashes)
Caffeine > 200 mg/day (sleep + flashes)
Spicy foods if flash-trigger
Ultra-processed

Exercise

Aerobic

150 min/wk moderate

Strength

3 d/wk RESISTANCE — bone + lean mass + insulin sensitivity. Heavy weights tolerated and preferred (≥ 70% 1RM).

Flexibility

Daily; yoga reduces vasomotor symptoms.

Weekly target

150 minutes

Supplements

Vitamin D3

1000-2000 IU/day

RCT

Calcium (food first)

1200 mg/day total

guideline

Supplement if dietary < 700 mg.

Magnesium glycinate

200-300 mg/night

observational

Sleep + mood + cramping.

Black cohosh

20-40 mg × 2/day

RCT (mixed)

Some hot-flash benefit; rare liver concern.

Monitor + cadence

What to track

Bone density (DEXA) at 65 or earlier if risk factors
Lipid panel annually
BP annually
HbA1c annually
Annual mood + sleep + vasomotor symptom review

Red flags — seek care

Heavy bleeding postmenopausally → urgent gynae (rule out endometrial cancer)
Severe mood with suicidality → urgent psych
Severe vasomotor + sleep loss → consider HRT

Sources

NAMS 2022 Menopause Position Statement
NICE NG23 Menopause 2015 (updated 2024)
Endocrine Society Menopause 2015

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