A note on the difference between perimenopause, menopause and post-menopause

Before assessing the nutrition claims in the video related to nutrition in perimenopause, it’s useful to clarify the menopause-related terms often used interchangeably:

• Perimenopause is the period leading up to menopause, when fluctuations and declines in estrogen and progesterone begin to cause symptoms including (but not limited to) hot flashes, night sweats, cycle irregularity, and mood shift.

• The menopause itself is the day marking 12 consecutive months without a period, provided there is no other medical condition that explains it. On average this occurs at the age of 51, but it can occur earlier or later. In some cases, menopause is ‘induced’ either due to the removal of the ovaries or damage of ovarian function (e.g., due to chemotherapy or radiation).

• The time from the final menstrual period onwards is known as post-menopause. (source).

A general note on estrogen and body changes

During the menopause transition, decrease in estrogen is linked to shifts in body composition, including a decrease in lean body mass (muscle), an increase in fat mass, and a gradual decrease of bone density. The hormonal changes are also associated with a shift toward a ‘pro-inflammatory’ state in the body, which can affect different systems, such as the brain, the heart, the bones, and the gut. As a result, risk of conditions such as cardiovascular disease, insulin resistance, osteoporosis, and cognitive decline may increase (source, source, source, source). 

Lifestyle and diet can play a major role in how strongly these changes are experienced, so adhering to healthier dietary patterns can support women’s overall health before, during and after the menopause transition.

Claim 1: A “plant heavy” diet is preferred for perimenopause

Fact check: True, though individual needs may vary,  and some people may require adapted eating patterns depending on their health and nutrition status.

Though there is no single perimenopause or menopause diet, certain dietary patterns are consistently associated with better overall health, improved nutritional status, and more favorable cardiovascular and metabolic outcomes. 

Eating patterns aligned with the Mediterranean-style diet may help prevent or improve several menopause-related health concerns (such as hot flashes and night sweats). This way of eating emphasises unprocessed plant foods—such as fruits, vegetables, whole grains, legumes, seeds, nuts, and olive oil—includes moderate amounts of fish, eggs, and some dairy, and occasional meat intake, with a preference for lean options like poultry over red meat (source, source).

While individual needs vary, the overall pattern of a plant-forward, minimally processed diet appears to be a supportive and an effective foundation for optimising health during the menopausal transition. At the same time, it’s essential to ensure that the needs for key micronutrients and protein are adequately met to support bone health, muscle maintenance, and overall wellbeing (source). A dietitian can help tailor the diet to individual needs. Key nutrients of interest and a few food sources include:

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Claim 2: “If you are making active decisions that are anti-inflammatory, you can tolerate the little things we know are going to cause inflammation in the body” - Dr. Natalie Crawford**

Fact check: True, with some nuance

Is inflammation always bad?

Inflammation is a normal biological response of the body to infections or injuries. However, when inflammation becomes chronic, it has been associated with the development of long-term conditions involving inflammatory processes, including cardiovascular disease, cancer, diabetes, and Alzheimer’s disease. Sedentary behaviour, chronic stress, and diets high in processed meats, sodium, saturated fats and added sugars have all been linked to higher levels of inflammation (source). Diets high in ultra processed foods (UPFs) have also been linked with inflammation and downstream complications (source).

What matters most is long-term eating patterns rather than achieving a perfect diet

A pattern of healthy eating over perfection is supported by emerging evidence showing that long-term adherence to diets that are rich in fibre, fruits, vegetables, nuts, beans, and seeds (such as the Mediterranean Diet) may lower inflammatory markers and improve health outcomes, and help create an internal environment that is less conducive to chronic inflammation (source, source, source). 

However, it’s important to recognise that there are no defined minimums or maximums of “good” or “bad” foods to maintain an ideal inflammatory status, and individual responses can vary. Generally speaking, as Dr Crawford highlights in the video, an anti-inflammatory eating pattern can help buffer the effects of occasional less nutritious choices.

The claim is supported by a growing body of evidence, acknowledging that overall dietary patterns do influence inflammation, but tolerance to specific foods and the degree of their impact can differ from person to person.

Recommendations that emphasise patterns of healthy eating and lifestyle over time are often a sign of more reliable nutrition information, especially when compared to oversimplified messages frequently seen on social media, such as the idea that “inflammation is bad” and any food that could cause inflammation should be eliminated entirely.

** Dr. Crawford mentioned this following a question about  “the best diet for fertility” – we included it in this fact check as Dr. Crawford linked it to the ongoing conversation related to diet in perimenopause.

Claim 3: “In late perimenopause there is a significant decrease in gut microbiome diversity (…) and we need to think more on the diversity of (our) plant foods ” - Dr. Stacy Sims

Fact check: True, but the underlying causes still need further research

Emerging research suggests that hormonal changes during the menopause transition may influence the composition and diversity of the gut microbiome (source). However, science is still evolving, and it is not fully clear how much of this change is due to hormones versus lifestyle, age, medication use, or diet.

What is clearer is that diet influences the gut microbiome. Fibre-rich foods, fermented foods, and plant diversity support beneficial gut bacteria. Probiotic supplements may be helpful for some people, but evidence remains mixed, and foods containing natural probiotics and prebiotics are generally preferred and advised to be part of eating patterns for most people.

The claim reflects the current body of research, but the evidence is still preliminary and there is more we need to understand regarding the changes of the microbiome during the menopause transition specifically. Dietary strategies that promote microbiome health such as diverse plant intake, fermented foods, and adequate fibre intake may be beneficial regardless (source).

Final takeaway

Though there is no single perimenopause or menopause diet, the evidence supports a plant-heavy, fibre rich eating pattern as a strong foundation for health during the menopause transition. However, individual needs vary, and some people may require adapted eating patterns depending on their overall health, digestive health (individuals with digestive diseases may need more specific recommendations),nutrition status and genetics 

Diet alone cannot prevent or manage all menopause-related changes, but long-term healthy eating choices, exercise, good sleep and mindfulness strategies may support metabolic, cardiovascular, bone, gut and mind health.