Going through perimenopause can be… a lot.

Even with more research than ever, this stage of life can feel mysterious, especially around nutrition, digestion and gut health.

Belinda Marshall, an Accredited Practising Dietitian from Ramsay Health Plus, provides evidence-based guidance to help women navigate nutrition and wellbeing during perimenopause. The Ramsay Health Plus team takes a holistic approach, supporting long-term healthy habits, balanced nutrition, and overall wellbeing, including blood sugar and energy management. Their comprehensive nutritional assessments help women actually understand their own unique requirements during this life stage.

Belinda believes perimenopause isn't something women just have to "deal with" — which is why she sat down with Mamamia to answer six of the most common questions women have during this transition.

What changes in the body can women expect in perimenopause?

Weight gain and changes in body shape can be a significant focus for women during perimenopause. Belinda's key message is that these changes are common and often a normal part of the transition.

"A shift in fat distribution, including an increase in abdominal fat due to changing hormone levels, is a common experience," she said. "While this can be a source of concern, it is helpful to understand that this is a physiological process."

However, while some changes are expected, women do not simply have to "put up with" feeling constantly fatigued or lacking motivation. Belinda explained that perimenopause symptoms can sometimes lead to lifestyle shifts, such as moving less or changing caffeine and alcohol intake, which may further affect sleep and energy. These factors can often be supported through lifestyle adjustments aimed at promoting general wellbeing and healthier routines (like around sleep hygiene).

Should I really be eating less during perimenopause?

The short answer? No.

The long answer: Belinda emphasised the importance of consistent, regular eating to maintain energy levels throughout the day. She noted that skipping meals, such as breakfast or lunch, can leave the body under-fuelled.

"While being mindful of nutritional intake is important for supporting a healthy weight, this does not mean restricting food to the point of hunger or skipping meals entirely," Belinda said.

Is it true that I should cut out caffeine during perimenopause?

"I will definitely talk about caffeine with my patients if sleep is an issue for them," Belinda said. "If they're getting night sweats, then yes, we might talk about the effects of caffeine and alcohol on those night sweats, and how we might manage them."

That doesn't at all mean that caffeine is off the table. It might mean, though, that there's a discussion to be had with a dietitian about how best to consume that caffeine through the day, like cutting out an afternoon coffee. 

Is there such a thing as a "right" way to eat during menopause?

It's a myth that there's one "right" way to eat that works for every woman, Belinda explained. "There's a misconception that you have to follow a very strict eating plan or focus on one or two ingredients to stay healthy during perimenopause, but that's not the case," she confirmed. 

"It's really about a balanced way of eating, centred on whole foods and limiting ultra-processed options. Ultra-processed foods lack nutrients, they're energy-dense, and they can be crafted in a way that leaves you wanting to eat more."

Rather than considering any proposed changes to how you eat as a "diet", Belinda prefers to frame it as "an opportunity to support your long-term health and wellbeing".

"You might be 35 or 40 now, but you're also thinking about your health in the decades ahead. When we look at nutrition during perimenopause, the goal is to support long-term wellbeing, so you can stay active, independent and feeling your best."

"From a dietitian's perspective, perimenopause is an opportunity to take a snapshot of ourselves at this point in time, to put in place good habits that will set us up well for our senior years."

What would a dietitian recommend to someone going through perimenopause?

If you've never seen a dietitian before, this is a big question — where would you even start? Will they recommend dramatic changes to your lifestyle and the way you eat? Will their recommendations be sustainable? 

"When I sit down with someone, I ask the basics first: who are you, what's your lifestyle, what's your medical history, your background, what are some of the symptoms and feelings you're having?" Belinda explained. "I want to know if you're tired, flat or feeling worried about certain things."

Critically, a dietitian is very unlikely to recommend a massive overhaul to the way you're already eating. 

"It's about looking at what you're currently eating and tweaking that diet. Are we eating enough things to support your health for this next stage? Are we eating mainly core foods, or mainly discretionary foods? Are we eating well for bone health and muscle health? Does the diet include quality lean protein, calcium, and good serves of veggies?"

"I don't want to be causing stress to women, sending them away thinking 'I don't even know what to cook for dinner now'."

Is weight loss the most important conversation during perimenopause?

"There's definitely a focus on the narrative about women and their weight," Belinda acknowledged. "It's unfortunate, because as women we're constantly getting feedback about our looks, and that feedback doesn't always fit women, their stage in life and their genetic profile."

Belinda said a much more important conversation to be having is about body composition. 

"What is our muscle mass? Do we have active tissue? Can we focus more on strength and giving ourselves a good base for the future, rather than the number on the scales?"

The takeaway? Perimenopause isn't about how you look. It's about your energy, strength and supporting your body in a way that helps you feel capable and healthy — now and into the future.

Book an appointment with your local Ramsay Health Plus team.

This information is general in nature and does not replace the advice of a healthcare professional. As with any medical condition, always seek health advice from a qualified healthcare professional.

Featured image: Getty.

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