Perimenopause is the transition leading up to menopause, when hormone levels begin to change and periods often become irregular, while menopause itself is defined as the point twelve months after your last period. Most women in the UK reach menopause between 45 and 55, with an average age of 51 (Source: NHS Foundation Trust patient information). Symptoms vary widely between individuals, and the NHS recommends a combination of exercise, diet and sleep changes as a first step for most people, alongside medical options such as HRT where appropriate (Source: NHS, Things you can do to help menopause and perimenopause symptoms).
Who this is for
You're noticing changes, whether that's hot flushes, low mood, disrupted sleep, weight changes, or something less obvious like memory lapses or irritability, and you want a clear, evidence-based picture of what actually helps, without being pushed toward one single solution.
What the evidence says about symptoms
Hot flushes and night sweats are the symptoms most commonly associated with menopause, but they're not necessarily the most common ones women actually experience. A 2024 study of a large cohort of perimenopausal and menopausal women found that feeling tired or lacking energy, memory problems, difficulty concentrating, irritability and feeling tense or nervous were all reported more frequently than hot flushes or night sweats, which ranked much lower on the list (Source: BJPsych Open, cohort study, 2024). This matters because it means the picture many people have of menopause, built mostly around hot flushes, misses a lot of what women are actually dealing with day to day.
Weight gain is also extremely common, affecting more than half of women during this transition, with an average gain of around 1.5kg per year during the perimenopausal period as hormone levels shift (Source: British Menopause Society, Tool for Clinicians, 2023). This isn't simply about eating more. Falling oestrogen levels are linked to an increase in fat stored around the abdomen and a slowing metabolic rate as lean muscle mass also tends to reduce.
Nutrition: what helps
The NHS advises eating a varied diet including plenty of fruit, vegetables and calcium-rich foods such as milk, yoghurt or kale, since falling oestrogen accelerates the loss of calcium from bones (Source: NHS, Things you can do to help menopause and perimenopause symptoms). The British Dietetic Association adds that combining healthy eating with exercise is more effective than either approach alone, and specifically recommends resistance or muscle-building exercise two to three times a week to help protect against the muscle loss common during this transition (Source: BDA, Eating well for the perimenopause and menopause).
There is currently no single "menopause diet" backed by strong evidence, and clinical guidance is cautious about products or plans that promise otherwise. The consistent, well-supported approach remains a balanced diet with adequate calcium, combined with regular movement, rather than restrictive eating.
Movement: what helps
The NHS recommends the same general activity target for menopause as for the wider adult population, 150 minutes of moderate activity or 75 minutes of vigorous activity a week, plus muscle-strengthening activity on two or more days (Source: NHS, physical activity guidance; British Menopause Society clinical resources). Weight-bearing and resistance exercises are particularly emphasised, since they help protect bone density at a time when the risk of osteoporosis increases as oestrogen falls.
The NHS also specifically names activities like yoga, tai chi and gentle movement as helpful for a different reason: alongside their physical benefits, they support the mood-related symptoms that, per the evidence above, are actually more commonly reported than hot flushes.
Sleep and mental wellbeing
Disrupted sleep and low mood or anxiety around menopause are common and, per the 2024 cohort data, may affect more women than the vasomotor symptoms most associated with this life stage. The NHS suggests maintaining a regular sleep routine and addressing stress directly, and notes that cognitive behavioural therapy (CBT) can be a helpful, non-medical approach for a range of mood-related symptoms during menopause (Source: NHS Foundation Trust, Menopause: A healthy lifestyle guide).
If low mood, anxiety or memory difficulties are significantly affecting your day-to-day life, this is a reasonable and common reason to speak to a GP, who can discuss options including HRT, which research shows can meaningfully improve mood-related symptoms for many women, alongside other approaches (Source: BJPsych Open, 2024).
Who else can help, beyond a GP
Depending on which symptoms are affecting you most, several types of support can be useful alongside, not instead of, your GP:
A registered nutritionist or dietitian can help translate general dietary guidance into a plan that fits your life, particularly around bone health, weight changes or specific concerns like cardiovascular risk.
A physiotherapist can support joint and muscle changes, and help build a safe, progressive strength programme if you're newer to resistance exercise.
A personal trainer or fitness instructor experienced in working with midlife clients can help you build the weight-bearing and resistance habits the evidence points to, especially if you haven't done structured exercise before.
A therapist or counsellor can support mood-related symptoms directly, particularly where these are affecting relationships or daily functioning.
None of these replace your GP for symptoms that may need medical management, including HRT, but they can meaningfully support the lifestyle side of managing this transition.
Perimenopause and menopause affect far more than hot flushes, with fatigue, mood changes and memory difficulties reported more frequently in recent research. The NHS recommends 150 minutes of moderate activity a week, including resistance training, combined with a varied diet rich in calcium and adequate protein.
The British Dietetic Association states that combining diet and exercise is more effective than either alone. Support can reasonably involve a GP alongside a nutritionist, physiotherapist, fitness professional or therapist, depending on which symptoms are affecting you most, and the right combination is individual rather than a single prescribed path.
Questions people often ask
A varied diet with plenty of fruit, vegetables and calcium-rich foods such as milk and yoghurt is recommended by the NHS. The British Dietetic Association notes that combining this with regular exercise, including resistance training, is more effective than diet changes alone. There's no single evidence-backed "menopause diet."
Yes. The NHS recommends 150 minutes of moderate activity a week plus muscle-strengthening exercise on two or more days, which helps protect bone density and supports mood. Weight-bearing and resistance exercise are specifically emphasised given the increased risk of bone density loss during this transition.
Depending on your symptoms, a registered nutritionist, physiotherapist, fitness professional experienced with midlife clients, or a therapist can all provide useful support alongside your GP. None of these replace medical guidance for symptoms that may need treatments such as HRT.
Not necessarily. A 2024 study found fatigue, memory problems, difficulty concentrating and irritability were reported more frequently than hot flushes and night sweats in a large cohort of perimenopausal and menopausal women.
Research cited by the British Menopause Society suggests an average of around 1.5kg per year during the perimenopausal transition, though this varies between individuals and is influenced by factors beyond diet alone, including metabolic changes linked to falling oestrogen.
This article is for general information only and is not a substitute for professional medical advice. If you are concerned about a specific symptom, please see a GP or other qualified healthcare provider.