Mood swings, mum rage and micronutrients - by Jessica English, RD

As more women delay motherhood, many will be slipping into perimenopause even as they cluster feed their newborns. [1] I certainly was. Top this with the knowledge that women often shoulder the majority of caregiving tasks and it’s easy for mothers to lose sight of their own health needs. However, it’s also a time when their nutritional needs become crucial - as risks of osteoporosis, cardiovascular disease and other chronic conditions rise exponentially.[2,3]  

This article explores the role of dietitians and nutrition professionals in supporting perimenopausal mothers with practical food-first strategies.

What early perimenopause symptoms may look like

Perimenopause is defined by the NHS as '...when you have symptoms of menopause but your periods have not stopped. Perimenopause ends and you reach menopause when you have not had a period for 12 months.' [4]

Although different for every woman, many women in their 30s and 40s may experience emotional disturbances long before perimenopause is considered.

Subtle signs include mood changes, anger, rage, tearfulness, forgetfulness, gastrointestinal symptoms, and changes in body composition.[4] These may be brushed away by healthcare professionals and women themselves, especially amidst the chaos and sleepless nights of early motherhood. Symptom tracking can prove invaluable here.

Nutrient deficiencies can also prevail in this subgroup; a hangover from pregnancy, childbirth, breastfeeding and skipped meals.5

Nutrition in perimenopause - food, mood, health and longevity

Besides the physical changes, the emotional rollercoaster is very real - and very draining. Whilst nutrition can't ‘balance’ hormones and emotions, there are many ways in which nutrition can help to create a solid foundation for mental and physical health.

Though evidence is still evolving, women in perimenopause appear to benefit from dietary patterns aligned with the Mediterranean diet, which may support cardiovascular, bone and cognitive health. [6]

Priorities include:

  • Regular, balanced meals and snacks - for stabilised energy and supporting any gastrointestinal symptoms

  • Food and symptom tracking - helpful for seeing how their body might be changing in reaction to fluctuating oestrogen levels

  • Fibre, plant variety - essential for gut health, overall health and its link with mental wellbeing [7-9]

  • Omega-3s - overall health [10]

  • Calcium and vitamin D - to mitigate accelerated bone and lean tissue loss [6,11]

  • Iron -  a recent small pilot study has indicated that even subclinical iron deficiency could impair cognitive functioning and mood in perimenopausal women [12]

Crucially, these principles can be integrated into family meals, minimising stress and time pressure for mothers.

Protein - the buzzword du jour

While each nutrient deserves its own deep dive, protein warrants special attention.

Declining oestrogen is linked to reductions in lean body mass and bone density, raising the risk of sarcopenia.[13] Protein, when combined with resistance and weight-bearing exercise, supports muscle retention, bone health, and metabolic resilience.

 The UK RNI remains 0.75g/kg/day, but growing evidence suggests 1–1.2g/kg/day may be more appropriate for older women, with emerging thought suggesting that perimenopause may also warrant higher intakes. [14,15] Food-first approaches that mix plant and animal sources support not just protein needs but overall nutrient intake in a way that supplemental powders and fortified foods cannot. Many mothers are also influenced by social media trends around protein, and I’d argue that this is where nutrition professionals can bust myths and provide clarity in a noisy online world.

Weight changes

Weight and body changes in perimenopause can be distressing, particularly for women with complex histories around food or body image. These shifts often occur despite no changes to diet or physical activity. Combined with raised cholesterol or blood pressure readings, the pressure to return to a ‘healthy’ BMI can feel impossible - especially when their body isn’t playing ball. But this isn’t the time to just eat less. Undereating only exacerbates nutrient depletion and lean tissue loss.

Dietitians and other nutrition professionals can help to reframe the conversation: from weight loss to strength, resilience, energy and long-term health.

HRT +/- nutritional interventions? 

Hormone replacement therapy (HRT), where suitable, can be highly effective for symptom relief and improved health outcomes, but it does not negate the need for nutritional support. In fact, nutrition interventions can enhance the benefits of HRT - particularly for bone and cardiovascular protection. [16]

The takeaway

Perimenopause is a critical window for nutritional intervention. For mothers navigating this life phase alongside parenting young children, dietitians have a powerful role to play - translating evidence into real-life, accessible strategies.

By supporting mothers now, we not only improve their immediate wellbeing, but help lay the foundations for healthier, stronger years ahead.

Jess is a self-employed private practice dietitian with interests in maternal and child health, IBS and public health.

Jessica English, RD

References

  1. Office for National Statistics. Birth characteristics in England and Wales: 2022 [Internet]. Newport (UK): ONS; 2023 Aug 1 [cited 2025 Jul 25]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2022

  2. McPhee C, Aninye IO, Horan L. Recommendations for Improving Women's Bone Health Throughout the Lifespan. J Womens Health (Larchmt). 2022 Dec;31(12):1671-1676. doi: 10.1089/jwh.2022.0361. Epub 2022 Nov 7. PMID: 36346282; PMCID: PMC9805882.

  3. Stevenson JC, Tsiligiannis S, Panay N. Cardiovascular risk in perimenopausal women. Curr Vasc Pharmacol. 2019;17(6):591–4. doi:10.2174/1570161116666181002145340. PMID: 30280667

  4. NHS. Menopause [Internet]. NHS; [cited 2025 Jul 25]. Available from: https://www.nhs.uk/conditions/menopause/

  5. Aparicio E, Jardí C, Bedmar C, Pallejà M, Basora J, Arija V, The Eclipses Study Group. Nutrient Intake during Pregnancy and Post-Partum: ECLIPSES Study. Nutrients. 2020 May 7;12(5):1325. doi: 10.3390/nu12051325. PMID: 32392706; PMCID: PMC7285175.

  6. Erdélyi A, Pálfi E, Tűű L, Nas K, Szűcs Z, Török M, Jakab A, Várbíró S. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients. 2023 Dec 21;16(1):27. doi: 10.3390/nu16010027. PMID: 38201856; PMCID: PMC10780928.

  7. Kim Y, Hong M, Kim S, Shin WY, Kim JH. Inverse association between dietary fiber intake and depression in premenopausal women: a nationwide population-based survey. Menopause. 2020 Dec 21;28(2):150-156. doi: 10.1097/GME.0000000000001711. PMID: 33350672.

  8. Evans CEL. Dietary fibre and cardiovascular health: a review of current evidence and policy. Proc Nutr Soc. 2020 Feb;79(1):61-67. doi: 10.1017/S0029665119000673. Epub 2019 Jul 3. PMID: 31266545.

  9. Mathers JC. Dietary fibre and health: the story so far. Proc Nutr Soc. 2023 May;82(2):120-129. doi: 10.1017/S0029665123002215. Epub 2023 Feb 14. PMID: 36786062.

  10. British Dietetic Association. Omega-3 [Internet]. Birmingham: BDA; [cited 2025 Jul 26]. Available from: https://www.bda.uk.com/resource/omega-3.html

  11. Cheng CH, Chen LR, Chen KH. Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover. Int J Mol Sci. 2022 Jan 25;23(3):1376. doi: 10.3390/ijms23031376. PMID: 35163300; PMCID: PMC8836058.

  12. Barnett AL, Wenger MJ, Miles P, Wu D, Isingizwe ZR, Benbrook DM, Yuan H. Cognitive Performance in Relation to Systemic and Brain Iron at Perimenopause. Nutrients. 2025; 17(5):745. https://doi.org/10.3390/nu17050745

  13. Sipilä S, Törmäkangas T, Sillanpää E, Aukee P, Kujala UM, Kovanen V, Laakkonen EK. Muscle and bone mass in middle-aged women: role of menopausal status and physical activity. J Cachexia Sarcopenia Muscle. 2020 Jun;11(3):698-709. doi: 10.1002/jcsm.12547. Epub 2020 Feb 3. PMID: 32017473; PMCID: PMC7296268.

  14. Department of Health. Dietary reference values for food energy and nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London: HMSO; 1991. Report No.: 41 [Internet]. Available from: https://assets.publishing.service.gov.uk/media/5a749fece5274a44083b82d8/government_dietary_recommendations.pdf. Accessed 28 July 2025

  15. Cortes TM, Serra MC. Dietary Strategies in Postmenopausal Women with Chronic and Metabolic Diseases. Nutrients. 2024 Apr 28;16(9):1329. doi: 10.3390/nu16091329. PMID: 38732576; PMCID: PMC11085258.

  16. British Dietetic Association. Menopause and diet [Internet]. Birmingham: BDA; [cited 2025 Jul 27]. Available from: https://www.bda.uk.com/resource/menopause-diet.html

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