DUTCH Testing for Midlife Women

If you are in your 40s or 50s and feel as though your body has changed almost overnight, you are not alone.

You may be sleeping less well, feeling more anxious or irritable, gaining weight around the middle, waking at 3am, craving sugar, struggling with brain fog, or noticing changes to your periods. This is often the point where many women start asking: “Is this my hormones?”

The answer is: quite possibly. But hormones do not work in isolation. They are influenced by blood sugar balance, stress, sleep, gut health, liver function, inflammation, alcohol intake, exercise, nutrient status, and the natural hormonal shifts of perimenopause and menopause.

This is where the DUTCH test can be helpful. Not because it gives you a simple label, diagnoses menopause, or explains everything. But because it can provide a more detailed picture of how your hormones are being produced, metabolised and cleared, alongside your daily cortisol pattern.

For many midlife women, that can be a useful starting point for a more personalised nutrition and lifestyle plan.

What is the DUTCH test?

DUTCH stands for Dried Urine Test for Comprehensive Hormones.

Instead of relying on a single blood sample, the DUTCH test uses dried urine samples collected at different points across the day. These are analysed to look at sex hormones, hormone metabolites and cortisol patterns.

Depending on the panel used, the test may include information on oestrogen metabolites, progesterone metabolites, androgens such as testosterone and DHEA, cortisol and cortisone patterns, melatonin markers, and some nutrient or organic acid markers.

The reason this can be useful in midlife is that symptoms are not always explained by whether hormones are simply “high” or “low”. Sometimes the more useful question is: what is your body doing with those hormones?

For example, two women may both have symptoms of oestrogen fluctuation, but their patterns may look quite different. One may have signs of lower progesterone output. Another may show a pattern that suggests less favourable oestrogen metabolism. Another may have a disrupted cortisol rhythm affecting sleep, energy, cravings and resilience.

Why not just do a standard blood test?

Standard blood testing absolutely has its place. It can be important for assessing thyroid function, iron status, B12, folate, vitamin D, inflammation, glucose regulation, cholesterol, and liver and kidney function.

When it comes to diagnosing perimenopause or menopause, however, UK guidance is clear that women over 45 with typical symptoms are usually diagnosed based on symptoms, not hormone testing. Hormones such as FSH and oestradiol can fluctuate significantly during perimenopause, so a single blood test may not give the full picture.

So, the DUTCH test should not be seen as a menopause diagnosis test.

Instead, I see it as a functional hormone insight tool. It can help us explore patterns that may be relevant to how you feel, especially when considered alongside your symptoms, health history, diet, lifestyle, cycle pattern, medications, stress load and other markers. For example:

Oestrogen metabolism

Oestrogen is not just produced and then switched off. It has to be metabolised and cleared from the body.

The DUTCH test looks at different oestrogen metabolites, which can give insight into how your body is processing oestrogen. This may be relevant for women with symptoms such as heavy periods, breast tenderness, cyclical headaches, PMS-type symptoms, bloating or worsening perimenopausal symptoms.

From a nutrition perspective, this may guide support around fibre intake, cruciferous vegetables, gut health, alcohol reduction, protein adequacy and overall metabolic health.

This does not mean “detoxing” in the trendy sense. Your body already has detoxification pathways. The question is whether you are giving those pathways what they need to work well.

Progesterone patterns

Progesterone may become more variable in perimenopause as ovulation becomes less consistent.

Lower or fluctuating progesterone may be relevant for women experiencing shorter cycles, heavier periods, premenstrual anxiety, poor sleep, night waking or feeling more emotionally reactive than usual.

The DUTCH test does not replace a full clinical picture, but it can give us useful information about progesterone metabolites and whether your symptoms fit with that pattern.

Cortisol rhythm

This is one of the areas I find most useful.

Many midlife women are not just dealing with changing sex hormones. They are also dealing with years of chronic stress, poor sleep, blood sugar swings and nervous system overload.

Cortisol should follow a natural rhythm. It is usually higher in the morning to help you wake up and gradually falls across the day so that you can wind down at night.

When this rhythm is disrupted, you may wake feeling unrefreshed, rely on caffeine to get going, experience afternoon energy crashes, feel wired but tired at night, wake around 3am, crave sugar or carbohydrates, feel less resilient to stress, or struggle to recover from exercise.

The DUTCH test can show the pattern of free cortisol and cortisone across the day, as well as cortisol metabolites. This is not about diagnosing “adrenal fatigue”, which is not a recognised medical diagnosis. It is about understanding stress physiology and using nutrition and lifestyle strategies to support better regulation.

Androgens

Androgens such as testosterone and DHEA can also change in midlife. For some women, this may be relevant to acne, facial hair, hair thinning or changes in body composition. For others, low libido, low motivation, low mood or reduced muscle strength may be part of the picture.

The DUTCH test can provide information about androgen metabolites, which may be useful when symptoms suggest that androgen balance could be involved.

What can you actually do with the results?

This is the most important question. Testing is only useful if it changes the plan.

With the DUTCH test, the goal is not to chase perfect hormone numbers. The goal is to understand your patterns and build a realistic plan around them.

Depending on your results and symptoms, we may focus on blood sugar balance, protein and fibre intake, gut health and regular bowel movements, plant foods to support oestrogen metabolism, alcohol and caffeine habits, sleep timing, stress resilience, strength training, food-first liver support, and supplements if appropriate.

We may also identify whether further GP blood testing or medical review would be helpful.

This is where the DUTCH test can be empowering. It can help move you away from guesswork and towards a more targeted plan.

Who might benefit from a DUTCH test?

The DUTCH test may be useful if you are a midlife woman experiencing symptoms such as worsening PMS, mood changes, heavy or irregular periods, breast tenderness, cyclical headaches, sleep disruption, fatigue, feeling wired but tired, low libido, midlife weight gain, brain fog, stress-related symptoms, or symptoms that do not seem to match standard blood test results.  Or for post-menopausal women who are still having symptoms. It can be taken whether or not you are on HRT (including the Mirena coil). But it is not so relevant if you are on the oral contraceptive pill.

It may also be useful if you have been told “everything is normal”, but you still do not feel like yourself.

Who does not need it?

The DUTCH test is not essential for everyone.

You do not need a DUTCH test to confirm that you are perimenopausal if you are over 45 and have typical symptoms. You do not need it before speaking to your GP about menopause symptoms, HRT or other medical options. And you do not need it if you are looking for an emergency answer to severe or sudden symptoms.

Please speak to your GP if you have very heavy bleeding, bleeding after sex, bleeding after menopause, unexplained weight loss, severe pain, new headaches, chest pain, significant depression, or any symptom that feels unusual or concerning.

As a Nutritional Therapist, I do not diagnose or treat medical conditions, and I do not advise on medication. My role is to help you understand how nutrition, lifestyle, stress, sleep, gut health and metabolic health may be influencing how you feel, and to work alongside appropriate medical care where needed.

The Annual Hormone MOT

If you feel as though your hormones, energy and resilience have changed in midlife, my Annual Hormone MOT has been designed to give you a deeper understanding of what may be going on.

It includes a DUTCH hormone test, one 75-minute consultation, and one 45-minute follow-up consultation.

We take a full look at your symptoms, health history, cycle patterns, diet, lifestyle, stress, sleep, digestion and goals. We then go through your results and create a clear, personalised nutrition and lifestyle plan.

This is not about handing you a complicated protocol or overwhelming you with supplements. It is about helping you understand your body and giving you practical, evidence-informed steps that fit into real life.

If you are ready to take a deeper look at your hormones, stress response and midlife health, my Annual Hormone MOT includes the DUTCH test and two personalised consultations. Click here to view the full details and book.

Why Midlife Hormones Feel So Chaotic 

Many women reach their 40s feeling as though their body has suddenly started behaving differently.

The coffee that once felt energising now triggers anxiety. A small amount of alcohol affects sleep for days on end. Energy crashes appear out of nowhere. Weight settles around the middle despite eating the same as before. Cravings become harder to ignore. Sleep becomes lighter, mood becomes more unpredictable, and stress suddenly feels far less manageable.

Women often tell me: “I feel like my body can’t cope with things it used to.”

And honestly, they are often right.

One of the biggest misconceptions about hormone health is that symptoms are purely caused by “low hormones” or that women simply need to eat more salads, avoid sugar or buy expensive supplements.

In reality, hormones respond constantly to signals from the brain, gut, nervous system, immune system, liver and metabolic system. During perimenopause and midlife, those systems often become more sensitive to stress, blood sugar fluctuations, poor sleep and under-fuelling.

This is why women can feel exhausted, anxious and inflamed despite trying incredibly hard to “be healthy”.

The good news is that nutrition can play a meaningful role in supporting resilience during this stage of life. Not through perfection or restriction, but by helping the body feel safer, steadier and better nourished.

Why Food Matters for Hormones

Hormones are not isolated messengers floating around independently. They are deeply influenced by:

• Blood sugar regulation
• Stress signalling
• Sleep quality
• Gut health
• Inflammation
• Nutrient intake
• Energy availability
• Muscle mass
• Nervous system regulation

This is one reason why highly restrictive dieting often backfires during midlife.

Women frequently start eating less in response to weight gain while simultaneously exercising harder and sleeping worse. The body then perceives this combination as stress. In clinic, I commonly see women skipping breakfast, surviving on caffeine, eating very lightly during the day and then wondering why they feel ravenous, emotional or desperate for sugar at 9pm. That is not lack of willpower. That is physiology.

Research increasingly shows that fluctuating oestrogen levels during perimenopause may affect insulin sensitivity, appetite regulation and body fat distribution. At the same time, sleep disruption and chronic stress can worsen blood sugar instability and cravings further. Many women are not “failing”. Their body is simply becoming less tolerant of habits that previously went unnoticed.

Protein, Fibre and Healthy Fats Explained

When women feel overwhelmed by nutrition advice, I often encourage them to stop focusing on restriction and start focusing on what their body may genuinely need more of. Three of the most important foundations are protein, fibre and healthy fats. These are not trendy or glamorous recommendations, but they are often transformative.

Protein: The Nutrient Many Midlife Women Are Missing

One of the most common patterns I see is women under-eating protein, particularly earlier in the day. Breakfasts built around toast, cereal, pastries or fruit alone may leave women feeling hungry, shaky or craving sugar within hours.

Protein becomes increasingly important during midlife because it supports: muscle maintenance, blood sugar regulation, satiety, recovery, neurotransmitter production and metabolic health.

This matters because women naturally begin losing muscle mass with age, particularly during perimenopause and after menopause. Lower muscle mass may reduce metabolic flexibility and insulin sensitivity over time.

Many women think they have a “slow metabolism” when in reality they are often chronically stressed, sleeping poorly or under-eating protein and losing muscle mass. Including protein more consistently can help many women feel calmer, fuller and more energised.

Fibre: One of the Most Overlooked Hormone Supporters

Fibre is not just about digestion. Higher fibre intakes are associated with improved blood sugar balance, cardiovascular health, gut health and metabolic function. Fibre may also support hormone metabolism by influencing how oestrogen is processed and excreted from the body. Many women are eating far less fibre than they realise, especially when relying heavily on ultra-processed convenience foods.

At the same time, the gut microbiome appears to play a role in hormone regulation through something known as the estrobolome, the collection of gut bacteria involved in oestrogen metabolism. Emerging research suggests microbiome diversity may influence inflammatory and hormonal pathways during midlife.

Women often assume hormone health is about removing foods. Very often, it is actually about adding more nourishment and diversity back in.

Healthy Fats: The Missing Piece for Satiety and Hormone Health

After decades of low-fat messaging, many women still fear fats. But healthy fats are essential for hormone production, brain health, cell membrane health, nervous system regulation, satiety and absorption of fat-soluble vitamins.

Meals that are excessively low in fat often leave women hungry and unsatisfied, particularly during stressful periods. Useful sources include:

• Extra virgin olive oil
• Avocado
• Walnuts
• Chia seeds
• Flaxseeds
• Oily fish

Omega-3 Fats and Inflammation

One thing many women notice during perimenopause is that their body feels more inflamed. Joints ache more. Recovery is slower. Skin changes. Brain fog worsens. Sleep becomes less restorative.

While inflammation is complex, omega-3 fats have been widely researched for their role in supporting inflammatory balance, cardiovascular health and cognitive function.

Good sources include:

• Salmon
• Sardines
• Mackerel
• Anchovies
• Walnuts
• Flaxseeds
• Chia seeds

If you'd like to discuss this further, why not get in touch? You can book a free call with me here.

There is often a point during perimenopause and midlife where women realise salads are no longer keeping them full. I frequently hear women say they are “trying to be good” by eating light lunches, only to find themselves exhausted, craving sugar or reaching for caffeine by mid-afternoon.

Many women in midlife are unintentionally under-fuelling, particularly earlier in the day. Meals that are too low in protein, fibre or healthy fats can leave blood sugar unstable and energy levels all over the place.

This salad is designed to do the opposite.

It combines protein, omega-3 fats, fibre, colour and healthy fats in a way that feels satisfying, nourishing and realistic for real life. It is quick enough for a weekday lunch but substantial enough to support energy, blood sugar balance and fullness properly. And importantly, it actually tastes good.

Serves 2

Ingredients

• 2 salmon fillets
• 1 large handful mixed leaves
• 1 large handful rocket
• ½ avocado, sliced
• ½ cucumber, chopped
• 10 cherry tomatoes, halved
• ¼ red onion, finely sliced
• 1 tbsp pumpkin seeds
• 1 tbsp flaxseeds
• 1 tbsp extra virgin olive oil
• Juice of ½ lemon
• Black pepper
• Fresh herbs such as parsley or dill

Method

1. Preheat the oven to 180°C fan.
2. Place the salmon fillets on a baking tray, brush with olive oil and season, and cook for approximately 12–15 minutes until cooked through.
3. Meanwhile, prepare the salad vegetables and divide between two bowls.
4. Top with avocado, pumpkin seeds and flaxseeds.
5. Flake the cooked salmon over the salad.
6. Drizzle with olive oil and lemon juice.
7. Finish with black pepper and fresh herbs.
8. Enjoy!

Easy Ingredient Swaps

One of the most important things for sustainable healthy eating is flexibility.

Some easy swaps include:

• Swap salmon for mackerel, trout or grilled chicken
• Use tofu or tempeh for a veggie version
• Add quinoa or lentils for additional fibre and carbohydrates
• Replace pumpkin seeds with walnuts or sunflower seeds
• Add roasted vegetables for a more substantial evening meal
• Include feta or olives for a more Mediterranean-style flavour

This is often how I encourage women to think about meals in clinic, not rigid recipes, but balanced templates they can adapt to real life.

How to Turn This into a Balanced Summer Meal

One of the biggest mistakes I see women make with salads is building meals that are too small or too low in protein. A balanced meal should ideally help you feel:

• Full for several hours
• Mentally clearer
• More energised rather than sleepy
• Less likely to crave sugar later

If you find yourself hungry an hour after lunch, that is often useful feedback rather than a sign you lack willpower. Depending on your needs and activity levels, you could make this salad more substantial by adding:

• Quinoa
• Chickpeas or lentils
• New potatoes
• Extra salmon
• Sourdough bread on the side

Many women feel significantly better when they stop trying to eat the smallest possible meal and instead focus on eating meals that genuinely support energy and resilience.

Exhausted, Foggy and Gaining Weight? Thyroid Health in Midlife

There is a particular kind of exhaustion that many women in midlife describe.

Not just feeling tired after a busy week but waking up exhausted despite sleeping. Struggling to concentrate. Feeling cold all the time. Watching weight creep up despite eating “healthily”. Finding exercise harder to recover from. Losing motivation because nothing seems to work the way it used to.

For many women, these symptoms develop gradually enough that they begin to normalise them.

They blame stress. Ageing. Being busy. Perimenopause.

And while hormonal changes during midlife absolutely matter, thyroid health is often part of the wider picture too.

The thyroid is a small butterfly-shaped gland in the neck, but its effects are far-reaching. Thyroid hormones influence metabolism, energy production, temperature regulation, digestion, mood, menstrual health and cardiovascular function.

When thyroid function becomes suboptimal, women can feel as though their entire system has slowed down.

What makes this especially challenging is that thyroid symptoms are often dismissed, misunderstood or attributed solely to ageing or stress. Many women are told their results are “fine” despite clearly struggling with fatigue, brain fog, poor resilience and unexplained weight changes.

Nutrition cannot diagnose or treat thyroid conditions, and it is important to speak to your GP about ongoing symptoms. However, nutrition and lifestyle may play a valuable supportive role alongside appropriate medical care.

Why Thyroid Symptoms Are Often Missed

One of the reasons thyroid issues can feel so frustrating is that symptoms overlap with many other health concerns.

Symptoms may include:

• Fatigue
• Weight gain
• Brain fog
• Low mood
• Poor concentration
• Hair thinning
• Dry skin
• Constipation
• Feeling cold
• Heavy periods
• Reduced exercise tolerance
• Muscle aches

Many of these symptoms are also common during perimenopause, chronic stress, iron deficiency and burnout. As a result, women often spend years feeling unlike themselves before joining the dots.

I frequently hear women say things like: “I thought I was just getting lazy.”

Or: “I kept being told it was normal for my age.”

Unfortunately, many women end up feeling dismissed or doubting themselves.

Research suggests that women are disproportionately affected by thyroid disorders, particularly during midlife, and autoimmune thyroid conditions such as Hashimoto’s thyroiditis become increasingly common with age.

At the same time, stress, sleep disruption, under-fuelling and chronic dieting may all affect how resilient women feel during this stage of life, even without a formal thyroid diagnosis.

The Link Between Thyroid Health, Energy and Metabolism

Thyroid hormones help regulate how the body produces and uses energy. When thyroid hormone levels are insufficient, metabolism can slow down. This may affect everything from body temperature and digestion to muscle recovery and cognitive function.

Women often describe feeling as though they are “running on low battery” all the time.

One particularly frustrating aspect is the relationship between thyroid function and weight. Many women are told they simply need to eat less and move more. But thyroid hormones influence resting metabolic rate, appetite signalling, muscle mass and energy expenditure. This does not mean weight changes are entirely caused by the thyroid alone, but it does help explain why women can feel as though their body suddenly responds differently during midlife.

At the same time, poor sleep, stress, low protein intake and blood sugar instability can all compound fatigue and make metabolic health feel even more challenging.

Nutrients Important for Thyroid Function

The thyroid relies on a range of nutrients for normal hormone production, conversion and regulation. A restrictive diet, poor digestion or long-term stress may increase the risk of nutrient insufficiencies over time. Some nutrients commonly discussed in relation to thyroid health include:

Selenium
Selenium plays a role in thyroid hormone metabolism and antioxidant protection within the thyroid gland itself.

Foods rich in selenium include:

• Brazil nuts
• Seafood
• Eggs
• Poultry

Iodine
Iodine is required for thyroid hormone production, although both deficiency and excess intake may be problematic, so be very careful about overdoing it. Useful food sources include:

• Seafood
• Dairy products
• Eggs

It is important not to self-prescribe high-dose iodine supplements without professional guidance, particularly where autoimmune thyroid conditions may be present.

Iron
Low iron status may affect thyroid hormone production and energy levels. This is particularly relevant for women with heavy periods, digestive issues or restrictive eating patterns.

Zinc and Tyrosine
Zinc and the amino acid tyrosine are also involved in thyroid hormone synthesis and broader metabolic processes. Useful food sources include:

• Meat
• Fish
• Pumpkin seeds
• Dairy products
• Legumes, where tolerated

Everyday Nutrition Strategies for Midlife Thyroid Support
There is no single thyroid “superfood” or miracle diet.

However, many women benefit from returning to simple foundational habits that support energy, blood sugar balance and overall resilience.

Prioritise Protein
Protein supports muscle maintenance, satiety and blood sugar regulation. Many women in midlife are unintentionally under-eating protein, particularly earlier in the day. Including protein regularly may help support steadier energy and reduce cravings.

Eat Regularly
Skipping meals can worsen energy crashes, particularly in women already struggling with fatigue or stress. Balanced meals containing protein, fibre and healthy fats may help support more stable energy throughout the day.

Avoid the “All or Nothing” Trap
One of the biggest challenges I see in clinic is women swinging between restriction and exhaustion. They attempt highly restrictive diets, feel worse, lose motivation and then blame themselves. Midlife health often responds better to consistency than intensity.

Focus on Recovery, Not Punishment
Sleep, stress management, strength training and realistic movement all matter enormously.Many women do not need to push harder. They need more support.

If you feel exhausted, foggy, unlike yourself or frustrated by unexplained weight changes, it is important to know that these experiences are common and valid. And you should definitely get these things checked with your GP

Thyroid health, perimenopause, stress, sleep and nutrition are deeply interconnected during midlife. While nutrition cannot replace appropriate medical investigation or treatment, supportive nutrition and lifestyle strategies may help women feel more resilient, energised and supported during this stage of life.

Most importantly, struggling does not mean you are lazy, failing or lacking willpower. Your body may simply be asking for a different kind of support than it needed ten years ago.

If you would like personalised support with fatigue, thyroid health, perimenopause or midlife nutrition, why not book in for a free call with me to discuss options?

Perimenopause: Nutrition for Hormone Balance

There is often a moment when women realise something has shifted.  They start waking at 3am for no obvious reason. Their usual exercise routine suddenly feels more exhausting than it did before. Their patience is shorter, their periods are heavier or closer together, and the weight that once felt ok now seems to have settled around their middle overnight.

I often hear from clients that they feel as though their body doesn’t belong to them anymore. 

They are eating the same way they always have, and yet they feel more tired, more anxious and far less resilient. They may have gone to the GP after months of fatigue and brain fog only to be told their blood tests are “normal”. They sometimes start wondering if they are simply failing to cope.

But for many women, these changes are not random - they may just be the start of perimenopause.

And despite what social media often suggests, perimenopause is not just about hot flushes. It can affect sleep, mood, blood sugar balance, energy, muscle mass, appetite, stress resilience, cognitive function and metabolic health long before periods stop completely.

The good news is that nutrition and lifestyle can make a significant difference to how women experience this transition.

What Actually Happens During Perimenopause?

Menopause is when you have been 12 months without a period. Perimenopause is the stage leading up to this where hormone levels begin to fluctuate dramatically. The average age of menopause is 51, but perimenopause can last 4-10 years, so changes post-40 might be the start of perimenopause. 

In perimenopause, symptoms often feel confusing and that’s because hormones do not simply decline in a straight line. Oestrogen can swing from high to low unpredictably, while progesterone often declines earlier due to less regular ovulation. This hormonal instability may explain why symptoms can appear suddenly or change month to month.

One month you may feel completely fine.

The next you may feel exhausted, anxious, bloated and unable to sleep.

Emerging research also shows that perimenopause is closely linked with changes in metabolic health. Fluctuating oestrogen levels can affect insulin sensitivity, appetite regulation and body fat distribution, particularly around the abdomen. At the same time, declining oestrogen may influence inflammation, vascular health and cognitive function. 

This is one reason why many women say: “I feel like I’ve suddenly aged overnight.”

In reality, there are complex hormonal and metabolic shifts happening beneath the surface.

Why Symptoms Often Feel Confusing
Perimenopause symptoms overlap with many other issues including thyroid dysfunction, iron deficiency, burnout, chronic stress and poor sleep.

Symptoms may include:

• Fatigue
• Brain fog
• Anxiety or low mood
• Reduced stress tolerance
• Weight gain
• Irregular or heavier periods
• Poor sleep
• Joint aches
• Increased cravings
• Digestive changes
• Hot flushes or night sweats

Many women spend years trying to “push through”, often assuming they simply need more discipline, more motivation or another diet. But this can sometimes make things worse.

In reality, many women in their 40s are carrying an enormous physiological load. They are often balancing careers, children, ageing parents, poor sleep and chronic stress while simultaneously navigating hormonal shifts that affect how their body regulates energy, appetite and recovery.

Mood, Sleep and Energy Changes

One of the earliest changes many women notice is disrupted sleep.

Progesterone naturally has calming and sleep-supportive effects. As progesterone levels begin to fluctuate and decline, women may become more sensitive to stress and less able to switch off at night.

Research also suggests that changing hormone levels during perimenopause can influence neurotransmitters involved in mood regulation, including serotonin and GABA pathways, causing feelings of irritability and anxiety.

In turn, poor sleep itself can then worsen cravings, blood sugar instability and fatigue. This creates a cycle where women feel increasingly exhausted but are often told to simply “manage stress better”.

I also commonly see women becoming more reactive to caffeine and alcohol during this stage. Foods and habits they once tolerated perfectly well suddenly affect sleep, anxiety or energy far more significantly.

Weight Gain and Blood Sugar Changes

One of the most frustrating aspects of perimenopause for many women is feeling as though their metabolism has changed overnight.

Women often tell me: “I’m eating less than I used to, but gaining more weight than ever.”

While nutrition still matters enormously, this is not simply about calories or willpower. Perimenopause is associated with changes in insulin sensitivity, muscle mass and fat distribution. Oestrogen fluctuations appear to influence where fat is stored, particularly around the abdomen, while poor sleep and chronic stress may increase cravings and appetite dysregulation.

At the same time, many women unintentionally under-eat protein, skip meals or rely on quick ultra-processed foods because they are overwhelmed and exhausted.

This is often why extreme dieting approaches backfire during midlife. Restrictive diets may temporarily reduce weight but can worsen stress, cravings, muscle loss and energy long term.

Nutrition Strategies That Support Hormone Balance

There is no single “perfect” perimenopause diet.

However, evidence increasingly supports Mediterranean-style dietary patterns rich in fibre, healthy fats, plant diversity and adequate protein for supporting cardiovascular, metabolic and cognitive health during midlife. Rather than focusing on restriction, I like to encourage women to think about nourishing their bodies, building resilience and trying to maintain consistency.

Prioritising Protein

Protein becomes increasingly important during midlife. Adequate protein supports muscle maintenance, blood sugar balance, satiety and recovery.

Many women are unknowingly under-eating protein, particularly at breakfast, which may contribute to energy dips and cravings later in the day.

Useful protein-rich foods include:

• Eggs
• Greek yoghurt
• Fish
• Chicken or turkey
• Lean red meat
• Tofu and tempeh
• Lentils and beans
• Nuts and seeds

Supporting Blood Sugar Balance

Blood sugar fluctuations can become more noticeable during perimenopause. Many women describe feeling “hangry”, shaky or desperate for sugar by mid-afternoon.

Simple habits can make a significant difference:

• Eating 3 regular meals each day
• Including protein and fibre at every meal
• Reducing reliance on ultra-processed snacks
• Avoiding skipping meals
• Building meals around whole foods where possible

Women often notice improvements in energy, cravings and mood stability when blood sugar becomes more consistent.

Increasing Fibre and Plant Diversity

Higher fibre diets are associated with improved gut health, cardiovascular health and metabolic function. Plant diversity also supports the gut microbiome, which may play a role in hormone metabolism through the so-called “estrobolome”. 

This does not mean women need to eat perfectly.

But regularly including foods such as vegetables, berries, herbs, nuts, seeds, beans and whole grains where tolerated may provide important support during this stage of life.

Including Healthy Fats

Healthy fats are essential for hormone production, brain health and inflammatory balance. Useful sources include:

• Extra virgin olive oil
• Oily fish
• Walnuts
• Chia seeds
• Flaxseeds
• Avocado