MENOPAUSE NUTRITION SERIES (PART 2 / 3)

Part 2: Heart health & blood sugar in menopause (what changes, what helps)

If you’re in perimenopause or menopause and noticing weight shifting to the middle, cholesterol creeping up, or blood sugar becoming less stable, youre not imagining it.

Hormonal changes during the menopausal transition can influence lipids (cholesterol and triglycerides), insulin sensitivity, visceral fat, and inflammation  all of which affect cardiovascular and metabolic risk.

At Deep Water Medicine, we support women through this transition with a holistic lens: symptoms matter, but so does long-term health. This post summarises key points from the 2024 review The Importance of Nutrition in Menopause and Perimenopause (Erdlyi et al., Nutrients) and turns them into practical, sustainable steps.

Why cardiovascular risk rises after menopause

Before menopause, estrogen has a protective effect on the cardiovascular system. The review explains that in the presence of estrogen, lipid profiles tend to be more favourable (lower total cholesterol, LDL cholesterol, and triglycerides).

With the onset of menopause:

  • Lipid parameters can deteriorate rapidly
  • Blood vessel elasticity can decrease
  • Central (visceral) fat tends to increase
  • Low-grade inflammation can rise

The review also notes that the speed and magnitude of the estradiol drop may influence how sharply cardiovascular risk increases.

Visceral fat, inflammation, and the metabolic syndrome pattern

During the menopausal transition, common metabolic changes include:

  • Increased visceral fat
  • Reduced energy expenditure
  • Worsening insulin sensitivity

The review highlights that central obesity, dyslipidaemia, glucose intolerance, and hypertension often cluster together. In postmenopausal women, the incidence of metabolic syndrome is reported as 2 times higher than before menopause.

Nutrition priorities for heart health in menopause

The review draws heavily on established cardiovascular prevention guidelines. The big picture is consistent: a balanced diet, built on whole foods, is protective.

Focus on fat quality (not just fat quantity):

  • Keep saturated fat to <10% of total energy
  • Replace saturated fats with polyunsaturated fats where possible
  • Prioritise omega-3 fats (EPA/DHA)

Practical swaps:

  • Use olive oil as your default cooking/salad oil
  • Choose nuts/seeds as snacks over processed biscuits
  • Aim for fish a couple of times per week (where appropriate)

Blood sugar and insulin sensitivity: what changes in menopause

The review outlines several mechanisms that can increase risk of insulin resistance and type 2 diabetes during menopause, including:

  • Reduced insulin secretion from pancreatic beta cells
  • Reduced muscle insulin sensitivity and glucose uptake
  • Increased liver glucose production
  • Increased lipolysis and inflammatory mediators from adipose tissue

Lifestyle intervention (diet + exercise) is emphasised as the cornerstone of prevention and management.

Practical nutrition steps that support metabolism in perimenopause

There’s no single perfect diet. The review leans toward balanced, sustainable changes over extreme plans.

The review suggests:

  • Keep daily carbohydrate intake at least ~120 g/day (especially to avoid overly restrictive patterns)
  • Prefer low glycaemic index, high-fibre carbohydrate sources
  • Minimise added sugars (WHO suggests <10% of energy; <5% may offer additional benefit)

Practical carbohydrate choices:

  • Vegetables, legumes, whole grains
  • Fruit (in whole form)
  • Unsweetened dairy (if tolerated)

A simple plate pattern for steadier blood sugar

Try this for most meals:

  • 1/2 plate non-starchy vegetables
  • 1/4 plate protein
  • 1/4 plate high-fibre carbs (legumes/whole grains/starchy veg)
  • Add healthy fats (olive oil, avocado, nuts/seeds) as needed

The non-negotiable: movement (especially strength training)

The review notes that regular exercise supports metabolic health and can reduce symptom intensity (including hot flushes for many women).

For cardiometabolic support, aim for:

  • Regular walking (daily if possible)
  • Resistance training 2x/week (muscle is a key glucose sink)
  • Any movement you can sustain long-term

What’s coming next

  • Part 3: Bone, sleep & the “key nutrients” — vitamin D, calcium, protein, fibre, and sleep-supportive nutrition.

Want support?

If youre navigating perimenopause or menopause and want support, we can help.

Appointments are available Lez & Lorielle online at https://deepwatermedicine.com.au or call 08 8323 9844.

Important note: This is general education and not individual medical advice. If you have new or concerning symptoms, please speak with your GP and/or a qualified practitioner.

Citation:

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 2024, 16, 27. https://doi.org/10.3390/nu16010027