The scale shows the same as a year ago, but the body no longer feels the same. Mariel Silva, Director of Medical Services and specialist in Healthy Aging at SHA Spain, with more than twenty years of medical practice, explains it bluntly. “In this stage body composition can change, fat can increase and lean mass can decrease, even without a significant change in weight. That’s why many women feel their body is changing, even though the scale says practically the same,” she notes.
To that change, another front is added. “In addition, protecting bone health becomes especially important. The diet must help to care for bone and muscle, ensure enough nutrients, and accompany metabolic health,” explains Silva. What used to work on the plate may fall short now, even though apparently nothing has changed. “At this stage it is important to review what we are eating and whether it covers our needs,” she adds.
Her example is very concrete. “Sometimes the most useful adjustment is to incorporate a source of protein into a meal that used to consist only of a salad or a vegetable soup,” she says. The two dishes are good options, she notes, but if they are the whole meal they can provide little protein. And nutrition does not work alone. “It must always be accompanied by physical activity,” the doctor reminds us.
When asked to choose, she is clear about where to look. “In this stage I would pay special attention to protein to support the muscle, calcium and vitamin D to protect the bone, and iron if heavy menstruations continue,” she explains. Each serves a different function and, according to Silva, needs should be evaluated based on the diet and the situation of each woman. With one of them there is an added difficulty: “Vitamin D deserves attention because few foods provide it in significant amounts.”
Iron, Soy, and Supplements
Iron deserves a separate chapter. “Iron requires a particular look: if there is heavy bleeding, we may be losing more than we can replenish with the diet,” explains Silva. And she issues a warning. “In that context, fatigue deserves assessment and should not be attributed directly to perimenopause,” she insists. Being exhausted is not something to simply accept because you are in this stage.
“Magnesium is also necessary and we can obtain it from legumes, nuts and whole foods,” she notes. Regarding the phytoestrogens from soy, she is cautious: “They can be part of a healthy diet, but we cannot guarantee that they relieve hot flashes.” She is also not in favor of taking supplements just in case. “Insufficient intake does not always mean a deficiency, and supplementation makes sense when there is a concrete indication,” she explains.
Before adding anything, she would review some very common habits. “One of the habits I would review is turning to more coffee to compensate for fatigue or alcohol at night to relax. In some women, these habits can worsen sleep or promote hot flashes,” she explains. The same goes for very restrictive diets out of fear of gaining weight, because eating less and less “can make the intake of protein, calcium and other important nutrients in this stage more difficult.”
What to Put on the Plate This Autumn
The season lends a hand. “Autumn offers foods that help add variety and quality to the diet, such as pumpkin, broccoli, cabbages, pomegranates, apples, pears, and citrus fruits,” Silva explains. When combined with legumes, whole grains, nuts and seeds, they allow nutritious meals within a predominantly plant-based pattern, which, according to the doctor, aligns with the recommendations for this stage. And without changing everything: “It’s enough to review the usual meals and make small adjustments that we can maintain.”
Her proposals are easy to apply: add pumpkin or cabbage to a lentil stew, accompany fish with broccoli, include a few walnuts at breakfast, or choose a whole seasonal fruit as dessert. Citrus fruits have an extra plus, because they provide vitamin C, which enhances the absorption of iron from legumes. And if dinner is a vegetable soup, she advises completing it with tofu, legumes, or fish. Protein, calcium, and vitamin D, she reminds, must be cared for all year round.
Is it really noticeable? “A Mediterranean pattern can improve measurable aspects, such as cholesterol, blood pressure, or glucose levels, and the evidence suggests possible benefits for mood,” Silva explains. If hot flashes or insomnia predominate, improving the diet “can support care, but it will not always be enough.” That is why she calls for tailoring care to each woman. “There is no need to wait for habit changes to fail before seeking help, nor do all women need medication,” she concludes.
