Metabolic Changes of Perimenopause and Nutritional Advice

PURPOSE OF REVIEW: Perimenopause is a period of hormonal volatility associated with clinically relevant changes in metabolism and cardiometabolic risk. In addition to vasomotor symptoms, sleep disruption, and changes in body composition, the transition from the late reproductive years to early postmenopause is characterized by physiologic alterations that may precede formal diagnostic thresholds for metabolic syndrome. However, screening and risk stratification are often anchored to postmenopausal benchmarks, potentially delaying identification of individuals at elevated risk. RECENT FINDINGS: Accumulating evidence supports earlier attention to dynamic indices of cardiometabolic deterioration during perimenopause. Lifestyle interventions and, for selected individuals, menopausal hormone therapy may mitigate progression, although important uncertainties remain, including the long-term effectiveness of precision nutrition approaches and genotype-informed strategies. This narrative review summarizes physiologic changes across the menopausal transition and evaluates nutrition and lifestyle interventions that may attenuate adverse metabolic trajectories.