Key Timestamps
- 00:00 — Introduction — why this conversation matters now
- 02:00 — How Andrea Donsky discovered there were 103 symptoms of perimenopause and menopause
- 04:45 — Why 9 of the top 10 most common symptoms are brain, cognitive, and mental health related
- 05:45 — The doctor visit problem: 40% dismissed, 75% seeing 2+ doctors
- 08:30 — A patient story — undiagnosed menopause, years of doctors, now thriving at 71
- 10:55 — What women are still getting wrong — and what to do differently
- 13:35 — The BALANCE Blueprint: the 7-letter nutritional framework
- 16:00 B — Blood sugar: the most important place to start
- 18:35 — Protein targets for women in menopause: the formula
- 20:30 — The digestion deep dive — what changes and why it matters
- 23:40 — How often should you go to the bathroom? What healthy digestion looks like
- 25:05 — Eating earlier in the day: the one habit with outsized results
- 27:40 — Foods that trigger hot flashes and night sweats
- 30:00 — Alcohol, perimenopause, and sleep: the honest conversation
- 33:00 — Foundational vs targeted supplementation
- 34:30 — Magnesium: why it is non-negotiable
- 35:45 — Omega-3s, vitamin D, and K2
- 37:15 — The vitamin D connection to hormones, oxytocin, and progesterone
- 38:45 — Rapid fire: one superfood, one habit to stop, one mindset shift
- 42:30 — Where to find Andrea Donsky and Nourishing Menopause
103 Symptoms — and 90% Are in Your Head (Literally)
Most women know the classic three: hot flashes, night sweats, mood swings.
What most women do not know is that there are actually 103 documented symptoms of perimenopause and menopause. And when Andrea Donsky’s research team analyzed the top 10 most common, nine of them were brain health, cognitive health, or mental health related.
Nine out of ten.
That is not a coincidence. Progesterone — which declines sharply in perimenopause — is one of the most neuroprotective hormones in the body. When it drops, anxiety, brain fog, sleep disruption, and mood instability often follow.
“90% of the top 10 most common symptoms are in the brain health, cognitive health, and mental health category. That was hugely surprising to me — not surprising knowing what women have gone through, but surprising that it was such a large percentage.”
Dr. Anna points out that this is exactly why so many women end up on antidepressants, anti-anxiety medications, or in therapy before anyone connects the dots: these aren’t psychiatric symptoms. They’re hormonal ones.
Knowing this is the first step. Understanding what to eat to support the brain and hormonal system in this transition is the second.
What Women Are Being Told (and Why It’s Wrong)
According to Andrea’s published research on doctor visits, 40% of women in perimenopause and menopause are being dismissed for their symptoms. Another 75% have to see two or more doctors before their symptoms are connected to perimenopause or menopause at all.
The most common advice they’re receiving?
“Exercise more.”
“Lose weight.”
“You just have to deal with it.”
Only 10% of doctors are proactively raising perimenopause or menopause as a possible explanation for what their patients are experiencing.
The result is women who feel dismissed, confused, and stuck in a cycle of trying the same things harder — and getting the same results.
Here is the truth: nutrition strategies that worked for your body in your 30s may actively work against you now. Insulin sensitivity changes. Gut motility changes. The gut microbiome changes. Protein needs increase. And what you eat, when you eat, and how you eat all take on a level of importance most women were never told about.
The BALANCE Blueprint: 7 Nutritional Strategies for Menopause
Andrea Donsky developed the BALANCE Blueprint as the nutritional framework in her book Nourishing Menopause. Here is what each letter stands for — and why it matters for women in this stage of life.
B — Balance Blood Sugar Levels
Insulin is, as Dr. Anna puts it, “a major puppeteer of our reproductive hormones.” As estrogen and progesterone decline, insulin and cortisol tend to rise. Managing blood sugar is not just about weight — it is foundational to how every other hormone in your body behaves.
Practical starting point: eat whole foods your body recognizes, pair carbohydrates with protein and fiber, and aim to finish dinner 3–6 hours before bed. Even that one shift — eating earlier — can significantly reduce overnight blood sugar spikes that disrupt sleep.
A — Add More Fiber
Fiber does more than keep digestion moving. It slows the absorption of sugar into the bloodstream, which directly supports the blood sugar balance above. Fifty percent of women in perimenopause and menopause are not getting enough fiber.
Practical starting point: aim for a variety of plant-based fiber sources. The goal of 30 different plant foods per week sounds ambitious, but it does not have to be. Five different colors of vegetables per day is a simple proxy.
L — Load Up on Protein
Protein needs increase in perimenopause and menopause. Most women are significantly underconsuming it.
Andrea’s formula:
140 lbs or less: aim for 20–25 grams of protein per meal (three meals)
More than 140 lbs: aim for 25–30 grams per meal
These are starting points. If you are very active or trying to build muscle, you will need more.
A — Add Good Quality Fats
Fat is not the enemy. Healthy fats — avocado, olive oil, fatty fish, nuts, seeds — are essential for brain health, hormone production, and cellular function. They also support the absorption of fat-soluble vitamins like D, A, E, and K.
N — Nurture Digestion
Digestion changes in this phase of life. Stomach acid decreases, gut motility can slow, and the gut barrier can weaken. This means you may not be absorbing the same nutrients from food that you were before, even if you’re eating well. More on this in the section below.
C — Choose More Plants
A wide variety of plant foods provides the antioxidants, polyphenols, and phytonutrients the body needs to manage inflammation and support detoxification. Eating the rainbow is not a metaphor — different pigments in plants represent different protective compounds.
E — Ensure You’re Hydrated
Every system in the body depends on water. Dehydration exacerbates fatigue (the number one symptom reported by 72% of women in Andrea’s research), worsens brain fog, and impairs digestion. Most women in menopause are mildly chronically dehydrated without realizing it.
How Much Protein Do You Actually Need?
The protein question is one of the most common in menopause nutrition, and the answers online are all over the place.
Andrea’s framework gives you a starting point (see the BALANCE section above), with the caveat that individual needs vary based on activity level, body composition, and specific health goals. She recommends using a macro calculator online to find your personal target.
Dr. Anna adds an important practical caveat: if you are eating 140 grams of protein per day but your digestion is compromised, you may not be absorbing enough of it. This is why nurturing digestion (the N in BALANCE) is not optional — it is what makes the rest of the framework actually work.
“It takes more than hormones to fix our hormones.”
Digestion Changes in Perimenopause (and What to Do About It)
This is where Andrea goes deep — and where many women find the biggest aha moment.
When hormones shift, the gut shifts too. Here is what that looks like in practice:
Digestion slows down
Gut barrier integrity can weaken, allowing inflammatory particles to enter the bloodstream
Food sensitivities can emerge or worsen, even to foods that never bothered you before
The gut microbiome shifts — research now shows it begins to resemble the male gut microbiome pattern in menopause
Gas, bloating, heartburn, and constipation become more common (50% of women report gut health issues)
Signs of healthy digestion to look for:
A bowel movement at least once per day
Stool that is dark brown and banana-shaped (look up the Bristol Stool Chart for reference)
No chronic bloating, gas, or discomfort after eating
What helps:
Taking a few deep breaths before meals to activate the parasympathetic nervous system (rest-and-digest mode)
Finishing dinner earlier in the evening — 3 to 6 hours before bed
A short walk after dinner to support blood sugar and motility
Reducing or eliminating inflammatory foods (gluten, dairy, seed oils, processed foods) on a trial basis
Supporting with targeted supplements, particularly magnesium and omega-3s
Foods and Habits That Trigger Hot Flashes and Night Sweats
Not everything affects every woman the same way. But there are common patterns worth knowing.
Andrea’s top triggers from personal experience and clinical observation:
Alcohol — particularly in the evening. Even a small amount of alcohol can cause blood sugar to remain elevated overnight, disrupting sleep and triggering night sweats when it metabolizes.
Chocolate — the caffeine and other compounds can trigger hot flashes, particularly if eaten close to bed.
High-sugar foods or anything that spikes blood sugar before bed.
Eating too late — the closer your last meal is to bedtime, the more likely it is to interfere with your sleep quality.
Dr. Anna adds alcohol to her list of things worth cutting out entirely for a two-month trial period, noting that many women in perimenopause and menopause report a complete loss of tolerance for alcohol and significantly better sleep and hormone symptoms after removing it.
A food diary is one of the most practical and inexpensive ways to identify your personal triggers. Keep track of what you eat, when you eat, and how you feel — symptoms can show up 24–48 hours later, so patterns are not always immediately obvious.
Foundational Supplements Every Woman Should Know About
Andrea makes a clear distinction between foundational supplements (non-negotiables for most women in this phase) and targeted ones (based on individual symptoms and lab work).
Foundational Supplements
Magnesium glycinate or bisglycinate — Responsible for over 600 enzymatic processes in the body. The glycinate form specifically helps with relaxation and sleep. Take it before bed.
Omega-3s (fish oil or algae oil) — Essential for brain health, heart health, hair, skin, nails, and hormonal communication. Also, one of the most underutilized remedies for itchy ears and dry eyes in menopause. Therapeutic dose: 2,000–3,000mg per day.
Fiber supplement — If dietary fiber is insufficient, a supplement supports digestion, blood sugar balance, and satiety.
Vitamin D3 with K2 (MK-7) — Vitamin D is a hormone, not just a vitamin. It supports immunity, mood, energy, bone health, and — as Dr. Anna adds — is required for progesterone and oxytocin to function properly. Get your levels tested at least once a year.
Note from Dr. Anna: If you are supplementing without addressing the nutritional foundation, you will get limited results. Supplements support a whole-foods diet. They don’t replace one.
The Mindset Shift That Changes Everything
Research confirms what many women have experienced intuitively: how you think about menopause affects how you experience it.
Women who expect menopause to be terrible are significantly more likely to have a worse symptom experience. Conversely, women who view it as a time of transformation and recalibration tend to navigate it differently.
“Stop beating yourself up. Be gentle with yourself. Perimenopause is a time of recalibration and your body is changing.”
Andrea went from what she describes as a “type AAA” personality before perimenopause to barely getting out of bed during it — and has come out the other side with a career built on helping other women do the same.
Dr. Anna’s reframe: you cannot change your genetic history, but you have real power over your physiology when you take the right steps. One next right step. That is all you ever need.
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FAQ:
Q: What should I eat during perimenopause and menopause?
A: Focus on whole foods that support blood sugar balance, adequate protein (20–30g per meal depending on body weight), high-fiber plant foods, healthy fats, and proper hydration. Andrea Donsky’s BALANCE Blueprint provides a practical framework: Balance blood sugar, Add fiber, Load up on protein, Add good fats, Nurture digestion, Choose plants, Ensure hydration.
Q: Why am I gaining weight in perimenopause even though my diet hasn’t changed?
A: As estrogen and progesterone decline, insulin and cortisol tend to increase. This shifts how the body processes and stores energy, particularly around the midsection. Strategies that worked in your 30s may not work the same way now. Balancing blood sugar, increasing protein, and eating earlier in the evening are among the most effective places to start.
Q: How much protein do women in menopause need?
A: According to nutritionist Andrea Donsky, women who weigh 140 lbs or less should aim for 20–25 grams of protein per meal (three meals per day). Women over 140 lbs should aim for 25–30 grams per meal. These are starting points — active women and those building muscle may need more. Using a macro calculator online can help personalize your target.
Q: What foods trigger hot flashes and night sweats?
A: Common triggers include alcohol (especially in the evening), chocolate, high-sugar foods consumed close to bedtime, and any food that causes blood sugar to spike before sleep. Individual responses vary. Keeping a food diary for two to four weeks is one of the most effective ways to identify your personal triggers.
Q: What supplements should women take during menopause?
A: Based on Andrea Donsky’s research, four foundational supplements are worth discussing with your healthcare provider: magnesium glycinate (supports relaxation, sleep, and over 600 enzymatic processes), omega-3 fatty acids (brain, heart, and hormonal support; 2,000–3,000mg daily), fiber supplements if dietary intake is insufficient, and vitamin D3 with K2 MK-7 (critical for bone health, immunity, mood, and hormone function). Get vitamin D levels tested at least once per year.
Q: Why has my digestion changed in perimenopause?
A: When estrogen and progesterone decline, the gut changes too. Digestion can slow, the gut barrier can weaken, food sensitivities can emerge, and the gut microbiome shifts. Fifty percent of women in perimenopause and menopause report gut health symptoms. Supporting digestion with magnesium, omega-3s, adequate fiber, and stress management techniques (like breathing before meals) can make a significant difference.
Q: Does eating earlier in the day actually help with menopause symptoms?
A: Yes, based on both clinical observation and personal experience from multiple practitioners. Eating earlier — finishing dinner at least 3–6 hours before bed — helps stabilize overnight blood sugar, which directly affects sleep quality, hot flashes, and morning energy. Even a single night of earlier eating can produce noticeable results in blood sugar and inflammation markers the following morning.
Q: What is the BALANCE Blueprint for menopause nutrition?
A: The BALANCE Blueprint is a nutritional framework developed by Andrea Donsky in her book Nourishing Menopause. It stands for: Balance blood sugar, Add fiber, Load up on protein, Add good quality fats, Nurture digestion, Choose more plants, Ensure hydration. It is designed as a practical whole-picture approach for women in perimenopause and menopause.
Resources Mentioned
Nourishing Menopause: Powerful Nutrition and Lifestyle Strategies to Feel Your Best (Simon & Schuster)
Andrea’s Pelvic Health Research Survey (co-authored with Dr. Anna)
Bristol Stool Chart — available free online, referenced in Andrea’s book resources
Connect with Dr. Andrea Donsky
Connect with Dr. Anna
* The information provided is for educational purposes only and should not be construed as medical advice. Always consult with your healthcare professional before starting any supplement program.
