Why Fasting During Perimenopause Feels Harder: ‘Your Body Is in a Higher Stress State’

Here’s the thing about perimenopause: When you’re in the throes of it, it can feel like you’ve been handed a whole new body. Many women report simply not feeling like themselves, and this can make things you’ve done for years—like fasting—feel…different.

With the Islamic month of Ramadan underway, many women are fasting from sunrise to sunset. Of course, that’s not the only reason someone may fast: Daily intermittent fasting to lose weight, avoiding meals ahead of a medical procedure or fasting for another religious purpose are just some of the reasons women may abstain from food and drink for periods of time.

Regardless of the why, it’s completely plausible that women who’ve been fasting for decades may suddenly find the practice more challenging. And if you’re feeling this way, it’s not in your head. Perimenopause can make fasting more complicated.

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Why fasting may be challenging during perimenopause

“Perimenopausal women, because their body is kind of in a higher stress state, they tend to not do as well [when fasting],” says Noor Al-Humaidhi, MD, a board-certified family physician and menopause specialist. “They have worse disrupted sleep [and] their cortisol levels are higher.” 

“Perimenopause is very badly defined, and the reason perimenopause is badly defined is because menopause is badly defined,” she explains. “We define menopause as the time when you are a year without a period, which is a terrible definition. It really doesn’t speak to what’s going on.”

There’s no test to determine whether or not you’re perimenopausal. There are a few signs, though: If you’re experiencing increased anxiety, sleep disturbances, hot flashes, brain fog or changes in mood, you may be in perimenopause, especially if you’re over 35. And if you suspect this may be the case, a chat with your doctor may be a good idea before you consider fasting. That’s because fasting can increase your body’s stress response—the very stress response is already heightened during perimenopause, Dr. Al-Humaidhi explains. 

That said, it’s worth noting that there’s data to indicate that postmenopausal women may actually have better fasting outcomes, adds Dr. Al-Humaidhi. She points out that post-menopausal women showed improved insulin sensitivity, weight loss and blood pressure in a study in Frontiers in Nutrition. 

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How to make fasting during perimenopause easier

While fasting may be more difficult during perimenopause, it’s often still possible to do it safely. Here, TK tips that make it easier:

Drink plenty of water

First things first: Unlike other forms of fasting, the Muslim practice of fasting during Ramadan doesn’t allow for even water intake. That’s why hydration is particularly important for women in perimenopause who are fasting during Ramadan. For this type of fasting, Dr. Al-Humaidhi suggests drinking plenty of fluids during the window in which you can eat and drink (which takes place from sunset to sunrise the following day).

Prioritize protein

Whether you’re doing intermittent fasting, alternate day fasting or any other form of time-restricted eating during perimenopause, getting enough protein is important. The macronutrient can keep you full longer, which is crucial when you’re staying away from food for long periods of time. But for women going through perimenopause or menopause, protein is especially vital.

“Your body’s need for protein increases in perimenopause and menopause, and that is generally because of the loss in our sex hormones,” notes Dr. Al-Humaidhi. “One thing that happens in our bodies is we very imperceptibly start to lose skeletal muscle, and it becomes very hard to maintain—let alone build—skeletal muscle. In order to do that, we need to make sure we are consuming an adequate amount of protein.”

Focus on fiber

After a long day of fasting, it can be tempting to reach for hearty foods. Why bother with a salad or fruit after you’ve gone hungry all day? But keeping your fiber intake up is also essential.

“There’s a metabolic shift [during perimenopause] in which our visceral fat, which is that fat inside our abdomen, starts to increase,” says Dr. Al-Humaidhi. “We become insulin resistant [and] our cholesterol starts to rise. One of the best ways of combating that, from a dietary perspective, is making sure we’re eating enough fiber.” 

When to skip fasting during perimenopause

You can do everything to set yourself up for fasting success, only for it to simply not be in your best interest. People with diabetes, low blood sugar, a history of eating disorders or low body weight should not fast regardless of life stage. Beyond those contraindications, it’s important to listen to your body.

“As a woman going through menopause or perimenopause, if you’re dizzy, if you’re finding that your sleep is very disrupted, your night sweats are getting worse, that you’re feeling at a heightened state of anxiety, perhaps fasting is not for you,” says Dr. Al-Humaidhi. “Part of what I preach is to listen to your body and to try to respond to the cues your body is giving you. If you’re very fatigued, having difficulty sleeping, if you are really thirsty, really hungry, if you’re dizzy, if your blood sugar is low…I would avoid it.”

For example, women who experience migraines may discover that the head pain gets more frequent (or more debilitating) during perimenopause. “Often migraines will be triggered by fluctuations in estradiol level. What we see in perimenopause is huge fluctuations in estradiol, and that tends to make everything significantly worse,” says Dr. Al-Humaidhi. “If it’s making the situation worse, I would recommend not fasting.”

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Is it safe to exercise when fasting?

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There’s no one-size-fits-all answer, but it’s important to be mindful when approaching fitness and fasting during perimenopause. “Exercise like HIIT and high levels of cardio are going to further increase the stress response in your body,” says Dr. Al-Humaidhi. “If you have very low blood sugar already or if you are under-hydrated because you are fasting, then [those types of exercise are] probably not a good idea.”

Instead, she suggests starting with gentle exercise while fasting (walking is a good option as long as you’re hydrated) and saving high-impact fitness for the windows during which you are able to eat and drink.

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