Perimenopause and menopause can bring a host of unwelcome changes — from weight gain and hot flashes to mood swings and insulin resistance. As women navigate these transitions, many are looking for dietary strategies to support their health. One approach gaining popularity is the ketogenic diet (keto). But can keto really help during perimenopause or menopause? Let’s dive into what the science currently says.
What Is the Ketogenic Diet?
The ketogenic diet is a very low-carbohydrate, moderate to high-fat and moderate to high protein eating plan. By reducing carb intake, the body enters ketosis, a metabolic state where it burns fat — producing ketones — for fuel instead of glucose.
Potential Benefits of Keto During Perimenopause / Menopause
Improved Insulin Sensitivity
One of the most common metabolic shifts during menopause is a decrease in insulin sensitivity. As the body becomes less responsive to insulin, blood sugar regulation can worsen, increasing the risk of type 2 diabetes. Evidence suggests that a low-carb ketogenic approach may help improve insulin sensitivity and lower fasting insulin. Lowering insulin can also reduce fat storage and support metabolic health.
Weight Management
Weight gain is often a major concern during perimenopause and menopause. Keto may support fat loss, especially visceral fat, because ketosis encourages the body to tap into stored fat for energy.
In women, particularly, keto’s appetite-suppressing effects (via reductions in ghrelin, the “hunger hormone”) might make weight control easier.
Appetite Regulation and Cravings
Keto has been shown to blunt hunger and help stabilise appetite. For women in menopause, who may be struggling with persistent cravings or fluctuating appetite, this could be especially helpful.
Reduced Inflammation
Some proponents suggest that ketosis has anti-inflammatory effects. While the direct link between reduced inflammation via keto and symptom relief (like hot flashes or brain fog) in menopause isn’t yet fully proven, lower systemic inflammation could theoretically support a more comfortable transition.
What the Research Doesn’t Strongly Support — Or Is Still Inconclusive
Hormone Balancing (Estrogen & Progesterone)
Despite enthusiasm, there’s no robust, high-quality evidence that keto directly rebalances reproductive hormones (such as estrogen or progesterone) in perimenopausal or menopausal women. Verywell Health notes that while keto might influence hormones related to appetite and insulin, there’s no strong proof yet for recalibrating sex hormones.
Keto Flu and Adaptation
When transitioning into ketosis, some people experience the “keto flu” — fatigue, nausea, light-headedness, sleep disruption. For perimenopausal or menopausal women, this adjustment phase could feel especially challenging.
Evidence from Related Conditions — What We Do Know
Because there’s limited direct research on keto in menopause, many of the findings come from studies on related conditions — especially PCOS (Polycystic Ovary Syndrome), which is also characterised by insulin resistance and hormonal imbalance.
-
A meta-analysis found that ketogenic diets in women with PCOS improved insulin sensitivity (HOMA-IR), decreased fasting glucose, and altered reproductive hormones like LH, FSH, and testosterone.
-
A randomised controlled trial comparing a ketogenic diet to a calorie-restricted moderate-carb diet in women with PCOS reported better weight loss, improvements in insulin measures, and positively shifted LH, FSH, and androgen levels with keto.
-
Another pilot study showed that women with PCOS on keto lost fat mass, saw reductions in insulin and androgens, and improved their LH/FSH ratio.
While PCOS is not the same as menopause, these results suggest that keto can positively influence metabolic and reproductive-hormone-related parameters in women — which raises interesting possibilities for menopausal applications.
Practical Considerations for Women in Perimenopause / Menopause
-
Talk to Your Healthcare Provider
-
It’s essential to consult your GP, endocrinologist, or naturopath — especially if you have cardiovascular risk factors, cholesterol issues, or hormone-sensitive conditions.
-
-
Monitor Key Health Metrics
-
If you try keto, consider monitoring fasting insulin, lipids (especially LDL), bone health, and micronutrient levels.
-
-
Combine Keto with Strength Training
-
Exercise — especially resistance training — can help preserve muscle mass, which is crucial during menopause when muscle loss accelerates.
-
-
Consider a Modified or Flexible Keto
-
Strict keto may not be suitable for everyone. Some experts recommend a more flexible version to maintain sustainability and nutritional adequacy.
-
-
Ease Into It
-
Transition slowly to reduce the severity of keto adaptation symptoms (“keto flu”).
-
Pay attention to hydration and electrolyte balance (sodium, potassium, magnesium).
-
-
Track Your Symptoms
-
Keep a journal of weight, hot flashes, mood, energy levels, and sleep. This can help you and your care team evaluate whether keto is helping.
-
There is promising evidence that a ketogenic diet can offer metabolic benefits during perimenopause and menopause — particularly around insulin sensitivity, appetite regulation, and weight management.
Ultimately, keto may be a useful tool in your midlife health toolbox — but it works best as part of a tailored, balanced strategy that includes medical oversight, nutritional planning, and physical activity.
If you’re considering keto, talk to a health professional and design a plan that fits your health goals, lifestyle, and long-term sustainability.
Sign up to my monthly Keto Naturopath newsletter by clicking the image below.
