How to Boost Immunity in Perimenopause

If you’re like us and many of our clients, you may be noticing subtle shifts in your energy and resilience—small things that make you wonder what’s happening with your body. Perimenopause is a unique transitional phase that can begin as early as your mid-thirties and usually becomes more noticeable in your forties, bringing shifts in hormones, metabolism, and even immune function. Many women notice subtle differences—they might feel more fatigued, take longer to recover, or just not bounce back as quickly from minor illnesses. Some also notice frustrating weight changes — especially increased belly fat — even when they’re eating and exercising the same way. Learning how to boost immunity in perimenopause can help you feel stronger, more energized, and better equipped to handle these changes. While this doesn’t necessarily mean you’re getting sick more often, it does signal that your body may benefit from strategic support to stay resilient and healthy.

The good news is that you can strengthen your immune system during perimenopause with nutrition, lifestyle adjustments, and targeted habits. We’ve worked with countless clients who felt sluggish, inflamed, or run-down, and after implementing a few simple strategies, they noticed more energy, fewer mid-day slumps, and overall better wellness. We’re sharing our approach.

1. Support Your Gut to Boost Immunity in Perimenopause

Your gut is central to your immune system—about 70–80% of immunity lives there! During perimenopause, hormonal changes can shift your microbiome, increasing inflammation and impacting immune function. In fact, recent research shows that hormonal fluctuations of perimenopause can alter the gut microbiome and increase inflammation, which in turn affects immune health.

Fiber is especially important because it feeds the beneficial bacteria that support immunity and it also helps stabilize blood sugar. Blood sugar control becomes more challenging during perimenopause as insulin sensitivity naturally decreases. So focusing on fiber-rich foods is a smart strategy—and that’s whether or not you’re in perimenopause. By helping keep blood sugar steady, fiber naturally reduces cravings and supports easier weight management—something many women find becomes more challenging during this stage.

Fiber First: Aim for 25–35 grams daily to feed beneficial bacteria, reduce inflammation, and support digestion. The average American gets 12 grams a day. Not us, not our clients, and not you! Our favorite sources include:

• • Lentils and chickpeas (we often suggest our clients make a big batch of lentil salad for the week and count one-half cup of those lentils as the healthy carb in their meal)

• • Leafy greens and cruciferous vegetables (like broccoli, Brussel sprouts, cauliflower, etc.)

• • Oats for breakfast or snacks

Prebiotics + Probiotics: Prebiotics feed the good bacteria, while probiotics introduce helpful strains to support immunity and hormone balance. We often recommend:

• • Prebiotics: garlic, asparagus, bananas, dandelion greens, and oats

• • Probiotics: Greek yogurt, kefir, sauerkraut, kimchi

Even just incorporating one prebiotic and one probiotic food daily can make a noticeable difference in gut health.

2. Prioritize Protein at Every Meal

Protein is critical for stabilizing blood sugar and supporting hormone production, both key ways to boost immunity in perimenopause. It’s also essential for maintaining muscle mass, which naturally declines, which are key ways to boost immunity in perimenopause. It’s also key for maintaining muscle mass, which naturally declines during perimenopause. It also keeps you fuller for longer and supports a healthy metabolism — two things that become especially important if you’re noticing weight loss feels harder during perimenopause. And from what we see with our clients, most women aren’t getting nearly enough. We recommend 20–30 grams per meal as a good target for most of our perimenopause clients.

Some of the ways we (and our clients) meet these goals are with:

• • Eggs and egg-based dishes

• • Greek yogurt or cottage cheese (nonfat or low-fat)

• • Poultry, fish, or plant-based proteins like organic tofu and tempeh

Even small tweaks—like adding a boiled egg or a scoop of lentils to a salad—can help keep energy steady and support immune function.

3. Power Up With Immune-Supporting Nutrients

Getting the right micronutrients consistently is another powerful way to boost immunity in perimenopause, especially as hormone changes alter how your body absorbs and uses key nutrients. During perimenopause, fluctuating estrogen and progesterone can affect nutrient metabolism, which can also influence weight regulation, appetite, and cravings—making it even more important to support immune function, hormone balance, and overall energy. Nutrients like vitamin C, D, zinc, and magnesium are especially important.

Research shows that menopause is associated with alterations in immune function, which often begin during perimenopause, making it even more essential to ensure your body is getting what it needs. Vitamin D, in particular, is critical for keeping your immune system working well and supporting overall health, so checking your levels and including vitamin D-rich foods can really help your defenses.

• • Vitamin C: Supports immune cell function. Sources: citrus fruits, berries, peppers, kiwi

• • Vitamin D: Helps regulate immunity and hormone balance. Sources: fatty fish (Try our Beginner Sardine Recipe), eggs, fortified foods; check levels with a blood test

• • Zinc: Important for immune cell development. Sources: pumpkin seeds, beans, seafood

• • Magnesium: Regulates stress, sleep, and inflammation. Sources: nuts, seeds, leafy greens, whole grains

One of our favorite simple ways to get fiber, zinc, and magnesium is to add a handful of pumpkin seeds to a salad or yogurt—easy, nutrient-dense, and immune-supportive.

4. Manage Stress Effectively

Perimenopause can amplify stress responses, raising cortisol levels and potentially suppressing immunity. Small daily habits make a big difference:

• • 10 minutes of meditation or deep breathing (we like 4-4-7 breathing, we wrote about it here)

• • Gentle movement like walking, yoga, or Pilates

• • Strength training 2–3 times weekly

• • Regular meal timing to stabilize blood sugar and cortisol

While deep breathing took a little practice for us, once we realized that just doing it for a few minutes truly took our body out of the stress response and into the “rest and digest” mode, life started to feel a lot easier! And many of our clients tell us that when they do a 10-minute evening meditation it’s their favorite reset, improving sleep and energy.

5. Prioritize Sleep

Hormonal fluctuations, particularly in estrogen and progesterone, can disrupt your sleep patterns—making it harder to fall asleep, stay asleep, or achieve restorative deep sleep. Poor sleep can compromise immune function, hormone regulation, cognitive performance, and mood, which is why it’s such a critical pillar of health during perimenopause.

We recommend:

• • Limiting screens an hour before bed

• • Keeping the bedroom cool, dark, and quiet

• • Creating a consistent wind-down routine

• • Including protein and fiber in your dinner to help stabilize overnight blood sugar

Improving sleep quality is one of the simplest ways to boost immunity in perimenopause because your immune system repairs itself during deep sleep. Even small improvements in sleep quality can have an enormous effect on energy and immune resilience. We, personally notice this in a big way!

6. Stay Hydrated

Even mild dehydration can stress your immune system, and staying well-hydrated is especially important in perimenopause because hormonal shifts can affect fluid balance and kidney function. Proper hydration supports optimal circulation, nutrient transport, and toxin removal, all of which are key for immune health.

Aim for 6–10 cups (or about half your body weight in ounces) of water daily, more if active. Adding electrolytes, like a pinch of sea salt or a hydration supplement, can help when exercising or in warmer climates. Our clients who track hydration often notice fewer fatigue dips and more consistent energy.

Bottom Line

Perimenopause doesn’t have to leave you feeling run-down. While these strategies—gut support, protein, key nutrients, stress management, sleep, and hydration—can make a meaningful difference, sometimes understanding your unique body and hormone patterns is the key. That’s where our guidance can help. Through 1:1 nutrition coaching, we provide personalized support based on your body, hormones, and lifestyle, with practical strategies to help you make choices that support your immunity, energy, overall well-being, and ideal weight—especially if weight loss has started to feel harder or more confusing than it used to—so you can feel more confident and resilient during this transition.

When you know how to boost immunity in perimenopause in a way that supports your unique body, everything—from energy to resilience—improves.

If you don’t want to wait to feel your best and want clarity on what could work for your unique body and hormones, fill out this form so we can get a good understanding of what’s going on for you and set up a call to see how we can best help you with our 1:1 coaching.

About the Experts

Tammy Lakatos Shames, RDN, CDN, CFT and Lyssie Lakatos, RDN, CDN, CFT are The Nutrition Twins, registered dietitian nutritionists and certified fitness trainers and nationally recognized nutrition experts with over 15 years of experience. They are the authors of Fire Up Your Metabolism, The Secret to Skinny and The Nutrition Twins’ Veggie Cure and have been featured in major media outlets including Good Morning America Health, Fox & Friends and CNN. The Nutrition Twins specialize in evidence-based nutrition advice for weight loss, disease prevention, and optimal health.