Water Retention During Perimenopause: Causes and How to Reduce It
Feeling puffy or swollen during perimenopause? Learn why hormonal changes cause water retention and discover practical strategies to reduce bloating and fluid buildup.
Why Perimenopause Causes Water Retention
Water retention, also called oedema or fluid retention, is the accumulation of excess fluid in the body's tissues. During perimenopause, fluctuating estrogen levels are a primary driver. Estrogen influences aldosterone, a hormone that regulates sodium and water balance in the kidneys. When estrogen surges before its overall decline, the body tends to retain more sodium, pulling water into tissues alongside it. Progesterone normally counteracts this effect by acting as a natural diuretic, but when progesterone levels drop first (as commonly happens in early perimenopause), estrogen's water-retaining effect goes unchecked. The result is puffiness, particularly in the hands, ankles, feet, and face.
How Water Retention Feels
Beyond visible puffiness, water retention can contribute to a sensation of heaviness or tightness, clothing that feels tighter than usual without weight gain, and a feeling of fullness or pressure in the abdomen. The scale may go up by one to three kilograms during a high-retention day without any actual fat gain, which can be distressing if you are trying to manage your weight. Some women notice their rings fitting more snugly, or their ankles swelling after sitting or standing for long periods. Bloating that is worse in the evening or premenstrually often has a fluid component.
Dietary Changes That Help
Sodium is one of the most controllable factors in water retention. Reducing processed foods, takeaways, packaged snacks, and condiments lowers your sodium intake significantly, as these account for the majority of dietary sodium rather than table salt added at home. Increasing potassium-rich foods such as bananas, potatoes, spinach, avocado, and yogurt helps the kidneys excrete excess sodium. Magnesium has also been shown to reduce fluid retention, particularly in the premenstrual phase. Paradoxically, staying well hydrated by drinking enough water actually helps the body release retained fluid, whereas dehydration can worsen it.
Movement and Lifestyle Strategies
Regular physical activity, particularly cardiovascular exercise and anything involving the leg muscles, supports the circulation that moves fluid back from the extremities toward the heart and kidneys for processing. Even short walks throughout the day help if you have a desk job. Elevating your legs for 20 to 30 minutes in the evening can reduce ankle and lower leg swelling. Compression socks are useful for women who travel or stand for extended periods. Reducing alcohol intake is also helpful, as alcohol is dehydrating, which paradoxically causes the body to compensate by retaining more fluid.
Supplements and Herbal Options
Magnesium glycinate or citrate taken at 300 to 400mg daily has reasonable evidence for reducing hormonally-driven fluid retention, particularly around the second half of the cycle. Dandelion leaf (Taraxacum officinale) has mild natural diuretic properties and is available as a tea or supplement. B6 at doses around 50mg has been studied for premenstrual water retention with positive results. Always check interactions with any existing medications before adding supplements. Herbal diuretics including green tea, hibiscus, and parsley are gentle options that can be incorporated as part of a varied diet.
When to Seek Medical Advice
Most fluid retention during perimenopause is hormonal and benign, but some causes require medical assessment. Seek advice promptly if swelling is sudden, severe, or confined to one limb (which could suggest a blood clot), if swelling is accompanied by shortness of breath (which could indicate heart or kidney problems), or if pressing on the swollen area leaves an indentation that persists (pitting oedema). Your GP can investigate kidney function, thyroid health, and cardiac function to rule out these causes. Unexplained persistent swelling always deserves investigation.
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