If you’ve been struggling with weight gain during menopause – particularly around your middle – you’ve probable come across the keto diet as a potential solution. It’s heavily promoted on social media, it promises fast results and some women swear by it. So is keto a good idea during menopause or post-menopause?
As a registered dietitian who specialises in menopause nutrition, I get asked this question a lot. My honest answer is: for most women going through menopause, keto is not the approach I’d recommend – and in this post I’ll explain why, what the evidence actually shows and what I suggest to my clients instead.
What Is The Keto Diet?
A keto or ketogenic diet is a very low carbohydrate, high fat, moderate protein diet. Fat typically makes up around 80% of total daily energy intake, with carbohydrates reduced to the point where the body enters a state called ketosis – where fat, rather than glucose from carbohydrates, become the primary fuel source. This effectively mimics the metabolic state of fasting.
There are several variations of the ketogenic diet[1]:
- Classical ketogenic diet
- Fat provides around 90% of total energy intake
- Carbohydrates are very strictly limited
- Modified ketogenic diet
- High fat with limited carbohydrate but unrestricted protein
- Medium chain triglyceride diet
- Higher intake of protein and carbohydrates
- Diet contains naturally occurring fat, as well as a medium chain triglyceride fat supplement
All versions significantly restrict carbohydrate intake, including many fruits, vegetables, whole grains and legumes.
Are There Any Benefits of a Keto Diet?
There is some evidence that keto can support short-term weight loss, reduce visceral fat (the fat stored around the abdomen), and help with appetite control. Some research also suggests that a high-fat diet may improve certain cholesterol markers – lowering LDL and raising HDL – and reduce triglyceride levels [2].
The strongest evidence for keto is actually in the management of epilepsy, where it has been used clinically for decades and is known to reduce seizure frequency in some patients [3]. Beyond that, the evidence for broader health benefits is considerable more limited that the online enthusiasm for keto might suggest.
What Are the Risks of Following a Keto Diet?
This is where I want to be straightforward with you, because the risks are often undersold in the spaces where keto is promoted.
In the short term, many people experience what’s commonly called ‘keto flu’ – a cluster of symptoms, that can include nausea, fatigue, headaches, insomnia and constipation as the body adapts to using fat as its primary fuel. For a women who is already dealing with menopause fatigue and disrupted sleep, adding keto flu into the picture is worth thinking carefully about.
Longer-term risks that have been reported include:
- Kidney stones
- Hepatic steatosis (fatty liver disease)
- Low protein levels in the blood
- Vitamin and mineral deficiencies – because cutting out whole grains, most fruits and many vegetables significantly reduces your intake of fibre, B vitamins and other key micronutrients
It’s also worth being clear that long-term compliance with the ketogenic diet is low. Most people find it difficult to sustain and the weight lost is often regained when carbohydrates are reintroduced[4, 5]. This is the pattern I see repeatedly in clinical practice – short-term results followed by rebound, which can be demoralising and further damages a woman’s trust in her own body.
In my experience, the women who come to me after trying keto aren’t just dealing with the weight coming back – they’re dealing with a renewed sense of failure and frustration. That’s one of the reasons I feel strongly that menopause is not the time for restrictive, all-or-nothing approaches. Your body is already under significant hormonal pressure. What it needs is nourishment and stability, not another diet to white-knuckle your way through.
Why Keto and Menopause Can Be a Particularly Poor Match
Even setting aside the general risks, there are specific reasons why keto isn’t well suited to the menopause transition.
Carbohydrates play a key role in energy and hormone balance
Starchy carbohydrates, such as potatoes, rice, lentils, and bread, are your body’s preferred source of slow releasing energy. During menopause, when your metabolism is already less efficient and fatigue is common, removing the energy source can worsen the very symptoms you’re trying to manage. Stable energy throughout the day is one of the cornerstones of managing menopause well – and that stability depends significantly on how and when you eat carbohydrates, not on removing them entirely.
Fibre is essential – and keto is very low in it
Fibre – found in whole grains, legumes, fruits and vegetables – is critical for digestive health, blood sugar regulation and keeping you feeling full and satisfied after eating. It also support the gut microbiome, which has a more significant role in hormone regulation than many people realise. A keto diet’s severe restriction of these foods means fibre intake typically drips significantly, which can worsen bloating, constipation and digestive discomfort – symptoms that are already common during menopause.
The nutrient gaps matter more in menopause
When you cut out whole grains, most fruit, and many vegetables, you’re also cutting our B vitamins, magnesium, potassium, and other micronutrients that play a direct role in energy, mood and bone health. During menopause, when your nutritional needs are already shifting and bone density becomes a priority, creating these gaps is a real concern.
What Does Actually Work for Menopause Weight Management?
Rather than removing an entire food group, the approach I use with my clients focuses on working with your changing hormones rather than against them. That meams:
- Eating regular, balanced meals that combine quality protein, healthy fats and slow-releasing carbohydrates to keep blood sugar stable and energy consistent throughout the day
- Prioritising protein at every meal to support muscle mass, which naturally declines during menopause and directly affects metabolism
- Including phytoestrogen-rich foods such as flaxseeds, soy, chickpeas, and lentils, which can help support hormonal balance and reduce symptoms like hot flushes.
- Eating plenty of fibre from a variety of vegetables, fruits, legumes, and wholegrains to support gut health, blood sugar regulation, and satiety.
- Not restricting, but being intentional — understanding which foods genuinely support your body right now and building eating habits around those, without guilt or rigidity.
The NHS Eatwell Guide recommends that around a third of your plate comes from starchy carbohydrates, ideally high-fibre varieties — and this principle holds during menopause. The goal isn’t to eat less, it’s to eat smarter for where your body is right now.
So – Should You Try Keto During Menopause?
My honest clinical view is that for most women in perimenopause or post-menopause, keto is not the right approach. The evidence for long-term benefit is limited, the risks are real, and the restrictive nature of the diet makes it difficult to sustain — often leading to a cycle of short-term loss and rebound that is both physically and emotionally draining.
That said, every woman is different. If you’ve tried keto and found it genuinely works for you — you feel well, your energy is good, and you’re sustaining it without distress — that’s worth noting. But if you’re considering it because you’re desperate for something to shift the weight that’s crept on, I’d encourage you to explore a more sustainable, nourishing approach first.
You deserve support that works with your body, not another diet to fight against it.
Ready to find an approach that actually works for your body?
If you’re tired of trying things that don’t last — and ready for a personalised, evidence-based plan that supports your hormones, your energy, and your relationship with food — I’d love to talk.
My Nourish & Thrive programme is a 1:1 menopause nutrition programme built entirely around you: your symptoms, your lifestyle, and what your body actually needs right now. No restriction, no quick fixes — just sustainable, meaningful change.
