What is Perimenopause really like? The signs, the struggles, and the support you didn’t know you needed.
Ever feel like your body and mind are shifting, but you’re not sure why?
It wasn’t until I started studying Nutritional Therapy that I began to understand the symptoms I was experiencing—depression, low energy, mood swings—had a root cause. For the longest time, I thought something was wrong with me. I assumed I was too young to be entering menopause, and I had never even heard of “perimenopause.” Learning about it was a revelation—it gave my symptoms a name and, more importantly, a reason. I wasn’t going crazy.
Perimenopause, menopause, and postmenopause are natural and powerful transitions in a woman’s life. Yet, they are often misunderstood, dismissed, or viewed negatively. Let’s change that narrative—starting with understanding what perimenopause really is.
What Is Perimenopause?
Perimenopause is the transitional phase leading to menopause. It literally means “around menopause,” and it marks the time when hormonal levels—particularly oestrogen and progesterone—begin to fluctuate (Cleveland Clinic, 2024).
It typically begins in a woman’s 40s but can start as early as the mid-30s. This phase can last anywhere from 2 to 10 years (Cleveland Clinic, 2024).
Perimenopause ends when a woman has gone 12 consecutive months without a menstrual period—this is when menopause is said to have occurred (Australia, 2019).
Common Symptoms of Perimenopause
1. Emotional & Mental Changes
Increased anxiety, irritability, low mood, or a sense of emotional fragility (Australia, 2019) .
Difficulty concentrating or experiencing “brain fog” (Australia, 2019).
Mood swings or feeling unlike yourself (Australia, 2019).
2. Physical Symptoms
Irregular periods (lighter/heavier, closer/further apart) (medical news today, 2017).
Hot flashes or night sweats (medical news today, 2017).
Breast tenderness, fatigue, weight gain (especially around the middle) (medical news today, 2017).
Changes in libido or vaginal dryness (medical news today, 2017).
3. Sleep Issues
Difficulty falling asleep or waking in the middle of the night.
Feeling unrefreshed even after a full night’s sleep.
Why It Feels So Confusing
I remember going to my GP to find answers—especially about my low energy and mood swings. She ran blood tests to check my thyroid, iron, and B vitamins, and everything came back “normal.” When I asked if it could be perimenopause, she said, “You’re too young.”
That moment stuck with me. I realised she might have confused perimenopause with menopause, which is a common misunderstanding.
Unlike menopause, which can be confirmed with blood tests and clinical history, perimenopause is diagnosed mainly based on symptoms—which are often dismissed or misattributed to stress, parenting, career demands, or aging. This lack of awareness leads many women to feel isolated or ashamed. This is where Nutritional Therapy can play a crucial role.
What’s Happening With Your Hormones?
1. Oestrogen Roller Coaster
Oestrogen levels rise and fall unpredictably. At times they’re too high, other times too low. These fluctuations are what cause many of the symptoms (NHS, 2022).
2. Progesterone Drops
As ovulation becomes less frequent, progesterone production declines. Since progesterone helps balance oestrogen, its absence can amplify symptoms (Harvard Health Publishing, 2018).
3. Hormonal Imbalance
High oestrogen + low progesterone → heavy periods, mood swings, breast tenderness (Rupa Health, 2024).
Low oestrogen → hot flashes, brain fog, night sweats (Rupa Health, 2024).
4. Cycle Chaos
Periods become irregular—shorter, longer, heavier, lighter—due to disrupted hormone signaling (Rupa Health, 2024).
5. Final Drop
As menopause approaches, oestrogen levels decline more permanently, ovulation stops, and periods cease.
Your hormones are a team. During perimenopause, the “players”—oestrogen and progesterone—stop coordinating smoothly. This imbalance creates the symptoms many women experience. After menopause, the body finds a new hormonal baseline (Rupa Health, 2024).
How You Can Support Yourself Naturally
Through Nutrition
Prioritise protein at each meal: eggs, legumes, fish, and poultry support muscle and metabolism (Erdélyi et al., 2024).
Focus on whole foods: vegetables (especially cruciferous like broccoli), fruit, lean proteins, healthy fats (Erdélyi et al., 2024).
Include phytoestrogens: flaxseeds, lentils, and chickpeas help modulate oestrogen levels (Schaeffer, 2016).
Boost omega-3s: salmon, walnuts, chia seeds support mood and reduce inflammation (Schaeffer, 2016).
Stay hydrated: helps reduce bloating, fatigue, and hot flashes.
Key Nutrients
Calcium & Vitamin D: from dairy, leafy greens, and sunlight to support bone health (Erdélyi et al., 2024).
B Vitamins: whole grains, seeds, and nuts to aid mood and energy (Erdélyi et al., 2024).
Magnesium: from pumpkin seeds and dark chocolate to support sleep and reduce anxiety (Erdélyi et al., 2024).
Lifestyle Strategies
Strength training: to preserve muscle mass and protect bone density (Ranjan et al., 2019).
Stress management: yoga, meditation, and breathing exercises reduce cortisol spikes.
Support sleep: wind-down routines, limiting screen time, and creating a cool, calm sleep environment.
How Nutritional Therapy Can Help?
A Nutritional Therapist works with you to explore the root causes of your symptoms. Instead of a one-size-fits-all approach, we look at your hormonal patterns, nutrient levels, gut health, stress response, and sleep quality.
Here’s how nutritional therapy can support you during perimenopause:
Develop a personalised food and lifestyle plan tailored to your symptoms and goals.
Support hormone balance with targeted nutrients and gentle dietary changes.
Recommend functional testing (if needed) to explore hormone levels, nutrient deficiencies, or gut health.
Help manage or reduce the risk of chronic conditions that become more common during this stage—like osteoporosis, insulin resistance, cardiovascular disease, and mental health concerns.
Most importantly, you are not alone. With the right support, you can move through perimenopause feeling more informed, empowered, and nourished—both physically and emotionally.
References
Australia, H. (2019). Perimenopause. [online] Available at: https://www.healthdirect.gov.au/perimenopause.
Cleveland Clinic (2024). Perimenopause: Age, stages, signs, symptoms & treatment. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/21608-perimenopause.
Erdélyi, et.al. (2024). The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients, [online] 16(1), p.27. https://doi.org/10.3390/nu16010027
Harvard Health Publishing (2018). Perimenopause: Rocky Road to Menopause. [online] Harvard Health. Available at: https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause.
Medicalnewstoday. (2017). Premenopause vs. perimenopause: Symptoms and stages. [online] Available at: https://www.medicalnewstoday.com/articles/318660#perimenopause-and-beyond.
NHS (2022). Symptoms - Menopause. [online] NHS. Available at: https://www.nhs.uk/conditions/menopause/symptoms/.
Ranjan, P., et al. (2019). Weight management module for perimenopausal women: A practical guide for gynecologists. Journal of Mid-life Health, 10(4), p.165. https://doi.org/10.4103/jmh.jmh_155_19.
Rupa Health. (2024). Available at: https://www.rupahealth.com/post/how-does-progesterone-therapy-affect-perimenopause.
