Perimenopause: Midlife's secret chapter
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Perimenopause is a term many women don’t hear until they’re already living it. It’s the phase before menopause—often the most dynamic and confusing part of the hormonal journey—and it can begin earlier than expected. While it may feel mysterious or overwhelming at first, understanding perimenopause can be empowering. It’s not a problem to fix, but a transition to navigate. With the right knowledge and support, it can become a time of clarity, growth, and reconnection.
What Is Perimenopause?
Perimenopause means "around menopause" and refers to the years leading up to menopause when hormone levels begin to fluctuate. This stage typically begins in a woman’s early to mid-40s but can start earlier or later. It ends when you’ve gone 12 consecutive months without a period, which marks the official start of menopause.
What’s Happening Hormonally?
Perimenopause is driven by changes in the ovaries, which begin to ovulate less regularly. This leads to a gradual decline in the hormone progesterone, often before oestrogen begins to fall.
Progesterone is released after ovulation, so when ovulation becomes irregular, progesterone levels decrease.
Oestrogen, meanwhile, doesn’t decline smoothly—it fluctuates, sometimes spiking and then dropping sharply.
These hormonal shifts can lead to an imbalance which is responsible for many of the symptoms women experience during perimenopause.
Common Symptoms of Perimenopause
Every woman’s experience of perimenopause is different, but common symptoms include:
- Irregular periods (heavier, lighter, missed, or more frequent)
- Mood changes, including anxiety, irritability, or low mood
- Hot flushes and night sweats
- Sleep disturbances or insomnia
- Lower libido
- Difficulty concentrating or memory lapses ("brain fog")
- Worsened PMS
- Weight gain, particularly around the abdomen
- Vaginal dryness or discomfort during sex
- Some women experience mild symptoms, while others find the transition significantly impacts their quality of life
Evidence-Based Ways to Support Yourself
See Your GP
Your general practitioner is your first point of contact. If you’re noticing changes in your menstrual cycle, mood, sleep, or overall health that feel out of the ordinary, it’s worth discussing them. Your GP can:
- Rule out other potential causes such as thyroid issues or iron deficiency
- Provide information about treatment options
- Help you track and understand your symptoms
It’s worth noting that blood tests are not always reliable for diagnosing perimenopause, since hormone levels fluctuate daily. Diagnosis is usually based on symptoms and age.
Prioritise Sleep and Stress Management
The drop in progesterone can affect sleep and increase sensitivity to stress. To support your nervous system:
- Create a consistent evening routine
- Limit caffeine and alcohol, especially in the evening
- Try mindfulness, meditation, or breathing techniques to support calm
Focus on Nutrition
This is a time for more intentional nutritional choices, thinking about:
- Whole foods including vegetables, legumes, whole grains, and healthy fats
- Adequate protein and fibre
- Calcium-rich foods to support bone health
Exercise Regularly
Movement helps improve mood, sleep and manage weight. Aim for a mix of:
- Resistance training to support bone density and muscle mass
- Cardiovascular activity for heart and mental health
- Gentle movement such as yoga or stretching to support flexibility and stress relief
Reframing the Transition
In many traditional cultures, the menopause transition is not viewed as a decline, but as a rite of passage—an entry into a new phase of wisdom, authority, and freedom. Perimenopause can be a time to pause, reflect, and begin prioritising your own wellbeing, possibly for the first time in decades.
In Summary
Perimenopause may be one of midlife’s least talked-about chapters, but it doesn’t have to be the most confusing. With knowledge, support, and the guidance of a trusted healthcare provider, this phase can become a powerful and meaningful part of your journey—not something to dread, but something to understand, honour, and embrace.