Perimenopause: How to manage the transition
Perimenopause: the menopause before menopause. It’s great that there’s growing awareness and media commentary on this important life stage but what exactly is it?
Perimenopause is the transitional stage before menopause when hormone levels begin to fluctuate and the body gradually moves toward the end of reproductive years. For many women this stage begins in their early 40s, though it can start earlier, and it may last anywhere from a few years to over a decade. Understanding what is happening biologically and psychologically during this time can help women make sense of symptoms and find effective ways to manage them.
What Is Perimenopause?
Perimenopause literally means “around menopause.” It refers to the period when the ovaries begin to change their hormone production, particularly estrogen and progesterone. Ovulation becomes less predictable, which leads to irregular menstrual cycles and a wide range of physical and emotional symptoms.
Menopause itself is defined as the point when a person has gone 12 consecutive months without a menstrual period. Perimenopause ends at that point.
Hormonal changes during perimenopause are often inconsistent rather than steadily declining. Estrogen levels can fluctuate significantly from month to month, which is why symptoms may appear suddenly, disappear, and then return.
Common Symptoms
The experience of perimenopause varies widely. Some women notice only mild changes, while others experience more significant symptoms.
Common physical symptoms include:
Irregular menstrual cycles (shorter, longer, heavier, or lighter)
Hot flushes, night sweats or changes in how you perceive temperature
Sleep disruption
Fatigue
Headaches or migraines
Joint or muscle aches
Changes in libido
Vaginal dryness
Weight changes or shifts in body composition
Psychological and cognitive symptoms are also common and often overlooked. These can include:
Increased anxiety
Low mood or depressive symptoms
Inexplicable rage
Irritability
An inability to tolerate things you used to tolerate
Brain fog or difficulties with concentration
Memory lapses
Reduced stress tolerance
These psychological changes are not simply “in someone’s head.” Fluctuating estrogen levels affect neurotransmitters such as serotonin, dopamine, and GABA, all of which play roles in mood regulation, cognition, and sleep.
Why Mental Health Symptoms Can Appear
For many women, the emotional symptoms of perimenopause can be the most disruptive. Hormonal fluctuations interact with other midlife stressors such as career pressures, caring responsibilities, relationship changes, and sleep disruption.
Women with a history of anxiety, depression, premenstrual mood symptoms, or postpartum mood difficulties may be particularly sensitive to hormonal shifts. However, even those without prior mental health concerns can notice changes during this transition.
Sleep disruption is often a key driver of emotional difficulties. Night sweats, frequent waking, and changes in sleep quality can significantly affect mood, resilience, and cognitive functioning.
Strategies That Can Help
Although hormonal changes are unavoidable, there are practical steps that can reduce the severity of symptoms and support overall wellbeing.
1. Prioritise sleep
Good sleep becomes especially important during perimenopause. Helpful strategies include:
Keeping a consistent sleep schedule
Limiting caffeine later in the day
Reducing screen exposure before bed
Maintaining a cool sleeping environment
Developing a calming pre-sleep routine
Refer here for a sleep article I’ve previously written
2. Regular physical activity
Exercise supports both physical and mental health during hormonal transition. Benefits include improved mood, better sleep, bone health, and reduced risk of metabolic changes. A combination of strength training, aerobic activity, and flexibility exercises is ideal.
3. Nutrition
Stable blood sugar and adequate nutrition can reduce fatigue and mood fluctuations. Helpful approaches include:
Eating regular balanced meals
Ensuring adequate protein intake
Increasing calcium and vitamin D for bone health
Limiting alcohol and highly processed foods
4. Stress management
Stress tolerance can decrease during perimenopause due to hormonal changes and sleep disruption. Practices that help regulate the nervous system may include:
Mindfulness or meditation
Breathing exercises
Yoga or gentle movement
Time outdoors
Setting clearer boundaries around work and responsibilities
5. Consider medical approaches
Hormone Replacement Therapy (HRT) isn’t for everyone, but it can make a massive difference for some women. If you think you’re experiencing perimenopausal symptoms then HRT approaches are an important part of the equation that should be discussed with your doctor. You might also have never experienced significant episodes of depression which could be frightening due to the intensity of the emotions. Both might warrant medical intervention.
Medical Misogyny
Women going through perimenopause sometimes encounter their symptoms being minimised or dismissed in healthcare settings, a pattern often linked to the long history of medical misogyny in medicine. For many years, women were underrepresented in medical research and hormonal health was poorly studied, which has contributed to gaps in understanding conditions like perimenopause. As a result, symptoms such as fatigue, anxiety, sleep disruption, brain fog, or mood changes may sometimes be attributed only to stress or ageing without deeper assessment. If you feel your concerns are not being taken seriously, it can be helpful to track symptoms, bring notes to appointments, ask clear questions about possible causes and treatment options, and seek a second opinion if needed. Advocating for your health is not unreasonable—persistent changes in your body or wellbeing deserve careful attention and support. I advise my clients often that if they feel like something is wrong, it usually is. If you feel like this is perimenopause, then say so, and say so loudly until someone listens. It can also be helpful to take a support person to medical appointments with you so that they can also advocate on your behalf and back up what you’re saying with their own observations (so it’s not just your own experiences that are taken into account).
When to Seek Support
While perimenopause is a normal life stage, some symptoms can become distressing or disruptive. Professional support may be helpful if someone experiences:
Persistent low mood or anxiety
Severe sleep problems
Significant cognitive difficulties
Relationship strain due to mood changes
Uncertainty about whether symptoms may have another medical cause
Healthcare professionals can help assess symptoms and discuss options such as lifestyle interventions, psychological support, medication, or hormone therapy where appropriate.
A Normal but Often Under-Discussed Transition
Perimenopause is a natural biological transition, yet many women feel unprepared for the changes it can bring. Greater awareness and open discussion can reduce confusion, stigma, and unnecessary distress.
Understanding that hormonal fluctuations can affect mood, sleep, cognition, and physical wellbeing helps normalise the experience and encourages women to seek the support they need. With the right information and strategies, this stage of life can be navigated with greater confidence and self-compassion.
