A deep dive into perimenopause

Firstly, I want you to know that it is pleasure, and not pain, that is your birthright.

With this in mind, I want to dive right into understanding perimenopause and menopause with you so at the end you have the knowledge (and power) to know that it should not be dreaded but rather embraced.

It is a stage of life, which can even be used to your advantage, as it goes hand in hand with newfound creativity, energy, vitality, meaningfulness and positive change. 


It’s split into 3 major phases:

  1. Active reproduction/fertility
  2. Menopausal years (including perimenopause)
  3. Post menopause years

Menopause, the 2nd phase – is in itself divided into 3 phases:

  1. Perimenopause – the time period before menopause starts, prior to the “cessation of periods for 12 consecutive months”
  2. Menopause – the time period that starts 12 months after a woman’s last menstrual cycle/last period
  3. Post menopause

For some women, perimenopause can come on so gradually amongst other life changes that symptoms can go unnoticed, even for several years.


How it starts and signs to watch out for

The start of perimenopause varies from woman to woman, but the average age of menopause has not really changed over the past few centuries except, that nowadays some women start earlier with the onset of medical conditions. 

It usually starts around mid-40s and can last for several years, even up to 10 years, with the following signs that your reproductive hormones are shifting.

  • Irregular menstrual cycles, or cycles becoming more frequent as you age

  • Agitation or premenstrual syndrome (PMS)

  • Painful and/or swollen breasts 

  • Cyclical headaches (particularly menstrual or hormonal migraines)

  • Your blood seems to pool easily, or your skin bruises easily

  • Hemorrhoids or varicose veins

  • Heavy or painful periods (heavy: going through a super pad or tampon every two hours or less; painful: you can’t function without ibuprofen)

  • Bloating particularly in the ankles and belly, and/or fluid retention
  • Ovarian cysts, breast cysts, or endometrial cysts (polyps)

  • Easily disrupted sleep, perhaps with night sweats

  • Itchy or restless legs, especially at night

  • Increased clumsiness or poor coordination

  • More cravings for food, alcohol, anything to calm you down

  • Miscarriage, usually in the first trimester

  • Infertility 

  • Vaginal dryness and changes: The vagina technically shortens and loses elasticity (called vaginal atrophy). Vaginal thinness and dryness can come along with higher susceptibility to urinary tract infections caused by vaginal fluid loss/less lubrication to move bacteria out.

  • Increased abdominal fat and weight gain: Due to a slowed metabolism.

  • Thinning hair and dry skin: Many women notice their skin starting to show signs of aging, such as wrinkles, dark spots, dryness, less elasticity and sometimes more itchiness.


During perimenopause, your body’s production of oestrogen and progesterone changes – this can make life can feel difficult.

Progesterone and oestrogen (specifically, estradiol) production drops.

Testosterone drops too, leading to less muscle mass (dropping 2.5kg of muscle per decade) and rising fat mass, a dreaded combination that accelerates aging. 

Low oestrogen may cause mood and libido to tank and make the vagina less moist, joints less flexible, and mental state less focused and alive. 

Low testosterone may cause fatigue, disrupted sleep, decreased libido, and weight gain. 

Low progesterone can make you feel more stressed. It’s tough to relax. In short, you may feel hyperaroused, which is not a good thing.

“Hyperarousal results from the disruption of specific hormones, including progesterone, cortisol, and even insulin, leading to poor food choices, sleep debt, and mood problems,” says Dr Christiane Northrup, a world renowned authority in women’s health and wellness.

This then leads to an increase in cortisol, the main stress hormone which also governs digestion, cravings, sleep/wake patterns, blood pressure, and physical activity. When cortisol is too high for you, certain bad habits can set in: you overeat, you drink coffee, you can’t sleep, weight rises. Over time, cortisol keeps going up, blood sugar spikes, and then you desperately need a glass of wine to unwind at night—it’s a vicious cycle that begets higher cortisol, lower progesterone, higher insulin.

Your thyroid can also go a little wonky. Thyropause is the decline in thyroid function that commonly hits in early mid-life, which starts sometime in the forties. Symptoms include weight gain, fatigue, cranky mood, dry hair and skin, maybe hair loss.

In addition, our toxic environment and fast paced way of life all add an additional burden and assault to our delicate hormonal system. I keep discussing this as it is so critical but everything you put in your body is absorbed. Endocrine disruptors are synthetic chemicals that are now rampant in plastic materials, cosmetics, cleaning supplies, and other products we use on a day-to-day basis. Endocrine disruptors interfere with the production, transportation, and metabolism of most hormones. And since these environmental toxins are almost impossible to avoid completely (agrochemicals, hormones in food, pesticides, pollution our water etc…) they may be wreaking havoc on your body without your awareness. The problem is these chemicals, aptly called obesogens, have the potential to make us sick and fat and cause more havoc on your hormonal system including during perimenopause.

85% of Western women experience hot flashes, night sweats, and mood swings and what I often see today is that women are told this is just aging, and pointless to try and do anything about it. Here is an antidepressant, a sleeping pill, SSRI for high cortisol and perhaps some HRT, instead of getting to the root cause.

This is NOT true, your hormones are not doomed, we simply need to learn to create the environment to optimise our bodies, upgrade the software so to speak so that you can get your hormones, your sex drive, your willpower, your energy and focus and emotional states back in balance.

Our current model isn’t working. We fail to neglect the fact that our bodies are more intelligent than we can ever comprehend. Given the right environment the body heals, repairs, regenerates. I have seen this over and over again. 


There are natural solutions that work if you empower yourself with the information and tools to understand exactly what is going on and what you can do about it. 

It is possible to navigate these transitions gracefully and bring the chaotic hormonal cascade back into balance and assist the transition into menopause with ease. 


How to create an optimal environment for hormonal balance

Focus on the following

  • Get your hormones checked

  • Actively manage your stress

  • Invest time in finding ways to optimise your sleep

  • Focus on reducing cortisol

  • Insulin balance

  • Try resistance training (muscle mass is critical)

  • Nourish your body with whole foods only

  • Look for therapeutic supplements based on your chemistry


Fundamentals for navigating perimenopause


A whole food diet as close to nature as possible and that’s unprocessed or unrefined, can help boost your nutrient intake, regulate hormones, manage weight, and reduce empty calories.

Foods for optimal health during menopause include organic fruits and veggies, nuts and seeds, omega-3s, probiotics, lean proteins (e.g. fish or grass-fed meat), healthy fats (e.g. olive and coconut oil), and foods with natural phytoestrogens (e.g. flax and fermented soy).

Cruciferous vegetables (e.g. broccoli, cabbage, and kale) contain indole-3-carbinol, which helps balance estrogen levels.

Fibre aids cardiovascular and digestive health, plus supports weight maintenance, and may help balance estrogen. Regularly eating omega-3s helps produce hormones which reduce menopause symptoms, postmenopausal osteoporosis, heart issues, depression, and breast cancer. For perimenopausal women, increasing phytoestrogen intake may decrease hot flashes, taken with vitamin D may reduce bone loss and improve density, and it may aid heart health.

Lastly, drink 8 glasses of water daily to replace fluid lost from hot flashes and reduce bloating.


Regular exercise has many benefits, including improved body weight, sleep quality, bone density, muscle mass, and reduction of inflammation and depression symptoms.

Even if you may not be a regular exerciser, it’s never too late to begin reaping the rewards of regular exercise – aim for 3 or more days of some cardio and strength/resistance-training activities per week.


Sleep is vital for restoring energy, balancing hormones, keeping cortisol levels under control, and reducing anxiety or depression.

Make sure to get 8-9 hours of quality sleep each night, with the same bed and wake times to sync with your biological Circadian Rhythm for overall health maintenance.

If you have difficulty sleeping, try essential oils such as lavender, journaling, taking magnesium supplements, soaking in a magnesium chlorate bath (BetterYou Magnesium Flakes are my favourite), cooling your bedroom, and practicing yoga and meditation.

Stress relief

Because sleep problems, anxiety, fatigue and depression tend to climb, it’s important to manage stress as best you can. Ways to do this include natural stress relievers like exercising, spending time outdoors, meditation or prayer, seeking social support, joining a helpful cause or volunteering, reading something inspirational and uplifting, and doing something creative.

Intermittent fasting

Since ageing can also throw off blood sugar levels, one of the best ways to correct insulin is with intermittent fasting. There is no one size that fits all and women with thyroid or adrenal issues need to be careful. There are various protocols but you can try the 16/8 fasting session – 16 hours of overnight fast followed by an 8 hour eating window, or starting out on a 12 to 14 hour fasts twice per week. Very few women know about the benefits and how it can work.

I am also a fan of outsourcing for Acupuncture treatments for neuroendocrine repair as it is shown to reduce hot flashes and night sweats. Paced breathing as also it’s shown to cut hot flashes by 44%. Simply breathe deeply twenty minutes 2 x per day with a five-second inhale, a ten-second hold, and a five-second exhale. 

Supplements and herbal treatments

  • Chasteberry
    Chasteberry, also known as chaste tree, chaste tree berry, or vitex, is a herbal remedy that has been traditionally used to support women’s health, particularly in relation to menstrual and hormonal imbalances. Chasteberry is often recommended to raise progesterone levels in women who are still menstruating. It has been studied in several randomized trials and has shown promise in alleviating premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It may also help improve fertility, reduce cyclic breast pain, regulate menstrual cycles, and alleviate hot flashes and sleep disturbances. The mechanism of action for chasteberry involves increasing the release of luteinizing hormone (LH) from the pituitary gland. LH, in turn, stimulates the ovaries to produce more progesterone. It’s important to note that chasteberry is less likely to be effective in women who are not ovulating.
  • Saffron extract
    Studies show that taking saffron improves peri and menopausal symptoms such as anxiety, depression, fatigue, basically supporting better overall emotional well-being. It also helps balance hormones and can be effective for libido. In addition, a study found that combined with chasteberry was more effective than a placebo in reducing anxiety symptoms associated with perimenopause-related PMS.
  • Berberine
    Weight gain and difficulties in weight management are common concerns during perimenopause. While individual experiences may vary, hormonal shifts, particularly a decline in estrogen levels, can contribute to changes in metabolism and body composition. Blood sugar regulation and insulin levels play a crucial role in weight management. As women age, there is a tendency for blood sugar levels to rise, which can impact weight and overall health. Managing blood sugar levels through a balanced diet is important for maintaining a healthy weight. A diet rich in vegetables and clean proteins, along with complex carbohydrates and healthy fats, can help stabilize blood sugar levels and support weight management. Berberine is a natural compound found in certain plants and has been investigated for its potential health benefits. It has shown promising effects on various aspects of health, including cholesterol reduction, glucose regulation, and weight loss. Berberine has been found to activate an enzyme called AMPK, which is involved in energy metabolism and plays a role in regulating weight. By activating AMPK, berberine can help enhance insulin sensitivity, improve glucose uptake by cells, and potentially support weight loss efforts.
  • Omega 3
    Omega-3 fatty acids provide various health benefits, including for pre and post – menopausal. It supports Hypertriglyceridemia, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to lower triglyceride levels in the blood. High triglyceride levels are associated with an increased risk of heart disease, so reducing them can help improve cardiovascular health. It support menopausal joint and arthritic pain through its anti-inflammatory properties, which can help alleviate joint pain and stiffness associated with arthritis. This can be beneficial for both menopausal women and others experiencing joint pain. It supports menstrual pain. It supports mood and depression. It supports hot flashes and vaginal dryness. It also supports the increase in bone mineral density and help prevent osteoporosis.
  • Ashwagandha
    A handy supplement to assist with balancing female hormones and managing the release of cortisol to support anxiety and manage stress better, as well as for better sleep. Regarding hormone balancing, ashwagandha has been studied for its potential effects on female hormones, particularly in menopausal women. One study did find that ashwagandha use in women with menopause increased estrogen levels.
  • Magnesium
    Magnesium is an essential mineral that plays a crucial role in numerous metabolic actions in the body. It is involved in over 300 biochemical reactions and is vital for maintaining good health throughout life. During perimenopause and menopause it can support cardiovascular health, bone health, blood sugar levels, cortisol release, muscle weakness, cramps and restlessness. Melatonin levels also decrease with age so magnesium helps support good quality sleep and energy levels.
  • Glutathione
    A powerful antioxidant,  it is involved in the production of hormones such as estrogen, progesterone and testosterone. It is produced in the body but levels drop with age which can lead to premature ageing and in the case of perimenopause and menopause it impacts ovarian changes which are characterised by signs such as irregular periods, night sweats, hot flashes, improved sleep and vaginal dryness. 
  • Maca
    A powerful herb helps with issues around hormonal imbalance, such as menstrual irregularities, fertility, menopause symptoms, and impotence. It increases estradiol in menopausal women and helps with insomnia, depression, memory, concentration, energy, hot flashes, and vaginal dryness, as well as improved body composition and bone density.
  • Alpha lipoic acid (ALA)
    A powerful antioxidant that occurs naturally in mitochondria, the energy organelles of your cells, can also reset your blood sugar. ALA prevents cell damage and repairs damaged cells, and critical for anti-aging, anti-inflammatory, and as a antioxidant. ALA may protect bones as you age and keep your cells insulin sensitive for balancing blood sugar.
  • Vitamin D3
    Bones may weaken with the changes in estrogen and so vitamin D works to slows the weakening process. Research shows it also helps stabilise mood including depression, supports fuzzy brain, poor memory and better concentration.
  • Vitamin K
    Vitamin K helps support healthy bones which during peri and menopausal times women experience a weakening of bones and are at risk of developing osteoporosis.
  • Other herbal supplements to explore are black cohosh, red clover, raspberry leaf and St. John’s wort. 

As always, speak with an integrative practitioner or functional medicine clinician before adding any supplements to your routine. Check that the supplement won’t interfere with any medications you’re currently taking.

In closing – hold onto the idea that your body wants to feel safe, focus on trying to achieve this instead of the pursuit of perfection in your life. I would like to share Donna Ashworth’s words with you – the first time I read it was like a gift – I hope it will be the same for you and provide you inspiration and intention that you need as you journey through life:

To the woman who thinks she isn’t good enough

by Donna Ashworth

“To the woman who looks around and wonders why everyone else is so much more capable, so much stronger, so much more ambitious than her.

To the woman who thinks everyone else is blazing a fiery path through this thing we call life, while she limps behind, barely getting through the days.

Somewhere, another woman is looking at you thinking exactly the same.

You see, we all look like we’re kinda nailing it, from the outside in.

We all look ‘together’ sometimes.
Catch us on the right day and hey, we look like we have it all.
Because guess what, we learned to look that way a long time ago.
We learned to hide our struggles behind a smile and whack on that mask every day.

And actually, we are doing each other a favour when we show up,
just as we are,
warts and all,

What we really need to see is that we are all the same.
We all struggle.
We all fall apart.

Some days we nail it, other days we get nailed.

By hiding our own weaknesses, fears, worries, we give them more power.
If you let it out, shine a light on it all, it becomes so much less scary, funny even…
And goodness only knows we need to laugh.

So, to the woman who wonders if she is good enough…

If this is you.
Yes you are.
You always were.

You don’t have to live up to everyone’s expectation of how you should be coping.
You are human, flawed, wonderful, miraculous, loveable, loved.

I see you,

Now do me a favour and go see all the others too.
Spread the word, we are good enough, just as we are.”



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