Everything you need to know to ease your transition through perimenopause

The saying goes that time, it grows old, teaches all things. But as I approach my 45th year, I feel none the wiser about perimenopause and its inevitable onset. When I was asked if I would like to write this piece, I was initially reluctant. What would I know about this stage of life? I have a bouncing 14-month-old toddler, am still breastfeeding, and feel mostly as hale and hearty as I did in my thirties. For now at least, the prospect of going through the menopause seems remote.

Yet as the nutritionist Pippa Campbell explains, having a better understanding of how my body may change over the coming decade can only be beneficial. "Perimenopause can come on 10 to 15 years before the menopause, so it’s likely that your hormones are already changing," she says. "But for a lot of women, it doesn’t even cross their mind, particularly if, like you, they have had babies later in life, as they simply put all the changes down to being post-partum."

Admittedly, I hadn’t even given a thought to the possibility that the symptoms I have been occasionally experiencing—brain fog, hot flushes, anxiety—could be anything other than a result of the hormonal fluctuations triggered by breastfeeding. Though my situation is unique, the diagnostic challenges I am facing are common to many women of my age. "Recognising the signs of perimenopause can be a grey area, as individual hormonal patterns make everyone’s experiences so different," says Campbell.  

Perimenopause can also be a painfully prolonged process, as the oestrogen and progesterone hormones constantly rise and fall before their final descent into the menopause, when the cycle stops for good. Dr Wendy Denning, a GP at the Health Doctors, explains that prescribing hormone-replacement therapy (HRT) for perimenopausal women can involve complex medical decisions. "The menopause is relatively easy to manage, as hormone levels flatten, so I only need to see women once a year," she says. "During perimenopause, however, hormone levels fluctuate a lot; you might get hot flushes and night sweats one month and nothing the next, which is why I would need to see you every two months. It’s like hormonal coaching."

In the early stages of perimenopause, progesterone, usually present in the second half of the cycle, begins to fall. "This can lead to anxiety, worsening PMS, breast tenderness, palpitations, frequent migraines, night sweats, cloudy thinking and insomnia," says Dr Rebecca Poet, a clinician at the Women’s Hormone Clinic. "As perimenopause progresses, oestrogen can start to rise, up to three times higher than is typical, provoking symptoms including irritability, breast pain and heavy periods. Oestrogen levels can also fluctuate wildly, causing hot flushes, sweats, palpitations, mood swings and weight gain as we become sensitive to insulin. There may be a change in our periods too."

Given all this, it is hardly surprising to learn that, until the official medical term was coined by a physician in 1821, the menopause was known as ‘women’s hell’—but it doesn’t have to be this way. "Talking about perimenopause isn’t about fearmongering," says Campbell. "The point is that, if you catch those subtle changes early, you can manage the transition beautifully." 

The first step after experiencing symptoms is to see your GP to request hormonal testing. Be aware that the UK’s clinical guidelines stipulate that after women have reached the menopause (defined as going 12 months without a period), testing is no longer required, so seeking medical help in the interim stage is crucial for accessing treatment. The gold standard is to get blood tests on day 21 of your cycle to measure progesterone levels; more detailed still is the 28-day Dutch urine test, which tracks your hormonal patterns throughout the month, though this is not yet available on the NHS. 

It is perfectly possible to have regular periods or get pregnant while experiencing perimenopause, so this should not preclude eligibility for hormone checks even for someone like me. "Plus, women who have children later in life can go into the menopause quite quickly afterwards," Campbell warns. While I will need to wait until I have stopped breastfeeding to undergo testing, I can focus on managing my stress levels—something all practitioners will advise.

"Treatments including acupuncture and herbal medicine can be very helpful," notes Denning. The problem is that the adrenal gland responsible for cortisol, the fight or flight hormone that is released when we are under pressure, also produces progesterone, and during stressful times will always choose life over fertility. "It’s why people who have had generally non-stressful lives will have an easier time, as they approach the menopause with more reserves."

Massages and other therapeutic treatments can help, as can healthy eating. Campbell advises her clients to follow a diet rich in good protein, such as organic meat and fish, and dark cruciferous vegetables to flush used progesterone from the system. We would also do well to top up with green powders—look for iodine to support the thyroid, spirulina for bone health and turmeric for achy joints—while prebiotics and probiotics will strengthen the gut. To rebalance blood sugars, Campbell warns against intermittent fasting and alcohol, both of which put pressure on your system at a time when insulin resistance is already increased.

While these hormonal changes and their potential effects may seem intimidating, the experts I spoke to all agreed that perimenopause need not be a time for suffering in silence. Rather, their goal was to ignite a conversation that would prompt women who might otherwise be caught up in their careers and family to focus on their own wellbeing—an ethos that I fully intend to embrace.

Wellbeing notes

Expert tips to ease your transition through perimenopause 

For sleep 

"For those experiencing insomnia, massages can directly influence the body’s production of serotonin and melatonin, both of which are needed to promote a good night’s rest." 

—Sarah Dewey, massage therapist

For skin 

"If you suffer from dry skin, be sure to add hydrating, lipid-rich skincare to your routine. Avoid hot showers, and eat an anti-inflammatory diet, with plenty of olive oil and leafy green vegetables." 

—Dr Usman Qureshi, wellness doctor and founder of Luxe Skin

For the body 

"The main goal of exercising at this stage in your life is to counteract insulin sensitivity and reduce inflammation. Strength training can also prevent hot flushes and improve brain functioning."

—Dr Rebecca Poet, clinician, the Women’s Hormone Clinic

For the mind

"Keep a journal: write down what you are grateful for and what you want tomorrow to hold. This stage of life should be about stepping up, not fading away."

—Rebekah Brown, founder of MPowder 

For well-being 

"Do explore holistic medicine; both acupuncture and herbal treatments can be extremely helpful for relieving symptoms of perimenopause."

—Dr Wendy Denning, GP and functional doctor

This piece originally appeared in the print edition of Harper's Bazaar UK