Perimenopause is a natural transitional phase marking the shift from reproductive years to menopause. It is not simply a hormonal rollercoaster before the hormonal flatline, but a neuro-endocrine recalibration of a woman’s biology.

As a woman in her late 40s, I am in that season of life. Perimenopause occasionally pops up in conversation with my female friends – some older and ahead of me on the journey, some younger. It is interesting to see the wild difference in attitudes among fellow women – from not wanting to talk about it, to ‘Nooo, you are too young to be going through perimenopause, you are not 50 yet!’ I smile.

While most women expect menopause at around age 50, perimenopause can begin as early as mid-30s to early 40s lasting anywhere from 2-10 years. It is a period where hormones fluctuate wildly before they decline and you reach menopause (see graph). Menopause is the day after you have had 12 consecutive months without a menstrual period. After that, you are in post-menopause.

Early perimenopause is primarily a progesterone deficiency stage (for information on the main hormones involved in an ovulatory monthly cycle refer to PART 1). Women are born with all their eggs and around the age of 40 the egg reserve is lower and the egg quality naturally declines. As a woman starts to experience anovulatory cycles, no corpus luteum means no progesterone. However, oestrogen is still being produced.

Progesterone’s roles include:

• Thinning of the uterine lining (which oestrogen has helped thicken in the follicular phase)
• It is also a calming hormone that helps reduce anxiety and promote sleep
• Anti-inflammatory and cardioprotective function
• Increases metabolic rate

Image from Lara Briden’s book Hormone Repair Manual

The fluctuations of oestrogen and progesterone during perimenopause are the reason for the wide variety of symptoms women experience. In the early stages, when oestrogen is often high compared to progesterone these include:

• Heavy, painful and clotty periods
• Short menstrual cycle (<25 days)
• Breast tenderness
• Weight gain around the thighs and hips
• Migraines around period
• Fibrocystic breasts, fibroids or endometriosis
• Irritability, mood shifts
• Anxiety
• Sleep disturbances

Symptoms of low oestrogen:

• Irregular or missed periods
• Vaginal dryness, recurring UTIs
• Thinning hair, brittle nails
• Diminished sex drive
• Body temperature fluctuations
• Fatigue, tiredness
• Brain fog, poor memory
• Decreased bone density
• Digestive issues
• Low motivation and emotions

Remember, oestrogen fluctuates during perimenopause so it is possible that you may experience symptoms of both high and low oestrogen before it finally flatlines and you reach menopause.

How to support your mindbody

Perimenopause is a whole-body transition, not just a period of oestrogen decline. Supporting the terrain means cultivating balance across your endocrine, detoxification, gut-immune, and nervous systems so the shift can occur gracefully, not chaotically. Here are some tips on how to do that:

1. Balance blood sugar and cortisol rhythm to stabilise mood, energy and weight.

• Include protein, healthy fats (avocado, extra virgin olive oil, walnuts, hemp, sardines, mackerel), and fibre in every meal. A protein rich breakfast – ideally within an hour of waking – is a must as amino acids that come from protein are needed for hormone synthesis. Aim for 1.5-1.6g of protein per kilogram of weight a day.
• Support circadian rhythm – daylight first thing in the morning for at least 10 minutes, reduce screen time before bed, aim to be asleep by 11pm at the latest

2. Support liver and detox pathways – a sluggish liver means hormones and toxin buildup
   • Cruciferous vegetables daily – broccoli, kale, Brussel sprouts, cabbage
   • Dandelion tea or beetroot juice are tonics for the liver
   • Avoid alcohol
   • Sweat: sauna, exercise, Epsom salt baths

3. Balance the gut microbiome – a healthy gut and balanced bacteria population support hormone detox, inflammation and mood.
   • Aim for a variety of vegetables and fruits in your diet to feed the different bacteria populations
   • Include fermented foods like sauerkraut, kimchi, miso
   • Ensure daily bowel movements for a timely elimination of toxins and metabolised hormones

4. Nourish Adrenals and Mitochondria – as ovarian hormone output declines, adrenals take over.
   • Build rest and movement into your day
   • Some of the adaptogens are wonderful for supporting the adrenals – ashwagandha, rhodiola, holy basil, reishi
   • Nourish with whole food nutrients – aim for a wide variety of fruits, vegetables, and protein sources.

5. Support neurotransmitter and brain health – oestrogen affects serotonin and dopamine influencing mood, sleep and memory.

• Omega 3s for mood and cognition – sardines, anchovies and wild salmon are good whole food sources.
• B vitamins (especially B6, B12 and folate) for neurotransmitter synthesis. And yes, I am on repeat – think whole foods first!
• Mindbody practices like journalling, gratitude, laughter, finding joy daily

6. Emotional and energetic terrain – perimenopause often invites a deep soul recalibration, shedding of old identities and patterns.
   • Include practices of embodiment – dancing, meditation, breathwork, nature walks
   • Seek connection with supportive women or community
   • Let go of ‘shoulds’ – embrace flow and intuition
   • Redefine personal boundaries – doing more of what is nourishing and less of what depletes you

Menopause

Once the ovaries stop releasing eggs and 12 months after your last period, you have officially reached menopause. On the day after and for the rest of your days, you are in post-menopause. The level of oestrogen (more specifically oestradiol) drops sharply and progesterone is already low due to the lack of ovulation. The pituitary gland increases FSH and LH levels in an attempt to stimulate the ovaries – these can be picked up on a blood test.

During post-menopause the primary source of oestrogen is called estrone. It is made when androgen hormones (androstenedione and testosterone) from the adrenal glands and ovaries are converted into oestrogen by an enzyme called aromatase. Aromatase is active in fat tissue, skin, muscle, brain and breast tissue. The brain, bone and vascular endothelium can synthesize some oestrogen for local use, but not systemic circulation.

During this life stage, your hormonal landscape depends even more on adrenal health, liver detox capacity and metabolic stability. The above 6 steps to support your body are vital as a healthy terrain is a landscape of balance and renewal, where body, mind and soul move in harmony as hormones ebb and flow. It is a time to deeply nourish yourself with whole foods, rest, and ritual, releasing what no longer serves you so the next chapter can unfold with wisdom, vitality, and grace.

If you would like to work with me on supporting your mindbody during perimenopause or menopause, get in touch at office@mindbody-one.com