The menopause transition or perimenopause means “around menopause”.  These are the years leading up to menopause, and it’s the bookend to puberty – the other stage in our life when hormones are fluctuating.  Puberty is all about ovulation winding up, and perimenopause is all about ovulation winding down.  As you can see from the diagram below, the fluctuations in oestrogen are much more extreme in the perimenopause.

Perimenopause comes after an average of 35 years of monthly rhythm and synchronisation of signals between the brain (producing FSH and LH) and the ovaries (producing oestrogen and progesterone).  It’s an intricate dance.  Let’s look at what happens in a normal cycle.

Perimenopause life curve

FSH stimulates the ovaries to produce a mature egg.  This maturing process produces oestrogen which promotes the growth of the uterine lining.

Oestrogen has an energising, mood boosting effect on the brain.  The first half of the cycle is a good time to be productive.

LH hormone initiates the luteal phase triggering the release of an egg.  Progesterone rises.  If the egg isn’t fertilised the uterine lining breaks down leading to menstruation.

Progesterone has a soothing effect.  The second half of the cycle is a good time to be creative.

As ovulation winds down, you will have cycles where you don’t ovulate.  Progesterone is made in the corpus luteum after ovulation, so no ovulation means no progesterone.  During perimenopause progesterone levels can drop quite rapidly, while oestrogen fluctuates dramatically.

What can you expect

Because progesterone is the “keep calm and carry on” hormone the very early symptoms may be changes in your mood or sleep, all too often brushed off as the consequence of leading a busy life.  Anxiety or feelings of overwhelm are very common.

You will start to notice some changes in your periods.  The drop in progesterone can lead to shorter cycles, and the higher levels of oestrogen can lead to heavy periods or flooding.  You may feel like your periods are all over the place with some periods being heavy and long while others are short and light.  Symptoms are usually intermittent to begin with, although there can be a sudden onset after stopping the pill (the oestrogen in the pill can mask symptoms).

Your periods are a good window into what is happening in the body.  Tracking your period is a great tool at any age and there are some brilliant apps that help with this.

Eventually, oestrogen starts to drop along with progesterone leading to a longer time between cycles and fewer periods.  Going longer between cycles can leave you feeling premenstrual and bloated with no period to relieve that feeling.  When oestrogen drops, you may feel very tired in the afternoon, or have a general overwhelming feeling of tiredness.  The oestrogen dominance symptoms like heavy periods start to go away and symptoms associated with low oestrogen start to increase.

As well as having oestrogen receptors in the ovaries, breast and brain we also have them in a wide range of tissues like the kidneys, bone, heart, lungs, intestinal mucosa and the cells that line the blood vessels and lymphatic vessels.  No wonder the symptoms are so diverse! They include hot flushes, night sweats, heart palpitations, vaginal dryness, low libido and weight gain as well as anxiety, depression and aches and pains.  It can be hard to connect the dots, so using a menopause symptom checker is a helpful tool especially if you want to reach out to your doctor or healthcare professional for support.  It is worth doing regularly to assess how symptoms change with time. 

Hormones not only affect the reproductive system but the brain, especially serotonin (the happy neurotransmitter) and GABA (the anti-stress neurotransmitter).  Oestrogen is key for energy production in the brain.  Most symptoms of the perimenopause like body temperature, sleep issues, emotions and memory actually stem from the brain!  If you have ever felt like you are going mad, rest assured that you are not.  But the body is adjusting to a new normal so midlife is a critical window of opportunity to take care of yourself.


What can you do to support your brain?

  • During this transition, the brain loses some flexibility so this is not the time to get an A* in multi-tasking. Thinking of two things at once overworks the brain.
  • Support your sleep at all costs. This might mean some lifestyle changes like stopping caffeine at lunchtime, limiting alcohol and looking at your bedtime routine.
  • Walking is good on so many levels. It’s gentle exercise, in the fresh air and daylight, and even better if you can walk in nature or through a park.  Build it into your daily routine aiming for a total of 30 minutes/day.
  • Get support, this might be from family, friends or someone specialising in menopause.

What can you do to support fluctuating oestrogen levels?

You can see from the diagram at the beginning that oestrogen levels can go very high during perimenopause.  You may also be taking HRT at this stage to help level out the fluctuations. So when you are done with that oestrogen, where does it go?

The body has to break it down so that it can be eliminated.  There are certain nutrients that help to support healthy detoxification:


  • Cruciferous vegetables (bok choy, broccoli & broccoli sprouts, Brussels sprouts, cabbage, cauliflower, collards, kale, kohlrabi, radish, rocket, swede, watercress). Try to include at least one of these vegetables every day.
  • Ellagic acid found in berries, pomegranate seeds and walnuts
  • B vitamins found in nutritional yeast, green leafy vegetables, mushrooms, nuts, seeds, beans, lentils, spirulina, organ meats and fish.
Berries good for perimenopause
Cruciferous veg good for perimenopause

Need inspiration? check out these recipes on the blog here

I just wanted to mention age because it isn’t always the best indicator.  The range is 45-55 with the average being 51.  But premature menopause is more common than you may think – 1 in 100 women experience it before the age of 40, and 1 in 1000 before the age of 30.  Premature menopause means the ovaries aren’t working properly and they stop producing eggs before they normally would.  This is known as Primary Ovarian Insufficiency.  Between the ages of 40-45, it’s called an early menopause.  If you just don’t feel yourself anymore but can’t fathom out why, there’s a good chance that hormones are involved – especially if symptoms have crept up slowly and seem totally unconnected.

A surgical menopause can cause a sudden onset of symptoms.

In all cases (early, premature or surgical), follow the tips for menopause.  It’s particularly important to look after your bone and heart health.  Looking after your bone health is important as soon as you realise you are in the transition because you lose 2% every year for the first 5 years post menopause.