By Dr Juanri Jonck
Menopause marks the complete cessation of ovarian function when estrogen production stops and menstrual periods end permanently. However, the journey to menopause, known as perimenopause, is a significant and often challenging transitional phase that can last anywhere from 7 to 14 years.
During perimenopause, the ovaries’ declining follicle reserve disrupts communication between the pituitary gland and the ovaries, leading to erratic hormone fluctuations. Estrogen, progesterone, and testosterone levels rise and fall unpredictably, affecting nearly every system in the body. This isn’t just about fertility winding down, it’s a neuroendocrine recalibration that impacts sleep, cognition, metabolism, bone density, skin health, and cardiovascular function.
For many women, this phase is a critical turning point that shapes long-term health and well-being. Yet, far too many endure it in silence, unaware that effective treatments and support exist.
Early Signs of Perimenopause
The initial symptoms of perimenopause can be vague and easily dismissed. These may include:
- Fatigue
- Forgetfulness (“brain fog”)
- Heart palpitations
- Itchy scalp or ears
- Vaginal dryness
- Low libido
- Insomnia
- Joint pain
- Mood swings
A more definitive early sign is a change in menstrual cycle length—specifically, a shift of 7 days or more for two consecutive cycles. However, not all women experience this clear signal, making it essential for healthcare providers to consider perimenopause in women over 35 with these symptoms.
By the time hot flashes appear, the body is already experiencing endothelial instability (changes in blood vessel function). While this doesn’t mean it’s too late for treatment, it underscores the importance of early recognition and intervention.
Debunking Common Myths About Perimenopause
Many women believe they must simply endure perimenopause as an inevitable part of aging, but this couldn’t be further from the truth. Some persistent myths include:
- “You just have to wait it out.”
- “Doctors can only treat symptoms, not the root cause.”
- “It’s all in your head.”
In reality, hormone replacement therapy (HRT) can be transformative – just as thyroid medication treats hypothyroidism, HRT can restore balance for perimenopausal women. Unfortunately, many are prescribed a patchwork of medications (sleep aids, antidepressants, anti-anxiety drugs) instead of addressing the hormonal imbalance directly.
Building Mental Resilience During Perimenopause
The emotional turbulence of perimenopause: mood swings, anxiety, depression can feel isolating. But recognising that these shifts are hormonally driven is the first step toward resilience.
Reframing this transition as a rite of passage can be empowering. Women move from their reproductive years into a phase of wisdom, self-ownership, and renewed purpose. While HRT remains the most effective treatment, mindset shifts, therapy, and coaching can also help manage cognitive and emotional symptoms.
Lifestyle Strategies for Symptom Management
While HRT is foundational, lifestyle choices play a crucial supporting role. The Mediterranean diet rich in phytoestrogens, healthy fats, and fibre has the strongest long-term health benefits. Reducing sugar, caffeine, and alcohol can also minimise hot flashes and anxiety.
Exercise is equally vital. Resistance training helps maintain bone density and muscle mass, while adequate sleep (7.5–9 hours nightly) regulates cortisol and supports mental clarity. Prioritising rest over late-night screen time is key.
Natural Remedies vs. Medical Treatment
Supplements like Maca root, Ashwagandha, Evening primrose oil, and Magnesium are often touted for perimenopause relief. While they may offer mild benefits, none match the efficacy of HRT in addressing the full spectrum of symptoms and long-term health risks.
Combatting “Brain Fog”
Cognitive decline, forgetfulness and a lack of focus are common and frustrating symptoms. Beyond HRT, strategies to sharpen mental clarity include:
- Prioritising sleep (critical for toxin clearance in the brain)
- Learning new skills (reading, puzzles, new hobbies)
- Meditation (reduces stress and enhances focus)
Navigating Relationships During Perimenopause
Hormonal shifts can strain relationships due to low libido, irritability, and mood swings. Open communication with partners, family, and friends is essential. Sharing the experience and seeking support can ease the emotional burden.
5 Keys to Thriving Through Perimenopause
- A Knowledgeable Healthcare Provider
- Example: Susan saw multiple specialists for fatigue and joint pain before a functional medicine doctor diagnosed and treated her hormonal imbalance.
- Self-Education
- Example: Jane thought her brain fog was normal aging until she learned about perimenopause and advocated for proper treatment.
- Community Support
- Example: Nicky found solace in an online perimenopause group, reducing feelings of isolation.
- Prioritising Self-Care
- Example: Jessica embraced hobbies and boundaries, reclaiming her time and energy.
- Reinvention
- Example: Jenny’s hormonal shifts unleashed her assertiveness, transforming her self-image.
What Employers Should Know
Perimenopause isn’t an “excuse”, it’s a biological transition impacting focus, energy, and productivity. Supportive workplaces could offer:
- Flexible schedules for fatigue management
- Cooler workspaces to ease hot flashes
- Mental health resources
The Power of Community
Connecting with others whether through support groups, book clubs, or fitness classes reduces stigma and fosters resilience. Shared experiences provide validation and practical advice.
Proactive Steps for a Smoother Transition
Women in their 30s and 40s can prepare by:
- Tracking menstrual cycles for early changes
- Adopting a Mediterranean diet
- Strength training to preserve bone density
- Prioritising sleep over late-night screen time
- Following the 80/20 rule (80% nutrient-dense foods, 20% flexibility)
Final Thoughts
Perimenopause is more than “pre-menopause”, it’s a profound physiological shift that deserves attention, treatment, and support. By advocating for proper care, educating themselves, and building strong support networks, women can navigate this transition with strength and confidence.
The message is clear: You don’t have to suffer in silence. Help is available, and thriving through perimenopause is possible.
