Survive and thrive through the perimenopause

Mood swings, night sweats, no sex drive, weight gain, heavy or erratic period bleeds, forgetfulness, feeling unmotivated and like anything you do requires buckets of effort and energy that you just don’t have anymore.

This can’t be the menopause, aren’t you too young for that? Actually, it’s probably not and, instead, it sounds like you may be in perimenopause. So, what’s the difference?

Perimenopause normally starts between the ages of 35 and 45. It is your body’s two-year preparation time where it makes huge, tumultuous and unpredictable hormonal shifts before everything hopefully will settle down to a new balance in the menopause. Menopause occurs when menstruation finally finishes and is defined as the 12 months after your last cycle.

Three women laughing

Now don’t too quickly heave a sigh of relief because perimenopause is actually where most of the real challenge lies. In fact, research suggests that women are three times more likely to suffer anxiety, depression and insomnia during the five years prior to the menopause.

Not only are the symptoms challenging, but it can be a hugely vulnerable time in a woman’s life, as she has more responsibility than ever before - looking after children, balancing a career and supporting ageing parents. This challenge, however, can be used to your advantage. Now is the time to make a whole life assessment and carve out positive changes that matter most to your overall well-being.

If you treat perimenopause with the care and attention it deserves by looking after your health, this can greatly improve the quality of those years of change and, moreover, of the rest of your life to come.

Hormonal imbalance

So, what are these huge hormonal shifts taking place and creating havoc in your body? Well, in perimenopause, a woman’s ovaries (the main site of sex hormone production) are essentially going into a gradual retirement.

Throughout perimenopause, there can be a huge change in your hormone production as the cycles become more unreliable and anovulatory (no ovulation). This of course, in turn, completely affects a woman’s ability to function. You could feel like you have permanent PMS, which is why you especially need extra support for this time.

The oestrogen roller coaster

Most often, and particularly at the beginning of perimenopause, rather than being on a slow, gradual decline, oestrogen behaves like it’s on a roller coaster ride; skyrocketing to high levels, only to crash down again. No wonder you can feel rough.

In fact, the average oestrogen levels in perimenopausal women are higher than in younger women. This is because your follicle-stimulating hormone (FSH) hormone is stimulating the ovaries to make more and more oestradiol (a form of oestrogen). Plus, if you already have any form of inflammation in the body, this may upset the normal detoxifying process and cause your body to reaccumulate more and more oestrogen.

Progesterone declines

To add even more fuel to the fire, progesterone (which helps keep oestrogen in balance) is at an all-time low. This is commonly described as ‘progesterone deficiency.’ The symptoms of low progesterone are heavier, longer periods that become closer together due to too much oestrogen stimulating your uterine lining to thicken and grow. Normally, progesterone would counteract this build up in the uterus by thinning the lining.

Swollen breasts and putting on weight are also common symptoms. In addition, you could suffer from insomnia, rage and irritability mood changes (feeling like you have permanent PMS), due to your heavy ratio of oestrogen to progesterone.

Progesterone is known as the ‘soothing hormone’ as it calms your nervous system and helps produce the relaxing neurotransmitter GABA. Without adequate sleep, your body is missing key recovery time. There is no doubt that this can all add up to be detrimental to your personal life if there is no health intervention put in place.

Oestrogen gradually decreases

When the body is experiencing a slow, gradual decline of oestrogen (most likely occurring nearer to actual menopause), your period becomes lighter and more spaced out as the cycles are reduced. This can be a relief short term. However, if your oestrogen levels are permanently too low, it can be a cause for concern as oestrogen protects against degenerative conditions such as osteoporosis and heart disease in later life.

A deficiency shows up as vaginal dryness (a red flag symptom), loss of bladder tone, increased urinary tract infections (UTIs), breast shrinkage, hot flushes and night sweats. The infamous flushes can vary in length between 30 seconds and 30 minutes.

Unstable blood sugar can also trigger hot flushes due to the surge in adrenaline it causes. This is why is it so important to make sure you have healthy levels of insulin (a hormone that helps your body use glucose for energy). Eating well throughout the day is crucial as your volatile blood sugar levels can cause further inflammation and this will only add to your hormonal imbalances.

Adrenal health

Another stress hormone is cortisol. Like adrenalin, it is made by the adrenal glands. When unbalanced, it often exists at either a constant high level or tends to be low in the morning and then soar up high at night, wreaking havoc with your sleep and consequently your energy levels. This is known as ‘adrenal fatigue’.

During the perimenopause - when our ovaries are no longer producing progesterone and oestrogen - our adrenal glands are working extra hard as we prepare to go into the menopause. At this time, our adrenal glands take over the responsibility to supply you with the progesterone and oestrogen you desperately require to keep hormonal balance.

Moreover, if your adrenals do not supply adequate oestrogen, your body is much more likely to gain weight around the middle as fat cells can form to produce a form of oestrogen. It is, therefore, vital that you support these glands by reducing your stress levels, reducing inflammation and supplying your body with ample nutrients.

Woman eating an apple

Foods for hormone balance

Throughout the perimenopause, it is of vital importance to your long-term physical health, emotional health and stress resilience to supply your body with the correct nutrition it requires to function optimally. Here is a list of ‘hormone heaven foods’ that can help restore your hormones to harmonious equilibrium.

Healthy fats

Getting good sources of fat in your diet is vital for hormonal balance. This makes sense as fats make up the cell membrane structure for every cell in our body. We need a healthy cell membrane for the rest of the cell to function. Omega 3 fats are particularly great because they improve fluidity within the cell membrane, reducing inflammation in the body.

Here are some good sources:

  • Monounsaturated fats - avocadoes, olive oil, coconut oil, nuts and seeds
  • Omega 3 rich fats - sardines, mackerel, salmon, herring, hemp seeds and chia seeds
  • Good quality animal saturated fats - organic ghee and butter

Fabulous phytoestrogens

Phytoestrogen foods are great for improving low oestrogen symptoms such as night sweats. They naturally and gently increase oestrogen levels and protect against estrogenic environmental toxins by binding to your hormone receptors. Furthermore, they help prevent osteoporosis from developing (a risk factor for low oestrogen).

Here are some good sources:

  • Vegetables - celery, garlic, carrots and broccoli
  • Herbs - sage, fennel and cinnamon
  • Legumes - lentils, chickpeas and soy
  • Grains - oats, rice and rye
  • Fruit - apples, plums and cherries

Powerful proteins

Eating a healthy ratio of protein to fats and slow burning carbohydrates with each meal helps balance sugar levels and, consequently, prevents an increase in perimenopausal symptoms such as increased irritability. Proteins are full of amino acids that help build and repair our muscles, bones, neurotransmitter and hormones.

Here are some good sources:

  • Animal - chicken, beef, lamb, (make sure organic and grass-fed), fish and eggs
  • Plants - lentils, beans, tempeh, nuts and seeds


Fibre is not a food in itself but it is a component of many foods. It helps with maintaining regular bowel movements which is important for your body to excrete oestrogen, particularly xenoestrogens (synthetic compounds that mimic oestrogen) and other substances that you do not want recirculating in your body. On average you want about 25-35 grams a day.

Good sources are:

  • cruciferous vegetables e.g. cabbage, broccoli and kale
  • raw carrot and beetroot
  • apples
  • chia seeds and flax seeds

Dark leafy greens

Dark leafy greens are super for women during the perimenopause as they stimulate liver function and are mineral rich in calcium, magnesium, potassium and vitamins A, C, E and K. Magnesium is particularly important as it helps with energy, muscle relaxation, balancing blood sugar, soothing anxiety and is helpful for restoring healthy sleep patterns.

Here are some good sources:

  • kale
  • spinach
  • swiss chard
  • rocket
  • watercress
  • beet greens

Balancing lifestyle changes

Just as our nutritional choices are important, there are other healthy lifestyle behaviours that may help improve your hormonal health and allow you to feel and perform your best.

  • Reduce alcohol, caffeine, sugar and other inflammatory foods.
  • Try to reduce your stress levels by setting healthy boundaries and arranging relaxation time in your week.
  • Exercise smarter not harder – think strength training and regular movement rather than excessive cardio.
  • Determine a consistent sleep hygiene routine.
  • Make a life assessment and prioritise what is actually important to you and how you can bring more of this into your future.

For more help and advice, visit the women’s nutrition section. Here you can find specific nutrition information for a range of topics, including pregnancy and preconception, PMS, polycystic ovary syndrome and the menopause.

The views expressed in this article are those of the author. All articles published on Nutritionist Resource are reviewed by our editorial team.

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Bristol, Avon, BS16 2JP
Written by Rosie Letts, BSc Hons, MBANT, CNHC| Online Nutritionist
Bristol, Avon, BS16 2JP

I’m Rosie Letts, Bristol-based Nutritional Therapist. With a BSc in Nutritional Therapy and the experience that comes from working with over 500 1-1 clients to date, my methods are proven and effective.

I’ve taken my signature Reinvent programme online so I can help more people realise the remarkable power of holistic nutritional therapy.

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