What exactly is perimenopause?
Perimenopause, literally "around menopause", is the phase in which your body transitions from the fertile years to menopause. During this period, your ovaries begin to gradually produce less oestrogen and progesterone. That may sound like a simple process, but in reality it is a hormonal roller coaster: your hormone levels fluctuate unpredictably, sometimes from day to day.
It is important to know that perimenopause is not a disease. It is a completely natural life phase that every woman goes through. But that does not make the symptoms any less real or any less troublesome. Many women are caught off guard by symptoms they did not expect, especially if they are in their early 40s and had not at all thought about "the change".
Menopause itself is officially the point at which you have had no period for twelve consecutive months. The average age for that is 51. Everything that precedes it (and that can be years) is perimenopause.
When does perimenopause begin?
Most women notice the first signs of perimenopause between the ages of 40 and 45. But it can also start earlier: some women experience symptoms around the age of 38. In rarer cases, with premature ovarian insufficiency, it can even begin before the age of 35.
Factors that influence when your perimenopause begins:
- Genetics: the age at which your mother went through menopause is often a good indication.
- Smoking: smokers reach menopause on average 1 to 2 years earlier.
- BMI: both a very low and a very high weight can influence the timing.
- Surgical procedures: an operation on the ovaries or uterus can bring perimenopause forward.
- Chronic stress: prolonged stress can disrupt the hormone balance earlier.
Do you recognise certain complaints but are unsure whether it is perimenopause? A blood test at your GP can help, although the hormonal fluctuations during this phase are so variable that a single test does not always provide a definitive answer. Your pattern of symptoms often says more than a lab value.
The most common symptoms
Perimenopause presents a wide range of symptoms. Some women experience only a few, others suffer from a whole series. Below are the most common complaints.
Hot flushes and night sweats
The best-known symptom of menopause: a sudden wave of heat spreading from your chest to your face and neck. Hot flushes usually last 1 to 5 minutes and can be accompanied by a red face, palpitations and heavy sweating. About 75% of women experience them to a greater or lesser degree.
Night sweats are essentially a hot flush that wakes you from your sleep. You wake up in a soaking wet bed, needing to turn your pillow over or even change your clothes. This directly affects your sleep quality and therefore how you feel the next day.
Sleep problems
Even without night sweats, sleep problems can arise during perimenopause. Progesterone, the hormone that among other things has a calming effect, often falls first. As a result you may have difficulty falling asleep, wake more frequently in the middle of the night, or lie wide awake at 4 in the morning. That tiredness accumulates and affects everything: your concentration, your patience, your eating habits and your motivation to exercise.
Mood swings and irritability
You may recognise this: one moment you feel fine, the next you are irritated by something that would not normally bother you. Or you feel low without an obvious reason. Oestrogen influences the production of serotonin, your "happiness hormone", and when oestrogen levels fluctuate, your mood follows.
This is not "making a fuss" and it is not "all in your head". It is biochemistry. And it is important that you know that, because many women feel guilty about their mood swings or think they just have to deal with them.
Weight gain, especially around the belly
You are not eating differently, you are not exercising less, and yet you see your weight creep up, especially around your middle. This is one of the most frustrating symptoms of perimenopause. The explanation: falling oestrogen changes the way your body stores fat. Instead of on hips and buttocks, fat is now stored more viscerally, around your abdominal organs.
Moreover, your muscle mass decreases as you get older, a process that accelerates during perimenopause. Less muscle mass means a lower metabolism, causing your body to burn fewer calories at rest. Crash diets are counterproductive here: they lower your metabolism even further and generate more stress hormones.
Brain fog: difficulty concentrating and forgetfulness
You are in the supermarket and cannot remember what you came for. You have forgotten a name you have heard a hundred times. You struggle to concentrate on a task you would normally do effortlessly. This "brain fog" is a frequently heard complaint and is caused by the influence of oestrogen on your brain function.
Oestrogen plays a role in blood flow to the brain, the formation of neurotransmitters and the energy metabolism of brain cells. When levels fluctuate, that can temporarily affect your memory and concentration. It is almost always reversible: after menopause these functions stabilise again.
Other symptoms
In addition to the five major complaints, many women also experience:
- Irregular or heavier periods
- Joint pain and muscle stiffness
- Dry skin, dry eyes or vaginal dryness
- Reduced libido
- Heart palpitations
- More frequent urinary tract infections
- Tingling in hands and feet
Why do you get these symptoms?
All perimenopause symptoms can be traced back to one central process: the fluctuating and ultimately declining production of oestrogen and progesterone. But why does that cause so many different symptoms?
The answer lies in the fact that oestrogen influences virtually every system in your body. Oestrogen receptors are found in your brain, your bones, your heart, your digestive system, your skin and your muscles. When oestrogen levels change, all those systems notice it.
Progesterone also plays a crucial role. This hormone has a calming effect on your nervous system, helps with sleep and keeps oestrogen in balance. During perimenopause, progesterone often falls faster than oestrogen, which can temporarily create a relative oestrogen surplus, also known as "oestrogen dominance". This can lead to bloating, tender breasts and heavier periods.
In addition, fluctuating sex hormones also influence your other hormonal systems. Your thyroid function, your cortisol levels (stress hormone) and your insulin sensitivity: they are all interconnected. That is precisely why an integrated approach — looking at the whole picture — is so much more effective than treating individual symptoms.
Nutrition that supports your hormones
What you eat has a direct influence on how you feel during perimenopause. That is not a vague claim, but is based on a growing body of scientific research. A number of concrete nutritional strategies that demonstrably help:
Eat sufficient protein
Protein is essential for maintaining muscle mass, and therefore for your metabolism. Aim for at least 1.2 grams of protein per kilogram of body weight per day, spread across your meals. Think of fish, chicken, eggs, legumes, cottage cheese, tofu and nuts.
Choose phytoestrogens
Phytoestrogens are plant-based compounds that have a mild oestrogenic effect. They can help to dampen hormonal fluctuations. Good sources are soy (tempeh, edamame, tofu), flaxseed, chickpeas and sesame seeds. Research shows that women in Asian countries, where a lot of soy is consumed, experience fewer hot flushes.
Stabilise your blood sugar levels
Fluctuations in your blood sugar amplify hormonal symptoms. Avoid refined sugars and white carbohydrates as much as possible. Choose wholesome carbohydrates (wholegrain, sweet potato, oats) and always combine them with proteins, fats or fibre to slow absorption.
Don't forget the fats
Healthy fats are the building blocks of your hormones. Omega-3 fatty acids from fatty fish, walnuts and flaxseed also have an anti-inflammatory effect and support your brain function. Eat fatty fish (salmon, mackerel, sardines) at least twice a week and use extra virgin olive oil as your daily fat.
Pay attention to your micronutrients
During perimenopause, the need for certain vitamins and minerals is greater:
- Vitamin D: essential for bones, immune system and mood. Have your levels checked.
- Magnesium: supports sleep, relaxation and muscles. Many women are deficient.
- Calcium: important for bone density, which decreases as oestrogen falls.
- B vitamins: support your energy metabolism and nervous system.
Exercise and lifestyle as medicine
In addition to nutrition, exercise and lifestyle adjustments are powerful tools for managing perimenopause symptoms. Here are the most important pillars.
Strength training: not optional but essential
If there is one form of exercise you should do during perimenopause, it is strength training. It helps maintain muscle mass and bone density, boosts your metabolism, improves your insulin sensitivity and has a positive effect on your mood. You don't need to become a bodybuilder: training two to three times per week with weights or your own body weight already makes a big difference.
Move daily, but don't overdo it
Daily movement in the form of walking, cycling or swimming supports your hormone balance, lowers cortisol and improves your sleep. But watch out: training too intensively can actually be counterproductive. Excessive cardio raises your cortisol levels, which worsens the hormonal imbalance. Listen to your body and choose a mix of strength training, gentle cardio and mobility work.
Sleep hygiene as a priority
Sleep is not a luxury but a biological necessity, especially during perimenopause. A few practical tips:
- Go to bed at the same time every day and get up at the same time, even at weekends.
- Keep your bedroom cool (16–18 degrees), which also helps with night sweats.
- Avoid screens for at least an hour before sleeping, as blue light suppresses melatonin.
- Limit caffeine after 2 pm and alcohol in the evenings.
- Consider magnesium before bed (in consultation with your GP or dietitian).
Stress management
Chronic stress is a hormone disruptor of the first order. Cortisol, your stress hormone, competes with progesterone and can influence oestrogen levels. Techniques that are proven to help with stress reduction:
- Breathing exercises: 5 minutes of deep abdominal breathing measurably lowers your cortisol levels.
- Walking in nature: research shows that 20 minutes outdoors significantly reduces your stress hormones.
- Conscious relaxation: yoga, meditation or a warm bath. Choose what suits you.
- Setting boundaries: learn to say no. Overload is one of the biggest sources of chronic stress.
When to see your GP?
Although perimenopause is a natural process, there are times when medical guidance is important. Contact your GP if:
- Your symptoms are so severe that they impair your daily functioning.
- You are experiencing low mood or anxiety that does not pass.
- You have spotting or very irregular, heavy periods.
- You are experiencing symptoms before the age of 40, as this can indicate premature menopause.
- You are considering hormone therapy and want more information.
Hormone replacement therapy (HRT) can be a good option for some women, especially when lifestyle adjustments provide insufficient relief. Insights into HRT have become more nuanced in recent years: it is no longer an all-or-nothing story. Discuss the options and risks with a doctor who has experience with the menopause transition.
In addition, it is wise during perimenopause to have your blood pressure, cholesterol, blood sugar, thyroid function and vitamin D levels checked regularly. The hormonal changes can also influence your cardiovascular health and bone density.
Whatever you do: take your symptoms seriously. You deserve to feel well, even in this phase of your life. And know that you are not alone. More than half of women in the menopausal transition experience symptoms that affect their quality of life. Being open about that, seeking information and taking action is not weakness. It is self-care in the most concrete sense of the word.