When we hear the word menopause, we often think of hot flushes and periods eventually stopping.
But what many women aren’t told is that the transition into menopause can begin years before the final menstrual period, and it can affect far more than our menstrual cycle.
Perimenopause is the period when the ovaries gradually become less predictable in their production of oestrogen and progesterone.
It doesn’t necessarily mean that our hormone levels are just getting lower. It’s more accurate to say that our hormones can fluctuate dramatically, sometimes from very high levels to very low levels. This hormonal unpredictability is one reason symptoms can come and go and can change from month to month. This transition can feel for some women like their body has suddenly become unfamiliar.
Perimenopause usually begins in the 40s, but some women can start showing symptoms in their mid to late 30s.
This varies among women, but what we do know is that it can span over several years.
Menopause is one day in our lives.
When we haven’t had a menstrual period for 12 consecutive months, with no other explanation for them stopping, that is menopause. After that we become post-menopausal.
Many people expect the obvious symptoms:
- Hot flushes
- Night sweats
- Irregular periods
What we’re not often told is that there can be many other, seemingly unrelated symptoms which include:
- Sleep problems or waking during the night
- Mood changes, irritability or increased emotional sensitivity
- Anxiety or feeling unusually overwhelmed
- Brain fog and difficulty concentrating
- Memory changes
- Fatigue and reduced energy
- Headaches or migraines
- Changes in libido and sexual function
- Vaginal dryness or discomfort
- Changes in urinary function
- Joint and muscle aches
- Changes in body composition
- Increased abdominal weight and body shape changes
- Changes in skin and hair
- Increased sensitivity to alcohol, caffeine or certain foods
Hot flushes are not necessarily one of the first symptoms we experience during perimenopause.
Some women notice changes in their mood, sleep, periods or cognition long before they experience traditional menopausal symptoms.
There is an outline, but the timeline is not a straight line.
One of the most frustrating things about perimenopause is that it isn’t predictable.
We can have a few months where we feel completely normal, and then the following month everything can be quite different.
What’s important to know is that you’re not imagining things.
Although we can’t stop the biological process of perimenopause and menopause, we can support the body as it transitions through each phase. We can do this through taking care of the following areas:
- Diet
- Exercise
- Sleep
- Stress management
All of these aspects play an important role throughout this process.
Diet
We need to prioritise protein. Protein becomes particularly important as we age because maintaining muscle mass supports strength, metabolism, bone health and healthy ageing.
Include good-quality protein such as eggs, fish, poultry, meat, dairy or suitable plant proteins at each meal.
We should also eat for metabolic and hormonal health. Building meals around whole, minimally processed foods can be helpful. Eating a variety of vegetables, healthy fats, fibre-rich carbohydrates, and nuts and seeds is key. It’s also important to get adequate hydration.
Rather than focusing on extreme diets, think about consistency, nourishment and blood-sugar stability.
Exercise
Don’t neglect strength training. This is one of the most valuable things a woman can do during midlife. Resistance exercise helps maintain muscle and bone strength; it supports metabolic health and can improve physical resilience.
Sleep and Stress Management
Sleep can become much more difficult during perimenopause, particularly when night sweats and hormonal fluctuations are involved. It’s more important than ever to create a calming evening routine, keep the bedroom cool, limit caffeine later in the day and try to maintain consistent sleep and wake times.
Stress management is important because chronic stress can make many hormonal symptoms feel worse. Breathing exercises, meditation, time in nature, yoga, mindfulness and regular movement can all be useful tools for regulating our nervous systems.
Our tolerance to certain things like alcohol or caffeine may also change during perimenopause.
Some women find that they can’t drink the same amount of alcohol or caffeine they used to before, but these, along with spicy foods can also trigger hot flushes or interfere with our sleep.
There are many natural products and herbal combinations marketed for menopause, but each person is different so what works for one, might not work for someone else.
It is always beneficial to discuss the options with a qualified healthcare professional rather than taking products simply because they are marketed as natural menopause support.
Listen to my interview with Anton Brink from Radio Cape Pulpit on 3 September 2026 to learn more. Listen to my next interview on Thursday at 7.45am.