Making Sense of Perimenopause: What’s Happening and What Helps

Grounded in science. Guided by curious possibility.

For many women, the years between 40 and 60 are challenging, with the changes that feel confusing and unsettling, often being harder than expected.

I often hear women say things like, “I don't know who I am anymore” and then quickly apologise — as if voicing their discomfort is somehow a failure.

Sleep becomes a challenge, that no one wants.

Mood feels less predictable.

Your "get up and go" feels like it "got up and left".

Weight shifts despite eating healthy foods and exercising.

Periods change — subtle change for some, dramatic change for others.

Anxiety may appear where it never existed before.

Concentration falters.

Confidence wobbles.

These experiences are real. And they matter.

Yet many women hesitate to talk about them openly, or struggle to find explanations that feel both accurate and reassuring.

Yes, the symptoms are real

Perimenopause is often described casually, as if it’s a brief transition that happens quietly in the background.

In reality, for many women it can be one of the most physiologically and emotionally demanding phases of their adult life.

Symptoms can include:

• disrupted sleep

• increased anxiety or low mood

• changes in appetite and weight

• reduced stress tolerance

• brain fog or memory lapses

• cycle changes

• fatigue that doesn’t resolve with rest

  
  

Experiencing these symptoms does not mean you are weak, failing, or imagining things. It means your body is adapting to a changing hormonal environment.

And that adaptation can feel like a wild ride.

Why there is so much confusion

One reason perimenopause feels so difficult to navigate is that the information landscape is deeply polarised.

On one side, hormone replacement therapy (HRT) is often presented as the primary — or only — solution.

On the other, women are offered an overwhelming array of supplements, protocols, and lifestyle rules that promise balance if you just do enough (or take this product).

In reality, uptake of HRT in women aged 40–60 remains relatively low (around 5 % of women). Many women are curious, but they are also cautious.

Others are unsure if it’s right for them, right now.

Some simply want to explore additional or alternative options.

That hesitation is not ignorance. It’s discernment.

In New Zealand, there’s also a very real constraint: GP visits often limit discussions to one symptom per consultation. Perimenopause rarely shows up that neatly — it’s usually a pattern, not a single complaint.

While HRT can be extremely valuable for certain women and certain circumstances, it is not the only way to support yourself through this transition.

Perimenopause is not a sudden event

One of the most important things to understand is that perimenopause doesn’t happen overnight- it doesn't just sneak up on you.

It exists on a continuum — a gradual shift that can unfold over many years. Hormone levels fluctuate long before periods stop completely. Communication between hormones becomes less predictable. The body works harder to maintain balance.

This is why symptoms can appear well before menopause itself, and why they can feel inconsistent or confusing.

Seeing perimenopause as part of a spectrum takes the pressure off trying to fix everything at once. It invites a steadier, more supportive approach instead.

It’s not just an ovarian issue

Another common misunderstanding, is that perimenopause is purely a result of an ageing ovaries.

In reality, it reflects a broader change across the endocrine system — the network of glands and hormones that communicate constantly to regulate energy, mood, metabolism, stress, sleep, and reproduction.

Over time, this communication becomes less efficient. Signals between the brain, thyroid, adrenals, ovaries, and other systems can weaken or misalign.

The result is not simply lower hormone levels, but less coordinated hormone signalling.

This matters, because perimenopause is not just about what hormones you have (or don't have) — it’s about how well those hormones are able to talk to each other.

When we care for the hypothalamic–pituitary–thyroid–adrenal–ovarian (HPTAO) axis — through nourishment, sleep, stress regulation, movement, and targeted nutritional support — we can often support the body’s capacity to continue producing its own hormones at biologically appropriate levels.

Not forever. Not perfectly. But meaningfully.

Where lifestyle and nutrition fit

For many women, lifestyle, diet, and specific plant-derived bioactives play an important supportive role during perimenopause.

This doesn’t mean extreme restriction or rigid protocols.

It means:

• eating in a way that supports stable energy and blood sugar

• prioritising adequate protein and essential fats

• reducing and managing stress

• supporting sleep and recovery

• using evidence-informed nutrients and plant compounds where appropriate

  
  

These approaches don’t replace medical care when it’s needed. They widen the options.

They give women a way to participate actively in their own care, rather than feeling like victims of their age.

An encouraging truth

Perimenopause can cause you to feel unstable — but this is not a signal that your body is failing. It is not a sign "of things to come".

It’s a phase of recalibration.

With the right support, many women find that symptoms ease, confidence returns, and their relationship with their body improves. Not because everything is controlled, but because it’s better supported.

This isn’t a promise, and it won’t look the same for everyone. But change is possible with the right plan.

A calmer way to navigate this phase

If you’re feeling uncertain, overwhelmed by conflicting information, or unsure which options make sense for you, you’re not alone.

My role is to help women make sense of this transition — to understand what’s happening, what matters most right now, and how to choose supportive strategies without fear or pressure.

Perimenopause doesn’t need to be navigated in isolation.

There is space for information, care, and choice — grounded in science, guided by curious possibility.

And sometimes, the most powerful first step is simply having a calm, informed conversation about what you’re experiencing.

Download the free guide → A Calmer Way To Think About Perimenopause

Start here:  Home

Ready when you are: Work With Me.

References: PMID 37667324; bpacnz.org.nz (2018–2019).