The Complete Guide to
Perimenopause & Menopause

You're Not Going Crazy

If you've picked up this guide, chances are something doesn't feel right.

Maybe you're lying awake at 3am, drenched in sweat. Perhaps you walked into a room and forgot why. Or maybe you snapped at your partner for no reason and felt terrible afterwards.

And when you mentioned it to your GP, they said: "It's just stress" or "You're too young for menopause."

This guide will help you:

• Understand what's happening to your body
• Recognise ALL the symptoms (not just hot flushes)
• Know when to seek help
• Make informed decisions about treatment
• Take control of your menopause journey

What Is Perimenopause & Menopause?

Perimenopause

The transition phase before menopause. Can last 4-10 years. Hormone levels fluctuate (not just decline). Periods may be irregular. Most symptoms happen here.

Menopause

Defined as 12 months after your last period. Average age is 51, but ranges from 45-55. Early menopause is 40-45. Premature menopause is before 40.

Post-menopause

Life after menopause. Hormone levels stabilise at a low level. Some symptoms continue. New considerations around bone health and heart health become important.

The 34 Symptoms of Menopause

Most women know about hot flushes, night sweats, and irregular periods. But there are 31 more symptoms that most women — and many doctors — don't connect to menopause.

Understanding Your Hormones

The Three Key Players

Oestrogen — The master regulator of 400+ body functions. Affects brain, heart, bones, skin, and metabolism. Declining oestrogen causes most symptoms; fluctuating oestrogen causes unpredictable ones.

Progesterone — Your calming hormone. Promotes sleep and relaxation. It's the first to decline in perimenopause, which is why anxiety and sleep issues are often the earliest signs.

Testosterone — Yes, women have it too. Drives energy, libido, and motivation. Declines by 50% by menopause and is often overlooked in treatment.

When to See a Doctor

See a GP if you have:

• Symptoms affecting your quality of life
• Very heavy or prolonged bleeding
• Bleeding after sex
• Bleeding after menopause
• Severe anxiety or depression
• Symptoms starting before 45

What to expect: Blood tests may or may not be useful (hormones fluctuate). FSH tests are only useful after periods have stopped. Diagnosis is usually based on age plus symptoms. You may need to advocate for yourself.

HRT: Facts vs Myths

What is HRT? Hormone Replacement Therapy replaces hormones your body no longer makes. Modern HRT uses body-identical hormones (molecularly identical to your own), available as patches, gels, sprays, or tablets, and tailored to your individual needs.

Who should consider HRT?

• Women with significant symptoms
• Women under 60 within 10 years of menopause
• Women with early menopause (before 45)
• Women at risk of osteoporosis

Natural Approaches That Actually Work

For Hot Flushes

• Cognitive Behavioural Therapy (CBT) — proven effective
• Cooling strategies (layers, fans, cooling pillows)
• Avoiding triggers (alcohol, spicy food, hot drinks)

For Anxiety

• Regular exercise (proven as effective as antidepressants)
• Mindfulness meditation
• Breathing exercises
• Vagus nerve stimulation devices

For Sleep

• Sleep hygiene (consistent times, dark room, cool temperature)
• Temperature-regulating bedding
• Magnesium glycinate before bed
• Limiting caffeine after midday

For Brain Fog

• Regular exercise (increases BDNF)
• Omega-3 fatty acids
• Adequate sleep
• Stress management

Nutrition for Menopause

1. Protein at every meal

Muscle mass declines with age. Aim for 1.2-1.6g per kg body weight. Sources: meat, fish, eggs, legumes, dairy.

2. Healthy fats

Omega-3 for brain and heart health. Sources: oily fish, walnuts, flaxseed. Avoid trans fats and excess saturated fat.

3. Calcium and Vitamin D

Bone loss accelerates at menopause. Calcium: 1000-1200mg daily. Vitamin D: consider supplementing (get a blood test first).

4. Fibre for gut health

Gut bacteria help metabolise oestrogen. Aim for 30g daily from vegetables, fruits, whole grains, and legumes.

5. Phytoestrogens

Found in soy, flaxseed, and legumes. Weak oestrogen-like effects that may help some women.

Exercise That Helps (Not Hinders)

Strength Training (essential)

Preserves muscle mass, protects bone density, boosts metabolism. Aim for 2-3 sessions per week.

Cardiovascular

Heart health risk increases after menopause. Also supports mood and brain health. 150 minutes moderate OR 75 minutes vigorous per week.

Flexibility & Balance

Supports joint health and fall prevention. Yoga, Pilates, and stretching are all excellent.

Sleep Optimisation

Why menopause wrecks sleep: Night sweats wake you up. Declining progesterone (a natural sedative) disrupts sleep architecture. Anxiety keeps you awake. Early morning cortisol spikes cause 3-4am waking.

Environment

• Dark room (blackout blinds)
• Cool temperature (16-18°C)
• Quality mattress and pillows
• Consider temperature-regulating bedding

Routine

• Same bedtime and wake time daily
• No screens 1 hour before bed
• Relaxation routine (bath, reading, breathing)
• Avoid alcohol (disrupts sleep architecture)

Supplements to consider

• Magnesium glycinate (400mg before bed)
• Ashwagandha (stress reduction)
• L-theanine (calming without drowsiness)

Managing Anxiety & Brain Fog

Anxiety in Perimenopause

Often caused by fluctuating oestrogen, low progesterone, disrupted sleep, and life stressors. The most important thing is understanding it's hormonal — not "just stress."

What helps:

• Regular exercise
• Breathing techniques (4-7-8 breathing)
• Limiting caffeine and alcohol
• Consider HRT (often dramatically helps)

Brain Fog

Word-finding difficulties, forgetting why you walked into a room, difficulty concentrating, feeling "fuzzy."

What helps:

• Adequate sleep (priority number one)
• Regular exercise (increases BDNF)
• Omega-3 fatty acids
• Reducing multitasking
• Writing things down
• HRT (oestrogen is neuroprotective)

Supplements Worth Considering

Tracking Your Symptoms

Why track? Identify patterns, correlate symptoms with your cycle, build evidence for doctor appointments, and monitor how well treatment is working.

What to Track

• Date, time, and symptoms (severity 1-10)
• Sleep quality
• Stress level
• Exercise
• Food and drink
• Medications and supplements

Useful Tools

• Balance app (menopause-specific)
• Oura Ring (sleep, HRV)
• Ultrahuman Ring (metabolism, recovery)
• Simple notebook or spreadsheet

How to Talk to Your GP

Prepare Before Your Appointment

1. Write down your symptoms (all of them)
2. Note how long you've had them
3. Rate severity (1-10)
4. Note what you've tried
5. Have questions ready

If You're Dismissed

• Ask: "If this isn't perimenopause, what else could it be?"
• Request a referral to a menopause specialist
• Seek a second opinion
• Consider a private consultation

Questions to Ask

• "Do you have experience treating menopause?"
• "What are my options for treatment?"
• "What are the risks and benefits of HRT for me?"
• "How will we monitor my progress?"

Getting Personalised Support

You've read this guide. Now what?

Self-Help First

• Start tracking your symptoms
• Implement nutrition and lifestyle changes
• Try evidence-based supplements
• Be patient — changes take time

When to Get Professional Help

• Symptoms significantly affect quality of life
• Self-help isn't working
• You want to discuss HRT
• You're under 45 with symptoms
• You need personalised guidance