The Overlooked Middle: Why Perimenopause Deserves More Support
Perimenopause – the transitional phase before menopause – can last anywhere from two to over ten years and often brings erratic hormone swings, mood shifts, insomnia, and weight challenges. Using age 50 as a proxy for menopause, about 25 million women pass through menopause each year, and by 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. However, it still remains under-discussed and under-supported, leaving many women confused and alone in their experience.
This transitional phase isn't just "the beginning of the end"—it's a unique physiological shift that deserves recognition, understanding, and strategic support.
What's Really Happening: Hormones, Mood & Metabolism
Estrogen
Estrogen levels begin to fluctuate erratically in perimenopause and ultimately decline in menopause. This drop is most strongly associated with:
- Vasomotor symptoms such as hot flashes and night sweats, which affect up to 75% of perimenopausal women and can persist for years after menopause onset
- Mood changes, including increased vulnerability to depression and anxiety, particularly in women with a history of mood disorders
- Urogenital symptoms such as vaginal dryness, itching, and discomfort with intercourse, driven by thinning of the vaginal epithelium
Beyond these, estrogen plays a critical role in cardiovascular health, bone density, skin elasticity, and cognitive function, making its decline a key contributor to increased risks of osteoporosis, heart disease, and memory changes in postmenopausal women.
Progesterone
Progesterone typically begins declining earlier than estrogen, often in the late 30s or early 40s, as ovulation becomes less consistent. This can lead to:
- Insomnia and sleep disturbances, as progesterone has natural GABAergic (calming) effects that promote sleep
- Increased anxiety and mood lability, partly due to altered GABA receptor sensitivity and the lack of its stabilizing influence
- Shortened or irregular menstrual cycles, as the luteal phase shortens or becomes anovulatory.
The early drop in progesterone can make perimenopause particularly frustrating, as symptoms often appear while periods are still occurring.
Testosterone
Although not often discussed, testosterone is essential to a woman's vitality. Produced by the ovaries and adrenal glands, levels begin to decline gradually in the mid-30s and may fall further during perimenopause and menopause.
Its decline is associated with:
- Reduced libido and sexual satisfaction
- Decreased muscle mass and strength
- Lower energy levels and motivation
Testosterone also contributes to cognitive sharpness and mood regulation. While there is debate around testosterone therapy for women, its role in overall well-being is becoming more recognized, particularly in midlife.
With all these internal changes happening beneath the surface, it becomes even more important to stay attuned to how your body is responding day to day.
Track What Matters
While ovulation and regular cycles may be fading, self-tracking still holds power during menopause. Monitoring your sleep, energy, mood, and digestion can provide meaningful data about how your body is adapting.
Digital tools like cycle apps with symptom-tracking features—or even a simple journal—can reveal patterns and help guide decisions about diet, lifestyle, and when to seek medical support. Read more about our favourite cycle tracking apps here.
Awareness is just the first step—how you respond to what your body is telling you is where transformation begins.
Redefining "Healthy Habits" in Midlife
Many women enter midlife with deeply ingrained routines—but not all of them still serve their bodies. What worked in your 20's or 30's may no longer apply. The shift toward hormone-friendly habits is more about sustainability than willpower.
Key strategies can include:
- Swap long cardio sessions for resistance training and daily movement that supports muscle and bone health.
- Prioritize protein and fibre-rich meals to maintain lean tissue and stabilize blood sugar.
- Build routines around nervous system regulation: deep breathing, nature walks, tech-free time.
- Instead of focusing on outcomes, manifest the traits that you require to build the identity that you desire.
Even small changes—when repeated consistently—can shift how you feel in your body.
One area where many women feel especially stuck during this transition is weight. Despite healthy habits, the scale—and the mirror—don't always reflect the effort.
Why Weight Loss Feels Harder in Midlife
One of the most common frustrations during menopause is weight gain—particularly around the abdomen—and difficulty losing it despite "doing everything right."
Several factors play a role:
- Insulin resistance becomes more common with age and hormonal shifts.
- Cortisol dysregulation from chronic stress can promote fat storage.
- Muscle loss due to declining estrogen and activity levels can reduce resting metabolic rate.
This means traditional weight loss advice often falls flat. The focus shifts from calorie restriction to blood sugar balance, strength training, recovery, and hormone support.
For some, even the best habits aren't enough. When symptoms persist despite lifestyle changes, it may be time to consider a more targeted intervention.
When to Consider Hormone Therapy
For some women, lifestyle changes alone aren't enough. Hot flashes, night sweats, insomnia, low libido, or persistent mood symptoms may signal that hormone therapy could be helpful.
Bioidentical hormone therapy (BHRT), when appropriately prescribed and monitored, can:
- Reduce vasomotor symptoms
- Support sleep and mood
- Improve vaginal and urinary health
- Help preserve bone density
It's not a one-size-fits-all solution, but it can be life-changing for the right candidate.
The Bottom Line: Menopause is Not a Decline, It's a New Beginning
Menopause isn't a finish line—it's a threshold into a new version of you. But crossing it well requires more than willpower. It calls for knowledge, self-compassion, and a shift in how you support your health.
Track your patterns. Nourish your body. Move with intention. Ask for support.
Book your initial consultation with one of our Naturopathic Doctors by clicking HERE.
References
- Hill K. The demography of menopause. Maturitas. 1996 Mar;23(2):113-27. doi: 10.1016/0378-5122(95)00968-x. PMID: 8735350.
- Baker FC, de Zambotti M, Colrain IM, Bei B. (2012). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep.
- Andreen L, Nyberg S, Turkmen S, van Wingen G, Fernandez G, Backstrom T. (2009). Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators. Psychoneuroendocrinology.
- Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. (2011). Duration of menopausal hot flushes and associated risk factors. Obstet Gynecol.
- Schmidt PJ, Ben Dor R, Martinez PE. (2004). Effects of Estradiol Withdrawal on Mood in Women With Past Depression: A Randomized Clinical Trial. JAMA Psychiatry.
- Palacios S, Castelo-Branco C, Currie H. (2015). Update on management of genitourinary syndrome of menopause: a practical guide. Maturitas.
