Perimenopause & Hormone Support Guide

[Written & reviewed by Dr Akanksha Sharma, MBBS MD (Preventive & Community Medicine)], Updated on [Dec, 2025]

Introduction: Why So Many Women Feel “Off” — But Are Told They’re Fine

If you’re in your late 30s or 40s and feel like your body doesn’t respond the way it used to, you’re not imagining it.

Many women experience:

• Weight gain despite “doing everything right”

• Poor sleep

• Mood swings or anxiety

• Fatigue and brain fog

• Heavier or irregular periods

And yet, they’re often told:

“Your reports are normal.”
“It’s just stress.”
“You’re too young for menopause.”

This guide explains perimenopause — the hormonal transition phase before menopause — in a way that is scientifically accurate, practical, and reassuring.

Related reading:
👉Fitness After 40: Why It Feels Different (And What To Do)

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What Is Perimenopause?

Perimenopause is the transition period before menopause, typically beginning between ages 35–45, and lasting anywhere from 4–10 years.

During this phase:

• Ovaries still produce hormones

• But estrogen and progesterone fluctuate unpredictably

• Ovulation becomes inconsistent

• Metabolic and stress hormones become more influential

👉 This is why symptoms can appear years before periods stop.

Related reading:
👉Navigating Perimenopause: Signs, Symptoms, and Strategies

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Common Symptoms (That Are Often Missed)

Perimenopause does not look the same in every woman.

Hormonal & Menstrual Changes

• Shorter or longer cycles

• Heavier or lighter periods

• Missed ovulation

• Worsening PMS

Metabolic Changes

• Central weight gain

• Reduced muscle mass

• Insulin resistance

• Higher cholesterol or HbA1c

Nervous System & Mood

• Anxiety

• Low mood or irritability

• Sleep disturbance

• Reduced stress tolerance

Cognitive & Physical

• Brain fog

• Fatigue

• Joint aches

• Reduced exercise recovery

Related reading:
👉A Doctor’s Natural Approaches for Perimenopause Symptom Relief

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Why Blood Tests Often Look “Normal”

This is one of the most frustrating parts of perimenopause.

• Hormone levels fluctuate daily

• A single estrogen or FSH value may look “normal”

• Symptoms often reflect hormone variability, not deficiency

👉 Diagnosis is clinical, not lab-only.

Labs help rule out other causes (thyroid, anemia, insulin resistance) — they do not always “confirm” perimenopause.

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The Hormone–Metabolism–Stress Triangle

In perimenopause, three systems interact:

1. Ovarian hormones (estrogen, progesterone)

2. Metabolic hormones (insulin)

3. Stress hormones (cortisol)

When estrogen fluctuates:

• Insulin sensitivity worsens

• Cortisol effects increase

• Sleep and recovery suffer

This is why:

What worked for weight, energy, and mood in your 20s may no longer work.

Related reading:
👉The Insulin Reset: A Women’s Guide

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What Actually Helps (And What Often Doesn’t)

Helpful Strategies

• Protein-adequate, anti-inflammatory nutrition

• Strength training (not excessive cardio)

• Sleep and circadian rhythm protection

• Stress-load reduction (not just “relax more”)

• Correcting iron, B12, vitamin D deficiencies

Common Mistakes

• Very low-calorie diets

• Excessive fasting

• Over-exercise

• Blaming “lack of willpower”

Related reading:
👉Strength Training: Your Secret to a Healthier, Longer Life

👉Understanding the Body’s Mechanism to Maintain Weight

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When Nutrition Alone Is Enough — And When It Isn’t

For some women:

• Nutrition, sleep, and training optimisation bring significant relief

For others:

• Persistent symptoms may need medical input, such as:

  • Thyroid optimisation

  • Progesterone support

  • Iron or B12 correction

  • Mental health support

Perimenopause is not a failure of lifestyle — it is a physiological transition.

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When to Seek Professional Support

Consider structured support if you experience:

• Rapid weight gain despite consistency

• Severe PMS or mood changes

• Persistent fatigue or sleep disturbance

• Anxiety that feels “new” or disproportionate

• Brain fog affecting work or daily life

👉Struggling with hormone changes after 35? Explore the FLOURISH Program (for women 35+)

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Frequently Asked Questions (FAQs)

Is perimenopause the same as menopause?

No. Perimenopause is the transition phase; menopause is defined as 12 months without periods.

Can I be perimenopausal if my periods are regular?

Yes. Many women have regular cycles but still experience hormonal symptoms.

Will I definitely gain weight?

Not inevitably — but body composition changes are common without targeted intervention.

Do I need hormone therapy?

Not everyone does. Decisions are individual and depend on symptoms, risks, and response to lifestyle measures.

Can perimenopause worsen PCOS or thyroid issues?

Yes. Existing metabolic or endocrine conditions often become more symptomatic during this phase.

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References

1. Santoro N et al. Perimenopause: from research to practice. J Womens Health.

2. Burger HG. The endocrinology of the menopause. J Steroid Biochem Mol Biol.

3. Davis SR et al. Menopause Hormone Therapy. Lancet.

4. El Khoudary SR. Age at menopause and cardiovascular risk. Nat Rev Cardiol.

5. Thurston RC et al. Vasomotor symptoms and sleep. Sleep Med Clin.

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Navigating hormone changes after 35 doesn’t have to feel confusing or isolating.

👉 Explore the FLOURISH: Women’s Hormone & Metabolic Health Program
A structured, evidence-based program designed for perimenopause and beyond.

Or Book a consultation call.