How Do I Know if I’m Perimenopausal?

How Do I Know if I’m Perimenopausal?

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How Do I Know If I’m Perimenopausal?

Most of us grow up aware that menopause will happen at some point in midlife, but how many of us know about perimenopause and when that begins? With so many different symptoms and no clear timeline to follow, a lot of women are asking the question: How do I know if I’m perimenopausal?


What is perimenopause?

There are 3 main stages to the natural menopause journey: perimenopause, menopause, and post-menopause. Perimenopause covers the months and years leading up to menopause when your hormones are fluctuating and causing all kinds of physical and mental symptoms.

On average, women move into perimenopause in their late 30s / early-mid 40s.  However, with premature menopause and Primary Ovarian Insufficiency fertility levels decline, and the menstrual cycle stops before the age of 40.

There are ethnic differences in how women experience perimenopause and menopause. Research shows that Black, Latina, and Asian women may begin perimenopause earlier than white women and may have a longer transition phase.

Periods continue during perimenopause, although it might not be a regular cycle and it may be longer, shorter, lighter, or heavier than before. And if your menopause journey is surgically or medically induced, you may not experience the perimenopause phase at all – you may jump straight to menopause.

Menopause is that point in time when your periods have stopped. The average age for women to reach menopause in the US is 51, though women of color often experience it earlier than this.

Menopause means ‘end of periods’ and is defined as that day on the calendar when you haven’t had a period for 12 months (or 2 years if you’re under 40). At this point you can say you’ve done it; you’ve gone through menopause!

The post-menopause phase is everything after this point – i.e., the rest of your life after your menstrual cycle has stopped. You may find a few symptoms lingering on, but these should settle down as your body adjusts to producing much lower levels of sex hormones.


What are the symptoms of perimenopause?

According to the Menopause Invisibility report by Gen-M, there are at least 48 different symptoms associated with perimenopause and menopause. There are the common ones that you’ve probably heard about, like hot flashes, anxiety, night sweats, weight gain, and brain fog, but there are plenty that are less well-known, including:

  • Altered sense of smell and taste
  • Acid reflux and bloating
  • Vulvovaginal dryness and pain
  • Itchy ears
  • Burning mouth and tongue
  • Dizziness
  • Cold flushes
  • Thinning hair
  • Pins and needles in your hands, feet, arms, or legs
  • Insomnia
  • Palpitations

If you’re in your late 30s or early-mid 40s and you’re starting to notice some of these symptoms – whether your periods are changing or not – you could be in perimenopause.

The reason for such a crazy range of symptoms is because estrogen and progesterone act in lots of areas of the body. From bones and nerves to the heart and digestive tract, our sex hormones do way more than just run the menstrual cycle.

Take the brain for example. A lot of women notice increasing anxiety and difficulty sleeping in their late 30s / early 40s. Their monthly cycle is the same and menopause may be ten or twenty years away yet, so they don’t make the link between these symptoms and their hormones.

But the brain is one of the first places to be affected by changing estrogen and progesterone levels. Progesterone has a calming effect on the nervous system and estrogen influences our sleep/wake cycle. So, when these hormones start to fluctuate during perimenopause, we can experience difficulty sleeping, mood swings, and frequent anxiety.


Can perimenopause symptoms be something else?

There is a crossover between some perimenopause symptoms and other health conditions. It’s always worth speaking to your healthcare provider if you are concerned about what’s going on, especially if you have a family history of health issues.

Health conditions to consider include:

  • Thyroid function can be affected by perimenopause and may cause similar symptoms. Weight gain, constipation, low energy, and brain fog are all signs of low thyroid function (underactive thyroid) while anxiety, racing thoughts, weight loss, diarrhea, and palpitations are classic signs of overactive thyroid.


  • Pregnancy! It may be the last thing on your mind at this point in life, but until you’ve reached menopause there is still a chance you can fall pregnant.


  • Over-exercising: a high-intensity training regime can cause periods to stop.


  • Sleep apnoea: night time waking can be due to hormone changes but can also be caused by sleep apnoea, a serious sleep condition. Left unchecked, sleep apnea can increase the risk of Type II Diabetes, heart disease, and high blood pressure.


  • Depression: mood swings and low mood are common during perimenopause but if symptoms persist or get worse, speak to your healthcare provider about support.


  • Arthritis: joint pains are common in midlife, but persistent pain and swelling may be a sign of osteoarthritis or rheumatoid arthritis.


  • Cancers: persistent fatigue, night sweats, and itchy skin can be signs of lymphoma, a type of cancer.


How can I manage perimenopause symptoms?

Diet and lifestyle changes are a great place to start. Food and drink, movement, relaxation, and sleep all provide the foundations for a healthy well-being and can go a long way toward easing perimenopause symptoms.

And, if you then decide to try Hormone Replacement Therapy (HRT) or herbal alternatives for hormone balance, your body will be in a better place to respond to them.

Try these five top tips for managing perimenopause symptoms:

  1. Minimise caffeine: this can be hard to stomach when you rely on a coffee fix, but caffeine is a major trigger for symptoms of anxiety, gastrointestinal problems, insomnia, and fatigue. Tolerance to caffeine can change over time and you may not be able to handle it as well as you used to. Try gradually replacing coffee, tea, and caffeinated sports drinks with water and herbal alternatives and see what a difference it makes.


  1. Nourish your gut: there’s a group of microbes in the gut called the estrobolome that processes deactivated estrogen. When the estrobolome is out of kilter, it produces too much of an enzyme that reactivates estrogen, sending it back into circulation. More estrogen might sound like a good thing but it’s not, and this recycled estrogen can worsen hormone imbalances. To keep your estrobolome in check, include fermented foods like sauerkraut, kimchi, natural yogurt, and kefir, and eat fiber-rich fruits, vegetables, and whole grains.


  1. Eat a rainbow of fruits and vegetables every day: the colorful compounds in fruits and vegetables help manage inflammation and hormone balance. Aim to include as many different colors as you can in each meal.


  1. Include plenty of good quality protein in every meal and snack: We start to lose more muscle mass after menopause, and this affects metabolism and bone health. Make space for at least ¼ plateful of protein-rich foods with each meal. Eggs, good-quality meat, fish, shellfish, beans, pulses, nuts, and seeds are all good sources. Collagen powder can help top up protein levels – vegetarians and vegans can use pea, hemp, or soy protein.


  1. Include phytoestrogen foods each day: chickpeas, tofu, tempeh, miso, alfalfa sprouts, and ground flaxseeds are all rich in plant-based estrogen compounds called phytoestrogens. These compounds help balance out fluctuating estrogen levels during perimenopause and can ease troublesome symptoms.


Perimenopause is a unique journey for each of us, and symptoms can change as we get nearer to menopause. Making diet and lifestyle changes is a good place to start, alongside finding a supportive healthcare practitioner to discuss any concerns.

Natural Nutrition for Perimenopause - What to eat to feel good and stay sane book cover by Sally Duffin Perimenopause Nutritionist

Discover even more nutrition and lifestyle tips for managing perimenopause and menopause in “Natural Nutrition for Perimenopause – What to eat to feel good and stay sane”.

Available on Amazon or direct from YPD Books, this friendly guidebook covers everything from what perimenopause is and how to spot the signs of change to essential nutrients, supplements, toxins, and lifestyle support.

“Reading this book has helped me understand how my diet and lifestyle can support my body through perimenopause.  And it’s written beautifully too.”   Amazon Reviewer

bones, skin, an

Perimenopause Support – A round up of the best articles

Perimenopause Support – A round up of the best articles

Concerned about perimenopause brain fog?

Anxiety levels rising?

Or maybe you’re experiencing uncomfortable vulvo-vaginal symptoms and need some self-care guidance.

I’ve got you covered.

Here’s a round-up of my most recent perimenopause support articles from around the web.  

Each one is packed with insights and top nutrition and lifestyle tips to help you manage your menopause, your way.

Perimenopausal Brain Fog: A Nutritionist’s Guide to Thinking Clearly

For many women, cognitive changes like brain fog and memory loss are some of the earliest signs of perimenopause. They creep in along with emotional changes like anxiety and mood swings, long before periods begin to stop. As a nutritionist, I’ve heard from women who fear they are losing their minds and are worried about early onset dementia, when in fact these shifts are all part of the menopausal transition…

Blog post: How can collagen help ease menopause symptoms?

Can Menopause Affect Mental Health?

Most people are aware of common menopause symptoms like hot flushes, mood swings, and insomnia. Less well known, however, are the effects menopause can have on mental health.

According to research by Nuffield Health, large numbers of women are struggling to cope with their mental health during menopause and perimenopause among their residing symptoms. Of the women surveyed experiencing symptoms:
– 47% feel depressed
– 37% are experiencing anxiety
– 18% have needed to take time off work because of their menopausal symptoms

How Eating Plant Foods Can Help Ease Symptoms of Perimenopause

During perimenopause, the hormones estrogen and progesterone begin to fluctuate, affecting every part of the body from bones, skin, and hair, to your muscle composition, your cholesterol levels, and even how your brain functions.  Many women turn to hormone replacement therapy (HRT) to gain relief, but HRT isn’t for everyone and ultimately it just delays the inevitable onset of menopause. Making diet and lifestyle changes, on the other hand, is something anyone can do, and there are several key plant foods that have been proven to help ease perimenopause symptoms.

eating plant foods can help ease perimenopause symptoms
menopausal vaginal health

The Menopausal Vagina: Everything You Wanted to Know But Were Afraid to Ask

Vaginal pain and dryness have to be the least talked about symptoms of perimenopause and menopause, yet an estimated 50-60% of women are affected. A lot of women don’t know how to talk about these symptoms because of upbringings that shroud anything to do with vaginas in an aura of shame and stigma. By the time menopause comes along, women can feel too embarrassed to seek help and suffer in silence.

We’re here to change that attitude. Let’s explore what happens to menopausal vulvas and vaginas (yes, there’s a difference!) and what steps you can take to get relief from painful discomfort…

Managing Midlife Anxiety

Most women are familiar with feelings of anxiety. Whether it’s a few pre-menstrual jitters, anxiety about work, or worrying about your child on their first day at school or college, we know what it’s like to experience that sense of panicky dread and uncertainty. But during midlife, a new kind of anxiety emerges. One with no particular rhyme or reason but enough power to make you think you’re losing your mind.

Katherine Tyack-Grant, from Yorkshire, UK, was in her early forties when she started to experience overwhelming anxiety…

Managing midlife anxiety
How Collagen Can Support Bone Health

How Pura Collagen Can Support Bone Health

Oestrogen plays a key role in bone health.  Once oestrogen levels drop post-menopause, the risk of bone fracture increases significantly. According to statistics from the Royal Osteoporosis Society, 1 in 2 women over the age of 50 will develop osteoporosis, with as many dying from fracture-related causes as from lung cancer.

Oestrogen influences bone health by regulating the activity of osteoblasts and osteoclasts. When oestrogen levels decline after the menopause, osteoclast cells start resorbing bone faster than osteoblasts can build it.  This leads to weak bones that are more prone to fracture.

Stress in the Menopause and How to Manage It

The way stress affects us can change during menopause. On top of the usual everyday demands of family, life, and work, our fluctuating hormones risk leaving us more exhausted and frazzled than ever. We may not be able to completely escape stress in the menopause, but there are tips and techniques we can use to manage it…

Stress in the menopause and how to manage it
Natural Nutrition for Perimenopause - What to eat to feel good and stay sane book cover by Sally Duffin Perimenopause Nutritionist

Enjoyed these articles?

You can discover even more nutrition and lifestyle tips for managing perimenopause and menopause in “Natural Nutrition for Perimenopause – What to eat to feel good and stay sane”.

Available on Amazon or direct from YPD Books, this friendly guidebook covers everything from what perimenopause is and how to spot the signs of change to essential nutrients, supplements, toxins, and lifestyle support.

“Reading this book has helped me understand how my diet and lifestyle can support my body through perimenopause.  And it’s written beautifully too.”   Amazon Reviewer

bones, skin, an

‘Natural Nutrition for Perimenopause’ is available now!

‘Natural Nutrition for Perimenopause’ is available now!

*Trumpet fanfare* Yes, I’m pleased (and ridiculously excited) to say that ‘Natural Nutrition for Perimenopause: What to eat to feel good and stay sane’ is available to buy now!

Packed with practical nutrition and lifestyle tips, it’s an easy to use guidebook full of suggestions for navigating the ups and downs of perimenopause and menopause

Topics covered include:
 – What is perimenopause?
 – Signs and symptoms
 – How perimenopause affects your brain, heart, and bones
 – Blood sugar balance for energy, weight balance, and managing stress
 – Key nutrients to include and where to find them
 – Phytoestrogens: what are they and where to find them
 – Supplements
 – Movement & exercise
 – Sleep tips
 – Emotional wellbeing
Plus, there’s a whole section on references and resources for further help. It’s a cracking read (I know, I’m biased!).

It’s ideal for women in their mid-late 30s/early 40s and heading into perimenopause; for those in the throes of it, or those coming out the other side.  And, it’s a helpful book for partners and loved ones to read to help them understand what perimenopause and menopause is like.

Here’s a sneek peek at part of the first chapter…

How are you doing?

How are you really doing?

Did you sleep well or wake every hour with hot flushes?

Are you getting anxious and forgetful?

Do your jeans feel tighter and tighter?

You are not alone. This is what happens as we head towards menopause – as we become ‘menopausers’ (new word, hope you like it).

This messy bit (the bit before the actual menopause which is simply the point in time when we haven’t had a period for a year) is known as perimenopause and can feel like an endurance trial of confusing and random symptoms. From hot flushes, palpitations and anxiety, to weight gain and levels of forgetfulness that cause some menopausers to fear they’re developing dementia: perimenopause doesn’t mess around.

One minute we’re being rational humans, making sensible decisions and knowing what’s what. Next minute we’re bathed in sweat, gripped with anxiety, and biting back tears – usually at the most inappropriate moment.

As hormonal rollercoasters go, perimenopause is as transformational as puberty, only this time around we’ve got a heck of a lot more to juggle compared to those heady teenage years of worrying about what to wear on Friday night and whether we’ll get served in the pub.

This guidebook is a response to the experiences of hundreds of amazing perimenopausal and menopausal clients with whom I’ve had the pleasure of working in my nutrition & lifestyle medicine clinic. Many of these clients were already struggling with long-term health conditions (fatigue, fibromyalgia, underactive thyroid, autoimmunity, digestive problems – sometimes all these combined) before finding themselves in the grip of perimenopause and desperate for help.

Their doctors were suggesting HRT (hormone replacement therapy) and/or an attitude of “it’s your age, just get on with it”. Quite how they were meant ot get on with ‘it’ while facing daily, life-altering symptoms is beyond anyones guess, but there we go. I must add that there are many medical professionals recommending more than just replacement hormones for perimenopause support: counselling for example, or CBT (Cognitive Behavioural Therapy) – and an increasing number recognise the value of nutritional changes and herbal medicine too.

The wonderful thing about nutrition and lifestyle medicine is that it’s open to all regardless of whether you’re taking HRT or not. We all need to eat, drink, breathe, move, and sleep every day, which means we have endless opportunities to positively influence our hormones via food and lifestyle choices.

To carry on reading order the book from Amazon or direct from York Publishing Services online store – the e-book version is coming soon.

Can nutrition help psoriasis? Tune into the Psoriasis Podcast!

Can nutrition help psoriasis? Tune into the Psoriasis Podcast!

Last month I had the pleasure of being interviewed by Gemma Boak (scientist, psoriasis patient expert, and anti-inflammatory lifestyle blogger) for her series the Psoriasis Podcast.  Gemma_snp

Gemma and I had fantastic discussion about the influence of nutrition on psoriasis, immune health, and inflammatory skin conditions; covering everything from fasting and juice diets to bodycare products and food diaries!

You can listen to the interview over at Podbean…


And catch up with all of Gemma’s other interviews too.

If you’re dealing with psoriasis or any other inflammatory auto-immune condition you might also like;

   Eat a Rainbow – #1 Small step

A lovely list of tips to help you pack more nutrients and anti-inflammatory antioxidants into your diet

   Your FREE food, mood & movement tracker – #1 Small Step

Gemma and I discuss using a tracker to help pinpoint any food triggers for symptoms

   Food intolerance or sensitivity?

Are you one of the 45% of UK adults with a food sensitivity?

Enjoy the Psoriasis Podcast, and if you have any questions or queries feel free to email me at or join in the Facebook group.

Stay up to date on psoriasis news with Gemma via Twitter – @gemma_boak

Clean Eating? I quite like being a bit dirty…

‘Clean Eating’ is the new buzz-phrase in nutrition.  Endorsed by countless celebrity dieters and fitness professionals filling Instagram with image of mashed avocado and raw brownies, this so-called new way of eating revolves around ‘clean’ foods and the avoidance of anything highly processed and sugar-laden.

On the surface, this seems like a good idea and is certainly the sort of approach I vegstallwould normally endorse: avoiding refined processed foods and eating a wide range of natural, nutrient-rich goods instead.  But dig a little deeper, and you find the world of clean eating is far murkier than it likes to appear.

A quick Google search reveals several ridiculous rules for clean eating;

  1. “Processed foods are anything in a box, bag, can or package.” So you’re going to have to carry that free-range chicken home in your bare hands.  And yes, you are indeed being ‘dirty’ by choosing lentils and chickpeas from tins despite the fact you haven’t got time to be soaking and simmering dried ones for hours.

  2. “Clean foods are naturally low in sugar, salt and fat.” ButterStatements like this perpetuate the widespread confusion we have over low-fat foods.  Trans fats and refined vegetable oils disrupt the actions of healthy fats in our bodies, but regular consumption of butter, ghee, good quality olive oil and coconut oil brings many health benefits.  And in terms of the so called ‘clean foods’; avocadoes, coconut oil, nuts and seeds are brimming with fats!

  3. “Use clean sugars.” I don’t think I understand this one at all.  Sugar comes in many guises and in various states of processing.  Avoiding the refined white table sugar is certainly helpful, but replacing this with huge spoonfuls of agave syrup (often favoured by clean eaters) is not a good alternative given its high fructose content.  Fructose is metabolised in a different way to regular glucose, with high levels contributing to the formation of triglycerides in the liver – long term issues with this include Non Alcoholic Fatty Liver Disease.

  4. A ‘Clean Eating Pyramid’: the science behind this pyramid evades me.  It encourages the majority of the diet to be Clean-Eating-Pyramid_Gglebased on fruit and water – great if you want erratic blood sugar levels, bloating and diarrhoea. Not so great for supporting your body in dealing with stress, hormone fluctuations, ongoing fatigue or digestive issues such as IBS.

The biggest disagreement I have with ‘clean eating’ is the phrase itself.  It implies foods are either clean or dirty, and therefore, by extension, YOU are either clean or dirty, according to your food choices.

It is yet another way in which food becomes demonized.  It is yet another way for eating disorders to develop, as people (mostly young women) begin to restrict and control the foods they eat, obeying rules set out by other followers on social media, each trying to outshine the other with the latest images of their ‘clean’ meals.

For me, dirty foods are the carrots I haven’t washed yet.  I enjoy mashed avocado as much as the next person, and just as much as I enjoy a bag of ‘dirty’ chocolate buttons at the cinema.


A shorter version of this article appeared in The Press on 07/06/2016