Perimenopause: What Every Woman Needs to Know (and What You Can Do About It)

Perimenopause is one of the most overlooked and misunderstood phases of a woman’s life. It can begin as early as 35 years old and continue for 10+ years given that the average age of menopause is 51 years old, yet many women are dismissed by doctors and left struggling with symptoms that feel confusing and frustrating.

If you’ve been experiencing changes in your cycle, unexplained weight gain, brain fog, anxiety, poor sleep, or new PMS symptoms that seem to appear out of nowhere—you are not crazy, and you are not alone. Even if you were made to feel that way in the doctor’s office. 

Studies show that 60-86% of women seek medical care for persistent symptoms but many feel that their concerns were not addressed. 

One study showed that 6.8% of physicians in training felt prepared to help women manage menopausal symptoms.

While there are many factors to consider when working to mitigate symptoms, it’s essential to highlight that as estrogen declines during menopause, the risk of chronic diseases—heart disease, hormone-sensitive cancers, insulin resistance, type 2 diabetes, and osteoporosis—rises. However, nutrition and lifestyle choices can significantly reduce these risks. 

Similarly, perimenopausal and menopausal symptoms vary in intensity but can be managed through targeted nutrition and lifestyle modifications. Not only has this been shown in research but my Dietitians and I have seen this in thousands of our clients who have undergone both perimenopause and menopause. 

What Is Perimenopause and When Does It Start?

Perimenopause is the transition phase leading up to menopause, when your hormones begin to shift and fluctuate. While menopause is officially defined as going 12 consecutive months without a period, perimenopause can start 5-15 years before that—which means some women may begin noticing changes in their mid-to-late 30s or early 40s. The onset of the transition is marked by changes in menses and/or development of hypoestrogenic symptoms like hot flashes, mood changes, sleep disturbances, increased visceral fat and more. 

Unfortunately, most women aren’t prepared for it, and many doctors don’t recognize the symptoms unless a woman is well into her late 40s or early 50s. This leads to misdiagnosis, dismissal, or Band-Aid solutions like birth control, antidepressants, ozempic or simply being told to “wait it out.” 

But perimenopause is not just “aging” or “stress.” It’s a real hormonal shift that can be supported through nutrition and lifestyle strategies that address the root cause.

What’s Happening Hormonally?

The biggest hormonal shifts in perimenopause involve estrogen and progesterone.

• Progesterone begins declining first, often in the late 30s or early 40s. Since progesterone is a calming hormone, this can lead to increased anxiety, insomnia, irregular cycles, and mood swings.
• Changes in estrogen can impact serotonin and norepinephrine levels, affecting mood and sleep but also increases in body fat, cardiovascular risk and others. 
• Cortisol (your stress hormone) can also become dysregulated, making perimenopause symptoms worse. Chronic stress can further deplete progesterone and contribute to weight gain, fatigue, and sleep disturbances.

In short, hormones are in flux, and when this transition isn’t properly supported, it can feel like your body is suddenly working against you.

Common Symptoms of Perimenopause

Perimenopause symptoms vary from woman to woman, but here are some of the most common:

• Irregular menstrual cycles (shorter, longer, heavier, lighter, skipped cycles)
• Increased PMS (more mood swings, anxiety, or irritability before your period)
• Unexplained weight gain, especially around the midsection
• Sleep disturbances (difficulty with falling or staying asleep)
• Brain fog and memory issues
• Increased anxiety or depression
• Hot flashes or night sweats
• Fatigue and low energy
• Thinning hair or dry skin
• Changes in libido or vaginal dryness 
• Digestive issues (bloating, food intolerances, constipation)
• Bone loss

If you aren’t engaging in nutrition and lifestyle changes, weight gain and muscle loss is inevitable. On average, women gain about 1.5 lbs per year during their midlife period (ages 50–60), regardless of their initial body size, race, or ethnicity. Age is strongly associated with involuntary loss of muscle mass such that after the age of 30, muscle mass declines by 3%–8%. Perimenopause is also marked by a significant decrease in estrogen hormone levels and the redistribution of subcutaneous fat to abdominal fat. This also increases the risk of heart disease, insulin resistance and inflammation. 

If any of these sound familiar, know that you’re not alone—and you don’t have to just “deal with it.” It highlights the absolutely essential role that nutrition plays in helping offset these changes. There are real, evidence-based ways to support your body through this transition.

Key Nutrition & Lifestyle Strategies for Perimenopause

1. Prioritize Protein & Strength Training

One of the biggest mistakes women make in perimenopause is not eating enough protein and not prioritizing muscle.

• Aim for 30-40g of protein per meal to help maintain muscle, balance blood sugar, and support metabolism. A high quality protein powder can also be helpful in smoothies, yogurt bowls, chia seed puddings and more. 
• Incorporate strength training 2-4x per week to prevent muscle loss, support metabolism, and improve bone density.

Muscle is your metabolic safety net during perimenopause. Losing muscle leads to more blood sugar swings, increased fat storage, a slower metabolism, and increased risk of bone loss.

2. Balance Blood Sugar to Support Hormones

Going through perimenopause increases insulin resistance of the muscles which contributes to worsening of all symptoms, weight gain, and risk of cardiovascular disease. This is where blood sugar balance comes in! 

For decades experts thought that weight gain in midlife women was simply due to aging and lower calorie needs associated. But it’s now been shown that these changes may be primarily due to the hormonal changes associated with the menopausal transition. 

Imbalanced blood sugar increases inflammation which alters hormonal balance further and exacerbates perimenopause symptoms, contributing to weight gain, fatigue, mood swings, and hormone imbalances.

• Start your day with a protein-rich breakfast (instead of carbs and coffee on an empty stomach).
• Prioritize fiber and healthy fats to help slow down glucose absorption with every meal.
• Avoid refined carbohydrates and choose only whole food carbohydrates that are paired with protein and fat in small servings to slow down glucose absorption.

3. Support Your Gut & Liver for Hormone Detoxification

Your liver and gut help process and eliminate excess estrogen. If they’re sluggish, estrogen can build up, leading to worse PMS, heavy periods, bloating, and mood swings.

• Eat cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) to support estrogen metabolism and lower risk of breast cancer.
• Include fiber-rich foods (chia seeds, flaxseeds, leafy greens).

4. Reduce Stress to Protect Progesterone & Cortisol Balance

Since chronic stress depletes progesterone, managing stress is non-negotiable.

• Prioritize high quality sleep (aim for 7-9 hours, and reduce screen time before bed). If you have difficulty sleeping, focus on blood sugar balance, magnesium, and other modalities that can help improve sleep quality. A regular eating schedule plays a key role in maintaining the circadian rhythm.
• Try nervous system regulation techniques like breathwork, meditation, or walking.
• Say no more often and reduce unnecessary stressors where possible.

5. Limit Alcohol to Support Hormone Balance

Alcohol can worsen perimenopause symptoms by disrupting sleep, increasing cortisol, and interfering with estrogen metabolism.

• Alcohol disrupts sleep cycles, making night sweats, insomnia, and fatigue worse. Even small amounts can affect deep sleep.

• It increases cortisol, which contributes to weight gain (especially around the midsection) and worsens mood swings.

• It affects liver function, making it harder for your body to detoxify and regulate estrogen properly.

If you’re experiencing perimenopause symptoms, consider reducing alcohol intake or cutting it out entirely for a few weeks to see how your body responds. 

Look into HRT

While nutrition and lifestyle changes are absolutely essential, also look into hormone replacement therapy and find a doctor who is open minded to weighing out the benefits versus the risks for you. While the latest research shows that this can be very effective for many women, it is not commonly recommended by physicians. 

You’re Not Alone—And You’re Not Powerless

You can support your hormones, regain your energy, and feel strong and confident in your body again.

If you’re in your late 30s, 40s, or early 50s and noticing changes, don’t ignore them. Take proactive steps now—because the choices you make today will impact how you feel today –but also for decades to come.

Remember: you deserve to feel good in your body at every stage of life.