Is It Perimenopause?

Understanding the late reproductive years, early hormonal changes & the menopause transition

Many women begin noticing changes in their cycle, mood, sleep, stress resilience, energy levels and body composition throughout their mid-30s and beyond.

This stage of life often coincides with busy careers, caring responsibilities, relationship pressures and the ongoing mental load of everyday life. As a result, it can sometimes be difficult to determine whether these changes are primarily related to life circumstances, hormonal changes, or a combination of both.

The stages described below are broadly informed by the STRAW+10 reproductive ageing framework, one of the most widely referenced systems used to describe reproductive ageing and the menopause transition.

Importantly, every woman's experience is different. Some women experience significant symptoms despite relatively regular cycles, while others have very few symptoms despite clear menstrual changes.

The Late Reproductive Stage

Many women first start questioning what might be going on for them and/or seeking support during what is often called the late reproductive stage.

At this point:

• cycles are often still mostly regular
• ovulation is often still occurring
• conception is often still possible
• subtle hormonal shifts may begin occurring

Common experiences may include:

• worsening PMS
• increased emotional sensitivity
• anxiety or reduced stress tolerance
• sleep disturbance
• breast tenderness
• heavier periods
• headaches or migraines
• fatigue

The late reproductive stage is considered the stage immediately preceding perimenopause. Although women are not yet technically classified as perimenopausal, hormonal fluctuations and different symptoms may already be emerging.

Early Perimenopause

One of the earlier signs of perimenopause is a persistent change in cycle length of around seven days or more.

Common symptoms may include:

• mood changes
• anxiety
• brain fog
• worsening PMS or PMDD
• sleep disturbance
• fatigue
• headaches or migraines
• reduced stress tolerance
• early hot flushes in some women

At this stage, ovulation may become less predictable and hormone fluctuations can become more noticeable, contributing to the often unpredictable nature of symptoms.

Mid To Late Perimenopause

As the transition progresses, cycles often become longer, more irregular and less predictable. Skipped periods and changes in bleeding patterns become increasingly common.

Women may begin experiencing:

• skipped periods
• heavier or more unpredictable bleeding
• hot flushes and/or night sweats
• insomnia
• vaginal dryness
• joint aches
• palpitations
• reduced libido
• changes in body composition and weight distribution

Hormonal patterns during this phase are often highly variable. Oestrogen levels may fluctuate significantly, while ovulation becomes less predictable and progesterone exposure may gradually decline. This can help explain why symptoms can sometimes feel intense, inconsistent or unpredictable.

Why Is My Body Changing?

In clinic, it is not uncommon to hear women say, "I haven't changed my diet or exercise, but my body seems to be changing anyway." Many women begin noticing changes in body composition throughout the late reproductive years and perimenopause, particularly around the abdomen, alongside shifts in energy, appetite, blood sugar regulation and weight management. These changes are influenced by an interaction of hormonal changes, ageing, muscle mass, sleep, stress, physical activity, genetics and overall metabolic health. As a result, strategies that may have worked well in a woman's 20s or 30s do not always produce the same results during this stage of life.

The late reproductive years and perimenopause can also provide an important opportunity to focus on long-term preventative health. Depending on your individual circumstances and family history, it may be appropriate to assess factors such as blood glucose regulation, insulin resistance, cholesterol levels, blood pressure and cardiovascular health.

While prolonged fasting or regularly skipping breakfast can sometimes appear attractive for weight management, these approaches may be counterproductive. In many cases, a balanced approach may involve focusing less on restriction and more on optimising meal composition, protein & fibre intake, blood sugar regulation, resistance training, stress management and sleep quality.

Very low-carbohydrate diets are often touted for weight loss and metabolic health. However, they can be difficult to sustain long term and may negatively impact the diversity and composition of the gut microbiota by reducing plant food & fibre diversity. Depending on food choices, they may also result in higher intakes of animal protein and saturated fat, which may not be a healthful long-term approach, particularly those with existing cardiometabolic risk factors.

Instead, many women may benefit from paying closer attention to the amount, type and timing of carbohydrates consumed. Emphasising whole, minimally processed carbohydrate sources, adjusting portion sizes to individual needs, and strategically timing carbohydrate intake soon after physical activity may help support blood sugar regulation, energy levels and long-term metabolic health.

Menopause, Early Menopause & POI

Menopause is defined retrospectively after 12 consecutive months without a menstrual period. The time following this is referred to as postmenopause. The average age of menopause in Australia is around 51 years.

Early menopause refers to menopause occurring before age 45, while premature ovarian insufficiency (POI) refers to loss of ovarian function before age 40.

These conditions warrant appropriate medical assessment and support due to potential impacts on bone health, cardiovascular health, fertility, cognitive health and overall quality of life. Menopausal Hormone Therapy (MHT) is often an important consideration for women with early menopause and POI and may play a key role in supporting long-term health outcomes where appropriate. Alongside medical care for POI & Early menopause, a naturopathic approach may provide additional support through personalised nutrition, lifestyle and complementary medicine strategies aimed at supporting long-term health and wellbeing.

Importantly, every woman's experience is individual. Not everyone will fit neatly into a "classic" textbook presentation or experience symptoms within expected age ranges or stages. Family history may sometimes provide useful clues, particularly where early menopause or premature ovarian insufficiency (POI) has occurred in close female relatives, although experiences can vary considerably between individuals.

If you are experiencing persistent symptoms or changes that feel unusual for your body, it is still so important to seek appropriate support and assessment — even if you feel "too young" or your cycles remain relatively regular.

Hormone Testing Can Be Valuable

Perimenopause and menopause are genreally identified through a combination of symptoms, menstrual cycle patterns and clinical history. Hormone testing may also provide valuable additional insight when interpreted alongside the broader clinical picture and well timed.

In women who are still menstruating regularly, mid-luteal progesterone testing may provide insight into ovulation and progesterone production. Early follicular phase testing may provide additional information regarding ovarian function and hormonal signalling between the brain and ovaries, including markers such as FSH, LH and estradiol.

Additional testing may also include androgens such as testosterone, DHEA-S and sex hormone-binding globulin (SHBG), which can provide further insight into hormone availability and areas such as sexual wellbeing, energy, metabolic and cardiometabolic health.

Alongside hormone assessment, factors such as sleep, stress, nutrition, metabolic health, thyroid function, iron status, lifestyle factors and overall symptom patterns are essential in understanding the best approach forward.

Stress, The Nervous System & Menopause

Hormonal changes during perimenopause and menopause are very real physiological processes. While these hormonal shifts are often the primary driver of symptoms, factors such as chronic stress, poor sleep, and nervous system dysregulation have been shown to impact symptom & frequency.

Supportive approaches for stress management may include:

• Supporting healthy sleep habits and sleep quality
• Resistance training and regular physical activity
• Walking in nature and spending time outdoors
• Mindfulness and meditation practices
• Yoga or tai chi
• Journalling
• Adequate protein and fibre intake & regular meal timing - for blood glucose regulation support
• Meaningful social connection and community engagement
• Counselling or psychological support where appropriate

These strategies may support nervous system regulation, stress resilience, overall wellbeing, and quality of life.

Small, sustainable changes are a great way to support you mind & body and reduce your stress response over time.

You Are Not Alone

Perimenopause can feel isolating, particularly when symptoms are minimised or dismissed.

Yet many women are navigating very similar changes, even if they are not always openly talking about them.

You deserve to feel heard, supported and informed throughout this transition.

Support Through The Late Reproductive Stage, Perimenopause & Menopause

As a qualified naturopath with over 10 years of clinical experience, I provide personalised, evidence-informed support for women navigating hormonal changes throughout the late reproductive years, perimenopause and menopause transition.

My approach considers the broader picture — including hormones, sleep, stress resilience, nutrition and metabolic & microbiome health — whilst working collaboratively alongside your broader healthcare team where appropriate.

If you are experiencing changes in your cycle, mood, sleep, energy or overall wellbeing and are seeking individualised support, I look forward to speaking with you soon.

 References

• STRAW+10 Reproductive Ageing Framework (Harlow et al., 2012)
• Vasomotor Symptoms and Menopause (Thurston & Joffe, 2011)
• Menopausal Symptoms and Cardiovascular Risk (Muka et al., 2016)
• Stress, Depression and Anxiety Across Menopausal Stages (Kuck & Hogervorst, 2024)
• Nutrition in Menopause and Perimenopause (Erdélyi et al., 2023)
• Menopause Transition and Cardiovascular Disease Risk (El Khoudary et al., 2020)