If your periods have gone weird, your sleep is cooked, you have hot flushes, your moods are all over the place, your jeans are tighter and your GP keeps saying “your bloods are normal”… you’re probably in perimenopause.
I’m Anastasia, a Registered Clinical Nutritionist and Certified Menopause & Women’s Health Coach. I run a perimenopause clinic in Wellington and I work online with women all over New Zealand and overseas. I also went into perimenopause at 37 with “normal” labs. So this is personal for me too.
Let’s walk through what to expect in perimenopause and menopause in detail and in plain language, with the medical bits translated so you actually understand what’s happening.
First: definitions – what stage are you in?
Menopause
Menopause is a point in time: it’s the day you’ve gone 12 months in a row with no period, not caused by pregnancy, breastfeeding, or medication. The average age of natural menopause is around 51–52 in countries like Australia and New Zealand. Menopause – StatPearls – NCBI Bookshelf
Perimenopause (the “transition”)
Perimenopause is the lead-up phase. Hormones fluctuate wildly, cycles change, and symptoms appear even though you’re still having periods. It usually starts in the mid-40s but can begin earlier, including late 30s.Menopause Australia+2menopause.org.nz+2
Typical duration: 4–8 years, sometimes longer.
Postmenopause
Once you’re 12 months past your final period, you’re “postmenopausal”. Your ovaries are no longer cycling, oestrogen and progesterone stabilise at a much lower level, and some symptoms settle while others (like vaginal dryness or bone loss) may slowly increase without support.
Premature & early menopause
- Premature ovarian insufficiency (POI): menopause before age 40.
- Early menopause: menopause between 40–45.
These women usually need more medical input and hormone replacement is strongly recommended unless there’s a clear reason not to, to protect bone, brain, and heart health.
What’s happening to your hormones?
Your brain and ovaries communicate through the hypothalamic–pituitary–ovarian (HPO) axis:
- The brain releases GnRH → tells the pituitary to release FSH and LH.
- FSH and LH talk to your ovaries → ovaries produce oestrogen and progesterone and (ideally) release an egg.
In perimenopause:
- The number and quality of follicles (eggs) drops.
- Ovulation becomes hit-and-miss.
- Progesterone often falls first because you don’t ovulate consistently, so you don’t form a good corpus luteum.
- Oestrogen becomes erratic – sometimes low, sometimes spiking higher than it ever did in your 20s.
- Your brain senses this instability and pumps out more FSH to “shout” at the ovaries. Over time, FSH stays high and oestrogen eventually settles at a lower, postmenopausal level.
These fluctuations affect:
- Thermoregulation (temperature control)
- Sleep centres
- Mood and cognition (oestrogen receptors live all through the brain)
- Bone turnover
- Fat distribution, muscle, and insulin sensitivity
- Vaginal and bladder tissues
That’s why symptoms feel “everywhere”, not only in your uterus.
What symptoms are common and why they happen
1. Period changes
What you might notice:
- Shorter or longer cycles
- Skipped periods
- Heavier bleeding, clots, gushes
- Worse PMS, more cramps
Why it happens:
In early perimenopause, you often have shorter cycles and heavy bleeding because oestrogen can spike high but ovulation is unreliable, so you’re not getting enough progesterone to balance that thickened lining. In late perimenopause, cycles stretch out (60+ days apart), then stop.
Red flags, see a doctor urgently if:
- You’re soaking through pads/tampons hourly
- You pass very large clots
- Bleeding occurs after sex
- Bleeding happens after 12 months with no period
Those need assessment for fibroids, polyps, endometrial hyperplasia, or cancer – don’t assume everything is “just menopause”.
2. Hot flushes and night sweats (vasomotor symptoms)
What you might feel:
- Sudden heat rising through the chest, neck, and face
- Red, flushed skin
- Heart racing
- Drenched night sweats
Why it happens:
Oestrogen helps regulate the hypothalamic “thermostat”. When oestrogen drops and fluctuates, the brain’s temperature control becomes oversensitive. A tiny change in core temperature triggers a big heat-dump response → blood vessels open wide (vasodilation), heart rate rises, you sweat to cool down.
These symptoms affect about 75–80% of women and can last 1–6 years for most, but up to 10–15 years in a subset.
3. Sleep, mood, brain fog, and anxiety
Common complaints:
- Struggling to fall asleep, waking at 2–3am wired
- Anxiety that “comes out of nowhere”
- Depressive symptoms, loss of motivation
- Brain fog, word-finding issues, forgetfulness
- Irritability, rage, emotional volatility
What’s going on:
- Oestrogen modulates serotonin, dopamine, and GABA, all involved in mood, anxiety, and calm. Fluctuations can feel like you’ve been put on a mental rollercoaster.
- Night sweats and hot flushes fragment sleep, which worsens mood, cravings, and stress tolerance.
- Lower progesterone means less of its naturally calming, GABA-like effect.
Many women are told they’re “stressed” or “depressed” and sent away with antidepressants, while the hormonal piece is ignored. Antidepressants can be appropriate in some cases, but they aren’t a replacement for understanding the underlying hormonal transition.
4. Weight, body composition, and metabolism
What you see:
- Weight creeping up, especially around the middle
- Same food and exercise as before, different result
- Harder to build or maintain muscle
Why:
- Lower oestrogen affects insulin sensitivity, fat storage, and appetite regulation.
- Muscle mass naturally declines with age (sarcopenia). Less muscle = lower resting metabolic rate.
- Poor sleep, hot flushes, and stress drive up cortisol, which encourages central fat storage.
You are not imagining that your body has changed. The rules really shift in perimenopause. You absolutely can lose weight and build muscle, but the strategy needs to be age-appropriate and hormone-aware , this is a big part of what I do in clinic.
5. Vaginal, bladder, and sexual symptoms
(Genitourinary Syndrome of Menopause – GSM)
Symptoms can include:
- Vaginal dryness, burning, or itching
- Pain with sex
- Recurrent urinary tract infections
- Urinary urgency or leakage
These tissues are very oestrogen-dependent. When oestrogen falls and stays low, the vaginal lining becomes thinner, less elastic, and produces less lubrication. The urethra and bladder also lose some support and resilience. Local vaginal oestrogen or DHEA, alongside lubricants and moisturisers, often works extremely well and has minimal systemic absorption.
6. Bones, joints, and muscles
Oestrogen helps protect bone. After menopause, bone turnover speeds up and bone density drops, increasing risk of osteoporosis and fractures later in life.
You may also notice:
- Stiff, aching joints
- New or worsening tendon issues
- Slower recovery from training
Strength training, protein intake, vitamin D, calcium, and sometimes hormone therapy all play roles in protecting your skeleton and keeping you physically capable into your 60s and beyond.
7. Skin, hair, and the “weird” symptoms
Many women experience:
- Hair shedding or thinning
- Itchy or crawling skim
- Tingling hands/feet
- Electric shock sensations
- Dry eyes and mouth
- Frozen shoulder or other odd musculoskeletal pains
These are linked to changes in collagen, nerve sensitivity, and the fact that oestrogen receptors exist in skin, mucous membranes, and connective tissue. They’re not “all in your head”, but they’re also not automatically serious disease, they need proper assessment, not dismissal.
How is perimenopause diagnosed?
In women 45 and over, current guidelines recommend diagnosing perimenopause based on symptoms and changes in menstrual pattern … blood tests are usually not needed because hormone levels fluctuate wildly day to day.
Bloods may be used when:
- You’re under 45 and there’s concern about early menopause / POI
- Your symptoms are atypical
- Your clinician needs to rule out thyroid disease, anaemia, coeliac disease, or other conditions that can mimic perimenopause
A single “normal” oestrogen or FSH level does not rule perimenopause out; it only tells you what your hormones were doing that morning. This is where women are often gaslit or told they’re “too young” – which is exactly what happened to me.
Treatment options: medical and lifestyle
1. Hormone therapy (HRT / MHT)
Hormone therapy remains the most effective treatment for hot flushes and night sweats and also helps with vaginal symptoms, sleep, mood in some women, and long-term bone protection.
Options include:
- Oestrogen alone (for women without a uterus)
- Combined oestrogen + progestogen (for women with a uterus, to protect the endometrium)
- Transdermal oestrogen (patch, gel, spray) – generally lower risk for blood clots compared with oral in many women
- Micronised progesterone or certain synthetic progestins
The exact regime should be individualised based on:
- Age and time since final period
- Personal and family history (breast cancer, clotting, cardiovascular disease, migraine, etc.)
- Severity of symptoms
2. Lifestyle foundations (where my nutrition brain goes to work)
None of these replace medical care, but they are powerful:
- Adequate protein to protect muscle and bone
- Blood sugar balance: structured meals, fibre, reducing ultra-processed foods
- Strength training 2–3+ times per week
- Cardio for heart health and insulin sensitivity
- Sleep hygiene and stress management (both impact hot flushes, cravings, and fat distribution)
- Alcohol and smoking reduction (both worsen vasomotor symptoms and overall risk profile)
In my clinic, this is where we do detailed work: labs where needed, personalised nutrition, weight-loss planning that respects hormones, and lifestyle changes you can actually stick to.
How I help women through this stage
I run a perimenopause and menopause clinic based in Wellington, and I work online with women all over New Zealand and overseas.
In a typical consultation we:
- Take a detailed history of cycles, symptoms, mental health, weight, family history, and medications
- Review any blood tests you already have and decide what’s actually worth repeating
- Map out where you likely are in the transition
- Build a clear plan around nutrition, movement, weight management, sleep, and stress
- Set realistic goals that match your life, not a fantasy schedule
Perimenopause and menopause are a biological transition, not a personal failure. With the right mix of medical care, nutrition, training, and support, you can feel strong, clear-headed, and at home in your body again.
If your symptoms are starting to affect your work, your relationships, your training, or your sense of self, that’s your sign to stop white-knuckling it alone and get proper help.
