Perimenopause: When Your Hormones Start Changing (Before You Realise What’s Happening)

Perimenopause has a bit of a branding problem.

Most women think it starts with hot flushes and missed periods somewhere in their late 40s or 50s. In reality, perimenopause often begins much earlier – and far more quietly.

For many women, the first signs show up in their late 30s or early 40s, often disguised as:

• Worsening PMS
• Shorter or heavier cycles
• Anxiety or low mood
• Poor sleep
• New food sensitivities
• Feeling “not quite yourself”

And the hormone most responsible for this early shift?
Progesterone.

Progesterone: The First Hormone to Decline

In early perimenopause, ovulation becomes less consistent. And when ovulation becomes irregular, progesterone production drops.

This matters because progesterone is your:

• Calming, anxiety-buffering hormone
• Sleep-supporting hormone
• Natural counterbalance to estrogen

When progesterone starts to decline, women often notice:

• Increased irritability or anxiety (especially premenstrually)
• Poor sleep or early waking
• Heavier or more symptomatic periods
• Breast tenderness
• Shorter cycles
• Stronger emotional reactions to stress

Many women describe this phase as:

“I feel more reactive, more tired, and less tolerant of everything.”

Sound familiar?

Estrogen Isn’t Necessarily “High” – But It Can Feel That Way

Here’s where things get confusing.

In early perimenopause, estrogen doesn’t usually drop straight away. In fact, it can fluctuate wildly – sometimes even spiking higher than it did in your earlier reproductive years.

When progesterone falls but estrogen remains the same (or rises), this creates what we call relative estrogen dominance.

This doesn’t mean estrogen is “bad” or something to eliminate – estrogen is essential.
It simply means the balance between estrogen and progesterone has shifted.

Common symptoms of relative estrogen dominance include:

• Heavy or clotty periods
• Breast tenderness
• Fluid retention
• Headaches or migraines
• PMS that feels more intense than it used to
• Mood swings or increased emotional sensitivity

Why Estrogen Metabolism Matters More Than Ever

In perimenopause, it’s not just about how much estrogen you produce — it’s about how well you metabolise and clear it.

Estrogen is processed primarily through the liver and gut. If these pathways are under strain, estrogen can recirculate rather than being eliminated efficiently.

Factors that can impair estrogen metabolism include:

• Chronic stress
• Poor gut function or constipation
• Nutrient deficiencies (particularly B vitamins, magnesium and fibre)
• Alcohol
• Environmental hormone disruptors
• Genetic tendencies (such as COMT or MTHFR variants)

Supporting estrogen metabolism is often a key missing piece in early perimenopause care.

Supporting the Early Stages of Perimenopause (Gently and Effectively)

Early perimenopause doesn’t require extreme interventions – but it does benefit from thoughtful, proactive support.

Some key foundations include:

1. Support Progesterone Naturally

• Prioritise sleep and nervous system regulation
• Reduce excessive high-intensity exercise if cortisol is elevated
• Ensure adequate protein and healthy fats
• Consider targeted herbal or nutritional support where appropriate

2. Balance Blood Sugar

Blood sugar instability worsens hormonal symptoms and stress responses.

• Eat regular meals with protein
• Avoid long fasting windows if symptoms are worsening
• Reduce reliance on caffeine to get through the day

3. Support Estrogen Metabolism

• Increase fibre intake to support estrogen clearance
• Support liver function through nutrition and lifestyle
• Address gut health if digestion or bowel habits are off
• Use practitioner-grade supplements when indicated

4. Lower the Overall Stress Load

Perimenopause is far less forgiving of chronic stress than earlier life stages.
This is often where women realise their old coping strategies no longer work – and that’s not a failure, it’s physiology.

A Reframe Worth Making

Perimenopause isn’t your body “falling apart”.

It’s a transition – one that asks for different support than you needed in your 20s or 30s.

“With the right guidance, early perimenopause can be a time of clarity rather than chaos – helping you feel more informed, more supported, and far more in tune with what your body needs now.“

Nikki