You don’t realise you’re in perimenopause —until you are. You start waking up in the middle of the night. Your periods become unpredictable. Your moods shift without warning. You brush it off as stress, age, or just a rough patch. Perimenopause doesn’t come up in everyday conversation, and when it does, it’s often after women have spent months, or even years trying to make sense of symptoms they didn’t recognise for what they were.
For something that affects so many women, it’s striking how little we’re told about it. It’s still not widely covered in everyday health media or advice. That gap doesn’t just delay understanding; it leaves many women second-guessing their own bodies.
It’s time to change how we talk about this phase of life, not by medicalising it, but by normalising it. When women understand what they’re experiencing, they’re more likely to feel informed, supported, and less alone. And with that clarity comes the confidence to navigate through it, and to seek medical advice when they need it.
What is perimenopause?
Perimenopause is the transitional phase leading up to menopause, typically starting in a woman’s mid 40s, but it can start earlier. During this time, hormonal changes start to affect several aspects of your body, including your menstrual cycle, fertility, and overall health. Perimenopause can last anywhere from four to eight years, with the average duration being about four years.
The symptoms
The symptoms of perimenopause can be unpredictable and varied, and many women suffer through them in silence, unaware of their significance. Imagine waking up drenched in sweat at 2AM, unsure whether it’s a fever or just another hot flash. Many women face this without realising it’s part of perimenopause, causing confusion and frustration.
Here are some of the most common, but often overlooked, symptoms:
Your period may become irregular—some months you might miss it altogether, while other times it may be unexpectedly heavy. For many women, this change is the first sign that perimenopause has begun, but it can easily be misinterpreted as something else, causing unnecessary concern.
A sudden wave of heat rushes through your body, leaving you bathed in sweat, wondering if you’re coming down with a fever or if it’s just another perimenopausal hot flash. These intense heat flashes, often followed by night sweats, are common and can be disruptive, happening at any time of day or night.
Sleep disturbances, including insomnia or waking up in the middle of the night drenched in sweat, are common but poorly understood symptoms of perimenopause. You may find it increasingly difficult to get a restful night’s sleep, leaving you fatigued and frustrated.
One moment, you might feel on top of the world; the next, you feel overwhelmed and anxious. Hormonal shifts during perimenopause can cause significant mood changes, sometimes leading to irritability or even bouts of sadness. These emotional fluctuations are often brushed aside or chalked up to stress, but they are part of the body’s natural transition.
Difficulty focusing, forgetfulness, and “brain fog” can sneak up on you. You might find yourself walking into a room only to forget why you’re there, or struggling to concentrate on simple tasks. These cognitive effects can be frustrating, especially when they impact your daily productivity.
You might notice that no matter how much you exercise, weight gain becomes more prominent, especially around your midsection. Hormonal shifts can slow down metabolism, making it harder to maintain your usual weight despite healthy habits.
According to Dr Tash, a Family Physician, Hormone Replacement Therapy (HRT) remains the most effective treatment for alleviating common symptoms associated with perimenopause and menopause.1,2 Approximately 80% of women going through this transition experience a range of symptoms, including:
- Joint pain
- Fatigue and sleep disturbances
- Mood swings and brain fog
- Hot flashes and night sweats
- Decreased libido
- Vaginal dryness and urinary symptoms
Beyond symptom relief, HRT plays a key role in preventing and managing osteoporosis.3 While the history of HRT has been debated, it is well established that oestrogen deficiency is the primary cause of postmenopausal osteoporosis, significantly increasing the risk of fractures. The global economic burden of untreated cases runs into the billions.
Dr Tash notes that transdermal oestrogen and testosterone, when combined with micronised progesterone, offer the best safety profile.4,5 Research also suggests cardiovascular benefits, especially when HRT is started early in healthy women around the time of menopause.6 It may help regulate cholesterol, blood sugar, and support vascular health. However, the type and dose of hormones remain important factors, and studies are ongoing.
Oestrogen’s role in supporting cognitive health is widely recognised in both clinical settings and research.7 While its full impact is still being explored, the work of Dr Lisa Mosconi continues to highlight the potential cognitive benefits of starting HRT early.
For women with Premature Ovarian Insufficiency (menopause before age 40), HRT is strongly recommended unless contraindicated.8,9 It should continue until at least the average age of natural menopause. If the benefits outweigh the risks, as they do for most women, use can extend beyond that. HRT offers essential protection against heart disease, bone loss, and cognitive decline. The same applies to women who enter menopause before age 45, either naturally or following surgical removal of the ovaries.
Preparing for perimenopause and the transition to menopause
With the right knowledge and support, you can navigate this transition with confidence. Here’s how you can take charge:
Start by familiarising yourself with the signs of perimenopause. While not all women experience the same symptoms, paying attention to changes in your menstrual cycle, sleep patterns, and emotional state can help you identify when perimenopause might be starting. Apps like Clue or Ovia Health can help you track symptoms such as changes in mood, hot flushes, or periods. This gives you a clearer picture of your body’s changes and helps you have more informed conversations with your healthcare provider.
During perimenopause, your body undergoes changes that impact your overall health. To support yourself during this transition, focus on maintaining a balanced diet, including calcium, vitamin D, and magnesium to help keep your bones strong. Regular exercise is key, especially weight-bearing activities like walking, yoga, or strength training to support cardiovascular health. Prioritise sleep hygiene to help with the sleep disruptions many women experience during perimenopause.
As you approach menopause, it’s important to understand the differences between perimenopause and menopause. Menopause is officially defined as the point when you’ve gone 12 months without a menstrual period. The hormonal shifts that began during perimenopause will continue into menopause. This is a good time to focus on your bone and heart health, as the decline in oestrogen increases the risk of osteoporosis and cardiovascular issues. It’s important to consult with your healthcare provider to discuss available treatment options, such as hormone replacement therapy (HRT) or non-hormonal alternatives, to manage symptoms and support your long-term health.
Perimenopause can sometimes feel like an isolating experience, but you don’t have to go through it alone. Whether it’s speaking to a therapist, joining a support group, or connecting with others in online communities, seeking support can make all the difference. Sharing your experiences with others going through the same transition can be reassuring and help you feel less isolated.
Dr Tash emphasises that one of the most important and evidence-based ways to manage menopause is by adopting a healthy lifestyle. This not only helps relieve symptoms but also supports long-term heart, bone, and mental health.10,11
The key pillars of lifestyle medicine include:
- Eating a nutritious diet rich in macro and micro-nutrients, including healthy fats, proteins, complex carbohydrates, omega-3 fatty acids, and magnesium, to support bone health, reduce inflammation, and balance hormones during perimenopause
- Exercising regularly, with an emphasis on strength and conditioning to support bone density and reduce cardiovascular and cancer risks
- Limiting alcohol, which can worsen symptoms and increase the risk of cancer and bone-related issues
- Avoiding smoking, as it raises the risk of nearly all major health problems
- Prioritising sleep is number 1
- Reducing stress, staying socially connected, being mindful of mental health, and seeking help when needed
Menopause is also an ideal time to review your overall health and ensure appropriate screenings are in place, including:
- Cervical screening (Pap smear)
- Mammograms
- Blood pressure and cholesterol checks
- Thyroid function, diabetes, and other metabolic screening
- Bone density testing for osteoporosis
- Colonoscopy and other gut health evaluations
By taking a proactive and personalised approach, women can navigate perimenopause and menopause more comfortably while protecting their long-term health.
How women can navigate perimenopause
Raising awareness isn’t just about talking more; it’s about providing women with the tools and support they need to navigate perimenopause with confidence. Here’s what you can do to manage symptoms and take charge of your health:
Regular exercise can help boost your mood, manage weight, and improve sleep quality. Strength training, walking, or other weight-bearing activities can also support bone health as oestrogen levels decline during perimenopause.
A healthy diet is key to managing weight and overall health during perimenopause. Focus on fruits, vegetables, whole grains, and lean proteins to support hormonal balance and alleviate common symptoms. Calcium and vitamin D are particularly important for bone health, as the decline in oestrogen during this phase increases osteoporosis risk. Good sources of calcium include dairy, leafy greens, and fortified plant-based milks, while vitamin D is found in fatty fish, egg yolks, and fortified foods.
However, perimenopause affects each woman differently, and nutrition needs can vary. If you’re unsure about your diet or how to balance your nutrients effectively, consider speaking to a dietitian or nutritionist. They can help you tailor your diet to meet your unique needs and ensure you’re supporting your health during this important phase of life. Working with a professional will provide personalised guidance and give you confidence in your dietary choices.
Managing stress through yoga, meditation, or simple deep-breathing exercises can help alleviate mood swings and anxiety, which are common during perimenopause.
Sleep disruptions are common during perimenopause, but establishing a bedtime routine and optimising your sleep environment can make a significant difference.
Oestrogen, testosterone, and progesterone (particularly micronised progesterone) are known to have a protective effect on the brain by supporting the production of key neurotransmitters such as serotonin and dopamine.12,13,14 When these hormone levels fluctuate, it can lead to a range of mood and cognitive changes, including irritability, depression, anxiety, insomnia, memory issues, decreased focus, and poor concentration. These symptoms can significantly disrupt a woman’s quality of life, impacting her health, career, and personal relationships.
Research shows that women in the perimenopausal stage face a markedly higher mental health risk, with a sevenfold increase in suicidal ideation compared to women in other age groups.15 Depressive symptoms are reported in up to 68% of perimenopausal women.
Those with a history of postnatal depression, premenstrual syndrome (PMS), or premenstrual dysphoric disorder (PMDD) may be particularly vulnerable to the hormonal shifts associated with perimenopause and menopause.
Psychological symptoms often intensify during the premenstrual phases of perimenopause and may persist into menopause and beyond. Common symptoms include:
- Irritability
- Heightened anxiety, particularly in the early morning
- Panic attacks
- Low mood
- Crying episodes
- Tearfulness
- Apathy
- Loss of confidence
- Reduced self-esteem
- Feelings of low self-worth
- Rumination
- Negative thoughts
- Suicidal thoughts
- Memory problems
- Poor concentration
- Brain fog
- Low motivation
- Insomnia
- Cognitive changes
Understanding the mental health impact of perimenopause and menopause is critical to ensuring appropriate support, timely intervention, and a more compassionate approach to care.
Redefining perimenopause for a new generation
For decades, perimenopause has stayed on the sidelines of women’s health. It’s rarely talked about and often misunderstood, even by those going through it. Many women aren't taught what to expect, and some doctors aren’t trained to recognise or support what they’re experiencing. That gap leaves too many feeling confused, dismissed, or alone.
And that silence has consequences. Without clear information, women may find themselves dealing with fatigue, mood changes, brain fog, or irregular periods without knowing why. It can lead to worry, second-guessing, and sometimes even misdiagnosis. Perimenopause isn’t just about shifting hormones. It’s about being able to understand your own body and feeling confident enough to seek support when something doesn’t feel right.
Thankfully, things are beginning to change. More women are speaking up, asking questions, and pushing back on the idea that they should just put up with it. The way we talk about ageing, hormones, and midlife health is starting to evolve. And that’s a good thing.
This phase of life shouldn’t be confusing or isolating. With better education, more open conversations, and the space to ask questions without hesitation, women can move through perimenopause with more clarity, support, and confidence. And they shouldn’t have to figure it out alone.
Dr Tash recommends that women speak with a trusted Family Physician/Healthcare Provider as soon as they notice any impact on their mental wellbeing. She also strongly encourages consulting a clinician with experience in menopause care.
It’s important to differentiate between symptoms driven by hormonal changes and those caused by other underlying factors. Dr Tash notes that she is fortunate to have the time in her consultations to speak in depth with patients, listen to their concerns, and identify what support they need.
Mental health support can take many forms. This might include lifestyle or workplace adjustments, access to reliable online resources, psychological counselling, or, when appropriate, medication. The key is offering women choice and tailoring treatment to their specific needs.
At Osler Health, patients are supported by a network of excellent professionals. As a family physician, one of her roles is to help patients navigate the healthcare system and connect them with the right specialists to ensure they receive comprehensive, supportive care.
This phase doesn’t need to be something women just get through. It deserves to be named, understood, and supported — both personally and publicly. Whether it’s recognising the signs earlier, seeking answers without hesitation, or advocating for better care, women should feel equipped to take the lead in their own health journey.
If something feels unfamiliar or uncertain, don’t wait to ask questions. Speak to your healthcare provider and share what you’re experiencing. Each of these conversations helps build a culture that listens to, understands, and supports women—not just during perimenopause, but throughout a woman’s health journey.
Dr Tash Mirando
Family Physician, Menopause Lead and Lifestyle Medicine Co-Lead
Osler Health International, Singapore
Instagram: @oslerhealth.sg
This article was produced by Healthful For You. The views and opinions expressed throughout are those of the authors and do not necessarily reflect those of the Professional Contributor. The Professional Contributor has provided input solely for the PROFESSIONAL INSIGHT and TIP segments, based on their professional expertise. These comments are intended to offer general guidance and may not apply to all individuals. Any interpretations or conclusions beyond that section are those of Healthful For You. This article is not a substitute for personalised medical advice, diagnosis, or treatment. Please consult your doctor or a healthcare professional regarding your specific health needs.
We hope you found this article informative. Healthful For You welcomes contributions from healthcare professionals, patients, and community members. If you have a story, research, or a perspective that can enrich our dialogue, please get in touch with us at [email protected].
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