April 10, 2025

Perimenopause is the transitional phase leading up to menopause, marked by fluctuating and eventually declining levels of oestrogen and progesterone. But what often gets overlooked is that our other hormones - notably testosterone, insulin, and cortisol - as well as neurotransmitters like serotonin, dopamine, and GABA, are also changing. If you haven’t heard the term neurotransmitter before, these are our hormonal messengers of the nervous system that control mood, reward, sleep, and emotional rationality, amongst other things.

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How long perimenopause lasts depends on the individual, but the average is about seven years. Some will experience longer or shorter transitions, from around four and up to ten years. It’s not that they are ‘struggling’ with symptoms or notice changes through that entire time, but this would mark the full hormonal evolution from premenopausal - so puberty, when your periods start - to postmenopausal, which is when a woman hasn’t had a menstrual period for a full 12 months.

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To start, I am going to run through what is actually happening with these hormones for you, so you can see how they all interlink with each other and how they immediately explain why many women will feel hopelessly overwhelmed by the fact that often they haven't changed anything, or actually will often be looking after themselves better, and yet their shape is changing in an unfavourable way. There’s nothing worse than feeling like your body is no longer your own, that the skin you’ve lived in for your entire life no longer fits like it did or responds to the switches you’ve always turned to in order to make yourself feel better. And it's for this reason I share videos like this - but also really encourage all my clients to tell me their actual pain points, rather than just the ‘health’ things they feel they should be more concerned about.

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So, what is going on with all these hormones then, and what are the implications for our metabolism, appetite, body mass distribution, and weight?

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1. Falling oestrogen levels affect where we store fat, shifting it towards the abdomen and making it more visceral fat - which is the internal kind around our organs - rather than subcutaneous fat, which is under our skin. This is why that weight shift can create more of an apple shape and feel very different to gaining weight earlier in life on the hips, bum, and thighs. It can feel quite hard and firm. We want to avoid this generally, as visceral fat is what we call “metabolically active” - it produces and interferes with other hormones itself, and that increases the risk of things like cardiovascular disease.

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2. Falling oestrogen also impacts how our body responds to insulin. Insulin is the hormone we produce to control our blood sugar levels, and it therefore decides how much of the energy we eat is used for fuel straight away and how much goes into storage. Perimenopause, like pregnancy, is characterised by increased insulin resistance, which means more energy can be diverted into fat storage if a woman isn’t careful about regulating her blood sugar stability.

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It’s blood sugar instability with insulin resistance that actually causes a lot of the anxiety-related symptoms during perimenopause as well, that are labelled as characteristically hormonal and often dismissed. Or, they're described antidepressants. And this infuriates me, as they can be easily supported and remedied so women don’t need to suffer!

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3. The next layer on this is an increase in cortisol - our long-lasting stress hormone - levels. Now again, this has a couple of points of significance about it.

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Firstly, increased cortisol will make us more emotional, more easily overwhelmed, more likely to crave quick energy from sweet foods, and, to cap it all off, interrupt our sleep as well. As we are also seeing progesterone levels fall, sleep is hit from another angle, as progesterone is our natural sedative. Many women will experience early waking as a sign of their progesterone levels initially declining, but this I will talk about in another video! Poor sleep will always make us wake up with higher blood sugar and higher insulin the next day and then see those blood sugar levels go up and down more for the next 24 hours, and hey presto - again we are moving towards increased fat storage because the body cannot discern that this internal stress is not a lack of food or risk to our survival, so it starts making a rainy day energy fund… in one central tyre around our middle, just in case.

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The second key thing is that the presence of cortisol will mean we need to produce three times the amount of insulin to control blood sugar, as opposed to if cortisol wasn’t present. So if we think about this layering onto the disruption of insulin by falling oestrogen levels, we can start to see how that shift towards fat storage can easily happen.

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If at this stage you’re thinking, ‘Christ, it looks pretty hopeless’ - do not fear! I have all the tricks up my sleeve for you to use to overcome all of this, and we will get there soon!

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4. Now we come to relative body composition and the impact of lowered oestrogen on our muscle mass. For everyone, male and female, age is associated with a progressive loss in muscle mass and bone mass potentially. If allowed to, then lowered levels of oestrogen will accelerate muscle mass loss, and this we absolutely want and need to stop in its tracks.

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Muscle is our metabolic engine. I think of it like a collection of little furnaces dotted all around the body. If we hold more muscle and we activate it on a regular basis, it will offer a sponge-like sink for blood sugar, soaking up anything extra circulating around. It is also going to be actively burning energy even when it is not moving, as opposed to fat, which sits there, taking up space and often producing hormones itself that disrupt our system.

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When people refer to metabolism slowing as we age, this is not a given - it is only going to happen if you allow your muscle mass to fall. And we aren’t going to do that! But this is where nuance during perimenopause is needed, as we are talking about a system that is seeing monsters everywhere, so exercising for muscle mass maintenance needs to be done with a level of care to avoid pushing an already overwrought system further into the swamp. And this is where lots of women will struggle, as they increase their exercise, decrease their food, and wonder why their weight gain actually increases rather than slows. More on this in a second. I'm just going to finish my list first!

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5. The last bit is to touch on regulation of appetite. And again, in swoops low oestrogen, which can increase levels of ghrelin, the hormone that makes us feel hungry. Ghrelin makes our stomach growl, which is how I remember it, whilst also reducing leptin, its opposite partner - the hormone that makes us feel satisfied. So here we need to look at really harnessing the satiety index of foods we are eating. I have done a full video on hacking the food matrix for weight management, which goes into this in more detail. Oh, and we couldn’t forget about the fact that low progesterone is very much linked to lower or more erratic moods, which can then cause hedonic eating - eating for emotional reward and pleasure rather than the need for fuel - which will further distort our hunger and fullness cues.

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And with that, the explanation ends! Now let’s talk about overcoming all of these bits.

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First and foremost, we have to create a sense of stability and security for the body. All of this internal shifting is singing a song of high stress and if your system perceives risk all the time, it’s going to live in that high cortisol, high insulin state, and your metabolic gear stick shall remain stuck in storage mode. 

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If you imagine your stress response as a light switch, perimenopause creates a situation where your finger is constantly on the switch just waiting to quickly flick you into that heightened stress state. So smaller things that wouldn’t have previously caused you an issue, and things that may not negatively impact other members of your family or your friends will now work strongly against you. 

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So, if I was reworking your routine, where would I start?

Stimulants - coffee is a really counterproductive inclusion. I encourage all my clients to switch to matcha or ceremonial cacao instead of coffee, and to try to save these until after they have eaten. Pair this with an increased level of focus on optimal functional hydration to support the adrenal system and your stress response. Take your body weight in kilograms and multiply it by 0.04 to get your daily water requirement in litres, and then add a pure electrolyte concentrate to all that water. I recommend using the Oshun product - nothing with sweeteners, additives, or 1000mg of sodium.

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Alcohol - again, hugely counterproductive for a couple of reasons, and many women will actually find their tolerance to alcohol massively drops anyway during this period. Alcohol will distort hunger signals, turning off that satiety response and increasing the snacking-style urge for crunchy, salty, sweet, and sugary foods - the ‘high calorie to low satiety’ group we really want to avoid. It will also cause blood sugar levels to peak and then fall further, triggering that insulin issue. To cap it all off, it prevents us from producing melatonin properly, which impacts sleep, delaying sleep onset but also making us wake earlier - which, as I’ve said, is a negative feedback loop we are already trying to break. If alcohol is part of your social wind-down and you don’t want to avoid it totally, then don’t drink on an empty stomach, avoid very sweet cocktails or mixers like tonic water, and try to stop drinking at least 2-3 hours before you want to go to bed.

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Stimulus from technology - this is a modifiable element that will make a huge difference. Scrolling on your phone before bed will now have a much greater impact on your ability to sleep well and work against you. No phones, tablets, or laptops at least 2 hours before bed, and definitely none in bed with you. Spending long periods of time on technology during the day without going outside and interacting with nature will do the same thing - raising stress hormone levels, creating a sense of overwhelm, and enhancing that state of perceived risk. Aim to take 5-10 minute fire-breaker breaks every 1 ½ to 2 hours to allow your system to come back from the edge. Pair this with gentle movement, like walking, to activate muscle tissue for that metabolic enhancement.

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Activity - I want the mantra here to become consistency over intensity. Think about your system like a nervous deer. You can calmly walk towards it, hands outstretched, and find it doesn’t run away. But bound towards it, and it’s going to think it’s being attacked and run a mile. It’s that ‘easy to scare’ sense we want to avoid, as that is what triggers the switch into guarding and storing fat, mood instability, et cetera.

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Running, spinning, endurance cardio, and HIIT cardio are all out, which I know can be a leap, as many professionals will say you’ve got to do these for your cardiac health. Post-menopausally, yes - not right now. Switch to walking in a weighted vest or with wrist weights, being mindful of any back, knee, hip, or ankle issues. Here, you get sustained work that is stressing and making your muscles active, but you aren’t triggering your stress response. I would suggest getting up, making a cacao, having water with electrolytes, and then heading out with the vest on for 20-30 minutes. Stride with purpose, but don’t feel you need to race. Then, come home and have breakfast. On the other days, add in something like yoga, Pilates, or bodyweight training - never fully fasted. Then, over the day, make sure to pepper in activity - a 15-20 minute walk at lunch and again in the evening. This will also help sleep. Some days, you could just go for a gentle walk in the morning but do a lower-intensity class at lunch. Resistance training is anything that increases burden on your system by about 25%, so resistance bands, bodyweight, and light dumbbells are all brilliant. Heavy, heavy weights often overdo things and create bulk, which women don’t like. And also prevent them burning fat.

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Sleep - this needs to become a priority. Create a non-negotiable routine that your body can rely on. Set a standard bedtime and wake-up time, the same for weekdays and weekends, and be aware that you will naturally need about 1 to 1 ½ hours more sleep than a male equivalent, and more than you were potentially used to having previously. The average ideal bedtime for a woman is 9.30pm, whereas for a man, it’s 10.30-10.45pm. Get used to loving going to bed early. If sleep is a struggle, try a magnesium bath around 7.30-8pm, eating earlier in the evening, using candles at dinner rather than overhead lighting, and consider magnesium bisglycinate, 5-HTP, and/or CBD oil as therapeutic supplements to support sleep quality.

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Okay, and what about what we should be eating?

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Many will focus on calories and ignore the relative satisfaction we get from different foods. Low-carb diets are the enemy of weight management for women generally, but especially in perimenopause, as in their absence, we will crave fats, sweets, and snack foods. It is much better to include whole-food carbohydrates at meals, turn off hunger, and avoid picking and grazing.

Fasting is absolutely out, as this will be perceived as an additional stressor. However, creating a well-timed routine of eating and then not eating is helpful to allow insulin levels to drop, and you can burn fat in those periods. This is not about denying hunger - it’s about eating to satiety, then having a break. 12-14 hours between dinner and breakfast the next morning, then 3 ½ to 4 hours between meals. Try to start eating earlier and then finish eating earlier, as opposed to the other way around.

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In terms of what meals should look like:

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Breakfasts - always savoury. Opt for root vegetables as your carbs and what we call high anabolic proteins. So meat, fish and poultry as these are high satiety and will stabilise blood sugar. Pair with fibrous vegetables and a little bit of healthy fat. 

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So you could make a hash, with grilled chicken breast, boiled new potatoes, steamed kale and tenderstem broccoli. Warm in a pan, add some lemon juice then drizzle a tablespoon of tahini over the top.

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Or you could sauté turkey mince with garlic and onions, roasted parsnips, wilted spinach, and serve with avocado, lemon & a drizzle of olive oil. Or make the mince into little patties that you could warm up over the week.

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On another day you might have leftover steak from the night before with eggs, roasted butternut squash and beetroot, sauteed cabbage and green beans, with pesto or chimichurri over the top. Or just eat the leftover from the night before in the morning.

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Lunches - follow a similar theme to breakfast. I like options that are easy to prep for a few days like sandwich or baked potato filling, or making all in one style options that use a grain, lots of lovely vegetables, a protein and a yummy sauce that actually get better being in the fridge for a few days. 

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Examples might be:

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A bowl with grilled salmon with roasted beetroot, carrots and cumin, grilled courgettes and hummus. All prepped at the weekend then just assembled or packed up. 

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You could also do something like a tin of salmon or mackerel, mashed with a tbsp yoghurt or cottage cheese, olives, chopped up steamed spinach, broccoli & parsley. Make a few portions and have in a sandwich, pre-baked potato or use crunchy whole grain crackers to eat like a dip.

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Or you could do something like a stir fry with cooked and cooled rice, prawns, tofu, mixed vegetables and topped with chopped nuts and some lime juice. 

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With snacks, it's about planning these in and picking savoury whole food choices rather than mindlessly grazing on stuff. So something like yoghurt with cooked fruit and seeds or cacao nibs, one or two boiled egg with a handful of almonds or edamame beans. Or maybe some crackers with cottage cheese or tzatziki and radishes or tomatos, something like that. You could also experiment with a baked good that is made with cooked vegetables, protein powder and raw cacao, kind of like a sweet potato brownie sort of thing, if you are getting cravings for sweets. 

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For dinners, we tend to go for lighter proteins with grains to support sleep and also gut transit. So scrambled eggs with smoked trout paired with cooked quinoa tossed with roasted aubergine, peppers and olives. Or something like grilled prawns or chicken breast, whole grain pasta, kale, mushrooms, peppers and pesto. Or maybe a lentil and lean beef bolognese made with lots of vegetables like squash, mushrooms, cabbage, celery and fennel, served in a baked potato.

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I’m hungry now!

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I hope you found this video helpful, do leave a comment if you did or if you have a question. More information on my clinical services and everything I do can be found at lieblinghealth.com. I will see you next time!

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