Skip to main content

What exactly is perimenopause?

Nutritional expert Emma Bardwell explains the symptoms, and advises on the supplements & strategies to support the transition...

What exactly is perimenopause and how do we know whether we're in it on not? These are the first questions and so many more follow!

So we talked to Emma Bardwell, a registered nutritionist, health writer and author of The Perimenopause Solution.

"My interest in perimenopause and menopause began when I started experiencing symptoms myself some 10 years ago, but found there just wasn’t enough evidence-based nutrition information to hand", says Emma."So I decided to educate myself and become the go-to source for reliable, actionable information that works. Fast forward to today. I blend nutritional science, diet therapy and behaviour change, alongside a generous helping of understanding, to get to the heart of what you need."

Emma's Instagram is a great follow for lots of free recipes and evidence-based info. She has also launched a new community subscription platform The M Collective which lifts the lid on menopause with a host of experts, live Q&A's, resources and support.

Here we ask Emma how to identify perimenopause - the symptoms, strategies and supplements that can support the transition...

I want the menopause transition to be celebrated, not feared...

What is perimenopause and how does it affect women? 
Thanks to the ‘Davina effect’ most people have now heard of menopause, which is when your periods stop for good and you no longer ovulate. The average age here in the UK is 51 but it’s important to note that Black, south Asian and Hispanic women often experience it a couple of years earlier.

Perimenopause is the time leading up to menopause. It signals that your hormones are starting to decline and can last anything from a few months to over a decade. That means many women will start to experience perimenopause symptoms as early as their late thirties or early forties - sometimes earlier. 

Most people talk about menopause when they actually mean perimenopause. For me it’s the most important stage to really be empowered and clued up about. If women were informed and prepared, I don’t think we’d have the issues we currently have with women leaving work and being absolutely floored by their symptoms. It’s the main reason I wrote my book The Perimenopause Solution, I wanted women to be armed with evidence-based knowledge and to have the tools to support their transition through to menopause.

How does someone recognise if they are entering perimenopause? What changes will they see in their physical health and mental wellbeing? 
So how do we know when we’re in perimenopause? The honest answer is, quite often we don’t. It’s not really talked about much and it’s very often put down to stress, getting older or the demands of family life or a full-on job. Some signs you might want to look out for though is that your periods can become more erratic. They might get further apart, or you might find you have 2 very close together. Some women will skip a few cycles and then find that everything becomes regular again. You might get lighter bleeding some months and then incredibly heavy cycles during other months. Or your periods might stay exactly the same. The truth is, we’re all different and every woman will have a very unique perimenopause journey. It’s important to note you can have regular periods and still be perimenopausal. 

We actually have hormone receptors all over our body, especially when it comes to oestrogen, so when levels dip during perimenopause we can feel the debilitating effects everywhere - including our brain, heart, skin, bowel and bladder. This is why symptoms of perimenopause can be so wide-ranging: from the psychological such as mood swings, joylessness and loss of confidence, right through to the physical effects like heart palpitations, joint pains, acne, thinning hair, weight gain, vaginal dryness and low libido. The lesser discussed ones include burning mouth syndrome, tinnitus, lack of spatial awareness, pins and needles in the feet and hands and a condition called formication which feels like insects are crawling under your skin.

Do you recommend any perimenopause supplements/ treatments that will help support one hormonally in their 40s?
I recommend all women try to get some basic bloods done: ferritin (iron), B12, folate, vitamin D and folate. If these are sub-optimal women can be left feeling low, tired and flat. Thyroid health is also important at this time of life and many of the symptoms mimic those of perimenopause: thinning hair, fatigue, weight gain, insomnia, anxiety and irritability, so if women can get their thyroid levels checked at the same time as their baseline bloods, even better.

I try not to recommend blanket supplements as everyone is so individual but there are a few basics that I think most women benefit from. Everyone needs a Vitamin D (ideally with a K2 as this helps with bone health) as we can’t get enough from food alone and some omega 3 if they’re not eating two portions of oily fish a week. For vegans/vegetarians who don’t eat fish, invest in an algae oil like Vim & Vigour by Bare Biology. 

A good B complex (containing all 8 B vitamins) can be beneficial for energy levels and healthy hormone synthesis, while magnesium very often helps with things like sleep and restless legs, particularly if taken before bed. Look for a glycinate variety as it’s well absorbed and aim for around 350mg. Creatine monohydrate is also deserving of a place in a perimenopausal women’s stack - it helps with muscle building and exercise performance and emerging science suggests it may also help with cognition. 

This isn’t nutrition or supplement related but carving out regular quiet time for yourself is so critical to good mental health and many women aren’t very good at giving themselves time out. Putting boundaries in place and being able to say ‘no’ to things you simply do not want to do is liberating at any time of life but especially during perimenopause when really you just need to be focusing on yourself as much as you can. Lots of my clients don’t enjoy meditating (it’s not for everyone!) so I tell them to make sure they weave pockets of silence into their day to keep their mental health in check. A solo walk in the park or a bath and a book are the best therapies for a frazzled mind. 

What foods are good for perimenopause? Please share your expert-approved nutrition guide for perimenopausal women.
Blood sugar control is crucial to help with mood, energy, sleep and weight management. It’s often overlooked but is a really quick fix for most women. Start by ensuring every meal includes what I call the key 3: protein, fibre and fats. Having all 3 of these on board slows down the release of sugars and helps you maintain a steady glucose state. This is most important at breakfast because starting the day right means you stay on this nice even energy buzz. Traditional breakfast choices like toast with jam, cereal, orange juice aren’t doing us any favours. A better choice would be Greek yoghurt or soy yoghurt if you’re vegan - they both have decent levels of protein - plus a tablespoon of ground flax for the fibre and a little nut butter for some healthy fat. Add in some berries for antioxidants and some extra fibre plus some sweetness and you have a pretty unbeatable start to the day. 

I follow the same principle for lunch. I ask my clients to fill in food diaries before our consultations and I see a lot of soup and salads or sandwiches for lunch. These women invariably feel shattered around 3 or 4pm because they haven’t had enough protein. Soup and salad is fine but add in some protein: some tofu or one of those pre-cooked mackerel fillets or some lentils.

Calcium is crucial for bone health. You need 700mg a day if you’re under 50 and 1200mg if you’re over 50. You can get it from dairy, fish with small bones (such as sardines), fortified plant milk (check the label), broccoli, figs, kale, sesame seeds and figs.

You don’t have to be vegan but a plant-focused diet is really helpful for the antioxidants that mop up free radicals that can damage cells and accelerate ageing. Fibre is the unsung hero of the nutrition world. It keeps our digestion regular (constipation can be a problem during perimenopause) and it feeds the trillions of bacteria that reside in our gut. Good gut health has benefits throughout the body and impacts every organ. It can affect mood, brain function, skin and heart health.

Healthy fats are needed to make hormones but also for a strong skin barrier (which women often find gets compromised at this time due to a lack of oestrogen) and to absorb certain vitamins: A, D, E and K all of which play a key role in skin health.


For more visit and follow @emma.bardwell