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How a Nutritionist navigates Perimenopause

Updated: Dec 8, 2023

Normally I write my blogs with ease and a comfy confidence. So why has it taken me weeks to finally sit down and write this one?

Imposter syndrome. That’s right – we can not move without seeing experts from all backgrounds talking about the perimenopause and menopause.

It seems EVERYONE is an expert. The cynic in me has even muttered to myself on numerous occasions something along the lines of ‘oh, another one jumping on the bandwagon’.

And when you are suffering from perimenopausal random days of decreased confidence and increased anxiety it is very easy to see all the stuff from ALL THE EXPERTS and think you don’t have anything to add.

BUT – I have had a word with myself and reminded my nearly 48-year-old arse that I am MORE than qualified to talk about it.


  • Because I am living and breathing it every single day (do not get me started on the 25-year-olds talking about how it feels to be perimenopausal)

  • Because I am managing to reduce the symptoms using my knowledge about nutrition and lifestyle – I am my own experiment and, so far, a fairly successful one at that

  • Because I am surrounded by lots of lovely friends going through exactly the same lifestage who are experiencing their own unique set of symptoms (indeed topic of the hot-tub weekend with school friends was how much one friends HRT patch would be leeching into the water for us all to share).

  • Because I’m able to access some pretty amazing functional tests which help you understand not only IF you should consider HRT, but if you do, how to manage your nutrition and lifestyle to best benefit from it (more on that later)

SO – here I am, sharing (possibly my first of many)......

‘Perimenopause 101’

(1) Work on balancing your blood sugar like your life depends on it

Ok, I know I talk about this A LOT. But, trust me, this becomes one of the most important weapons in your arsenal when it comes to this life-stage.

There are many reasons why this is my number one tip. Firstly, oestrogen helps us utilise our insulin better. It helps us take glucose from the carbohydrates and sugar we eat out of our blood and into our cells where we use it for energy.

During early perimenopause our oestrogen is ALL OVER THE PLACE. It experiences highs and lows like no other time in our life, before finally hitting the floor as we actually menopause (this is 12 months after our last period). Take a look at this picture from one of my favourite female health writers, Lara Briden:

So – as our oestrogen is all over the place, the efficiency of our insulin to help us balance blood sugar is similarly erratic. This can lead to a lack of energy, mood swings, anxiety and generally feeling rubbish.

Unbalanced blood sugar also adds fuel to the fire that is abdominal weight gain during perimenopause. Even ladies who have never had a belly, or who are overall very slim, can start to notice a change to their body shape.

Researchers believe this is because after menopause our fat cells make oestrogen in small amounts to try to compensate for the lack of production from our ovaries. Fat cells around our middle are more efficient at this production of oestrogen than fat cells anywhere else on our body.

So, if we keep releasing more and more insulin to keep up with a blood sugar that is too high, the insulin sees an opportunity to store our spare glucose as fat around our midsection. Quite clever really….but rarely desirable!

In the longer-term, unbalanced blood sugar can lead to many undesirable health consequences like insulin resistance, type 2 diabetes, high cholesterol and a higher risk of heart disease and dementia.

Take a look at my blog on balancing blood sugar here.

(2) Look after your liver

I feel sorry for our livers. They are very misunderstood. We really don’t appreciate what they are trying to do for us when it comes to hormone balance.

Basically, like most things, we want to use our hormones and then lose them. To do this, our liver has to ‘metabolise’ (i.e. breakdown) every single hormonal molecule we create. Then, much like a production line of Christmas gifts, it packages them up ready to be transported out via our gut into our poo.

But we can really get in the way of helping our livers do this. First of all, we don’t always give our livers the nutrients they need to work properly. Not many of my clients eat sufficient levels of leafy green vegetables or protein to provide crucial nutrients for liver health.

Secondly, our liver MUST deal with any toxins we present it BEFORE it gets to our hormones. So every time we drink alcohol, our livers deal with this first, leaving an unruly line of erratic hormones waiting to be broken down and most likely getting re-circulated in our bodies…contributing to the peaks and troughs we are already experiencing. Mayhem.

It really is a cruel fact of life that just as we are dealing with the stresses of teenagers, elderly parents, work/money responsibilities and hormone craziness we can’t even enjoy a glass of wine without contributing to our problems.

Other toxins matter too – whether that be exhaust fumes, particular chemicals we are exposed to in a working environment or chemicals from the personal care or cleaning products we use. Now is the time to go as natural as possible with these types of products if you can.

(3) Deal with those niggly gut problems

If you’ve always had a tendency to constipation or diarrhoea, acid reflux or bloating, but it’s not been bad enough to focus on fixing it – may I suggest now is the time.

Firstly, we do not want our liver to go the trouble of wrapping our used hormones up so they can safely travel to our gut and out in our poo only for us to be constipated and for them to sit around dissolving in our gut. This wrapping is not that secure – think of the flying saucers you used to eat as a kid….a little bit of liquid and that wrapping will melt….only this time in your gut. Again, we don’t want these used up hormones to be re-circulating in our blood stream and adding to the crazy rave already going on.

Secondly, the health of our gut bacteria is super important in perimenopause. Too many of the bad-guy bacteria can impair our ability to breakdown our crazy peaks of oestrogen and contribute to heavier periods and sore boobs. In later perimenopause, dysbiosis in the gut microbiome can contribute to the health of our vaginal microbiome and symptoms of dryness and irritation.

It is also really important that our stomach acid is working well to maximise the nutrients we are getting from our food which are feeding our liver. Now is the time to get to the root cause of that irritatingly frequent acid reflux or indigestion and don’t just rely on Gaviscon.

(4) To HRT or not to HRT? Find out what is right FOR YOU

It has surprised some of my friends that I am absolutely not anti-HRT. I will not rule out exploring my options if I get to the point where I think I need it.

If you take HRT and feel better for it, that's great. You have nailed the right dose and timing for your body.

BUT – what I have seen in practice are many women who’ve gone on HRT during the early stages of perimenopause only to feel worse.

Think about it – if our oestrogen is all over the place, when that is peaking at levels we’ve never seen before, do we really want to add more of it? NO! Yes, progesterone is gradually declining, but in the UK at the moment the NHS do not prescribe progesterone on its own. In latter perimenopause, it is also possible that we need testosterone more than other hormones, but again, this is not routinely prescribed.

In an ideal world, I suggest that before you go on HRT you test both your genetic predispositions AND what your current hormone levels are doing via a urine profile (DUTCH test). If you are already on HRT these can still be really useful.

Why? I’ll use myself as an example. I know that my genetics lend themselves to metabolising oestrogen in a less than favourable way. Bear with me here….

There are three main routes by which your oestrogen is metabolised in our bodies. My genetic variances mean that my body naturally prefers the route that is the most inflammatory. Metabolising oestrogen down this route can lead to more inflammatory ‘waste products’ called semi-quinones, which can damage DNA and lead to cancer.

Scary stuff – yes. But – because I know that, I can do something about it. A diet rich in flavonoids and resveratrol such as berries, red cabbage, kale, and dark chocolate (shame) encourages my body to process oestrogen down one of the other pathways – magic!

It will also be a factor in my decision to take HRT or not – if I’m putting more oestrogen in, I need to be sure I’m eating my bodyweight in blueberries (etc!) every single day. Obviously, it’s a bit more complicated than that, but you get the idea. Nutrigenomics only tells you about the things you can influence with diet and lifestyle, so why would you not want to know?

Testing your current levels of hormones and how you metabolise them can be done via something called a DUTCH test. You take samples of urine over a 24 hour period. This enables you to understand what might be driving your very unique perimenopausal symptoms and therefore what you should focus on to manage them. It does also show you which pathway you metabolise the most oestrogen through. This is infinitely more useful than testing your hormones through blood tests as it shows what is actually happening to them in a more holistic way.

To give you an idea of cost - both of these tests cost around £200-£300 depending on the level of detail you require. An investment - yes, but potentially a very worthwhile one.

And as a last leftfield thought on this for now, there has been an increase in vets seeing dogs and cats with symptoms caused by absorbing HRT gels and creams from their owners – so take care not to get any HRT near Fido & Felix if you are using it!

Final thoughts for now…..

There are numerous symptoms and as numerous supportive foods and supplements that can help you address your unique perimenopausal experience.

I don’t like to broadly recommend supplements on my blogs because there are SO MANY interactions with regularly taken medication that you really must seek advice from a qualified health practitioner before taking any new supplements.

However, alongside magnesium and a decent B-complex, there is one supplement that does deserve special mention that has really helped my anxiety and mood – Saffron. I particularly like the products from the Naked Pharmacy. But please please please check with your doctor before taking it if you are on any medication.

There is obviously so much more I could say on Perimenopause (I seem to be over the Imposter syndrome….) so let me know what you’d like to know more about specifically and I’ll do some more blogs on this in the future.

Meanwhile, if you’d like to get in touch for a no-obligation chat about how I may be able to support you during your perimenopause journey, or if you’d like more information on nutrigenomics or the DUTCH test please drop me a message.



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