@nourishingapothecary: You can still have regular periods, normal hormone blood tests and be experiencing perimenopause. This is something I wish more women understood, particularly those in their late 30s and 40s who are beginning to notice changes in their bodies. Perimenopause is the hormonal transition leading up to menopause, and one of the biggest misconceptions is that it involves oestrogen gradually declining in a straight line. That’s not what happens. During perimenopause, ovarian function becomes less predictable, and hormone levels can fluctuate considerably. Oestrogen may be relatively high during one cycle and much lower during another. Ovulation can also become less consistent. And this matters because progesterone is primarily produced by the corpus luteum after ovulation. When ovulation becomes less predictable, progesterone production can become more variable too. This changing hormonal environment helps explain why symptoms can fluctuate so much from month to month. One month you might feel completely normal. The next, you’re waking at 3am, experiencing night sweats, feeling unusually anxious or noticing that your PMS has become significantly worse. And here’s something particularly important. Perimenopause doesn’t necessarily begin with irregular periods. Some women continue having apparently regular menstrual cycles while experiencing symptoms associated with the hormonal transition. Others notice their cycles becoming shorter, their bleeding becoming heavier or their periods becoming less predictable. But what about blood tests? This is where understanding the physiology becomes important. FSH, or follicle-stimulating hormone, is released by the pituitary gland and helps regulate ovarian follicle development. As ovarian function changes, FSH can become elevated. However, FSH and oestradiol can fluctuate substantially during perimenopause. You might have elevated FSH during one cycle and a result within the reference range during another. Similarly, oestradiol may be relatively high or low depending on the timing of the test and what is happening within that particular cycle. So a single blood test doesn’t necessarily tell us whether someone is experiencing perimenopause. In women aged 45 and over with typical symptoms, assessment is generally based on clinical history rather than routine hormone testing. For women aged 40 to 45, hormone testing may sometimes be useful alongside symptoms and menstrual history. And symptoms suggesting menopause before 40 require further medical investigation. Another important point is that not every new symptom in your 40s should automatically be attributed to perimenopause. Changes in thyroid function, iron deficiency, medication effects, sleep disorders and other medical conditions can produce overlapping symptoms. Heavy, prolonged or unusual bleeding should also be investigated rather than simply dismissed as hormonal. This is why I think understanding perimenopause requires much more than checking whether your oestrogen is low. We need to consider your age, menstrual history, sleep, symptoms, general health and whether other conditions could be contributing. And importantly, there are evidence-based treatment options available, including menopausal hormone therapy for appropriate patients, alongside individualised lifestyle and symptom management. Perimenopause is a normal biological transition, but that doesn’t mean you need to simply tolerate symptoms that are affecting your quality of life. At Nourishing Apothecary, our perimenopause naturopath Toni supports women navigating perimenopause, menopause, hormonal changes, sleep disturbances and metabolic health. We offer consultations in Liverpool and Australia wide via Zoom. Book a free discovery call to find out which practitioner is right for you. www.nourishingapothecary.com #perimenopause #menopause #womenshealth #hormonalhealth #naturopath

Jaime | Naturopath & Homeopath

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Sunday 25 October 2026 21:17:16 GMT