Perimenopause isn’t just about hot flashes and mood swings. From joint pain to brain fog, this stage of life brings a host of changes — but with the right exercise, nutrition and self-care, you can hopefully navigate this transformative period with confidence.
As part of our #madetomove campaign, Living360 conducted a survey to uncover the barriers faced by women when it comes to exercise and nutrition.
The response was overwhelming: readers told us they wanted to know more about perimenopause.
To help, we’ve put together an expert-led guide, drawing on insights from somatic therapists, nutritionists and gynaecologists, so you can move, eat and care for yourself with confidence during this pivotal stage of life.
Read more: Perimenopause vs menopause and everything you need to know about ‘the change’
What is perimenopause? Symptoms every woman should know
Perimenopause marks the transition towards menopause, typically starting between ages 45 to 50. However, you can go through early perimenopause.
Fiona L Smith, somatic therapist and women’s coach, explains: “Perimenopause is a period of significant change in a woman’s body, mind and nervous system. Hormone fluctuations during this time can cause a wide range of symptoms, some well-known and others less recognised.”
The ‘classic’ symptoms that most of us recognise include hot flashes, night sweats, irregular periods, mood swings and weight gain.
Fiona adds that often-overlooked symptoms include: “Tendon problems, such as frozen shoulder, joint pain, dizziness, brain fog and memory lapses. Women are sometimes offered anti-depressants for anxiety or mood swings instead of recognising that perimenopause may be the root cause.”
Neuroscientist Dr Lisa Mosconi’s research further explains the cognitive changes, with Fiona explaining: “During perimenopause, parts of the brain literally undergo a pruning process and have less energy available. This explains why mental fatigue, difficulty concentrating and the loss of our multi-tasking superpowers are also very common during these years.”
How to exercise safely during perimenopause
Movement is essential during perimenopause, but respecting hormonal rhythms maximises benefits. Elentay Alcock, expert nutritionist, says: “Exercise becomes especially important during perimenopause, in order to support bone density, cardiovascular health and mental wellbeing.”
Expert tips for aligning exercise with your cycle:
- High-energy phase (ovulation): resistance training or brisk cardio to support metabolism, muscle mass and bone density.
- Low-energy phase (pre-menstruation): gentle, restorative movement like walking, yoga or tai chi to protect joints and prevent burnout.
Read more: Experts say this is how you should be exercising at each stage of your menstrual cycle
What to eat during perimenopause for hormonal health
Supporting your body with the right foods can help ease perimenopausal symptoms. Elentay advises:
- Progesterone support: Eggs, pulses, nuts, seeds and whole grains, especially before menstruation.
- Brain and joint health: High-protein, fibre-rich, anti-inflammatory foods help stabilise blood sugar and cortisol.
- Phytoestrogens (plant-based compounds, similar to oestrogen): Flaxseeds, fermented soy, red clover and sage can gently support oestrogen balance.
- Gut health: Pre- and probiotic foods like kefir, sauerkraut and yoghurt could help optimise hormone metabolism.
- Hydration: 1.5 to 2 litres water daily helps regulate temperature, metabolism and cognitive function.
- Limit triggers: Reduce alcohol, caffeine and spicy foods to help manage hot flushes.
Some women experiment with intermittent fasting aligned with their menstrual cycle, but anyone considering this should consult a healthcare professional.
Read more: This is what you should be eating at each stage of your menstrual cycle, according to the experts
How to care for your mind and body during perimenopause
Jo Lothian, founder of wellbeing platform The Happy Reset, highlights that rather than waiting for symptoms to spiral, early self-care is critical. This includes prioritising seven to nine hours of quality rest per night, regular yoga and Pilates to help regulate mood, and daily nervous system resets to help prevent chronic stress.
To help regulate your nervous system, Fiona recommends the below easy somatic practices:
- ‘The physiological sigh’: Inhale fully through the nose, take a short ‘top-up’ inhale, then exhale slowly through the mouth. Repeat two to three times to calm your nervous system.
- Grounding and orientating: Pause and feel your feet on the floor. Slowly scan your environment with your eyes. This signals safety to your brain and reduces stress.
- Fascial shaking: Stand with soft knees and gently bounce, letting your shoulders, arms, hips, and spine shake naturally. This releases tension stored in connective tissue and restores energy.
When combined with nutrition and movement, self-care strengthens resilience and emotional balance.
Perimenopause and HRT
Hormone Replacement Therapy (HRT) for perimenopause replaces declining oestrogen and progesterone to help relieve symptoms like hot flashes, mood swings and sleep problems by restoring hormone levels. It’s taken using patches, gels, sprays or tablets and can significantly improve quality of life while also preventing osteoporosis.
For some women, bioidentical HRT can be transformative. Fiona notes: “When combined with somatic practices, cycle-aligned exercise and nutrition, HRT can be transformative. Expert guidance ensures an individualised approach based on lifestyle, symptoms and overall health.”
Nutrigenomics involves looking at how your diet works with your body’s individual biology — it can also guide personalised nutrition, supporting hormone metabolism and mood. Jo says: “Understanding how your genes influence stress processing, detoxification and hormone metabolism gives women practical ways to support their mood and energy, as well as autonomy and knowledge as to whether HRT is the right choice.”
To find out about your nutrigenomics, you can take a genetic test by ordering a kit online (for example Savoir Fayre), providing a saliva or cheek swab sample, and sending it for analysis.
Read more: Menopause treatments to discuss with your doctor: from HRT to non-hormonal options
Perimenopause red flags to look out for
Dr Prabha Sivaraman, consultant gynaecologist at the The Manchester Deansgate Clinic, says that while perimenopause brings natural changes, some symptoms should never be ignored.
These include:
- Sudden changes in menstrual patterns, including heavier or irregular bleeding
- Bleeding between periods, after sex, or post-menopause
- Persistent fatigue, palpitations, or breathlessness (this may indicate anaemia)
Regular cervical screenings remain essential, as missed tests are a major risk factor for late diagnosis of cervical issues.
Feature image: Canva
