Navigating a healthy perimenopause

In this insightful piece, Fiona L Smith explores perimenopause as the ‘autumn of life,’ offering practical guidance and hope for women navigating this transition.

Photographs: Pexels

Text: Fiona L Smith

September signals the shift into autumn as the long, light-filled summer days shorten and Nature prepares for cooler, darker months. A woman’s life mirrors these seasonal rhythms, and perimenopause – the transition leading to menopause – is often described as the ‘autumn’ of life, much like the pre-menstrual phase is the autumn of our monthly cycle.

Perimenopause is a time of change, sometimes painful, sometimes freeing. In Japan, menopause is called the Second Spring – a new beginning where women can step more fully into themselves, free from earlier roles and expectations.

The body and brain in transition

The discomfort of this stage extends far beyond hot flashes. Many experience tendon issues, joint pain, weight gain, dizziness and brain fog, often unrecognised as hormonal in origin. Research by Dr Lisa Mosconi shows that during perimenopause, parts of our grey matter undergo pruning, reducing energy in the brain. The result: fatigue, forgetfulness, difficulty concentrating, and the loss of our multi-tasking ‘super power’.

This doesn’t mean deficiency or disease. Like a caterpillar in its cocoon, old structures must dissolve before the butterfly can emerge. Patience, compassion, and self-care help us move through this transition. Studies across Australia, the UK and Denmark show that many post-menopausal women report greater independence, more satisfying relationships and often feel happier than before.

Supporting the nervous system is vital, as it governs stress response, hormone balance and emotional regulation. When it’s dysregulated, symptoms like anxiety and fatigue worsen. Gentle movement, strength training, micro-pauses, and proper breathing all help signal safety to the body. Sleep is equally crucial: it repairs, consolidates memory and regulates hormones. Poor sleep magnifies brain fog, reactivity and discomfort.

Nutrition also plays a key role. Hørsholm-based health coach Simona Morandi highlights three groups of nutrients that support hormone production, brain function and joint health:

Protein – lean meats, eggs, legumes, Greek yoghurt.

Fibre – vegetables, whole grains, flaxseeds, legumes.

Anti-inflammatory foods – fatty fish, berries, turmeric, leafy greens, olive oil.

Reducing caffeine and alcohol further helps ease symptoms and steady energy.

"Supporting our nervous system and metabolic health is key to navigating the changes."

Seeking the right support

Unfortunately, many doctors receive little menopause training, leaving women without guidance. At 52, despite using lifestyle strategies, I experienced severe mood crashes linked to my cycle. When I asked for bio-identical hormone support, my GP instead prescribed synthetic HRT. Within days, I developed headaches, cramps, ringing in my ears and concentration issues. Initially I thought I had Covid, but when the symptoms returned with the next cycle of pills, I realised the medication was the cause.

When I questioned my GP, she told me I couldn’t have bio-identical hormones while still menstruating and would have to “just manage.” Because of my research and network, I knew this wasn’t accurate. After waiting six months for a referral, a specialist confirmed that bio-identical hormones were appropriate even though I still had periods. Since starting the right treatment, I no longer suffer mood crashes. At 55, I still menstruate yet feel clearer, stronger and more resilient.

This reinforced the importance of understanding our bodies and advocating for ourselves. My doctor wasn’t being deliberately misleading; she simply lacked knowledge. Bio-identical HRT isn’t for everyone, but for many it can be transformative. Experts like Dr Louise Newson stress the need for individualised approaches combining lifestyle changes, accurate information and medical guidance so women feel empowered.

The power of connection and renewal

Connection and community are just as important as treatment. Talking to other women provides reassurance and practical wisdom, and sharing experiences helps normalise a natural process that has too often been silenced or stigmatised. Coming together also offers clarity when the healthcare system feels overwhelming.

Perimenopause can feel like moving to a new country – disorienting, emotionally intense, and full of unfamiliar terrain. It often invites us to address what we may have hidden or neglected. Many women use this time to heal old wounds, prioritise their needs and rediscover passion and purpose.

With knowledge, self-care and connection, the autumn of life can become fertile ground for a Second Spring – rich with possibility, authenticity, and the quiet joy of being truly me.