What I wish I knew about perimenopause before turning forty.

By Simone Jeffries, BHSc (Naturopathy), Naturopath & Perimenopause Coach – women's health – Sydney's Northern Beaches

When my periods started to change in my early 40s, my insomnia got really bad, and I stopped being able to cope with my everyday life the way I had before, I didn't think of perimenopause. I'd never heard of it. I had no idea that my periods would be completely finished by 55, or that perimenopause could start so soon.

In my mind, menopause was a far away thing that happened to women in their 60s, maybe late 50s if they were unlucky. What I vaguely associated with menopause was grey hair, old age, and experiencing hot flushes at some point in the distant future. When the photo below was taken of me at 50, I had already been in perimenopause for eight years.

It took me years to unpack what was happening to me and I was shocked at the amount of different health problems that could all be linked back to hormone changes. The health spiral I experienced during this time was part of what led me towards studying naturopathy.

I often think how different my experience might have been if I had understood what was happening in my body a little earlier. This blog is what I would have wanted someone to tell me.

perimenopause begins earlier than you expect

The hormonal changes that drive perimenopause symptoms begin well before your periods stop in your late 40s or early 50s. It's common to start ecperiencing perimenopause by age 42. The earlier you understand this, the better placed you are to support your body through the transition.

when your periods change

Heavier periods are one of the earliest and most common signs of perimenopause, and one of the most misunderstood. I assumed menopause meant lighter periods, and eventually none. So when they become heavier, or more unpredictable, or start arriving more frequently, it doesn't fit the picture you had in your head. It didn't fit mine either.

In the lead-up to perimenopause, progesterone is the first hormone to decline. Progesterone has a calming, stabilising effect on the nervous system, as it declines you can feel like your PMS symtoms are worse, mood is worse, anxiety is worse and sleep is hard to get. When it declines, estrogen can become relatively higher by comparison. The uterine lining builds up more than it should, which results in heavier, sometimes flooding, periods.

If you are experiencing this, it is worth speaking with your GP to rule out other causes such as fibroids or adenomyosis. But very often, what's driving the change is simply this early

hormonal shift.

A stressful lifestyle makes this worse. Chronic stress affects progesterone production directly, because your body prioritises producing cortisol (your stress hormone) over progesterone when it's under pressure. If you are running on empty in your late 30s or early 40s, your progesterone levels will likely reflect that.

anxiety seemed to come from nowhere

This is why it caught me so off guard. I had always been a fairly calm person.

Maybe you've had some anxiety in the past but managed it well. Then somewhere in your early 40s, life just starts to feel harder. Things that didn't used to bother you do now. You feel more reactive, more overwhelmed, more on edge. Some women experience anger and rage out of nowhere. It's easy to put this down to life circumstances. You're busy, you have a lot on, the world is stressful. But for many women this anxiety is hormonal, and the driving factor is declining progesterone.

Progesterone supports the production of a neurotransmitter called GABA, your brain's natural settling mechanism. When progesterone drops, your nervous system becomes more reactive. Anxiety that you previously managed well can suddenly feel much harder to keep on top of.

histamine in perimenopause

At the same time, estrogen is fluctuating rather than declining steadily. Some months it spikes quite high before dropping again. These estrogen fluctuations drive histamine release in the body, which can amplify anxiety, trigger migraines, worsen skin reactions, and create a sense that you are developing all sorts of new sensitivities and intolerances.

What can feel like five separate health problems in perimenopause often has one hormonal story underneath it. The heavy periods, the anxiety, the disrupted sleep, the new food sensitivities, the migraines, bloating and allergies. They are connected, and understanding that changes how you approach them.

Insomnia and why 3am became my least favourite time

Sleep disturbance is one of the symptoms I hear about most often in my Sydney Norhtern Beaches clinic. Women who have always slept well find themselves waking at 3am, unable to get back to sleep. Others struggle to fall asleep in the first place, or notice that their sleep has become lighter and less restorative.

Again, progesterone is central to this. Progesterone supports deep, restorative sleep. As it declines, sleep architecture changes. You spend less time in the deeper stages of sleep, which means you wake more easily and feel less rested even when you have technically slept enough hours.

The 3am waking in particular tends to be driven by cortisol. When your hormones are fluctuating, your stress response system becomes more sensitive. Cortisol, which should be at its lowest in the early hours of the morning, can spike at the wrong time and jolt you awake.

Lifestyle matters more now than it ever has

It sucks that perimenopause hits at the busiest and most stressful stage in your life. One of the things I come back to again and again with my clients in perimenopause is this: your body has less hormonal buffer than it used to have.

In your 20s and 30s, your hormonal system had a certain resilience. You could push through a stressful season, eat poorly for a few weeks, stay up too late, skip exercise, and your body would largely bounce back.

In perimenopause, that buffer narrows. A stressful period affects your progesterone more directly. Poor sleep compounds your cortisol. Inflammatory foods amplify estrogen fluctuations and histamine responses. The habits that you could get away with before start to show up as symptoms.

You don't have to do everything perfectly. But understanding the connection between your lifestyle and your symptoms gives you something useful to work with.

You don't have to just wait it out

There is a lot of good support available during perimenopause, both from your GP and from a naturopath working alongside your medical care.

From a naturopathic perspective, herbal medicine is genuinely helpful for supporting progesterone balance, calming the nervous system, improving sleep quality, and settling the histamine responses that estrogen fluctuations drive. For me, having a naturopath to guide me through was a game changer.

Nutrition, flower essences and lifestyle work are also central to how I support women through this transition.

If you are in your late 30s or early 40s and recognising yourself in any of this, I'd encourage you to take it seriously sooner rather than later. Early support makes a real difference to how you experience this transition.

I created my THRIVE program specifically for women who want to understand perimenopause and move through it well, rather than waiting until symptoms become hard to manage. This affordable program will explain how perimenopause can impact all the things I've mentioned above, plus I delve into common vaginal and libido changes. You can find out more about THRIVE here.

And if you'd like to talk through what's happening for you individually, you're welcome to book a consultation here. If you're based on Sydney's Northern Beaches, you can see me face to face in my Manly clinic. If not, you can work with me online using Telehealth from anywhere in Australia.

I wish you all the very best for your perimenopause journey.

Simone :)

Simone Jeffries is a naturopath specialising in women's hormonal, digestive and vaginal health based on Sydney's Northern Beaches.

Simone holds a Bachelor of Health Science (Naturopathy) and is an accredited SIBO naturopath with Dr Nirala Jacobi.

This blog is intended as information only, and is not to diagnose or provide specific treatment advice. If you are struggling with anxiety and/or digestive symptoms, please seek medical advice.