What every woman should know about perimenopause

The ultimate toolkit

Think menopause is the main event? Think again. Perimenopause is the hormonal plot twist not enough people have been talking about – until now.

It’s 2025 and menopause is finally having its moment. Celebrities like Naomi Watts and Elle Macpherson are smashing taboos and sharing their experiences on the global stage. Even the healthcare system seems to be catching up, with the federal government pledging $573 million for women’s health following a 2024 Senate inquiry into issues related to menopause in Australia. Along with subsidising menopause treatments, it also called for a GP education boost after the inquiry found many have “limited and varied” medical education on a transition experienced by more than half the population. 

However, if the veil on menopause has started to lift, perimenopause remains shrouded in confusion and misinformation. Where menopause is a single moment – the one day marking 12 months without a period – perimenopause is the transition phase leading up to it and can last anywhere from one to 10 years. And it often starts earlier than expected: one in five women will experience symptoms by the age of 40. 

The issue isn’t that women aren’t paying attention, it’s that many haven’t been told what to expect. So, when changes start showing up (in mood, sleep, energy and cycles), it’s no surprise that 90% report feeling inadequately prepared for this transition. 

To help navigate this significant life stage and surf the sea of information (and misinformation) out there, we asked leading experts what the most important things that they wanted you to know about perimenopause were. And this is what they had to say…

Perimenopause shows up differently for everyone

Dr Ceri Cashell, specialist GP with an interest in female hormones, describes perimenopause as the ‘zone chaos.’ “Estrogen can swing dramatically and progesterone can fail to show up every month, affecting everything from mood and sleep to cognition and metabolism,” she explains. “It’s so much more than periods – although they often change, too.” 

“Hot flashes and night sweats aren’t even the most common symptoms of perimenopause,” says Sarah Gray, expert perimenopause nutritionist. “That’s one of the things I try to bust.” As Gray suggests, perimenopause symptoms are varied, and sometimes completely unexpected. Some women notice brain fog, dry eyes and itchy skin. For others, it can be sleep problems and increased sugar cravings. 

Up to 40 per cent of women experience mental health symptoms during this stage, with anxiety being one of the first to show up.

Studies have found that diets rich in fibre and plant-based foods which help reduce inflammation are linked to fewer perimenopause symptoms, while those high in refined carbs and sugar were associated with worsened night sweats and fatigue. Gray recommends choosing smart carbs that slowly digest for sustained energy throughout the day. “That can be really great for weight control, blood sugar control and energy levels,” she explains, particularly if you’re struggling with symptoms of midline weight gain or finding it harder to gain muscle. Don’t forget to speak to your doctor if you experience any symptoms that aren’t normal for you. 

Don’t hesitate to seek out expert support 

While we often hear about the physical symptoms of perimenopause (hello, hot flashes), the emotional shifts can be just as significant. As the experts will tell you, recognising them early can make all the difference. 

Up to 40 per cent of women experience mental health symptoms during this stage, with anxiety being one of the first to show up. “I tend to find with my clients who come in, for the first 10 to 15 minutes of our appointment, there are lots of tears and overwhelm and confusion, and that mental side of things is huge,” confirms Gray. 

Starting to notice symptoms that are out of the ordinary? Write them down. Image: Pexels

The good news? You don’t have to push through alone. Professor Jayashri Kulkarni, director of the Monash Alfred Psychiatry Research Centre, who’s spent decades researching women’s mental health, shares an important reminder, “Remember, it’s not a shameful secret. Try to discuss your issues in your workplace, so that you don’t have to leave your job. Importantly, let your family know what you’re going through – so that they can understand and assist.” Dr Cashell also suggests bringing someone to your health appointments for support, describing it as her ‘ultimate weapon of choice.’ 

Keep a thorough track of your symptoms

Starting to notice symptoms that are out of the ordinary? Write them down. By tracking these shifts, you’re essentially building a hormonal case file, and this can be vital information for your doctor or specialist. 

To assist with the detective work, Dr Newson created the Balance app where women can track symptoms and print them out in a free health report to take with them to medical appointments. “Presenting your doctor with a detailed list of symptoms can be a really great way of opening the conversation, advocating for yourself and asking for the treatment you want,” explains Dr Newson. 

“It’s about making sure your diet fills in the gaps and helps boost that a little bit more to help you feel better but also prevent whatever might be more risky when you get into that post-menopause phase.” Image: iStock

Don't forget nutrition

“We can’t forget about our lives post-menopause,” explains Gray, pointing to long-term diseases like osteoporosis and heart disease. “It’s about making sure your diet fills in the gaps and helps boost that a little bit more to help you feel better but also prevent whatever might be more risky when you get into that post-menopause phase.” 

Prioritise mental wellness

“Many women feel very stressed and either leave their job or take part-time options or a lesser level,” says Professor Kulkarni. She cites the Association of Superannuation Funds of Australia (ASFA) which estimates women who transition out of the workforce due to menopause could suffer a superannuation deficit of $40,000. 

Readjust your sleep routine 

Though under-discussed, 40-69 per cent of women across the menopause transition suffer from sleep disturbances. It might be a common symptom but as Australia’s leading sleep expert, Olivia Arezzolo asserts, “Just because it’s normal, does not mean it needs to be your normal.” 

Whether that’s searching out books, apps, or verified websites, clarity is key to empowerment. Image: iStock

To combat the overheating caused by night sweats and hot flashes, Arezzolo advises her clients to regulate temperature with air-con or a cooling mattress topper. Choosing temperature-regulating sheets in a natural fibre can also help absorb sweat. For those whose sleep is being side-tracked by anxiety, she suggests a smooth wind-down that includes an evening shower and at least 30-minutes of tech-free time to lower cortisol levels. Racing thoughts keeping you up? Arezzolo also recommends stress-reducing activities (think meditation and listening to calming music) which can support feelings of relaxation. 

Lastly, remember knowledge is power

Let’s be real. Myths and misinformation surrounding perimenopause is something Dr Cashell has seen frequently in the field. As a result, she’s an ardent advocate for greater education so women head into this life stage feeling confident, in control and – above all – prepared. “Knowledge is power…we’re long overdue for a proper public awareness campaign,” she says.

Just one example of how the impact of misinformation continues to show up in menopause care? Dr Louise Newson, GP and menopause specialist, cites the 2002 Women’s Health Initiative Study that wrongly suggested hormonal replacement therapy could lead to breast cancer. “Because of its lingering impact, many doctors and physicians still offer advice that is outdated, meaning that accessing treatment and support is difficult for many women.” 

As Dr Newson sagely advises, “Educate yourself as best you can.” Whether that’s searching out books, apps, or verified websites, clarity is key to empowerment. Gray even works with clients to re-train their algorithm (yes, really) helping to weed out fact from fiction. “Follow the science-based practitioners and you’ll start to get better feeds coming back at you with verified information,” she adds. And in the quest for no-BS advice, what’s not to love about that?

Originally published as What every woman should know about perimenopause