Perimenopause: calling for Compassion and Reconnection

A Profound Biological Transition and a Silent Onset of a Major Life Phase

For many of us perimenopause comes as a surprise - not because they didn’t know it would arrive, but because of how little they were prepared for what it entails. Often dismissed as a short prelude to menopause, this phase is in fact a profound biological transition that can span up to a decade, beginning as early as a woman’s late 30s or early 40s. It’s a time of seismic hormonal shifts, neurochemical changes and emotional turbulence, often accompanied by a strange sense of disconnection from the body. But it is also a time of transformation, opportunity and a call to re-learn how to live in partnership with our own bodies.

Hormonal Fluctuations and Systemic Impact

Scientifically, perimenopause is defined as the period during which the ovaries begin to produce less oestrogen, culminating in the complete cessation of menstruation - menopause. During perimenopause, levels of oestrogen, progesterone and even testosterone fluctuate unpredictably. These hormonal oscillations can impact every system in the body, says Professor Jayashri Kulkarni, a leading researcher in women’s mental health at Monash University. They influence not only the reproductive system, but also the brain, the cardiovascular system, the musculoskeletal structure and emotional regulation.

The Brain in Flux: Neuroscience of Perimenopause

The brain, in particular, is a key player of this transition. Neuroscience has shown that oestrogen is deeply intertwined with brain function. It modulates the production and uptake of key neurotransmitters such as serotonin, dopamine and GABA, which influence mood, cognition, and sleep. As oestrogen fluctuates, many women experience symptoms that are often misdiagnosed or dismissed: forgetfulness, word-finding difficulties, anxiety, sudden bouts of sadness, even panic attacks. These are not character flaws, nor signs of weakness. They are neurochemical consequences of biological shifts. In fact, studies published in The Lancet Psychiatry confirm that women are at increased risk of depression and anxiety during perimenopause, particularly those with a history of premenstrual or postpartum mood disorders.

Sleep Deprivation and Daily Exhaustion

Sleep is another battleground. The drop in progesterone, a natural sleep-promoter, often results in fragmented or poor-quality sleep. Combined with night sweats - triggered by unstable thermoregulation governed by oestrogen - it’s no wonder that fatigue and irritability become near-constant companions. And yet, society often expects women in midlife to operate at peak performance: in their careers, parenting teenagers, supporting ageing parents. The invisibility of this struggle compounds the burden.

Metabolic Changes and Physical Identity

Perimenopause also affects metabolism and body composition. A study by the Journal of Clinical Endocrinology & Metabolism showed that women can gain up to 2.1 kg on average during this phase, even without changes in diet or exercise. This weight tends to redistribute around the abdomen, which not only affects self-image but increases the risk of insulin resistance and cardiovascular disease. Muscle mass begins to decline, bone density decreases and joints may ache. What once worked - intermittent fasting, long cardio sessions, calorie tracking - suddenly stops yielding results. And we panic, we get mad at our bodies for not doing what they used to, for not listening to us, for being as we want them to be. 

Reclaiming the Body with Kindness

But here lies a crucial turning point. Perimenopause is not a decline in womanhood. It’s a shift. It requires us to re-learn how to inhabit our bodies with kindness, not rage, shame or control. Nutrition must become about nourishment, not restriction. Movement should support hormonal balance and joint health, not just burn calories. Sleep and rest must be prioritised, not seen as luxuries. As psychotherapist and women’s health advocate Susie Orbach says: We live in a culture that wants women to shrink. But midlife asks us to expand - our thinking, our compassion, our definitions of power.

Biological Tools and Therapeutic Support

Biologically, the decline in oestrogen is inevitable - but how we support our brains and bodies through this process can make a significant difference. Adaptogenic herbs like ashwagandha and rhodiola, cognitive behavioural therapy, mindful movement such as yoga or pilates, and even hormone replacement therapy (HRT) are valid and valuable tools. The North American Menopause Society reports that HRT, when started within 10 years of menopause onset, can be effective in reducing symptoms and protecting against osteoporosis and cardiovascular disease, with minimal risks for most women.

Psychological Awakening and Midlife Power

Psychologically, perimenopause also offers a unique opportunity. It is a reckoning with our own needs, limits and desires and it often tends to be the first time in our lives where we have the opportunity to do so. Many women report a stronger sense of clarity, assertiveness and self-prioritisation during this time. This is not selfishness; it is biological self-preservation. The brain’s limbic system - responsible for emotional processing - is remodelled in midlife, and women often find themselves less tolerant of inauthenticity or overextension. In the words of author and physician Dr. Christiane Northrup, Perimenopause is not a disease. It is a wake-up call.

The Loneliness of the Unspoken Journey

Yet the loneliness of this transition cannot be overstated. Because perimenopause is rarely spoken about openly, many women feel shame or confusion. We don’t recognise ourselves in the mirror, in our moods, or in our capacities. This silence is harmful. We need more conversations, more medical education, more societal support - and above all, more compassion. As researcher and author Brené Brown writes, Shame cannot survive being spoken. It cannot survive empathy.

A New Definition of Power and Beauty

What would it mean then to approach perimenopause not as a fight, but as a form of reclamation? To stop waging war against the body and begin listening to it with reverence? To speak not of decline, but of evolution?

The science is clear: perimenopause is complex, multifaceted and deeply individual. But with understanding, community and the right tools, it can become less of a crisis and more of a return to wholeness. We do not need to be fixed. We need to be heard, held and honoured in this extraordinary phase of life.

After all, this is not the end of youth. It is the beginning of something else entirely: power unbound by pleasing, wisdom earned through resilience and a body that deserves not discipline, but devotion.