From Rage To Sobbing In A Corner - The Many Faces Of Perimenopause

Dr Sadhia Khan works as a GP in central London. She has an interest in women's health, digital innovation and preventative medicine.

The peri-paradox is real. One minute, you’re fine. Annnnd why am I crying again? 

We dive into the emotional whirlwind of perimenopause. We'll be getting to grips with why you can swing from fiery anger to uncontrollable tears at the drop of a teabag (literally happened to us). We’ll help you understand these intense mood shifts, and gain strategies to manage your emotions and find calm amidst the chaos. 

When it all goes out of the window. Many women say it’s rather like being on an emotional rollercoaster that you didn’t ask to ride. Hormones are playing games with your feelings, and sometimes it feels like there’s no simple way to stay grounded.

These emotional swings are completely normal, even to be expected. Many women don’t realise that their mood shifts are connected to perimenopause. The good news is understanding what’s happening in your body makes it easier to manage it, or possibly avoid it.

Going back to basics now. What does perimenopause mean for your hormones?
Perimenopause can be described as being like a second puberty, except this time, it is very different. That monthly cycle that used to keep you in sync suddenly becomes unstable. Your hormones start fluctuating. Leaving you feeling out of step with yourself. It’s disorienting, stepping into a new phase of life where the long-established rules no longer apply.
That said, it’s not just about physiological changes. There is almost always an emotional element to perimenopause, and it often goes overlooked in society. After all, your period has been a constant (if not always welcome) companion. Saying goodbye to it can feel like you’re losing a part of yourself. This shift isn’t simply about fertility. It may, for some, be about letting go of something that’s been there, like clockwork, for decades of your life.

Many women may not even be aware that their symptoms are reflective of the perimenopause changes happening in their body. The lives of many women in their 30s-50s tend to involve a lot of change. Think taking care of family members, adjusting to new work commitments or even embarking on a totally new career. It is very easy to fall into the trap of putting your symptoms into the same category as “circumstantial stress”.

But if you’ve been feeling like your emotions are really all over the place, you might not be imagining it. There’s a reason why you can go from calm to furious in no time flat. It’s all down to the fluctuating hormones. Oestrogen levels change unpredictably, while progesterone gets thrown into the mix, leading to chaos in your brain. This affects the production of serotonin (the happy chemical), leaving you more prone to mood swings.

Then there’s the unpredictability of ovulation. During perimenopause, it is a bit of an ovulation-lottery. Sometimes you ovulate, sometimes you don’t. You’re along for the ride. It really is no wonder a minor irritation can suddenly feel like a huge deal. It is because your brain’s just not getting the same level of mood regulation that it used to with a regular cycle of ovulation and menstruation.

You may be thinking that menstruation isn’t a common thing for a lot of women of reproductive age. Things like contraception methods may prevent it. Pregnant women and women in a postpartum state also do not get a period. But the difference here is that these women are likely to get their period back after, say, the contraceptive medication is finished, or the pregnancy and postpartum era is over. With perimenopause, it’s pretty clear that the regular cycle isn’t returning. I think this mindset of “mourning” should be flipped on its head. I know it is easier said than done. But in order to get the most out of this time in your life you have to let go of the hang ups and lean into it, embrace it even. I see many women even more healthy than they ever have been in their entire lives once they hit perimenopause. 

This is because they hit a moment of realisation to truly care for their body, by paying close attention to every aspect of their health. Adopting proper ways of eating, sleeping, exercising, anything that will show your body some love. It all counts towards a happy perimenopause and fulfilling menopause thereafter.

I would agree, stress is one of the less fun effects of perimenopause. The little things that used to roll off your back now feel like personal attacks. That’s because your body can produce more cortisol (aka the stress hormone) in response to even minor frustrations. And once your cortisol levels spike, they take longer to settle back down.

In answer to this, I would say it’s biology, not a character flaw. You may need to pause and leave some responsibilities out of your life, where possible. This is not a time to be hard on yourself. Think about making time for the things that bring you joy and focus on what you are grateful for.

One of the most frustrating aspects of perimenopause is feeling like your energy is on a disappearing act. You might start the day feeling ready to take on the world, only to hit a wall by noon. It can be exhausting in a way that’s hard to explain.

Will you ever get that energy back? Yes it is possible, it isn’t something to worry about, but it does take some adjustment, it’s all about finding a new balance. A few changes to your diet, lifestyle, or even adding supplements can make a big difference. 

Once you start listening to your body’s needs (instead of pushing through), many women find their energy levels improve. It’s just about learning to work with your body rather than against it.

So we have seen there’s this unspoken expectation that women should be able to handle everything. But it really is okay to slow down. In fact, it’s necessary for the good of your health. You’re not “slacking”— you are surviving.

We’ve all seen the way perimenopause gets treated in the media. It’s usually sensationalised, focusing on things like libido and desire swings. Which, in their own right, are worthy topics. Yet it could also be said that this is just the tip of the iceberg.

I observe that it is more commonly about those little, everyday things that get harder to manage. 

Things like having the energy to go for coffee with a good friend may seem more difficult after a hard day's work, leaving some to have to choose how to best spend their time. Surely this is no way to live, can it be helped? 

Even businesses trying to “help” women through menopause could miss the mark. There’s this pressure to be perfect. To “manage” menopause like a boss. To handle work, family, and relationships with ease, all while tackling hormonal chaos. But let’s be real about it. For most of us, that’s not going to be the case. Life isn’t some perfectly curated Instagram reel. It’s pretty messy, and that’s okay.

Yes, education around menopause and perimenopause is important and most definitely has its place. But it can be just as important to be kind to yourself. Don’t let the pressure to do it all add to the emotional toll of perimenopause. I’m here to reassure you that it's okay to pause, rest, and take care of yourself. Minus any guilt.

When dealing with perimenopause, you don’t have to overcomplicate your approach to health. Start with the basics and the fundamentals of good health, for any gender and at any age. These are sleep, a balanced diet, and cutting down on screen time can do wonders for stabilising your body.

We can go even further. There are six pillars of lifestyle medicine: eat well, take care of your mental health, stay active, avoid harmful habits, nurture good relationships, and get proper sleep. These simple things lay the foundation for better managing symptoms. Once you’ve got those in place, you can build on them with supplements or other treatments. But it all starts with the basics.

It could be said that no two women experience perimenopause the same way, so there’s no “one-size-fits-all solution”. For some, yoga and mindfulness might be enough. Others might need a more comprehensive approach to get to their optimal health, they may need supplements, therapy, or medications. And that’s okay too.

And yes, Hormone Replacement Therapy (HRT) is a great option for some women, but it’s not the only path. You have to remember here that women have been navigating menopause for centuries (millennia even) without it. But one could also argue they didn’t have full-on office jobs and mortgages to pay back then. Either way, the root is to figure out what works for you, your body, and your lifestyle. 

You may not want to hear this, but for the women I advise about perimenopause, there often is no straightforward answer. That’s simply because everyone is truly unique, and that’s a beautiful thing! But it also means taking the time to work out what is best for your body. This may involve thinking about what your health and wellness routine has been lacking over your menstruating years.

It may also be about adjusting mentally and physically to what is happening now, in the present moment. So, whatever perimenopause is looking like for you in particular — always remember to be kind to your body, treat it with respect, be patient and in alignment with your changing wants and needs.

A huge thank you to Dr Sadhia Khan for sharing her wisdom and experience. You can follow Sadhia here.

We have had the pleasure of featuring the voices of many experts and medical professionals in our blog series, including their specialist perspectives on all things from natural health to supporting a healthy sex drive. 

We have shared insightful tips and tricks, dealt with the hard facts and even had some laughs along the way! Now is the time to get empowered for the good of your health and happiness.

Why? Because no one should go through perimenopause uninformed (or misinformed). You, as well as every other woman out there truly deserve to know what is best for you and your hormones. So, go on and check them all out here. 

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