Hacking perimenopause: A survival (maybe even thriving) guide

Perimenopause isn’t one moment; it’s a long, messy transition with constant ups and downs. It’s like puberty, except now you’ve got bills, a career, maybe kids, aging parents, and absolutely zero interest in tolerating bullshit.

Hormones start shifting and suddenly you’re crying at a toothbrush advert, waking up at 3:14am for no reason, wanting to strangle your partner for breathing “too loudly”, smelling EVERYTHING, and genuinely wondering if your entire personality has slipped out of your ear.

It’s… a lot.

But it doesn’t have to be terrifying. You’re not broken. You’re rewiring. And the more you work with your body instead of against it, the easier this ride becomes.

Look — I’m not a doctor. I’m a 44-year-old woman who has been trudging through this sh*t for a few years and wants to share what’s helped, in case it helps you too.

Here’s what’s made this hellish rollercoaster at least navigable (with a mix of science, common sense, and the occasional swear).

1) Start by actually noticing your body, your thoughts, your feelings

I know — obvious. But most of us were raised to power through everything: be productive, be pleasant, don’t be weird, don’t take up space, don’t inconvenience anyone (feel free to add more patriarchal nonsense to the list).

So noticing yourself — really noticing — can feel strange at first.

Start tiny:

• Check your breath.

• Notice tension without judging it.

• Do a quick body scan once a day.

• Observe symptoms without spiralling.

It’s all data. Treat yourself like an experiment. You can’t support a body you’re ignoring. This doesn’t require monk-level meditation. Just… notice.

2) Track the sh*t out of yourself

If you only take ONE thing from this: track what’s happening and where you are in your cycle (or, if you don’t have a cycle, track patterns anyway — especially if you’re on hormonal contraception).

I use a spreadsheet because I’m old-school/nerd-adjacent, but apps like Balance or pen-and-paper work too.

Perimenopause symptoms can mimic anxiety, ADHD, IBS, food intolerances, depression, fatigue, insomnia, skin flare-ups, bladder issues, brain fog, low libido, tinnitus, heart palpitations and basically anything that makes you think, “Am I losing the plot?”

So track everything:

• Mood: reactions, feelings, sociability, irritability, rage at strangers.

• Thought patterns: ruminating? foggy? hyper? overthinking? losing your words mid-sentence (hello neurospicy friends — we get hit earlier and harder, apparently!)

• Physical sensations: palpitations, dizziness, skin changes, heat from nowhere, dryness (yes, there), cramps, inflammation.

• Looks: glowing vs dull skin, hair texture, puffiness, breakouts.

• Urges: cravings, libido (or complete disappearance of…), the desire to throw things.

• Energy: zero-energy sofa slug vs “I might run 20km for fun”.

Patterns = power. They help you separate hormonal from stress from life.

TOP TIP: Learn your ovulation signs — temp shift, egg-white discharge, mid-cycle cramps (the Germans call this mittelschmerz which is both dramatic and accurate), higher libido, glowier skin.

FACT: As perimenopause progresses, cycles get irregular and anovulatory cycles increase — you bleed but don’t ovulate. No ovulation = no progesterone. No progesterone = symptoms ramping up.

For me: nausea, upset stomach, low-level infections, inflammation. Your version might look different — so keep tracking.

3) Learn just enough science to not freak yourself out

You don’t need a PhD in hormones. Just a working understanding of what’s going on.

A quick primer:

• Oestrogen: Not just reproduction — it affects brain, bones, heart, mood, sleep, energy. Highest around ovulation. Often your most sociable time.

• Progesterone: Calming, anti-inflammatory, supports sleep, slows digestion. Needs carbs to be produced. Peaks after ovulation — often the more introverted phase.

• Testosterone: Yes, women have it. Helps libido and sleep, energy, brain fog. Without enough oestrogen, your testosterone can convert back into oestrogen — so balance matters.

• Perimenopause isn’t linear: Progesterone and testosterone decline first; oestrogen is the chaotic friend who sticks around longer but fluctuates wildly.

TOP TIP: My symptoms started in my mid-30s (common with ADHD): UTIs on repeat, anxiety spikes, awful sleep. Progesterone would have helped. If you’re 35+, pay attention.

A little knowledge = less panic, more agency.

4) Get medical support (if and when it makes sense)

You are allowed to ask for help. You are allowed to advocate for yourself. You can take HRT, not take it, or change your mind later. Your body, your call.

Access and privilege matter, of course. I’m in the UK and deeply grateful for free healthcare.

TOP TIPS:

• If you’re under 40, get baseline bloods (note your cycle day).

• UK doctors should prescribe HRT based on symptoms, not blood tests.

• Ask for testosterone testing — it’s often missed and declines early. Doctors usually only prescribe it for low libido (don’t get me started), so note that symptom if you want access.

• Advocate for yourself — or bring someone who can.

• They may offer antidepressants before hormones. Nothing wrong with them, but you don’t have to take them. My anxiety/depression improved dramatically once my hormones were supported.

Your body. Your rules. Full stop.

5) Listen to your intuition as much as the science

Your symptoms won’t look like someone else’s. Hormones interact with stress, trauma, sleep, nervous system health, neurodiversity, and life.

Science matters — but so does lived experience.

Listen to your body. Advocate for yourself. Get support where you can. Doctors don’t have all the answers.

6) Take care of your body like it’s someone you love

Perimenopause is a stressor. Your body is working overtime. It needs support, not punishment.

Tell it out loud (yes, really):

“You are safe.”

“You are healing.”

It works. Your nervous system listens.

Movement & nutrition:

• Ovulation phase (roughly days 5–16): cardio + strength if that feels good. You can fast, but watch cortisol. Prioritise protein.

• Luteal + menstrual: slow it down — walking, yoga, Pilates, qigong. Eat the carbs. Your body needs them for progesterone.

And for my fellow elder millennials raised in the brutal 90s diet culture: this might be the season where softness is allowed. Maybe even welcomed.

7) Supplements: helpful or hype?

Up to you. Some women swear by them, others don’t. Just be informed — the wellness industry loves a vulnerable woman.

FACT: Creatine has solid research behind it for both brain and body during this phase.

8) Be patient. This isn’t a quick fix.

Hormones shift slowly. Tweaking things is normal. Not failure.

If you choose HRT, it takes months to settle. You may need a different type. As ovulation stops, symptoms shift again.

This is physiology, not personal incompetence.

9) Talk about it. Share it. It helps.

• Talk to other women — normalise it.

• Share symptoms with friends, colleagues, managers (if safe).

• Check your company’s menopause policy.

• Put your cycle on the family calendar (yes, really).

• Talk to your partner — or send them a podcast if that’s easier.

And yes, if you need time off work? TAKE IT. Your health is not an inconvenience. Let’s normalise menopause breaks.

10) Get psychological support if you need it

Change is hard. Identity shifts are hard. Grief around fertility (or lack of it) can hit unexpectedly.

I’m a huge fan of therapy — highly recommend it.

I was mostly shocked it hit in my early 40s… until research confirmed women with ADHD can enter perimenopause up to 10 years earlier. Suddenly my life made sense.

Everyone’s emotional experience of this stage is different. Make space for yours.

Final truth: Perimenopause isn’t you falling apart. It’s you recalibrating.

Your body hasn’t stopped working.

It’s asking for a different kind of support.

Hold yourself through it with curiosity, compassion, and information.

You are safe. You are changing.

And you’re still you.

Just… maybe a hotter, moodier, wiser, more intuitive version. 🌙💛