Most women don’t realize they’ve entered perimenopause until something seems off. Everything starts to feel more sensitive (your mood, your cycle, your sleep, etc.), and the things that used to “work” suddenly don’t land the same. For many women, this transition begins without a clear explanation, somewhere around the early 40s. While it’s a milestone that every woman eventually reaches, it can come across as a bit taboo. And most of what you’ll find online is either overly clinical or disconnected from the reality of day-to-day life. What’s often missing? A practical understanding of what’s happening and how to support your body in a way that feels genuinely helpful.
Image above by Michelle Nash
What Is Perimenopause, Exactly?
Perimenopause is the transition phase leading up to menopause, and it can start earlier than most women expect, often in the late 30s or early 40s. During this time, hormones begin to fluctuate. Estrogen doesn’t just steadily decline—it rises and falls unpredictably. Progesterone tends to drop more consistently. And these shifts can influence everything from mood to metabolism to sleep. This phase can last anywhere from a few years to over a decade, which is why understanding the signs of perimenopause early on can make a big difference in your energy and demeanor day to day.
Common Perimenopause Symptoms
When people think about menopause, they usually think about hot flashes. But perimenopause symptoms are often more subtle and can show up in ways that are easy to dismiss. Some of the most common ones I see in practice include:
- More intense PMS or new perimenopause mood swings
- Irregular cycles or changes in cycle length
- Sleep disruptions, especially waking in the middle of the night
- Increased anxiety or feeling more “on edge”
- Lower stress tolerance
- Changes in body composition, especially perimenopause weight gain around the midsection
- Brain fog or reduced focus
In essence, these are all signals from your body that your hormonal landscape is shifting.
Why Weight Gain and Stress Feel More Intense
One of the biggest frustrations I hear from clients is: “I’m doing the same things I’ve always done, but my body is responding differently.” This is especially true when it comes to perimenopause weight gain and stress. As progesterone declines and estrogen fluctuates, your body can become more sensitive to stress. This often shows up as higher baseline cortisol levels, or what people refer to as perimenopause cortisol issues. And cortisol matters here.
Chronically elevated cortisol can:
- Make it harder to build or maintain lean muscle
- Increase fat storage, especially around the abdomen
- Disrupt sleep, which then further impacts hunger and metabolism
So it’s not just about “eating less” or “working out more.” In fact, pushing harder often backfires during this phase.
What Helps During Perimenopause
This is where I like to shift the conversation away from overwhelm and toward what’s (scientifically) supportive. In my coaching sessions, I focus on helping women build a foundation that stabilizes blood sugar, supports hormones, and lowers unnecessary stress on the body. But beyond the basics, there are a few slightly less talked-about shifts that can make a noticeable difference during this phase.
1. Start Your Day With Light
One of the most overlooked pieces of hormonal health is your circadian rhythm, and it plays a direct role in how your body regulates cortisol, sleep, and even mood. Getting outside within 30 minutes of waking, even for 5-10 minutes, helps anchor your internal clock for the day. It signals to your body when to be alert, when to wind down, and supports more stable energy overall. It’s simple, but I’ve seen this make a meaningful difference for women who feel wired at night and tired in the morning!
2. Front-Load Protein Earlier in the Day
Cortisol naturally peaks in the morning, which is part of what helps you wake up and get moving. But without enough protein early in the day, blood sugar can become more unstable, leading to energy dips, cravings, and feeling more on edge. A helpful target here is aiming for around 30 grams of protein at breakfast, ideally within an hour or so of waking. This might look like eggs with cottage cheese on sourdough and greens, a protein smoothie, or Greek yogurt with added protein. It sets the tone for more stable energy and fewer swings throughout the day.
3. Strength Train Consistently
Muscle becomes incredibly important during perimenopause. It’s not just about how your body looks; it’s about how your body functions. Muscle supports insulin sensitivity, metabolic health, bone density, and overall hormone balance. And as estrogen begins to fluctuate, maintaining lean muscle becomes more challenging, which is why this matters even more now. I typically recommend strength training 2-3x/week (so long as you’re reaching close to “failure” with your sets), paired with lower-intensity movement like walking. More isn’t better here! Consistency is.
4. Don’t Overlook Key Nutrients
This is something I see often as a nutrition consultant. Women are doing all the “right” things, but still feeling off. Sometimes, it comes down to nutrients. For example, creatine is starting to get more attention for its role beyond muscle, including cognitive function, focus, and even mood—all areas that can feel impacted during this phase (most women do well with 3-5 grams/day). I also pay attention to nutrients like zinc, which plays a role in hormone production and can influence things like PMS symptoms, skin, and overall mood. This isn’t about adding a long list of supplements, but about recognizing that as your body shifts, your needs might shift too.
Eat in a Way That Supports Blood Sugar
Honing in on blood sugar, keeping glucose stable is one of the most underrated pieces of the puzzle when it comes to how to support perimenopause, and it’s something I focus on heavily with clients in this phase. Practically, this looks like building meals that are anchored in protein, supported by fiber, and rounded out with healthy fats and carbohydrates so you’re not riding constant spikes and crashes throughout the day.
Perimenopause Protein and Fiber Macros
A helpful starting point: aim for roughly 25–35 grams of protein per meal, which typically gets you into the 90–120 grams per day range depending on your needs. This supports muscle and satiety, all of which become more important as hormones shift. Fiber is just as important here. I usually recommend working toward 25–35 grams of fiber per day. Fiber helps slow the absorption of glucose, supports gut health, and plays a role in estrogen metabolism.
Be Selective About Wellness Trends
If there’s one reframe I come back to with clients, it’s this: perimenopause isn’t your body “breaking” or “rebelling.” It’s your body asking for a different kind of support. And often, what helps most is mastering the basics: eating enough protein, lifting weights, sleeping more, and managing stress in micro, sustainable ways. This is also where it helps to take a more thoughtful approach to wellness trends. After all, so much advice is built around doing more or restricting more. Here’s to building habits that carry you through this phase (and beyond).
Edie Horstman
Edie is the founder of nutrition coaching business, Wellness with Edie. With her background and expertise, she specializes in women’s health, including fertility, hormone balance, and postpartum wellness.
