It can start subtly. A slightly shorter fuse, a sleepless night, a period that isn’t quite like it used to be. For many women, these early signs of perimenopause sneak up while juggling work, family and life’s daily demands, making them easy to miss or dismiss. But understanding what’s happening in the body can make this transition less confusing and even empowering.
Local leading expert in perimenopause and menopause Dr Hilma Starostina says the signs can be different for each woman and sometimes they are even attributed to something else, or missed altogether.
“Some women might notice emotional changes such as feeling less lively, losing their temper more easily, difficulty sleeping, or even severe anxiety and depression,” Dr Hilma says.
“Physical signs can include changes in period patterns, joint aches, sports injuries, hormonal migraines and subtle changes in internal body temperature. Many women describe feeling ‘not quite themselves,’ and that’s because hormones are fluctuating unpredictably during this stage.”
Dr Hilma says during perimenopause, estrogen and progesterone levels swing in ways the body hasn’t experienced before.
“Estrogen can spike higher than ever and then drop suddenly, causing mood changes, breast tenderness, migraines and heavy periods.
“Meanwhile, progesterone levels are often lower, which can lead to anxiety, sleep disturbances and irregular cycles. But each woman experiences this differently, which is why an individualised approach is so important.”
Most importantly, Dr Hilma can’t emphasise enough how crucial lifestyle is during this time of life.
“Sleep, nutrition, stress management, movement, social connections and avoiding harmful substances, what I call the six pillars of health, play a huge role in how a woman navigates this stage. Poor sleep and high stress can disrupt hormone regulation, while diet affects liver and gut function, which in turn impacts how hormones are processed,” she says.
Dr Hilma says practical ways to ease symptoms naturally include exposure to morning light, regular micro-breaks with deep breathing, reducing alcohol and eliminating ultra-processed foods. Complementary therapies such as yoga, acupuncture and counselling can also help.
When it comes to hormone replacement therapy (HRT), Dr Hilma stresses context and perspective.
“Modern body-identical HRT carries a lower breast cancer risk than older non-body-identical HRT, as the earlier studies suggested, though the risk is still present. The risk can be optimised, for example, by maintaining a healthy weight, avoiding a sedentary lifestyle or regular alcohol consumption, and it should always be considered alongside a woman’s personal health, symptoms and family history.”
Her biggest advice for women? “Focus on lifestyle first. Get a comprehensive health check, prioritise sleep, nutrition, movement, stress management and meaningful connections. Other treatments can be layered on top of this foundation.
“And most importantly, avoid relying on social media for medical advice. Speak with a qualified doctor if you need guidance.”
Culturally, menopause has long been a taboo topic. Thankfully, that is changing with more women talking openly about their experiences, and healthcare is taking a holistic approach.
“It used to be that women’s experiences were swept under the carpet, partly because of societal stigma around ageing and partly due to lack of knowledge,” Dr Hilma says.
Community support from friends, workplaces and local networks also plays a vital role.
“Acknowledging what someone is experiencing, listening and helping them seek appropriate support can make a huge difference.”
Finally, one myth she wants to see disappear is: “That perimenopause has to be tough. It’s actually a wonderful window of opportunity to optimise health and thrive.”