Perimenopause FAQs: Your Questions Answered by a Menopause Nutritionist

Can your mood change before your periods do? Why does stress suddenly feel harder to handle? And do you really need to change your diet or start taking a menopause supplement?

As part of Menopause Awareness Month, we asked you to send us your perimenopause questions - then we asked Charlotte Hunter, Registered Nutritionist and Menopause Nutritionist to answer the most common ones.

Can perimenopause affect your mood before your periods change?

Yes. Your periods don’t have to become irregular before you notice that your mood feels different.

During perimenopause, oestrogen can fluctuate, and the brain can be sensitive to those changes. Sleep may also start to suffer - which doesn’t exactly help when you’re trying to stay patient with everyone around you.

A useful place to start is simply noticing patterns.

Does your mood change at particular points in your cycle? Are you sleeping badly at the same time? Do you notice certain weeks when anxiety, irritability or low mood feel more noticeable?

Try writing it down for a couple of months. It gives you something tangible to look back on and can also be useful to take to your GP, particularly if low mood or anxiety is starting to affect everyday life.

Why do I suddenly feel less able to cope with stress?

You may genuinely have more stress in your life than you used to - but even when life itself hasn’t changed dramatically, poor sleep and hormonal fluctuations can affect how you respond to it.

Something you would normally shrug off can suddenly feel overwhelming, particularly if you’ve been awake since 3am and your head is already full.

Before jumping straight to a supplement marketed for stress or cortisol, Charlotte recommends looking at what is actually happening day to day.

Are night sweats interrupting your sleep? Are you skipping lunch? Are you relying on coffee to get through the afternoon?

Start with those foundations. And if anxiety or stress is becoming difficult to manage, speak to your GP or another healthcare professional.

Why has my PMS got worse in perimenopause?

Some women find that the days before their period become noticeably harder during perimenopause.

As oestrogen levels fluctuate and cycles become less predictable, hormone levels may not follow exactly the same pattern from one month to the next.

That can mean feeling relatively fine one month and very different the next.

Instead of trying to remember how you felt afterwards, track symptoms alongside your cycle as they happen.

Mood, sleep, headaches, bleeding and other symptoms can all be useful to note. If you can see a pattern, you have much more useful information to work with when deciding what support you might need next.

And if your mood becomes very low, don’t assume you simply have to put up with it because it is “only PMS” or “only menopause”. Speak to a healthcare professional.

Do I need to eat differently in perimenopause?

You don’t need a special “menopause diet” - and you certainly don’t need to give up potatoes or all your favourite carbohydrates.

Instead, Charlotte suggests asking whether your usual meals are doing enough for you.

• Are you getting some protein at each meal?
• Are you eating enough plants and fibre?
• Do your meals include sources of healthy fats, including oily fish if you eat it?
• Are you actually eating lunch - or suddenly realising at 5pm that you’ve survived on two coffees and half a biscuit?

Nutrition matters for muscle, bones and long-term health, and it can also help day-to-day energy feel more stable.

Rather than trying to overhaul everything at once, Charlotte’s advice is simple: improve one meal at a time.

Should I be taking a menopause supplement?

The answer is: maybe - but first, work out what you are actually trying to support.

Charlotte recommends thinking about your diet and individual needs before automatically reaching for a generic menopause supplement.

Vitamin D is one nutrient to keep on your radar in the UK, particularly through autumn and winter. It is also worth considering whether you are getting enough calcium from food for bone health, and if you rarely eat oily fish, you may want to think about your omega-3 intake.

If mood and emotional wellbeing are a particular concern, Charlotte is also interested in targeted ingredients such as saffron.

With so many menopause supplements available, it can feel like a minefield. Charlotte looks for formulas that are targeted, evidence-led and transparent about why each ingredient is included, rather than products containing a huge list of ingredients simply because more sounds better.

That is one reason she likes Efamol Omega Femme, a focused formula containing ingredients including saffron, Evening Primrose Oil and vitamin B6, created with women experiencing hormonal change in mind.

But supplements are only one part of the picture. If you are exhausted, for example, it is important not to automatically assume menopause is the cause. Heavy periods, poor sleep, low iron and other health issues could also contribute.

Work out what is going on first - then decide whether a supplement has a useful role to play.

Why am I waking up at 3am and finding it impossible to get back to sleep?

Sometimes the reason is obvious.

You wake up boiling hot, throw off the duvet and, by the time you’ve cooled down, you’re completely awake.

But some women find themselves waking at 3am without night sweats or any obvious trigger at all.

Sleep can become more fragile during perimenopause, and stress may be part of the picture too.

If night sweats are regularly waking you, Charlotte recommends speaking to your GP.

And if you are awake and becoming increasingly frustrated, try to avoid repeatedly checking the time or reaching for your phone and doom-scrolling.

It is also worth looking at caffeine intake - particularly if a bad night’s sleep is leading to an afternoon coffee, which may then make the following night more difficult.

It can become a frustrating cycle, but small changes can begin to break it.

Still have a question about perimenopause?

We’ll be sharing more practical advice and answers from Charlotte throughout Menopause Awareness Month, including a deeper look at why your brain can feel different during perimenopause.