Perimenopause is a natural phase of hormonal change that can begin years before menopause, often bringing shifts in mood, sleep, energy and skin. While it’s a normal transition, it can feel anything but. At Rheal, we believe in supporting your body through every stage of the menopause - which is why we’re breaking down the signs of perimenopause and how to nourish yourself through it, with the help of our new Balance Tonic Menopause blend.
What is perimenopause?
Perimenopause is the transitional phase leading up to menopause.
Menopause is defined as 12 consecutive months without a period (6.)
During this time, the ovaries begin to change how they produce sex hormones. This does not happen in a steady way. Hormones can rise and fall quite unpredictably, which is why symptoms can feel inconsistent and often confusing.
As perimenopause progresses to menopause:
- Ovulation becomes irregular
- Hormone levels become more unstable
- Oestrogen gradually declines overall
- Periods eventually stop
When it typically begins
Perimenopause can begin in the mid to late 30s, although it is more commonly recognised in the early 40s (7.)
Many women still associate menopause with their late 40s or 50s, which means earlier symptoms are often overlooked.
It is common for women in their late 30s to notice:
- Feeling more anxious
- Lower energy
- Less resilience to stress
- A general sense of not feeling like themselves
This can happen before any obvious changes to the menstrual cycle.
It is also important to consider that some women experience menopause earlier, which can due to medical treatments such as chemotherapy or surgery, and even genetic factors.
Common symptoms
Symptoms vary from person to person, but tend to fall into a few main areas.
Cognitive:
- Forgetfulness - this might look like walking into a room and not knowing why, difficulty finding words or recalling names
- Reduced concentration
- Brain fog
Mood:
- Low mood or depressive symptoms
- Anxiety
- Irritability
- Agitation or sudden anger without a clear trigger
Physical:
- Hot flushes, where temperature regulation becomes unstable, and you experience sudden waves of heat, sweating, or dizziness
- Night sweats that disrupt sleep
Metabolic and body composition:
- Weight gain, particularly around the middle
- Previous nutrition and exercise routines no longer having the same effect
Sexual health:
- Reduced libido
- Vaginal dryness
Why hormone fluctuations impact mood, sleep, energy
The main hormones involved in perimenopause are:
- Oestrogen
- Progesterone
- Testosterone
- Cortisol
Oestrogen and progesterone help regulate key brain chemicals such as serotonin and dopamine. These are involved in mood, motivation, and focus.
Progesterone has a more calming role:
- It supports sleep
- It helps reduce anxiety
- It works through calming pathways in the brain
As hormone levels become less stable:
- Brain chemistry becomes less stable too
- Mood can feel more reactive
- Sleep can become lighter or more disrupted
- Energy levels can feel inconsistent
The stress system is also affected. When Oestrogen and progesterone are fluctuating:
- The body can become more sensitive to stress
- Cortisol can become more disregulated
- This can feed into poor sleep, low energy, and mood changes
Sleep is often impacted by:
- Night sweats
- Changes in temperature regulation
- Shifts in circadian rhythm
The important role of nutrition in perimenopause
Nutrition becomes more important during this phase because hormonal changes affect multiple systems, including the brain, bones and metabolism (8.)
Getting enough of the following key food groups can help your body to best navigate these changes.
Protein: (meat, fish, eggs, dairy and plant-based proteins)
- Supports muscle mass, which helps protect bone density
- Helps regulate appetite
- Provides amino acids needed to produce neurotransmitters such as serotonin and dopamine
Carbohydrates: (wholegrains, oats, sweet potatoes, vegetables and fruits)
- Support brain function
- Play a role in mood regulation
Healthy fats: (fish, nuts, seeds, avocados, extra virgin olive oil)
- Support hormone production
- Are important for brain health
Micronutrients:
- B vitamins support energy and the nervous system - Eggs, oats, lentils, meats
- Magnesium supports sleep, mood, and muscle function - Pumpkin seeds, dark chocolate (70%+), spinach
- Iron supports energy levels, particularly if periods are still regular - Red meat, lentils, dark green veg
- Zinc supports hormone balance and immune function - Pumpkin seeds, chickpeas, beef
- Vitamin D3 support bone health and hormone function - Sunshine, very small amounts in mushrooms and seafood
- Vitamin K supports bone health and blood clotting - Leafy greens (spinach, kale), broccoli, fermented foods
- Vitamin A supports immunity and thyroid health - Carrots, sweet potatoes, spinach, organ meats, dairy.
- Vitamin C supports immunity and reduces oxidative stress - Oranges, strawberries, red peppers
-
Antioxidants- Help support the body during increased oxidative stress linked to hormonal changes - Fruits, vegetables, nuts, spices
Simple daily habits to support the body during perimenopause
Daily movement:
- Walking supports nervous system regulation
- Time outdoors supports mood and circadian rhythm
Strength training:
- Aim for 3 to 4 sessions per week
- Focus on resistance training to maintain muscle mass and bone strength
As oestrogen starts to drop, bone health becomes something to pay more attention to.
Oestrogen helps keep bones strong. When levels fall, the body starts breaking down bone faster than it can rebuild it, which can increase the risk of osteoporosis over time (5).
At the same time, muscle mass often declines. This is important, because strong muscles help to support and protect your bones.
Things like strength training can help keep bones strong, but the key thing is consistency, doing a little bit regularly.
Adaptogens explained
Adaptogens are natural compounds, often herbs or mushrooms, that help the body adapt to stress.
They work by supporting the body’s stress response system, rather than overriding it.
Ashwagandha is one of the most researched adaptogens (2.)
KSM-66 ® ashwagandha:
- Has been studied for its effects on stress, anxiety, and sleep (3.)
- Is commonly used at doses around 600 mg per day
- Supports a more balanced response to stress
It helps regulate how the body responds to stress, rather than simply lowering cortisol.
How Balance Tonic Menopause can help perimenopause
Balance Tonic Menopause has been designed to support women through this transition using targeted, evidence-based ingredients.
KSM-66 ashwagandha:
- Included at clinically studied doses
- Supports stress, mood and sleep
B vitamins:
- Support energy production and brain function through perimenopause and post menopause (9.)
Iodine from Scottish Seaweed:
- Supports thyroid hormone production
During perimenopause, oestrogen fluctuations can affect how thyroid hormones are used in the body. This can make symptoms like fatigue, brain fog, and weight changes feel more noticeable (4.)
Iodine supports healthy thyroid hormone production. We have used a gentle form of iodine from seaweed.
Vitamin D3 and K2:
- Support bone health (5.)
- Help regulate calcium metabolism
Antioxidants such as blueberry extract:
- Provide polyphenols that support cognitive and vascular health (1.)
These ingredients have been carefully selected, to support different systems that are affected during this period of life.
Balance Tonic Menopause was developed with expert nutritionists, using carefully selected clinically studied ingredients. It's your daily support for perimenopause, designed to help you feel balanced, supported and more like yourself again.
Because when your body is changing, the right support matters.
References
1. Woolf EK et al. (2023). Daily blueberry consumption improves endothelial function in postmenopausal women with above-normal blood pressure. Food & Function. https://doi.org/10.1039/d3fo00157a
2. Vani I et al. (2026). Ashwagandha root extract shown to support menopausal symptoms in women. Frontiers in Reproductive Health. https://doi.org/10.3389/frph.2025.1647721
3. Gopal S et al. (2021). Ashwagandha root extract shown to improve symptoms during perimenopause. Journal of Obstetrics and Gynaecology Research. https://doi.org/10.1111/jog.15030
4. Usha SMR et al. (2022). Thyroid dysfunction in perimenopausal women. Journal of Mid-Life Health. https://doi.org/10.4103/jmh.jmh_67_22
5. Cheng CH et al. (2022). Osteoporosis due to hormone imbalance: effects of estrogen deficiency and glucocorticoid overuse on bone turnover. International Journal of Molecular Sciences. https://doi.org/10.3390/ijms23031376
6. British Menopause Society (2026). Evidence-based guidance on menopause and post-reproductive health. https://thebms.org.uk/
7. Hedges MS et al. (2026). Global perspectives on perimenopause: a digital survey of knowledge and symptoms using the Flo application. Menopause. https://doi.org/10.1097/GME.0000000000002730
8. Murphy MB et al. (2025). Nutrient intake and menopausal symptoms in perimenopausal women. Nutrients. https://doi.org/10.3390/nu17243887
9. Raczkiewicz D et al. (2024). Impact of vitamin D, B6, and B12 on cognitive function and quality of life in peri- and postmenopausal women. Medical Science Monitor. https://doi.org/10.12659/MSM.943249
