What women often notice
- Irregular or changing periods
- Hot flushes and night sweats
- Sleep disturbance and fatigue
- Anxiety, irritability or low mood
- Brain fog and poor concentration
- Central weight change and joint aches
Perimenopause
The decade before menopause
A real physiological transition.
Perimenopause usually starts in the mid-to-late 40s (sometimes earlier) and often lasts about four to eight years, longer if it begins earlier. Hormone levels fluctuate. How you feel can sit a long way from “how you look on paper”. Face-to-face at The Richmond House Clinic, Penarth, and video consultations for the UK.
Common symptoms and common pitfalls
What the consultation holds
- Not dressing symptoms up as “just ageing”
- Sleep treated as a foundation, not an extra
- Resistance training over “eat less, more cardio”
- Blood sugar volatility and stress physiology
- Looking for overlap: thyroid, iron, sleep apnoea
- HRT discussed where it belongs, not assumed
Lifestyle medicine sits beside medical treatment
Some women do well with lifestyle interventions alone. Others benefit from hormonal or non-hormonal therapies. The aim is not to “biohack hormones”. It is to reduce symptom burden, protect cardiometabolic and bone health, and write a plan that matches your risk profile and values.
Start with the four-levers map in the Journal — muscle, protein, sleep and a plan that fits you. The navigating note and the older symptoms guide are still there if you want more clinic context.
Perimenopause: the four levers I use with patients
Journal notes
Practical notes on women's health, from clinic
Occasional writing from clinic: cycle health, midlife change, and lifestyle medicine. No daily emails.