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Perimenopause: More Than Just Hormones

When most people think of perimenopause, the conversation often focuses on hormones. The body's production of estrogen and progesterone decline, bringing hot flushes, mood swings, and irregular cycles. While that’s true, it’s not the whole story.

Perimenopause is also a neurological and stress-regulation transition. It’s not just your ovaries winding down, it’s your brain and nervous system adapting to a new hormonal situation. These changes influence how you think, sleep, regulate stress, and process emotions.

In this article we will examine how your brain rewires during perimenopause and discuss how your nervous system and stress response play a bigger role in your experience than you may realise. Your adrenal system also influences the symptoms like fatigue, anxiety, and brain fog that are prevalent in perimenopause.

Beyond Hormones: The Bigger Picture of Perimenopause

The traditional view frames perimenopause as a simple hormone decline. We know that less estrogen and progesterone mean you start to experience hot flashes, night sweats, and mood changes. While accurate, this hormone-only focus misses the neurological layer.

Perimenopause is a neuro-endocrine transition. Estrogen and progesterone are not just messengers of the reproductive system, they also influence neurotransmitters that regulate sleep, stress, mood, and memory. That’s why brain fog, anxiety, or emotional swings are so common during perimenopause—they’re part of your brain recalibrating.

Understanding perimenopause through this lens is empowering. Your symptoms certainly aren’t “all in your head.” They reflect the reorganisation that your nervous system is conducting for itself to prepare for the decades ahead.

The Nervous System Shift in Perimenopause

Estrogen and progesterone are neuroactive steroids, natural chemicals made from cholesterol that affect how the brain and nerves work. They can change the activity of brain cell receptors which influences mood, stress, sleep, memory, and even pain. In simple terms, they are “brain-active hormones” that help regulate how the nervous system responds to signals.

They directly affect brain chemistry in the following ways:

Estrogen boosts serotonin and dopamine, enhancing mood, motivation, and focus.
Progesterone interacts with GABA, another brain chemical, to promote calmness, sleep, and stress regulation.

When these hormones fluctuate, the impact is felt in the functions of the autonomic nervous system, or the part of your nervous system that works automatically, without you having to think about it. It controls things like heartbeat, breathing, digestion, sweating, and blood pressure.

Increased activation of the sympathetic system → anxiety, heart palpitations, insomnia.
Reduced activation of the parasympathetic system → poor recovery, digestion issues, and restless sleep.

Emerging research suggests perimenopause is a period of brain rewiring, particularly in areas tied to memory, cognition, and emotional regulation. That explains why women often describe feeling unlike themselves, with brain fog or unexpected mood volatility.

Seen this way, perimenopause isn’t just a hormonal decline, it’s a neurological reset. This can feel unsettling, but it also offers an opportunity to strengthen stress resilience for the years ahead.

The Role of Adrenal Health in Perimenopause

The adrenal glands are tiny organs located just above the kidneys. As ovarian hormone production declines, these glands play a critical backup role. After menopause, they produce cortisol, adrenaline, and small amounts of sex hormones.

This process, sometimes called the “adrenal handoff,” is essential. But if your adrenals are already taxed from chronic stress, perimenopause can feel especially turbulent. Symptoms of adrenal dysregulation—fatigue, midsection weight gain, irritability, and sleep problems—mirror common perimenopausal complaints.

Supporting adrenal health means less turbulence during the transition. When your adrenal system is working well, your body adapts more smoothly to your shifting hormones.

Practical Ways to Support the Nervous System & Adrenals

Instead of only focusing on hormone replacement, you can also build resilience through practices that nourish the nervous system and support adrenal health in perimenopause.

1. Stress Regulation Practices

Breathwork, meditation, or yoga nidra help calm the stress response and bring the body back into balance. Supporting the vagus nerve through simple techniques like humming, chanting, or even brief cold exposure can further improve parasympathetic activation, which encourages relaxation and recovery.

2. Sleep Hygiene

Prioritising good sleep hygiene is another key pillar. Keeping consistent times for sleeping and waking, getting morning light exposure to reset your circadian rhythm, and limiting stimulants after midday all support better rest. Adding calming evening rituals such as gentle stretching, journaling, or a warm shower can also prepare the body and mind for deeper, more restorative sleep.

3. Nutrition Support

Eating protein-rich meals helps stabilise blood sugar, while adaptogens such as ashwagandha or rhodiola—used with professional guidance—can offer additional support. Reducing processed sugars is equally important, as blood sugar crashes can worsen both anxiety and fatigue.

4. Balanced Movement

Maintaining balanced movement helps protect your overall health. Strength training supports bone density and preserves muscle mass, while gentle practices like yoga, tai chi, or walking encourage recovery and nervous system balance. It's also important to avoid overtraining, since pushing the body too hard can add unnecessary stress to the adrenal system.

5. Community and Connection

Human nervous systems regulate in connection with others. Supportive friendships, group exercise, or women’s health communities buffer stress and reduce isolation.

6. Professional Support

Hormone replacement therapy (HRT) when appropriate.
Somatic therapies like craniosacral therapy or somatic experiencing.
Counseling or therapy for emotional and stress regulation.
Menopause MOT from a women's health physiotherapist to treat pelvic floor dysfunction.

Reframing Perimenopause: A Transition, Not a Breakdown

Too often, perimenopause is framed as a loss—of fertility, energy, or youth. But this stage of life is not a breakdown, it’s a transition; one in which your brain and body adapt to a new chapter.

Your symptoms aren’t evidence of losing your womanhood. They’re signals of recalibration. With support, your nervous system can adapt, and many women find they emerge stronger and more resilient.

By reframing perimenopause as a neurological reset, you can see this time as an opportunity: a chance to release old stress patterns, restore balance, and build a healthier foundation for the decades ahead.

Rethinking Perimenopause

Perimenopause isn’t just about declining hormones. It’s about how your brain, nervous system, and adrenal system adapt to change. When viewed through this lens, your symptoms make more sense, and solutions become more holistic.

By supporting your nervous system with stress regulation, sleep hygiene, nutrition, movement, and connection, you can navigate perimenopause with greater ease and resilience.

If you’d like support, consider speaking with a women’s health physiotherapist, your healthcare provider, or exploring programs designed to guide you through perimenopause with clarity and strength. In particular, a women's physio can help you with many of the physical symptoms you may be experiencing.

Book A Women's Physio Consultation Now

For advice on your pelvic health questions, call Magdalena on 07877 017 936 or drop PelviCare an email. Alternatively, you can book an appointment online.

PelviCare Women's Health Physiotherapy is located on the border of Greenwich and Deptford in London, serving women across South London, East London, Essex, Kent and beyond.