Why is a cosmetic doctor like myself talking about Perimenopause?

Because if you successfully managed,

  • the need for cosmetic treatments will be less or can be delayed as you’re not prematurely ageing
  • you get better results from your treatments
  • you heal faster
  • you feel better and it shows on your face
  • you look less tired, less angry and more healthy

In this blog post, I will be giving you a summary of:-

  • What is Perimenopause?
  • What causes it?
  • How to diagnose it?
  • How to manage it?


It typically starts from 35 years old and slowly build up/ worsen until menopause at 50 years (unless you take steps to manage it)

Common symptoms include:-

  • Worsening PMS
  • Increasingly painful periods
  • Breast tenderness
  • Exacerbation of headaches & migraines
  • Increasingly erratic periods
  • Menstrual type cramps which occurs any time
  • Hot flashes
  • Less able to respond to stress
  • Easily put on weight especially the midriff

Do you have any of these symptoms? Could you be going through Perimenopause?


Your hormones will rise and fall depending on the time of the month or the stage of your life. When your hormones are balanced, it operates within a nice healthy range and as long as it fluctuates within this range, you will feel on top of your game ????????.

However if it swings way out of the range, you get symptoms of perimenopause. So the aim is to avoid the big swings of hormone levels.

One way is to be aware of the factors that disrupts hormonal balance and take steps to prevent, stop, manage or treat them.

Common disrupters:-

  • Nutritional deficiencies
  • Extreme dieting
  • Low caloric diet
  • Low fat diet
  • Excessive exercise
  • Chronic stress
  • Obesity
  • Infections
  • Toxins
  • Bad diet
  • Smoking
  • Food allergy/ intolerance
  • Alcohol
  • Caffeine
  • Genetic predisposition

So apart from symptoms and looking at your lifestyle to check off what may disrupt your hormonal balance, you can also have investigations done to confirm whether you are in perimenopause or not.


Unfortunately there is no single test that will easily detect perimenopause but a combination of test. The best time to do your test is day 19-21 of your menstrual cycle.

Here is a summary of the important basic ones:-

A. Saliva Hormone Test 
– to check your progesterone/oestrogen levels/ratio. A good healthy result is progesterone : oestrogen ratio of at least 300:1

B.   Blood Hormone Test 
– High FSH above 20mIU/ml (however this can vary greatly)
– Oestrogen test (it is usually higher in early perimenopause as it tries to squeeze the last few eggs out of the ovaries and lower in later years)

C.   Other important test which may mimic the symptoms of perimenopause 
– Blood Thyroid hormone profile – sluggish thyroid can cause irregular menstrual periods, hot flashes and fatigue.
–  Adrenal stress saliva test – high cortisol and an unhappy adrenals can also mimic, trigger and even worsen perimenopause.

Every hormone doctor will have their favourite test. Some test are far more detailed and can detect hormone levels throughout the month instead of a snapshot picture. These are usually much more expensive.

Whichever test you decide to have at the end of the day, remember you will also need to take into account your symptoms and medical history to paint the whole picture.


I’m breaking this section into 2 parts – first one is with lifestyle and food, while the second will touch on supplements and herbs.


How to manage Perimenopause with lifestyle and food – less diva and more best friend.

The aim is to:-

  • Boost your calming best friend Progesterone (think better sleep, clearer skin, feeling calmer, less PMS)
  • Detoxing excess diva hormone Oestrogen (think water retention, breakouts, painful periods, feeling cranky)

LIFESTYLE recommendations:-

  1. Slow your breath down (e.g. meditation, yoga, conscious breathing). This will help calm your cortisols which in overdrive eats up your Progesterone
  2. Hang out with good friends (good belly laughs, no gossip or b****ing) which will help boost Progesterone
  3. Choose more relaxing type of exercise (stretching, Pilates, dancing, swimming)
  4. Enjoy practicing self care
  5. Cut down on meat and alcohol (both increasing excess diva hormone)
  6. Cut down on coffee, sugar and the white stuff (which increases cortisol which can reduce production of progesterone)
  7. Reduce chemical exposure to household cleaning agents (this often contain Xenoestrogen, the chemicals mimicking the bad oestrogen)

FOOD recommendations:-

  1. Choose foods that help detoxify the liver and kidney (helping to flush out excess bad oestrogen) – garlic, grapefruit, beetroot, carrots, green tea, leafy dark green vegetables, avocados, apples, olive oil, cruciferous vegetables (broccoli and cauliflower), lemons & limes, cabbage and walnuts
  2. Increase your fibre eg flaxseeds and legumes so you open your bowels more regularly (this is how excess oestrogen is removed from the body)
  3. Increase building blocks to produce progesterone eg
  • Vitamin B’s found in seafood, beans, bananas and spinach
  • Zinc found in chickpeas, pumpkin, watermelon and dark chocolate
  • Magnesium found in halibut, raw plantain, black beans, whole grain, okra and nuts


How to manage Perimenopause with supplements and herbs. This is a big topic and unfortunately there is no silver bullet to manage this phase.

There are many options/combinations e.g. Chinese medicine, acupuncture, energy work, aromatherapy, Ayurvedic medicine and  homeopathy. You have to choose what works for you based on your values, your medical history, your philosophy, your belief in the process and your lifestyle.

The suggestion I list below is what I use for myself and my patients. Before you start anything, I would highly recommend you doing your research and where necessary, work with a practitioner to have your hormone levels checked so treatment can be more bespoke and tailored to you.

Typically in the early years of Perimenopause, there is more oestrogen dominance (think too much diva) whereas in later years, there is less so there’s more hot flashes and night sweats ???? Here’s what I recommend supplement wise whIle you work on the lifestyle/food solutions for Perimenopause.


  • Good quality Multivitamin & Multimineral
  • Omega 3
  • Vitamin D (if it’s low)
  • Adrenal support e.g. Adrenotone by Designs for Health


  • Agnus Castus or Vitex drops (helps relieve PMS)
  • DIM (helps to remove excess oestrogen)
  • Black cohosh (better for later years)
  • Dong Quai (good especially if you have heavy bleeding)
  • Evening primrose oil (better for later years)

So there it is, a crash course in Perimenopause.

In my next blog post on this topic, I will cover Bio-identical Hormone Therapy and who you can see if you need them.

If you would like to see more tips on wellness, you can follow me on my Instagram or FB page.

Until then, may you find balance and wellness in your many years ahead.

To your best self,