The changes might start quietly..
A restless night’s sleep..
Feeling a bit warm.
Skin that’s suddenly acting like you’re 16 again..
Weight around the middle that won’t budge.
Vaginal irritation or discharge that’s never happened before.
PMS that seems to linger longer, or hit harder.
These aren’t random symptoms.
For many women, these are early signals that your hormones, and vaginal microbiome, are starting to shift.
This phase is called perimenopause and it can start up to 10 years before your period stops and the ovaries effectively “retire.”
The good news is that this isn’t the beginning of the end (no matter what we read).
It’s the body preparing for a new chapter, a second Spring.
But to navigate this transition, we need to understand what’s really going on below the surface.
I’ve heard of perimenopause, it’s when my oestrogen drops, right?
Well, not quite.
That’s actually post-menopause, when oestrogen drops for good.
Perimenopause is marked by fluctuations in hormones, particularly oestrogen, as it surges wildly during this period of time.
These surges can lead to symptoms like mood swings, migraines, heavy periods and bloating.
And as oestrogen behaves unpredictably, progesterone declines, quietly reducing the calming and stabilising effect it once had.
This shift doesn’t just affect your mood, sleep and skin, it also directly impacts your vaginal microbiome.
Meet the Hormones
Oestrogen:
Rises and falls throughout the cycle in a mostly predictable rhythm throughout our menstruating years.
It supports mood, skin, metabolism, and more, so erratic spikes and drops can really throw things off.
Progesterone:
Calming and sleep-supportive.
It rises in the second half of the cycle and drops before a period.
Lower levels, during perimenopause and beyond, can worsen PMS, sleep, and stress responses.
Testosterone:
Supports energy, libido, and motivation.
Women need it too!
Yet we often forget about it and blame everything on oestrogen, progesterone and stress.
Cortisol:
The main stress hormone.
Oestrogen helps buffer its effects, so as oestrogen drops, cortisol becomes harder to manage, and more disruptive.
The vaginal microbiome is hormone-sensitive
Oestrogen plays a critical role in maintaining the health of the vaginal microbiome, particularly by supporting a healthy
Lactobacilli level, the bacteria that keeps the vagina acidic and protected.
As oestrogen levels become more erratic, this delicate balance can be disrupted.
That’s why during perimenopause, many women experience:
New or recurring thrush
Bacterial vaginosis
Increased (or decreased) discharge or odour changes
Vaginal dryness or irritation
Often these are brushed off, misdiagnosed or masked with a band-aid solution like antifungals or oestrogen creams,
without proper testing to see what’s actually going on.
Why most tests miss the mark
Maybe you’ve been told “your blood tests are normal”, but here’s the truth:
hormones are dynamic and shifting not just day to day, but hour to hour.
Standard blood tests (especially when done at random points in your cycle) often don’t reflect what’s happening in your body over time.
And they certainly don’t give insight into what’s going on in your vagina.
That’s why I use advanced microbiome testing to map what’s really happening, and why you’re feeling the way you are.
You don’t have to tough this out alone.
Perimenopause isn’t a “problem” that needs to be fixed.
It’s a transition to move through with insight and support.
This isn’t about quick fixes, it’s about understanding.
Diet and lifestyle really matter, but they’re rarely enough on their own if your body is struggling with deep imbalances.
What women need is understanding and a clear roadmap.
Where to Find Real Support
Finding the right help can feel overwhelming, but it’s possible.
And it’s what drives my signature approach.
Having not just first-hand experience, as well as supporting many women over the years, and having additional training
in hormonal and vaginal health, my approach includes:
Step 1:
In-depth assessment
We start by mapping your symptoms, cycle patterns and history to understand the root causes of what’s showing up.
Step 2:
Advanced vaginal microbiome and hormone testing
Forget the guesswork.
We need to test properly so you’re not just treating thrush that isn’t there, or missing a hidden imbalance.
Step 3:
A personalised plan for lasting change
There’s no cookie-cutter approach.
This is real answers, targeted treatment and support that adapts with your needs.
Too often women instead feel dismissed, overwhelmed or unsure where to turn.
If you’ve been told “everything looks fine” but you don’t feel fine, trust that inner knowing.
You deserve more than a quick 10-minute consultation and a prescription you don’t understand or want.
You deserve personalised support from someone who takes your symptoms seriously, understands the complexity
of this hormonal transition, and can decode the hidden signals your body is sending.
Both your hormones and vagina.
Here’s Some Things to Start Looking After Yourself Right Now
Breakfast matters:
A protein-rich breakfast helps regulate blood sugar and stabilises energy and mood.
Try eggs with veggies, chia pudding with nuts and seeds, or a protein smoothie with greens and flaxseeds
(which also support oestrogen and progesterone levels).
Get morning sunlight:
A 10-minute walk or even breakfast outdoors helps reset the body clock and supports sleep hormones.
Cut back on alcohol:
Aim for at least five alcohol-free days a week, especially in the lead-up to a period.
This reduces inflammation and supports liver function (essential for hormone balance and vaginal health).
Lift something heavy:
Muscle mass declines with age, and more rapidly as oestrogen drops.
Weight-based training supports metabolism, blood sugar, and energy.
But avoid overtraining and listen to your body.
Get support:
Book an appointment with an appropriately qualified Women’s Health Specialist practitioner today to get a
personalised plan to support you in the way you deserve.
By Alison Patchett