September Is Perimenopause Awareness Month

What Exactly Is Perimenopause?

If there's one thing I've realised from learning more about this stage of life, it's this: many women enter perimenopause without really knowing what to expect.

We know that menopause is when menstruation stops. This is the simplest explanation.

But perimenopause, the transition phase before menopause, can last up to 8 to 10 years before menopause actually occurs.

During perimenopause, which Dr Mary Claire Haver describes as the Zone of Chaos, hormones such as estrogen, progesterone and testosterone become increasingly unpredictable, and the effects can show up in ways that don't immediately seem hormonal at all: brain fog, anxiety, poor sleep, mood changes, joint aches, palpitations, changes in body composition and many more.

Which is why, so many women in their 40s seem to describe similar experiences:

"Maybe I'm just stressed."

"Maybe I'm just getting old already lah."

"Why don't I feel like myself anymore?"

And then you finally start connecting the dots.

Discovering the Perimenopause Rollercoaster

My Blog Posts

I thought estrogen was just a reproductive hormone. Here's what I learnt about estrogen's role in brain fog, mood, sleep and other perimenopause changes.

Why do anxiety, irritability, and poor sleep feel different in perimenopause? Here's what I learnt about progesterone and feeling less steady in midlife.

Feeling flat, less motivated or low in energy? Here's what I learnt about testosterone in women and how it may affect drive, strength, and midlife.

Aha. No wonder lah!

Perimenopause Deserves More Conversations

Awareness matters because recognising that these changes could be related to perimenopause gives us more context. It helps us ask better questions, seek appropriate support and have more informed conversations about what is happening to our bodies.

If you're wondering whether some of the changes you’ve been experiencing could be related to perimenopause, you can also reach out to Menopause Asia.

It is a digital platform that connects women with independently licensed doctors, reliable information and practical midlife health resources, with the aim of making menopause support easier to access and navigate. Menopause Asia itself is not a healthcare provider; medical consultations are provided independently by licensed healthcare professionals.

Sometimes, knowing what might be happening is already a very useful first step.

So this September, maybe tell another woman what you've learnt too.

Because the more openly we talk about perimenopause, the less likely someone else is to spend years thinking: "What on earth is wrong with me?"

❤️ Share this with a woman who might need her own Aha, No Wonder Lah moment.

Adding Oil to Everything Is Now Part of My Parenting Strategy

I came home from a dietitian appointment recently with a new parenting strategy:

Add oil to lunch, dinner, and whatever food my child will happily eat.

So apparently, when you're trying to help a child gain weight, sometimes the answer isn't eat more. It's figuring out how to make what they're already eating work a little harder.

I just realised this is one of those parenting things I never thought I'd know need to put into practice.

For the past few months, we've been working with a dietitian to help our youngest kiddo with his growth. He's always been on the smaller side, so we're trying to help him gain weight steadily and, hopefully, support his height growth along the way.

The good news from our latest appointment is that he has gained some weight.

Although not a drastic increase, it was enough for the dietitian to mention that whatever we're doing, keep doing it.

So next, we add oil.

One of the things I've learnt is that helping a child gain weight doesn't necessarily mean piling more food onto his plate.

Because if your child already doesn't eat very much, staring at an even bigger mountain of food isn't exactly going to inspire him.

Instead, we're learning to increase the calorie density of the food he's already eating.

Hence: oil (e.g., olive oil, butter).

And we're also encouraged to add things like fried shallots, fried garlic, and fried ikan bilis to his meals; basically foods that add more oil, protein, and calories without significantly increasing the amount of food he has to finish.

Vegetables require a different strategy.

This is another thing I liked from the dietitian.

Instead of constantly introducing vegetables as a separate 'you must eat this because it's good for you' item, we can introduce them through something he already likes.

He loves tom yum, for example.

So rather than saying, "Here is a new veggie. Eat it." It can be, "Here's your tom yum. There's a nice veggie in it." 😂

He's already started accepting a few vegetables, so the idea now is to keep those consistent while slowly expanding the selection.

Sleep is not for the weak.

This one is probably going to be harder than adding oil.

The dietitian also reminded us that nutrition is only one part of growth; sleep matters too.

So we're now working towards an earlier and more consistent bedtime, which means my child's growth plan involves not only what happens at the dining table, but also what time he needs to be in bed.

Wish me luck!

Small progress is still progress.

I think that's probably my biggest takeaway from these appointments.

When you're watching a child's growth over time, progress doesn't always look dramatic. Sometimes it's simply seeing that the gap on the growth chart has become a little smaller.

And for now, that's enough to make me happy.

We have another few months before the next check-in, so the plan is pretty simple:

• Keep doing what seems to be working.
• Keep making his snacks more substantial.
• Keep introducing food, including veggies, without turning every meal into a battle.
• Get him to bed earlier.
• And of course, add oil to his food.

Wish me luck!

Where Did My Spark Go?

After learning about the chaotic behaviour of fluctuating estrogen and progesterone during perimenopause, I thought I understood this whole hormone situation.

Then testosterone came along.

Women Have Testosterone Too

What? Seriously? 

Did you know that women have testosterone too? This was probably the first misconception I had to get rid of.

Testosterone is not exclusively a male hormone. Women produce it too, just in smaller amounts.

Source: Instagram | joiedevivrefit

In women, testosterone supports:

• Energy and vitality
• Libido
• Muscle and strength
• Bone health
• Confidence and drive
• Cognitive sharpness
• Skin and hair

Okay wait.

So, estrogen has its hands in almost everything.

Progesterone is involved in calmness and sleep.

And now testosterone is in the picture, deciding whether I still have energy, drive, and motivation.

How many functions are these hormones actually running? 😑

The "I've Lost My Spark" Feeling

Because low testosterone in women can be described less like feeling unwell and more like this vague sense of flatness.

It's not necessarily sadness or depression. Just... "I don't feel like I used to."

Some women describe it as:

"I've lost my spark."

"I feel flat."

"I'm going through the motions."

"I don't recognise myself."

That whole cluster stood out to me because it's such a subtle thing.

There may not be anything dramatically wrong; you're still functioning, going to work, doing what needs to be done, and showing up.

But somewhere along the way, the enthusiasm feels smaller and the drive is less.

The "I can't be bothered" moments become more frequent.

And you may start wondering, "Am I just tired? Lazy? Burnt out? Bored? Getting old? Or is there something else going on too?"

Then There Is the Energy Problem

This one is interesting, because "tired" can mean so many things.

There's sleepy tired, physically exhausted tired, and mentally overloaded tired.

And then there's this other kind of "tired" where you can technically do something but just don't feel like it.

Because the motivation, enthusiasm, and that forward momentum are missing.

Now to be fair, sometimes I genuinely cannot be bothered because the thing is annoying and I have reached that stage in life where I no longer want to waste energy pretending otherwise. 😂

But still.

I find it striking that testosterone is also associated with drive and vitality, because those are not usually the things women are taught to connect with hormones.

Strength Training Is a Big Deal

Declining testosterone has been linked to reduced muscle mass, less physical resilience and shifts in body composition. This is probably the most practical takeaway I got from this topic.

Experts put a lot of emphasis on resistance or strength training and suggest two to three sessions a week as an important part of supporting strength and muscle in midlife.

Strength training seems to be the "prescription" for almost everything related to perimenopause, bone health, muscle mass, and metabolism.

Sigh, I suppose this is one of those moments where I can no longer pretend I didn't get the memo.

Looks like I need to stop avoiding strength training. 😑

Excuses Vs Context

Anyway, learning about hormones isn't about finding an excuse.

It's about understanding that sometimes there is more context behind the question, "Why don't I feel like myself anymore?"

Maybe the better questions are, "What has changed?" and "What can I do?"

Why Don't I Feel As Steady As I Used To?

After learning about estrogen, I thought, okay... at least now I understand a little better why perimenopause can feel so random.

Then there's one more hormone in the picture: progesterone.

Just like estrogen, I associate progesterone with pregnancy or fertility. That's it.

What I didn't realise is that progesterone is closely linked to sleep, anxiety, mood, and that general sense of feeling calm and steady.

And when I learnt that?

Aha. No wonder lah!

Progesterone Is the Underrated Hormone

Estrogen gets a lot of attention when we talk about menopause. And progesterone seems to be the quieter one sitting somewhere at the back.

But I'm beginning to realise this quiet hormone may explain some of the things that bother me the most. Things like:

• Why am I more easily overwhelmed than before?
• Why does anxiety appear when there isn't actually anything specific to be anxious about?
• Why can I be physically tired, but my brain refuses to switch off?
• Why don't I feel as emotionally steady as I used to?

That last one really caught my attention because sometimes it isn't even about being sad, angry or anxious. It's just this feeling of... I used to handle things better.

Let me to explain what that means:

• I begin to realise things that I would previously just let them be; now they suddenly irritate me more.
• Stress seems to use up my mental bandwidth way faster than what I'd like to admit.
• Some days I just have less tolerance for nonsense.

Okay, maybe the last one is also age and experience. 😂

But still.

It made me wonder how much of what we describe as "I've changed" could actually be happening alongside hormonal changes too.

Progesterone Apparently Starts Changing Early

Source: Dr. Mary Clair Haver

This was another thing I didn't know.

I always assumed all our hormones basically started declining together as we approached menopause.

Progesterone is produced after ovulation. But as we move through our late 30s and 40s and ovulation becomes less consistent, progesterone production can also become less consistent.

You may still be having periods, not having hot flushes, or not even be thinking about perimenopause. But hormonally, things may already be changing.

Aha. No wonder lah!

This also made me realise why the beginning of perimenopause can be so confusing.

We tend to look out for the stereotypical menopause symptoms. No hot flush? Still menstruating? Then surely everything is normal, right?

Except the changes may have started much earlier and may show up in completely different ways.

Then There Is the Anxiety

This was actually one of my bigger aha moments.

I recently understood that anxiety can worsen when progesterone declines, while fluctuating estrogen can also contribute to it.

My immediate response was basically: AHA. NO WONDER LAH.

So progesterone is fluctuating; estrogen is going up and down like a rollercoaster.

And my nervous system is somewhere in the middle, going, "Good luck everybody!" 😂

Of course, anxiety has many causes, and I'm not going to blame every anxious moment on hormones.

Work, family, traffic, incompetent people are... well, incompetent people.

But what I find frustrating is the kind of anxiety that sometimes seems to come from nowhere.

Nothing particularly terrible has happened >> You're not consciously worried about anything >> Yet somehow your body feels unsettled >> Your mind is restless >> You're more easily triggered >> And you can't quite explain why

You feel me?

And Then There Is Sleep...

...or the lack of it.

I have recently also been learning about the relationship between progesterone and sleep, particularly that progesterone has calming effects in the brain and is associated with restorative sleep.

Which brings me to another question: How can you be tired and STILL not want to fall sleep easily?

I can be physically exhausted and I know I should sleep.

But somehow my brain thinks 11pm is an excellent time to play brain games. One round, then another round, then another, and one hour passed.

Earlier I joked that perhaps I'm addicted to dopamine.

Maybe not literally, but I have definitely trained my brain to expect entertainment right until bedtime instead of winding down.

So now I'm experimenting. No brain games for about an hour before sleeping.

Brain, please understand that office hours are over. 😭

Having More Context Is Important

When you're more anxious, sleeping badly, easily overwhelmed and not feeling as emotionally steady as before, it is very easy to turn everything inward.

Why am I like this nowadays? Why can't I handle stress like I used to? Why am I so easily irritated? Am I just becoming grumpier as I get older?

To be fair, yes, hormones may not be the explanation for everything.

But for me, learning about perimenopause isn't really about finding a hormone to blame or pigeonholing symptoms. It's about having more context. Because once you understand that something may be changing inside your body, you stop interpreting every change as some kind of personal failing.

The thought then changes from, "What is wrong with me?" TO

"Ahhh... so THAT might be what's going on."

And there it is again.

Aha. No wonder lah!

Next experiment: convincing my brain that bedtime is for sleeping, not achieving a new high score. 😑