Metabolism in Perimenopause

Teresa Manafaia
Written by Teresa Manafaia

Many women experience various symptoms when they reach the ages of 40 to 45 years old.

The years leading up to menopause can be much more challenging for women who haven’t prioritised healthy habits earlier in life.

Even if a woman exercises, has a balanced diet, & manages her stress, perimenopause can hit hard. There is evidence that lifestyle can positively impact women in menopause and perimenopause. Nutrition and exercise have a significant impact on the quality of life of mature women (1, 2).

During perimenopause, some women may experience irregular periods, hot flashes, vaginal dryness, insomnia, and mood changes such as depression and anxiety. They may also find that they tend to gain weight more easily.

Sleep significantly impacts metabolism and endocrine regulation. For instance, sleep deprivation can reduce glucose tolerance by 40% (3), which can disrupt overall metabolism, particularly if insomnia persists for a prolonged period, such as during perimenopause. Although the precise mechanisms behind insomnia and anxiety during this period are not fully understood, potential associations and causative factors are worth considering.

Sleep disturbances can have multiple underlying causes. Understanding which hormones decrease during this particular phase of a woman’s life may provide insights that help explain the causes.

In the context of menopause, the reduction in estrogen is often top of mind. However, in many cases, progesterone levels decline first. Women with the most pronounced symptoms typically experience higher estrogen levels combined with lower progesterone levels (4). This phenomenon, known as “estrogen dominance,” can be easily confirmed with blood tests.

The decrease in progesterone levels during the second phase of the menstrual cycle has been associated with negative mood symptoms, increased aggression, and fatigue (5). From my extensive experience working with women over the years, I have observed that sleep disturbances tend to worsen in the presence of “estrogen dominance.”

Photo by engin akyurt on Unsplash

Progesterone has been shown to have a neuroprotective role in both men and women. Several clinical studies confirm its high therapeutic efficacy in mitigating necrotic damage and behavioural abnormalities caused by traumatic brain injury (6). Many women end up being treated with anti-depressants & sleeping pills when they could be treated with hormone therapy (7). They often resort to various diets, supplements, and medications to lose weight.

As progesterone declines during this phase of a woman’s life, inflammation can increase because progesterone is an important anti-inflammatory hormone. Recent studies have connected the regulation of inflammatory processes to steroid hormones, particularly progesterone. These effects are nonspecific and include the inhibition of NF-kB and COX, as well as the suppression of prostaglandin synthesis. Other effects include the regulation of T-cell activation, the production of pro-inflammatory and anti-inflammatory cytokines, and the phenomenon of immune tolerance (8).

Progesterone has also been researched for its potential as a pharmacological treatment for inflammatory diseases (9).

Before and during menopause, the dramatic decline in estrogen levels also impacts brain function and metabolism.

Fortunately, naturopathy offers effective tools to help mitigate the effects of hormonal changes (insomnia, anxiety & depression) during perimenopause (10, 11).

In my next article, I will talk about estrogens in perimenopause 😊

  1. The Importance of Nutrition in Menopause and Perimenopause-A Review – PubMed (
  2. The effect of diet and exercise on climacteric symptomatology – PubMed (
  3. Sleep and Metabolism: An Overview – PMC (
  4. Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause – PMC (
  5. Physiology, production and action of progesterone – Taraborrelli – 2015 – Acta Obstetricia et Gynecologica Scandinavica – Wiley Online Library).
  6. Progesterone as an Anti-Inflammatory Drug and Immunomodulator: New Aspects in Hormonal Regulation of the Inflammation – PMC (
  7. Perimenopause and First-Onset Mood Disorders: A Closer Look – PMC (
  8. Association of Oxidative Stress and Proinflammation with Insomnia in Perimenopause – PubMed (
  9. Progesterone as an Anti-Inflammatory Drug and Immunomodulator: New Aspects in Hormonal Regulation of the Inflammation – PMC (
  10. Medicinal Plants for Insomnia Related to Anxiety: An Updated Review – PubMed (
  11. Medicinal Plants Used for Anxiety, Depression, or Stress Treatment: An Update – PubMed (

Main – Photo by Mikhail Nilov