If you are like one of the many women who have reached perimenopause or menopause and just don’t feel like you anymore, keep reading. Many of us have one day taken a long look in the mirror and wondered who was looking back at us. Our skin may be duller, hair could be thinning and extra belly fat may have crept on and hung on. Diet may be the same, exercise routine also consistent and general lifestyle similar. Why has this happened when nothing has changed over the last few years? A trip to the GP may not have helped either, as a blood test may reveal all is well in their eyes. You may just be ‘getting old’. Do not believe this. It is an out-dated narrative that couldn’t be further from the truth. The reality is that our hormones shift throughout our lives and how well we handle these shifts determines whether we sail through life healthily or have to jump many speed humps along the way! The unfortunate thing is that women are not told how to manage these shifts in preparation for the changes we meet as we move through our youth, puberty, reproductive years, pregnancy, perimenopause, menopause and beyond. There should be a Master Class for all women to learn the tips for easier transitions through these shifts.

Hormonal shifts

Life happens. One day you’re an innocent child in primary school going about your business, then you turn 12, and everything changes.

Puberty (for girls starts around 12-13 years, and it can be earlier):

Many young women reach this stage and they think it is normal to have a very painful period, with extreme symptoms such as bloat, mood swings and painful cramps. They are under the impression that you just have to put up with this discomfort each month or that you can take birth control pills to regulate the cycle or even skip it each month. There is no reason for young women to suffer through adolescence. Her hormones need appropriate checking, not just the brief glance that a normal blood test offers. We need to intervene and run the pathology tests that check a range of hormones to determine what is out of balance and then remedy the problem.

Reproductive years (around 20-40 years old):

This is a busy time when women are generally chasing a career or still trying to determine what direction to go in. For many women it also includes their choice to start a family. So, this can be a very exciting and challenging time. However, our hormones are easily impacted by very busy work schedules, raising babies and children, providing regular meals and all the other things that often create overload and overwhelm and leave our hormones in limbo.

Perimenopause (around 41-55 years old):

This is a time where there is a dramatic shift in our hormones, as menstrual cycles become irregular and often other symptoms begin to appear. We have many demands placed upon our time. Our children are growing up, work is busier than ever and added to this picture, often our parents begin to require more support. These further demands may cause stress and poor sleep, which will further impact our hormonal balance.

Menopause Plus (around 50 years +)

When finally, our menstrual cycles cease at menopause, another major shift in our hormones occur. After 12 months of no menstrual cycle, we have officially reached menopause. Just how healthy the transition is, will be determined by your level of health in the preceding decade. Many women sail through menopause and beyond in great health, while far too many suffer, mostly in silence, when really what they need is appropriate pathology testing to check on their hormones and determine what needs to be done to bring them back into balance.

Menopausal Symptoms

Common symptoms experienced by many women during menopause and
beyond, which reflects hormonal imbalances, are

  • Anxiety
  • Brain fog
  • Constipation
  • Diabetes Type 2
  • Depression
  • Fatigue
  • Frequent urination
  • Hair loss or thinning
  • Heart palpitations



  • Hot flushes/night sweats
  • Inflammation
  • Insomnia
  • Joint pain, muscle stiffness
  • Low libido
  • Poor concentration
  • Skin issues – acne, psoriasis, tingly, dry or itchy skin
  • Vaginal dryness
  • Weight gain

Hormone Master Class

This is the Hormone Master Class I wish all women had to take in their teens. Then we would truly understand the changes that occur ahead of time and what to be aware of as we age. Which hormones are the likely culprits to impact our health during puberty, our reproductive years, perimenopause, menopause and beyond? 


Cortisol is a stress hormone. It needs to be in just the right amount to work well. It is made in your adrenal glands, located above your kidneys. This hormone increases the amount of sugars in your body. The right amount of cortisol helps get you moving. Cortisol levels are meant to peak in the morning so you can get out of bed and do whatever you do. The levels gradually decline as the day progresses, winding down as we approach sunset each day and by bedtime, they should be low. Cortisol is replenished overnight as we sleep so we will have higher levels again when we awaken. Too much cortisol and you feel stress, such as heart palpitations, anxiety or trouble sleeping, often referred to as ‘wired and tired’. Too little cortisol and you are chronically tired or crave salt and then the body starts to break down.


Melatonin is the hormone that regulates your sleep cycle, or the circadian rhythm. It is made in both the gut and the pineal gland, which is located in the centre of your brain. It is secreted at night and helps you fall asleep. It is released in response to light, and so it should peak in the evening after dark. Melatonin production begins to fall after midnight and drops to its lowest by sunrise. Too little melatonin presents sleep challenges, from trouble falling asleep to poor sleep quality and wakefulness during the night. Too much melatonin can be a result of over-supplementation. The side effects can include daytime sleepiness, dizziness and fatigue. If you stay up past the point where you are exhausted and know you should go to sleep, your melatonin levels will be disrupted. Over time, your natural circadian rhythm will be disrupted, impacting not just your sleep but also the secretion of all your other hormones, as well as your digestive health. This is because over 80% of our melatonin is actually produced in the gut.


This is the hormone that regulates your blood sugar by removing sugars from the blood and sending it to the cells to make energy. It is produced in the pancreas, one of our organs of digestion. Insulin is responsible for fat storage and plays an important role in our metabolic health. Low insulin levels keep too much glucose in your bloodstream and not enough gets sent to the cells. This can result in hyperglycaemia, which includes symptoms of sweating, dizziness, feeling shaky, agitated or nervous. High insulin levels occur from eating too many processed foods, or a meal predominantly made from simple sugars, eg. a bowl of cereal with honey, with a glass of orange juice. Having an exaggerated insulin response occasionally is no problem for most people. But when it happens multiple times throughout the day on a regular basis, for years and years, you can develop insulin resistance. This resistance happens when the insulin levels stay elevated and continue to push glucose into the cells. But since this is too much fuel to be used up at the time, something has to happen to that excess glucose. It is stored as fat. 


How often have you heard that your TSH (thyroid stimulating hormone) is normal after a blood test and that all is well? Unfortunately, knowing this hormone level is only a small part of the picture. We should always opt for a full thyroid panel, which looks at all of our thyroid hormones and different metabolites, as they give us a broader look at what is really happening. 

TSH, T3 and T4

These are the three key thyroid hormones. Apart from being made in the thyroid gland after receiving signals from certain glands in the brain, these thyroid hormones are also made in the gut, as the microbiome determines the conversion of T4 (the less active form), into T3. TSH, T3 and T4 regulate your metabolism, including how well you burn calories. Thyroid hormones impact and influence so many different aspects of your health – your energy, mood, memory, gut health, hair and skin, eyebrows and eyelashes. The thyroid hormones, like all other hormones in the body, work in concert with insulin, cortisol, estrogen and progesterone. For example, when your adrenals are stressed, this can trigger a thyroid dysfunction. Also, if your estrogen is too high, the thyroid has to work even harder to produce its hormones. 

RT3, free T4, free T3, thyroid antibodies

RT3 (reverse thyroid hormone) is typically high when the body is under stress or undergoing a prolonged illness. Thyroid antibodies (antithyroglobulin ab and thyroid peroxidase antibodies), when high indicate you are dealing with chronic inflammation. Total T4 and T3, along with free T4 and free T3, refers to the amount of hormones that are both freely floating and the amount bound to the proteins. Both are needed for optimal thyroid function. An underactive thyroid or hypothyroidism occurs when you don’t have enough of the thyroid hormones you need. You can have a wide range of symptoms, such as weight gain, fatigue, fertility issues and feeling cold all the time. An overactive thyroid or hyperthyroidism triggers overproduction of thyroid hormones. This can cause weight loss, irritability, vision loss, fatigue, sleep issues and mood swings.

Portrait of a tired young girl wearing sweater standing isolated over pink background, yawning


Estrogen is the primary female hormone. It is mainly produced in your ovaries, but it is also secreted from your uterus and body fat. Estrogen helps trigger puberty, prepares the uterus and body fat for pregnancy and regulates the menstrual cycle. Levels of estrogen build during the first two weeks of your cycle and then lower during the second half. You need the right amount of estrogen to build up your endometrial lining, have a monthly period and be fertile. You also need enough estrogen to have good skin, hair, brain function and cognition and good bone health. When estrogen levels are low, your menstrual cycle will be irregular or cease altogether. You may also experience dry skin, dry hair and more fatigue or depression. As the amount of estrogen continues to lower, there is a greater risk for osteoporosis, dementia, altered gut health and cardiometabolic profiles. Too much estrogen, or estrogen dominance, leads to a thickened uterine lining that can trigger spotting, heavy periods, fibroids and ovarian cysts, as well as migraines, headaches, anxiety, depression, brain fog and joint pain. Tender breasts, bloating and constipation are also signs of estrogen dominance.


Progesterone is a critical anti-inflammatory hormone that is often overlooked. Its levels increase in the second half of the menstrual cycle, and as it falls, it triggers the menstrual flow. It is made in the ovaries. Progesterone is needed for your menstrual cycle and to sustain a pregnancy. It triggers the second half of your monthly menstrual cycle, helps to balance estrogen levels, and regulates mood, sleep, energy and fluid levels in the body. It is also anti-inflammatory and helps to manage the gut microbiome. It is a calming hormone and is critical in helping you manage stress, but at the same time gets depleted when you are stressed far too long. When levels of progesterone drop, there is more chance of anxiety, shortened menstrual cycles and sleep disturbances. This can begin a vicious cycle of stress, causing progesterone levels to be rapidly depleted, which then triggers more stress and anxiety, since progesterone is the anti-inflammatory and calming hormone. Too much progesterone gives you that heavy, pregnant feeling. Many women feel like they are walking through mud or are foggy, feel heavy or gain weight rapidly. Balancing your progesterone levels will have you feeling calmer and like yourself again.

Yoga woman meditating and practicing yoga at home. Recreation, s


Just as men have low levels of female hormones, women have low levels of androgens, or male hormones. Primarily they are made in the ovaries, with smaller amounts secreted from the adrenal glands and fat cells. Androgens play a role in gender characteristics, overall hormone balance and hormone breakdown. They kick-start puberty and are responsible for facial, underarm and pubic hair. Further, they are involved in the health of the muscles, liver and bones. Low androgen levels can cause low libido, bone loss and hot flushes. Androgen deficiency can also delay puberty. Androgen levels seem to be increasing in women. From early puberty to acne and issues with ovulation and infertility, we are seeing an explosion of problems caused by androgen excess. As women age, falling levels of estrogen and progesterone can allow androgen dominance, resulting in late onset acne and male-pattern balding. Excess androgens can also trigger insulin resistance of high blood sugar levels, impacting all hormones. Androgen levels increase with stress, poor sleep, nutrient depleted diets, processed foods and trauma. There’s even a neuroinflammatory component, with androgen-related anxiety, depression and trouble focusing. Androgen sensitivity is responsible for the rise in PCOS, hair loss, thyroid conditions and infertility.

Diet and lifestyle recommendations for a smoother menopause


Encourage patients to opt for a Mediterranean style of diet that features a high intake of nutrient-rich foods, such as fruits and vegetables, quality good fats and lean protein, some wholegrains and a low intake of sugar/refined or processed foods, hydrogenated fats, high salt and fast food. 

  • Water intake needs to be consistent, 6-8 glasses daily and more if exercising
  • Reduce caffeine, alcohol and/or tobacco, particularly later in the day
  • Avoid alcohol and spicy foods which can exacerbate hot flushes.
  • Balance your meals, by including protein, good fats and a lot of fibre in each meal. Then on occasions, add some rice or oats or quinoa, which are not processed grains. This helps balance all of the hormones mentioned above.


  • Lowering core body temperature may also help prevent hot flushes.
    Cooler environments, swimming, lower air temperature within the
    house, avoiding overheating while sleeping and dressing in layers that
    can be adjusted as necessary, are all useful strategies.
  • Regular exercise, especially weight bearing exercise, can provide a great
    boost to energy, strength, mental health and wellbeing, while preventing
    osteoporosis. Outdoor fitness activities in nature, with fresh air and
    sunshine, is ideal. Aim for 30-60 minutes daily.
  • Catch up with friends and family regularly. Interaction with people you
    love is paramount to optimal health.
  • Mindfulness is a great daily practice to begin at any age as it allows us to
    become more aware of how stress and a day-to-day busy lifestyle can
    impact our health. Start with 10-12 minutes a day of regular breath work
    and see how much calmer you can feel.
  • Yoga is also a valuable practice on a regular basis. This can help us reduce
    stress-induced insomnia and promote more optimal sleep.
  • Support healthy circadian rhythms in your sleep cycle.