Perimenopause: everything you need to know and how massage can help

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About this post

My name's Dr Ella Woods, I consider myself an expert in perimenopause for two reasons: I’m a clinical psychologist who specialises in the topic; and I’m going through it myself. I’m working with Urban to answer some of the most common questions I get, and how you can best manage your symptoms.

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Dr. Ella Woods

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What is perimenopause?

Perimenopause is the phase before menopause where hormones like oestrogen and progesterone start to fluctuate. It’s often called “reverse puberty” because of the rollercoaster of symptoms that can come with it.

It can last a few months to several years, with symptoms appearing as early as your mid-to-late 30s and usually wrapping up in your early 50s.

During this time, your hormone levels rise and fall unpredictably, and this can lead to all sorts of symptoms.

Common symptoms of perimenopause

Some of the common signs of perimenopause include:

Changes in your period: heavier, lighter, longer, or irregular
Mood swings: anxiety, low mood, irritability, or increased PMS
Sleep disruptions: trouble falling or staying asleep, night sweats
Fatigue and joint pain: feeling more tired and achy
Vaginal dryness: changes that might affect your comfort or sex life

Perimenopause vs menopause – what’s the difference?

Perimenopause is the lead-up to menopause. During perimenopause, your hormones are fluctuating, causing all these symptoms. When you haven’t had a period for 12 months straight, you’re officially in menopause – but here’s a fact not many people know – that status lasts for just one day. After that, you enter the postmenopausal phase.

Managing perimenopause symptoms naturally

Here are a few common symptoms you might experience and some easy ways to manage them — including how massage and self-care can play a part in feeling better.

Managing perimenopausal mood swings

Mood swings, irritability and anxiety are common in perimenopause. Your changing hormones mess with the neurotransmitters in your brain, leading to feelings of stress, anxiety or sadness.

Keep a mood diary to track changes, this will help you work out whether your moods are linked to hormones or something else
Make sure you’re getting a nutrient-dense diet, cutting out as much sugar, processed food and alcohol as possible
Prioritise sleep: it’s critical for mood stability, so go back to the basics of sleep hygiene
Find a movement or exercise routine that works for you
Mindfulness and breathing techniques can help ground you during anxious moments
Massage for relaxation: Regular massages can calm your nervous system and reduce stress hormones

If you’re really struggling to cope, speak to your doctor as there are many treatment options including HRT (Hormone Replacement Therapy), anxiety/depression medication, therapy and lifestyle changes.

Changes to your weight during perimenopause

Perimenopause often brings weight gain, especially around the abdomen, even if your diet and lifestyle haven’t changed. This happens due to hormonal shifts and age-related metabolism changes. Here’s how you can manage it:

HRT (Hormone Replacement Therapy): HRT can help reduce abdominal fat, especially when paired with exercise and a balanced diet.
Exercise: Strength training and interval training are key to building muscle and boosting metabolism
Diet: Prioritise a balanced diet rich in fibre, lean proteins and healthy fats, reducing sugar, processed foods and refined carbs
Massage for stress relief: Stress makes it harder to manage weight. Massage reduces cortisol, your body’s stress hormone, which helps with weight control – a de-stress massage is your go-to

Navigating changes to your sex life

Some women notice changes in libido and sexual comfort during perimenopause, especially with vaginal dryness due to lower oestrogen levels. This can make intimacy uncomfortable or even painful. But there are things you can do:

Use PH-balanced over-the-counter lubricants or vaginal moisturisers to help with dryness and make sex more comfortable
Talk to your doctor if dryness is severe or you’ve had a low libido for over six months – ask about treatment for Hypoactive Sexual Desire Disorder (HSDD) or hormone replacement therapy (HRT- including vaginal oestrogen)
Talk to your partner to stay connected and communicate your needs
Maintain intimacy that feels right for you (which doesn’t necessarily have to include intercourse)

Bladder issues and UTIs – can perimenopause be the cause?

Yep, lower oestrogen levels during perimenopause can lead to bladder control issues and frequent UTIs. The tissues in your urinary tract lose some of their strength, making infections more common and your bladder more vulnerable.

Tips for prevention:

Hydration: drink plenty of water to keep your urinary tract healthy
Vaginal oestrogen: this can help restore tissue health and is safe for most women
Good hygiene: wipe front to back and use gentle, unscented soaps
Cut back on alcohol and sugar: both can irritate your urinary system

If you’re dealing with frequent UTIs or bladder issues, speak to your doctor. There are treatments available, and lifestyle changes can make a huge difference.

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How massage can help ease perimenopause symptoms

Relieving joint pain and muscle tension: as your hormones shift, you may notice more aches and pains. A massage can help release tension, boost circulation, and give your body that deep relaxation it craves.
Improving sleep: a sleep massage can relax the nervous system, helping you drift off more easily.
Mood-boosting benefits: regular massages reduce cortisol (stress hormone) levels and boost your serotonin and dopamine, leaving you feeling calmer and more balanced.

What about skin changes during perimenopause?

Perimenopause can mess with your skin, leaving it dry or more sensitive. Urban recommends a soothing facial that focuses on hydration to help calm those hormonal shifts. Treatments that focus on moisture and calming ingredients can also help reduce breakouts and soothe dry patches – speak to your pro and they’ll know what to do.

Getting help from your GP

When it comes to perimenopause, it’s important to advocate for your health. Some doctors may not recognise or take your symptoms seriously right away, so it’s crucial to prepare for your appointment:

How to make sure your GP listens:

Track your symptoms: Keep a journal of what you’re experiencing, including how often and how severe your symptoms are
Do your research: Understand what perimenopause is and how it affects your body so you can have a clear conversation with your doctor
Be assertive: Don’t downplay your symptoms, be direct about how they’re impacting your life
Book a double appointment, especially if you have more than one symptom to discuss
Download the free guide from my website to help you structure your appointment, have helpful question prompts and quick grab resources for you and your doctor

If your GP dismisses your concerns, it’s okay to seek a second opinion. There are also specialist private medical centres specialising in menopause you can access.

Dr Ella Woods sitting at a desk writing in a notebook

Finding extra support

Perimenopause is a journey, and you don’t have to go through it alone. Finding a community or professional support can make a huge difference.

Consider these options:

Menopause specialists: Doctors who specialise in menopause can offer more personalised treatment plans
Support groups: Online or local groups can connect you with other women going through the same things
Therapists: A mental health professional with experience in women’s health can help you navigate the emotional challenges

Take control and feel your best

Perimenopause can feel overwhelming, but there are plenty of ways to manage the symptoms and stay in control of your health. Whether it’s through lifestyle changes, hormone treatments, or something as simple as booking a massage, there’s help out there.

If you're feeling the stress, aches, and emotional rollercoaster that comes with perimenopause, take a step back and prioritise self-care. With the right knowledge and support, you can navigate this transition and come out the other side feeling empowered.

Please check out my website for more information on my Perimenopause Balance Plan which provides you with a step by step process to not only surviving perimenopause but initiating a lifestyle that will support your health longevity.

Instagram: @perimenopause_balance

Website: www.perimenopausebalance.com

Link to free guide

FAQs about perimenopause

Yes, you can! Even though your periods may be irregular, you’re still ovulating (just not as often). If you don’t want to get pregnant, you should still use contraception until you haven’t had a period for 12 months – but if you have your last menstrual period before 50, you should still use contraceptives for two years.

Most of us expect menopause to happen in our 50s, but perimenopause sneaks up on us much earlier—sometimes as early as your 30s. Many women don’t realise this until they’re in the thick of it, wondering why their body seems to be acting up.

Perimenopause typically begins in your 40s, but it can start as early as your mid-30s or as late as your 50s. There’s no universal “normal” age to experience this, but the average starting age is around 45.

If you’re noticing symptoms earlier or later, it doesn’t mean something is wrong – everyone’s journey is unique. On average, women in the UK on average hit full menopause at age 51.

During your fertile years, your hormones usually follow a pretty predictable pattern. But as you enter perimenopause, your egg supply dwindles, and your hormones—especially oestrogen and progesterone—start to fluctuate. Progesterone tends to gradually decline, while oestrogen can swing wildly from high to low, leading to symptoms like mood swings, joint pain and trouble sleeping.