A Comprehensive list for Healthy Living - Summer Edition

The hormonal shifts that begin in perimenopause influence nearly every major system in the body. Understanding what’s happening isn’t just useful for easing symptoms, it helps you make informed decisions about your long-term health.

Bone Health

Oestrogen does more than regulate periods, it helps keep bones strong. When levels start to dip, usually in the late perimenopausal years, bone mineral density can decline too. That’s when the risk of osteoporosis (when bones become fragile and prone to breaking) starts to rise. The steepest drop in bone strength tends to happen around two years before your final period and can continue for several years after.

Tip: Aim for strength training and weight-bearing exercises at least three times a week — think resistance bands, brisk walking, or light weights. Eat calcium-rich foods (aim for 1200 mg a day), get your daily dose of Vitamin D (800 IU), and top up with supplements if needed. Avoid smoking, go easy on alcohol, and talk to your doctor about hormone therapy, which can help protect against fractures and bone loss.

Muscle Mass

As oestrogen, testosterone and progesterone levels fall during menopause, it becomes easier to lose muscle, a condition known as sarcopenia. That can affect strength, balance and how well your body supports itself over time.

Tip: Some research suggests hormone therapy may help preserve muscle mass, though results vary depending on the study and the person. To support your muscles: follow the advice under “Bone Health”, keep strength training part of your weekly routine, and aim to eat around 1 gram of protein per kilogram of your ideal body weight each day.

Heart Health

Lower levels of oestrogen after menopause are linked to increased cardiovascular risk. This hormonal shift can affect cholesterol, raise blood pressure, and change how fat is stored in the body, often around the waist, which is tied to insulin resistance. Interestingly, low testosterone is actually linked to a more favourable heart profile in women.

Tip: Hormone therapy isn’t recommended to prevent heart disease after menopause. That said, it may still be helpful for some younger, perimenopausal women, speak with your doctor to assess your risk. Meanwhile, protect your heart by cutting out smoking, staying active (aim for 150 minutes of moderate aerobic exercise a week), and eating a heart-healthy diet like the Mediterranean style. Keep up with routine checks for blood pressure, cholesterol, and blood sugar. Manage stress, support your mood, and make sleep a proper priority.

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A running path showcasing how outdoor activities can promote a healthy lifestyle.

Mental Health

During the menopause transition, shifts in hormones, particularly oestrogen and, to a lesser extent, progesterone, can increase the risk of low mood, anxiety, and the return of pre-existing mood disorders. It’s a well-documented pattern, but often not openly discussed.

Tip: Transdermal oestradiol (with or without intermittent micronised progesterone) has been shown to help prevent or ease depressive symptoms during perimenopause. Options like hormone therapy, CBT, or SSRI/SNRI medication can all be considered depending on what’s going on. Just as important: move your body regularly, prioritise sleep, stay socially connected, reduce stress where you can, and support yourself with nourishing food and daily structure.

Brain Health

Changes in oestrogen levels during perimenopause and menopause can affect how the brain functions, particularly in areas linked to memory and focus, like the hippocampus and prefrontal cortex. This can lead to that familiar “brain fog” feeling. For most people, it’s temporary. But in some cases, especially where there’s early menopause, prolonged oestrogen deficiency, or a strong family history of Alzheimer’s, the risk of long-term cognitive decline may be higher.

Tip: Hormone therapy isn’t currently recommended to treat brain fog or prevent Alzheimer’s disease. That said, some studies suggest oestrogen-only therapy started during perimenopause may lower risk in certain women. What’s more strongly supported is lifestyle: diets like MIND, Mediterranean, or DASH are all linked to better brain health over time. As ever, what supports your heart tends to support your brain, so follow the tips under “Heart Health”, stay socially active, and don’t underestimate the power of conversation and connection.

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A cozy bedroom designed for promoting relaxation and healthy sleep.

Gut Health

Oestrogen and the gut microbiome have a close, two-way relationship. Certain gut bacteria help process oestrogen, and in turn, oestrogen shapes which microbes thrive. When hormone levels drop, this balance can shift, affecting the integrity of the gut lining, increasing inflammation, and potentially contributing to metabolic issues. The roles of progesterone and testosterone in gut health are less understood, though testosterone has been linked to changes in the microbiome in some studies.

Tip: For a gut that works with you, not against you, focus on a Mediterranean-style diet, it’s one of the best-supported approaches for increasing microbial diversity, strengthening the gut barrier, and lowering overall inflammation. Prioritise fibre from legumes, vegetables, fruit, and whole grains; stay active; and consider adding a quality prebiotic or probiotic supplement. Hormone therapy may also support gut balance, depending on your individual needs.

Metabolism

When oestrogen levels drop, it can throw off the body’s energy balance, how we store, burn, and use fuel. This shift often leads to more fat being stored (especially around the middle) and a slower, less adaptable metabolism. It’s one of the reasons midlife weight changes can feel frustratingly out of our control.

Tip: Hormone therapy isn’t prescribed purely for metabolic health or weight loss. But when started in perimenopause, it’s been linked to lower belly fat, better insulin sensitivity, steadier blood sugar, and a reduced risk of Type 2 diabetes. Pair this with the lifestyle habits mentioned in the sections above — regular movement, balanced eating, quality sleep — to support a more responsive, resilient metabolism.

Sleep

Falling levels of oestrogen and progesterone can make sleep harder to come by, not just because of night sweats or hot flushes, but also due to how these hormones affect the brain’s sleep regulation systems. The result? More disrupted nights and harder mornings.

Tip: Hormone therapy may help, especially combinations that include progesterone, which has been shown to be particularly beneficial for sleep disturbance. Cognitive behavioural therapy (CBT) remains the most effective non-medication approach for improving sleep in midlife. Regular exercise, mindfulness, and relaxation techniques can all support better rest, as can managing vasomotor symptoms and keeping a steady sleep routine. If sleep issues persist, consider seeing a specialist to rule out an underlying sleep disorder.

Genitourinary Health

As oestrogen levels drop, the tissues of the vulva, vagina, and urinary tract can become thinner, drier, and more prone to irritation. This can lead to symptoms like vaginal dryness, discomfort or pain during sex (dyspareunia), increased urinary urgency, burning, or recurring infections. The natural decline in testosterone with age may also make these symptoms more persistent.

Tip: Local oestrogen therapy is considered the gold standard for managing Genitourinary Syndrome of Menopause (GSM). Another option is intravaginal DHEA (prasterone), which converts to both oestrogen and testosterone locally, offering dual benefit where it’s needed most. Use oil-based or silicone-based lubricants for added comfort, and steer clear of perfumed soaps or other irritants. Pelvic floor physiotherapy can also help with urinary issues, vaginal discomfort, and overall pelvic support.

Sexual Health

Oestrogen plays a key role in maintaining vaginal tissue health, blood flow, and sensitivity, so when levels drop, sexual function can be affected. Common issues include vaginal dryness, discomfort during sex, reduced arousal, and difficulty reaching orgasm. Lower testosterone levels may also contribute to a drop in desire and overall sexual interest.

Tip: For support with physical symptoms, see the “Genitourinary Health” section above. But there’s more to sexual wellbeing than hormones. Structured approaches like cognitive behavioural therapy (CBT) and mindfulness have shown real benefits for desire, arousal, lubrication, satisfaction, and even pain. It also helps to explore any unspoken beliefs, past experiences, or relationship dynamics that might be affecting intimacy. In some cases, testosterone therapy may be considered for low sexual desire — speak with a qualified provider to weigh your options.

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Maintaining a healthy lifestyle is a continuous journey that encompasses various aspects of life. By focusing on balanced nutrition, regular exercise, mental well-being, and sufficient sleep, you can pave the way for a healthier and happier you. Remember, it's about progress, not perfection. Make small adjustments, and watch as they lead to significant changes in the long run.