A note from Alice:
You wouldn't believe how excited I get when I meet someone as geeked out about fibre as I am. Julia McHale is one of those people. Julia connected with us through her work supporting women in perimenopause. She was thrilled to find a fibre supplement free of sneaky extras and artificial sweeteners, and it wasn't long before the women she was supporting started finding their way to No.2 too.
Julia's approach is equal parts cheerleader and advocate. She helps women join the dots between what's happening and why, and more importantly, what you can actually do about it. She is a firm believer in preventative health care and has a special interest in women's health. She's written something for No.2 that answers all the questions you've been dying to ask about perimenopause - including fibre; and why you need it.
Over to you, Julia.
There’s not much in my 58 years I would like to change but If I could turn my biological clock back to my late 30’s and recognise the signs and symptoms my body was trying to bring my attention to, I would. Or at least I’d like to write myself a letter and say it will be ok, you’ll be fine, but manage things a bit differently, be ready and offer a lot more grace and kindness to yourself.
I was leading the charge of the perimenopause flag. At 39 I had a long-awaited pregnancy and that was really the last time I remember feeling my self until my mid 50’s. I was fit, active, working hard teaching resuscitation at Wellington hospital, coaching sports teams, leading committees- we had a busy house.
My perimenopause symptoms didn’t hit hard and were easy to dismiss. Low libido (you just had a baby!) Fatigue (You’re a busy working mum!). Sleep issues (You’re stressed!). I was often unwell (You’re just run down and need a holiday!) Stubborn weight (Eat less move more!). Plantar Fasciitis (Stop running!).
I kept waiting for life to calm down, for the fatigue to pass. But that wasn’t the problem, my hormones were changing, and I just wasn’t joining the dots. I look back now and can clearly see the signs and I wish I had been a bit more prepared. I thought I was too young to be experiencing menopause- at 39 this was too early! I just didn’t know all the above were part of the same story- perimenopause.
I started to do a bit of reading and realised that testosterone could possibly help with my symptoms, so I went to see my amazing, now retired GP whose words were “I’ve never prescribed a woman testosterone before but let’s explore this together”. What fantastic words a woman at this stage needed to hear and henceforth my journey into menopause started.
It was around this time I started exploring other health options. I had been working in critical care for a number of years and was getting frustrated with the amount of people whose health conditions were preventable. Wellbeing is never too late, and it often took a catastrophic event in someone’s life (an accident, a diagnosis, death of a loved one) for a person to change their lifestyle- what if I could help people before these events? So, at the age of 45 I started retraining. I was already active and a regular runner, but I joined the local gym, trained as an instructor and started running classes. Then I went back to tertiary education and got my PT license through New Zealand Institute of Sport. By the time I was 50 I was running my own gym, had qualified as a nutritionist, and was a serial certificate junkie. I met the amazing Rachel Burke at Tiaki Physio while studying Pilates- if you need an amazing Pelvic Floor Physiotherapist- Rachel is your woman. There is nothing this woman doesn’t know about pelvic floor health and Pilates. Plus, she is incredibly inspiring to be with!
Rachel put me in touch with Alice at No.2 (another inspirational woman!) and another relationship blossomed. By this stage I had spent years helping people improve their fitness, nutrition and metabolic health, but I kept seeing the same pattern in women in their 40’s and 50’s. They were doing all the things that worked before, yet their bodies seemed to be playing by a completely different rulebook. That curiosity led me into the world of perimenopause, gut health, and simple evidence-based tools such as psyllium husk that can make a meaningful difference during this period of transition.
What Exactly Is Perimenopause
The word perimenopause literally means “around menopause” and marks the beginning of the end of fertility. Biologically, it starts when a woman has roughly 5%-10% of her eggs left, about 1 to 10,000 follicles still active. At that point, the ovaries become less predictable. Oestrogen and progesterone fluctuate wildly, ovulation becomes hit or miss, and cycles lose their rhythm. Those changes disrupt the hormones that guide the menstrual cycle:
- Oestrogen begins to swing sharply, sometimes higher than ever, sometimes suddenly low. Remember, oestrogen affects mood, energy, memory, and body temperature, so these shifts ripple across daily life.
- Progesterone declines gradually, especially in months when ovulation does not occur. With less progesterone, sleep quality drops and mood stability weakens.
- FSH (follicle-stimulating hormone) rises as the brain pushes harder to get the ovaries to respond. Elevated FSH is often the first measurable sign that perimenopause has begun.
In short, perimenopause begins when egg supply runs low, hormonal communication between the brain and ovaries becomes less steady, and the body starts adjusting to a new hormonal balance.
Why We Can Miss It
The signs of perimenopause can easily be missed, dismissed, or explained away as something else. But there are more than 30 recognised symptoms of perimenopause- some experts now cite more than 40. Part of the problem is that many symptoms don’t fit the picture most people have of menopause- like mine listed above, not a hot flush in sight (they came later). Few women expect menopause related symptoms to begin in their 40’s, let alone in their 30’s like me, I was active and healthy after all. But most people are looking for hot flushes and missed periods, not things like insomnia, dry vagina, joint pain, low mood, brain fog, weight changes, libido issues, crime scene periods or periods missed altogether, hair and skin changes, anxiety-even low-level rumination, loss of confidence- apprehensive to join an activity or drive the car at dusk, and others.
The first signs rarely look like hormones, they look like a busy life: Stress, exhaustion, mood changes, forgotten words, terrible sleep, period fluctuations, repeated illness.
When you understand what may be driving these changes, you can start recognising patterns and start preparing for the changes your body is making in this transitional phase.
The Early Warning Signs - Remember the B.A.S.I.C.S. of Perimenopause.
We will explore the symptoms more later, but first it helps to understand the patterns women experience as they move through perimenopause. If you notice several of these changes happening at the same time, perimenopause may be part of the picture. BASICS is an easy way to remember 6 of the most common early warning signs.
Body Changes.
What happens:
One of the earliest signs of perimenopause is the body starts responding differently to the things that used to work; same meals, same exercise, same routines but the weight starts to creep, especially around the middle. As oestrogen declines, women naturally begin to lose muscle mass and gain body fat. Recovery can feel slower. Joints ache, skin feels drier and less supple.
That doesn’t mean weight gain is inevitable; it means we must change up what we were doing.
What helps?
Strength training. This is a non-negotiable, if you haven’t started, reach out to me and I’ll help make this an easy transition for you. Lifting weights is the best gift you can give your body. I spend a lot of my time talking with women to hardcore lock in their workouts into their schedules like their life depends on them, because the quality of your life does depend on the amount of strength your have. If you chose not to strength train then accept that at this moment in time, this is the strongest your body will ever be but if you lift weights, you can get stronger, fitter, and feel amazing. Lift Heavy Stuff ladies.
Protein. This matters more than ever. Most women are consuming enough protein just to survive. Far few are getting enough to thrive- are you thriving or surviving here?
Fibre. Fibre becomes increasingly important during perimenopause because the changes women experience are often linked to blood sugar control, appetite regulation, gut health, and body composition.
A diet rich in fibre helps keep you fuller for longer, reduce hunger, slow digestion of carbohydrates, and support gut microbiome. Most women consume far less than the recommended 25-30g per day. Increasing your fibre intake can be as easy as simply consuming more seasonal fruit and vegetables, plus adding a scoop or two of No.2 Good Gut Fibre to your daily regime. Kiwi Berry is my favourite flavour. In fact, protein is the current social media favourite topic of nutritionists at the moment; but fibre really needs to be up there too.
Most Western diets lack fibre with the average daily intake sitting at only 15g per day. Ideally, like I mentioned, fibre intake needs ideally needs to be 25-30g per day. Why? Because higher fibre intake is associated with better gut health, bowel regularity, lower LDL cholesterol, greater satiety and appetite control, reduced risk of cardiovascular disease, type 2 diabetes, and colorectal cancer. If you re read that list these are symptoms often linked to perimenopause- blood sugar crashes, increased insulin resistance, weight gain-especially around the middle, constipation, IBS issues, inflammation and other issues. Improving fibre intake isn’t about preventing constipation. It is a tool for managing some of the biggest drivers of perimenopause symptoms and it is difficult to find another single nutrient that influences so many systems affected during the menopause transition.
Sleep. Protect your sleep like your life depends on it, follow me for sleep tips that actually work. For some women HRT can play a significant role in sleep quality. Be patient if you start this route and experience side effects, talk with your prescriber and adjust the dose just as they would do for any other hormone imbalance heath issues.
Arousal (or changes in libido).
What happens:
This was my first sign. This change in sexual desire had nothing to do with how much I loved my partner, thankfully we worked through this together and got help. The thing is falling oestrogen and testosterone can affect arousal, vaginal tissues, lubrication and sensitivity (did you know you have more testosterone circulating in your body than oestrogen for most of your reproductive adult life?) Sex may become uncomfortable, it can take longer to feel enjoyable as clitoral atrophy is a thing that happens during perimenopause, or sex just stops feeling like a priority. The key thing to understand is this is your physiology, not about attraction, and it can be fixed. Having a vibrant sex life as you head into this next phase can be an amazing thing! Don’t accept that your sex life is over, investigate testosterone replacement, check out the link included at the end of this article.
What helps?
If pain, dryness and discomfort are an issue, get yourself a real good lubricant and use it liberally…build it into your sex life, the more lube the better! I recommend Uber lube to my clients. I’ll include a link below. The other helpful tool is vaginal oestrogen (I call this skin care for down there!) Vaginal oestrogen (Ovestin) is an amazing product, available on prescription from your GP, Ovestin is one of the safest, most effective and under-utilised treatments for the Genito-urethral syndrome of menopause. Most women, of any age can use this safely. Even those who choose not to use systemic or transdermal HRT can use this as absorption into the bloodstream is minimal and restricted to local area of application. It does not cross over the pituitary barrier of the brain and is not metabolised in the liver (neither is transdermal HRT). It is one of the most underused treatments for menopause, despite it being a very cheap and highly effective treatment for UTI’s, vaginal discomfort, lichen sclerosis and other Genito-urethral issues. Tell your girlfriends all about this one- it’s a game changer.
Sleep Problems.
What happens:
Sleep is often one of the first things to unravel, we use alcohol to try to fix this, usually with worsening results. Alcohol and menopause are not good bed partners…
Waking at night is common, often between 2-4am and unable to get back to sleep. Night sweats or overheating, brain fog, increased irritability, low energy, restless legs, the list goes on…
What helps?
Protect your sleep like it’s a medicine. Keep bedtime and wake up times the same, as sleeping in and trying to ‘bank’ sleep stops working. Limit alcohol, reduce sugar- especially at bedtime. Limit caffeine to mornings only as caffeine half-life metabolism changes with the shift in hormones we experience. Get morning daylight exposure to support natural circadian rhythms. Move your body- workout, not just walking but structured exercise that you can regularly commit to. Book your exercise classes into your schedule as your most important client. Take magnesium glycinate at night to help you relax. Better fibre intake is associated with deeper, more restorative sleep. Diets low in fibre and high in ultra processed foods are linked to lighter, more disruptive sleep patterns. In fact, a green kiwi fruit or two (packed with serotonin precursors) at bedtime has been associated with better sleep.
Irregular Periods.
What happens:
For many of us, this is either the final symptom where we realise something is wrong or we completely gaslight ourselves as it being a normal part of life- trust me, crime scene periods are not normal and need to be checked out by your health care professional. As hormones fluctuate, ovulation becomes less predictable, progesterone isn’t doing its job properly in the luteal phase and you are premenstrual for days…periods are early/late/ or not at all.
What helps?
Track your symptoms and cycle. Talk to your GP and take this record with you. If bleeding becomes heavy this can affect energy levels, iron stores, quality of life, sleep. Don’t assume it’s something you need to put up with. Effective treatments are available. And on this note- 12 months without a period is when menopause if officially diagnosed.
Cognitive (Brain Fog and Mood).
What happens:
This is often the symptom that makes women question themselves the most. You just don’t feel yourself; you walk into a room and forget why you’re there; family and life feels like an endless to-do list. Words disappear mid-sentence, decision fatigue is a thing and even hair washing can feel like a chore. I felt like I was losing my edge. But one of the most exciting areas of fibre research is its impact on the brain. Psyllium husk isn’t absorbed into the bloodstream. It stays in the gut where it forms a gel, slows glucose absorption, binds cholesterol and feeds beneficial gut bacteria. Those bacteria produce compounds that can enter the bloodstream and influence inflammation, metabolism, hormone balance and brain health.
What helps?
Be patient with yourself, offer the grace over yourself that you would with a member of your family experiencing the same thing. Reduce stress where you can, investigate the amazing TED talk ‘The Seven Types of Rest’. Get good sleep. Exercise is one of the best tools for improving cognitive function- exercise is medicine. Most importantly, don’t dismiss this as just fatigue. Ask your GP to check your iron stores, vitamin B12, vitamin D and thyroid function. All of these can be driving cognitive and fatigue issues.
Sweats and Hot Flashes.
What happens:
Hot flushes are probably the symptom most people associate with menopause, and they are often far more disruptive than most people realise. As oestrogen levels fluctuate, the brain’s temperature control centre becomes more sensitive. The body can suddenly decide it’s overheating, even when the room temperature is perfectly normal. A hot flush is a neurological event triggered by changes in oestrogen. Oestrogen helps regulate a part of the brain called the hypothalamus, which acts as the body’s thermostat. This thermostat becomes more sensitive and the body’s comfortable temperature narrows. Normally your body temperature is happy within a broad temperature zone, during perimenopause that zone becomes tiny. About 75% of women experience hot flashes or night sweats during perimenopause. For roughly a third, symptoms last more than five years. Interestingly fibre plays a surprising role in hormone regulation, particularly during perimenopause. One of the key mechanisms involves oestrogen. After the liver has processed oestrogen, it is excreted into the gut. If there isn’t enough fibre, some of that oestrogen can be reabsorbed back into the bloodstream through an action of gut bacteria and an enzyme called beta-glucuronidase. Fibre helps bind and carry excess oestrogen out of the body, supporting healthier hormone balance.
What helps?
Hydration- get your 2 ½ litres a day. Be a boss at water drinking. Reduce alcohol and other triggers such as caffeine and sugar. Choose breathable fabrics and bedding. Keep your room a balmy 16 degrees. Look into including a scoop or two of No2.co.nz psyllium husk into your daily regime. Effective treatments are also available, including Transdermal HRT.
Checklist: The Peri B.A.S.I.C.S.
Take a screenshot, save it to your phone or print it out.
Body changes (weight gain, stiff joints, appearance changes)
• Arousal (libido, dryness, pain or discomfort)
• Sleep disruption
• Irregular periods
• Cognitive (brain fog and mood changes)
• Sweats and hot flashes
If you start to notice 3 or more of the BASICS consistently, it’s worth considering whether perimenopause could be contributing to what you’re experiencing.
Keep in mind the symptoms of perimenopause can begin years before periods stop and often appear gradually, making them easy to dismiss. If I had recognised the signs sooner my symptoms would have been alleviated quicker. The earlier symptoms are recognised, the earlier you can experience symptom relief. The biggest mistake many women make is not starting HRT early enough, perimenopause is not an endurance event. The sooner you recognise what’s happening, the sooner treatment and lifestyle strategies can be implemented.
What to Remember
Perimenopause is not something that suddenly appears when periods stop. For many women, it begins with years of seemingly innocuous health issues or disturbances. These quietly influencing our quality of life such as sleep, mood, weight, confidence, memory, relationships. The challenge is that these symptoms rarely arrive at once and are difficult to put together for some medical specialists who may have had little or no training in this area.
Remember that perimenopause symptoms can start appearing up to 5-10 years before a last menstrual period and menopause symptoms can last for up to 10 years. So, self-awareness matters- become the expert of your body, advocate for yourself, know that you’re not imagining it; you do not have to put up with symptoms that are affecting your quality of life. Talk to your friends, family, workplace colleagues and your doctor.
Understanding creates knowledge, knowledge creates options, and options create hope. You are not alone ladies, and there is light at the end of the tunnel.
If you recognised yourself, your partner, a friend or a family member in these pages, share this article with them. Sometimes understanding what’s happening is the first step towards feeling better.
Julia McHale is a functional nutritionist, wellbeing coach and former emergency medicine professional with a passion for helping people improve their health through evidence-based nutrition and lifestyle strategies. She is the founder of McHale Nutrition Wellness and works with clients across New Zealand and internationally.
If you’d like practical, evidence-based information on nutrition, exercise, menopause, healthy aging, follow Julia at McHale Nutrition Wellness for regular education and support.
Helpful links:
UBERLUBE SILICONE LUBRICANT - 2ml sachet, 55ml and 100ml bottles | Restore Physiotherapy
Home • Ovestin New Zealand
AndroFeme®1- Women's Health | AndroFeme
(5) Facebook McHale Nutrition Wellness
https://www.drlouisenewson.co.uk/search?query=perimenopause
https://www.drlouisenewson.co.uk/knowledge/what-is-hrt
