10 min read

In this article:

• It is not in your head — it is in your brain
• What is actually happening neurologically
• The progesterone picture
• The gut barrier connection
• The domino effect
• What diet can do
• What lifestyle changes support the transition
• What targeted nutritional support may help
• A note on when to seek further support

October is World Menopause Awareness Month — and if there is one thing we hear from women more than anything else during this transition, it is some version of the same sentence: I just don't feel like myself anymore.

It sounds like a small thing. It is not. The loss of a sense of self — the feeling that the person you have been for decades has shifted in ways you cannot predict or explain — is one of the most disempowering experiences perimenopause brings. And because it is so hard to put into words, it is also one of the least talked about.

We asked our in house head of nutrition, co-founder Alice to tell us more about why this happens and what we can do about it.

When women come into my clinic saying they don't feel themselves, I always ask them to elaborate. What I hear most often is a cluster of things: low-level anxiety without an obvious trigger, irritability that feels disproportionate, a flatness or loss of motivation, and a brain fog that makes ordinarily straightforward tasks feel effortful. There's often something else too — a nervous system that feels permanently on edge, making everything from driving to handling conflict at work or at home feel harder than it should. For women already carrying significant responsibilities at this stage of life, that background hum of dysregulation only adds to the frustration.

These feelings can creep up on you, making it difficult to pin-point what is going on, especially when life is so busy.

The first thing I want to reassure our readers of, is that though it might feel like it — this is not usually a sign that something has gone badly wrong, or even that you're a bit depressed. Instead, they are often a direct neurological consequence of a major hormonal transition — one that reshapes the chemical environment of the brain in ways that are increasingly well-understood, even if they are still rarely discussed with the clarity they deserve.

It is not in your head, but it is in your brain!

Perimenopause is often described as a reproductive transition. That framing, while accurate, doesn't cover why the changes that occur can feel so all-encompassing. That's because the shift is also a neurological one.

A growing body of neuroscience research now describes perimenopause as a major neurological transition state, comparable in its effects on the brain to puberty, but operating in the opposite direction. As ovarian function begins to change, the brain is exposed to dramatically fluctuating levels of oestradiol and progesterone.

Given the receptors for these hormones are located around the entire body (bones, brain, heart, gut, reproductive organs…) it's not surprising that neuroimaging studies have documented changes in oestrogen receptor availability and brain metabolism across the menopausal transition will exceed those that would be expected from chronological ageing alone.¹

The pituitary gland acts a bit like a thermostat for your hormones — it constantly reads the levels circulating in your blood and sends signals to other glands to produce more or less as needed. During perimenopause, it works increasingly hard to stimulate the ovaries as their response becomes less reliable, driving the erratic hormonal swings that many women experience. These fluctuations don't stay in the reproductive system — they ripple into areas of the brain involved in emotion regulation, memory, stress response, and sleep, including the hypothalamus and hippocampus. The result is not just mood instability but a measurable shift in how the brain regulates emotional responses, motivation, and cognitive function. Many women describe feeling pulled in different directions, unable to quite keep up — and there is a very real neurological basis for that.

It's no wonder so many women describe the experience as feeling unlike themselves — neurologically, they are operating in a significantly altered internal environment.

I should hasten to add here, these shifts are not permanent, so don't lose hope.

What is actually happening?! How your hormones impact your brain's neurotransmitters

Oestradiol isn't just about the reproductive system. It's a potent neuromodulator — ergo, it impacts the brain, and the activity of serotonin, dopamine, noradrenaline, and GABA.²

Serotonin is the neurotransmitter most associated with mood stability, emotional resilience, and the body's response to stress, and it is directly influenced by oestrogen. As oestradiol fluctuates and eventually declines, serotonin availability can fall and the activity of MAO-A, the enzyme that breaks serotonin down, can increase. This is one pathway that for some women, can lead to low mood, reduced emotional resilience, and heightened reactivity.²

Dopamine (the neurotransmitter associated with motivation, reward, focus, and drive) is also positively modulated by oestrogen. Its decline contributes to the loss of enthusiasm, the reduced ability to feel pleasure in previously enjoyable things, and the cognitive flatness many women describe as brain fog.¹

GABA is the neurological equivalent of a brake pedal — it slows neural activity and creates feelings of calm. This neurotransmitter is influenced by Progesterone — as it converts in the brain to allopregnanolone, which acts as a natural positive modulator of GABA receptors. As progesterone declines, this calming influence reduces. The nervous system can become more reactive, sleep lighter and more fragmented, and anxiety can appear in women who have never experienced it before.

The progesterone picture & why it often starts earlier than you expect

Progesterone is typically the first hormone to decline in perimenopause, often beginning in the mid to late 30s as ovulation becomes less consistent. This means the GABA-related symptoms — anxiety, sleep disruption, emotional reactivity — can begin well before oestrogen has significantly changed, and well before periods become irregular or hot flushes appear.

Chronic stress compounds this further. Progesterone is a biochemical precursor to cortisol. When the body is under sustained stress, it can prioritise cortisol production over progesterone synthesis — accelerating and worsening the progesterone decline of early perimenopause.

The gut connection — and why it matters more than most people realise

There is one more system in this picture that is consistently underappreciated: the gut. And its role in perimenopausal wellbeing extends well beyond digestion.

Within the gut microbiome there is a specific community of bacteria called the oestrobolome — a collection of microbes that produce enzymes responsible for metabolising and recirculating oestrogen as it passes through the digestive tract.⁴ When the oestrobolome is healthy and diverse, it helps regulate how much active oestrogen circulates in the body. When it is disrupted (through poor dietary diversity, stress, antibiotic use, or the hormonal changes of perimenopause itself) oestrogen metabolism becomes less efficient. The reassuring news is that the gut microbiome is one of the most responsive systems in the body to dietary change, and the downstream effects of disruption are very often reversible.

Research has shown that the gut microbiome changes significantly during the menopausal transition. A large study found that after menopause, women's gut bacterial profiles shift to more closely resemble those of men of a similar age — a change likely driven by declining oestrogen and progesterone and associated with reduced microbial diversity.⁵ These microbiome changes have been linked not only to menopausal symptoms but to increased cardiometabolic risk.⁵ This sounds significant, and it is worth knowing, but it also underscores how much leverage good nutrition has here. What we eat is one of the most powerful drivers of microbiome composition, and women who prioritise dietary diversity during this transition are actively working with their biology… more on this below.

The gut-brain axis is something else we should consider here, because this connection may also be playing a role with our mental health. The gut produces approximately 90% of the body's serotonin — the neurotransmitter most associated with mood stability and emotional resilience. When the gut microbiome is disrupted, serotonin production can be affected — and this is one of the mechanisms through which gut health connects to the anxiety, low mood, and emotional reactivity that characterise perimenopause for so many women. Again, this is good news in disguise: it means that dietary changes which support the gut microbiome are also supporting the neurochemical environment of the brain. Evidence consistently shows that increasing whole plant foods has a meaningful impact on anxiety symptoms, and that the Mediterranean dietary pattern is associated with beneficial effects on brain health and mood, partly through its influence on the gut.⁶

IBS and gut sluggishness (including constipation) are also commonly reported to worsen during perimenopause. Constipation in particular matters hormonally: when bowel transit is slow, oestrogen that has been packaged by the liver for excretion can be reabsorbed through the gut wall rather than cleared. Whilst this isn't always a bad thing, a slower gut can throw the balance out. Regular, healthy bowel movements are therefore not just a digestive priority — they are a hormonal one. And bowel regularity is something that often responds well to the same dietary foundations that support the microbiome more broadly: fibre, hydration, fermented foods, and consistent meal timing.

Supporting gut health in perimenopause is therefore not simply about reducing bloating. It is about supporting the hormonal environment, the nervous system, and the brain — all at once. And crucially, it is something you can meaningfully influence at every meal.

The gut barrier itself

One area of emerging research that deserves more attention is the gut barrier itself — and what happens to it during the transition.

A very recent landmark study followed nearly 1,000 women over many years and found that the lining of the gut (the thin layer separating your digestive tract from your bloodstream) starts to become more permeable around two and a half years before periods stop, and continues to do so for several years after.⁷

As the gut wall weakens, tiny bacterial products can slip through into the bloodstream. The immune system mounts a low-grade inflammatory response to what it encounters there — and that slow background inflammation is increasingly being linked to some of the most frustrating perimenopausal symptoms: joint aches, persistent fatigue, reactive skin, and shifts in mood.

Importantly, this isn't a sign something has gone wrong. It appears to be a normal — if largely unrecognised — feature of the transition in otherwise healthy women. And the gut lining is one of the most nutritionally responsive tissues in the body, which is why so many women notice meaningful improvements in these kinds of symptoms when they prioritise gut support.

The domino effect

It is also worth understanding that these neurological changes rarely happen in isolation from everything else perimenopause brings. A 2025 review in the journal Menopause described what it called the "domino effect" — where vasomotor symptoms like hot flushes disrupt sleep, disrupted sleep worsens mood and cognitive function, and compromised mood and cognition increase stress, which further disrupts the hormonal environment.³ Each element therefore needs to be given support — and this is where nutrition, alongside exercise and stress management, can be genuinely powerful. The impact of these foundations, applied consistently, is global.

This domino pattern is why addressing perimenopause from a single angle so often produces limited results. The systems involved are interconnected, and meaningful support addresses several of them simultaneously. Below, we cover exactly what that looks like in practice.

What diet can do

Diet is not a replacement for medical support where it is needed — but it is a meaningful and often underestimated part of the picture.

A 2024 cross-sectional analysis of perimenopausal and menopausal women found that higher adherence to a Mediterranean-style diet was associated with reduced severity of menopausal symptoms including psychological symptoms.⁸ The Mediterranean pattern — rich in vegetables, legumes, whole grains, oily fish, olive oil, and nuts — supports several of the systems most affected in perimenopause: it is anti-inflammatory, it supports gut microbiome diversity, and it provides the amino acid precursors (particularly tryptophan) that the brain uses to produce serotonin.

A few specific dietary priorities are worth highlighting:

• Protein at every meal — the amino acid tryptophan, found in eggs, oily fish, turkey, dairy, nuts, and seeds, is the precursor to serotonin. Adequate protein intake is essential for neurotransmitter production and becomes more important, not less, as the hormonal support for serotonin pathways declines.
• Reduce refined carbohydrates and sugar — blood sugar instability amplifies mood swings, worsens energy crashes, and places additional demand on the adrenal glands that are already managing elevated cortisol. Prioritising complex carbohydrates alongside protein and healthy fat at every meal supports more stable blood sugar and a more stable mood.
• Healthy fats — olive oil, oily fish x3 per week (I recently discovered sprats — so good!), avocado, nuts, and seeds support the anti-inflammatory environment that the brain needs to function well. Evidence suggests that higher olive oil intake specifically is associated with reduced psychological symptoms in perimenopause.¹⁰
• Fibre and fermented foods — fibre is the primary fuel source for the beneficial bacteria in your gut microbiome, and diversity of plant foods is one of the strongest predictors of microbiome richness. Aim for 30 different plant foods across the week — this includes vegetables, fruit, wholegrains, legumes, nuts, seeds, and herbs. Fermented foods such as live yoghurt, kefir, kimchi, and sauerkraut add beneficial bacteria directly. Both are foundational for the oestrobolome and gut barrier health covered above.
• Limit alcohol — unfortunately alcohol disrupts sleep architecture, depletes the B vitamins and magnesium that the nervous system depends on, worsens hot flushes, and can increase anxiety the day after even modest intake. This is not about abstinence but it is about being clear-eyed that alcohol actively works against the neurological stability that perimenopause makes harder to maintain. It also becomes harder to tolerate as you go through peri-menopause, which may mean the trade-off isn't worth it.
• Minimise ultra-processed foods — evidence consistently links higher ultra-processed food intake with increased depressive symptoms and poorer mood outcomes. Improving dietary quality is one of the most meaningful changes that can be made — not for aesthetic reasons, but for neurological ones.

Symptom guide — what to eat, do, and avoid

Use the table below as a practical reference — it maps the most common perimenopausal symptoms to the systems involved and the most evidence-backed food, lifestyle, and avoidance strategies for each.

What lifestyle changes support the transition

• Exercise is one of the best-evidenced non-pharmaceutical interventions for perimenopausal mood. A 2025 comprehensive systematic review and meta-analysis of randomised controlled trials found that physical activity significantly reduced depressive and anxiety symptoms in women during the menopausal transition, with effects most pronounced for programmes lasting more than twelve weeks.⁸ Resistance training additionally helps maintain muscle mass and bone density during a period when both are at greater risk and has emerging evidence for cognitive benefits. Remember that walking counts, yoga counts… The key is consistency and regularity.
• Sleep — protecting sleep quality during perimenopause is important both for its direct neurological benefits and because disrupted sleep amplifies every other symptom. A consistent sleep schedule, limiting screen light in the hour before bed, keeping the bedroom cool, and cutting caffeine before midday are foundational.
• Stress management — given the cortisol-progesterone relationship described above, any sustainable practice that reduces chronic cortisol elevation is directly relevant to hormonal balance. This is not vague wellness advice — it is physiology. Whether that is regular outdoor time, a consistent movement practice, breathwork, or simply protecting time that is genuinely restorative — the nervous system often needs it more in perimenopause than it did before.
• Reducing alcohol and caffeine — both act on the nervous system in ways that worsen the perimenopausal picture, which is perhaps why women notice tolerance reducing where before they didn't. Caffeine elevates cortisol and can worsen anxiety; alcohol disrupts GABA and sleep. Being more intentional about timing and quantity — is a meaningful step.

What targeted nutritional support may help

I often explain to clients that nutritional supplements cannot replace the hormonal environment that is shifting. What it can do is gently support the neurotransmitter systems, stress response pathways — that are most affected — helping the nervous system maintain some of its capacity for calm and resilience during a period when that capacity is under significant biological pressure.

Magnesium bisglycinate supports GABA receptor activity directly — the same system that allopregnanolone modulates. A 2025 randomised double-blind placebo-controlled trial found that magnesium bisglycinate supplementation significantly reduced insomnia scores compared to placebo, with improvements in both sleep onset and sleep continuity.¹⁰ Menopause Formula provides 200mg per serving in bisglycinate form.

KSM-66 ashwagandha — the specific root extract used in Menopause Formula — has good evidence for HPA axis modulation and cortisol regulation. A randomised double-blind placebo-controlled trial found significantly reduced cortisol, stress, and anxiety scores compared to placebo.¹¹ Given the cortisol-progesterone relationship described above, supporting the stress response is very relevant to hormonal balance.

Rhodiola rosea complements ashwagandha through a different mechanism. Where ashwagandha primarily modulates cortisol, rhodiola appears to support dopamine and serotonin pathways — making the two adaptogens complementary in a context where both cortisol dysregulation and neurotransmitter decline are in play. The evidence base is promising, though still developing.¹²

B vitamins in active methylated forms (particularly B6 as pyridoxal-5-phosphate) are essential cofactors for the enzymes that convert tryptophan to serotonin, and glutamate to GABA. Without adequate B6, these neurotransmitter pathways cannot function efficiently regardless of dietary intake. Gentle amounts of B12 as methylcobalamin and folate as 5-MTHF support the methylation processes underpinning mood, cognitive function, and hormonal clearance through the liver.

L-tyrosine, included in Menopause Formula, is a precursor to dopamine and norepinephrine — supporting the motivational and cognitive dimensions of perimenopausal neurological change that B vitamins alone do not address.

Creatine is an emerging area of significant interest for women in perimenopause — and one that Dr Stacy Sims, exercise physiologist and leading researcher in women's physiology, has been vocal about. As oestrogen declines, many women experience reduced neuromuscular efficiency, slower recovery, and increased risk of muscle protein breakdown and sarcopenia. Creatine transitions from being primarily a performance enhancer to serving as foundational nutritional support during this life stage. Research supports this: postmenopausal women who supplement with creatine during resistance training gain more lean mass and strength than those who train without it.¹² Emerging evidence also points to cognitive and mood benefits — particularly relevant given the brain fog and motivational changes many women experience as dopamine support declines.

While creatine is not currently included in Menopause Formula, it is worth considering as a complementary addition — particularly for women who are also doing regular resistance training. We have developed a standalone Creatine Edition for exactly this reason — a pure, high-quality creatine monohydrate designed to sit alongside your daily Formula.

A note on when to seek further support

Nutritional and lifestyle support is one part of a broader picture. For women experiencing significant anxiety, persistent low mood, or symptoms that are affecting daily functioning, a conversation with a GP is important — both to rule out other causes and to explore the full range of options, including HRT.

These approaches are not mutually exclusive. Many women use HRT and nutritional support alongside each other, with each addressing different aspects of the transition. The question is not which to choose but what each can contribute — and for the nervous system symptoms of perimenopause, targeted nutritional support has a meaningful and well-evidenced role to play alongside whatever else is part of your protocol.

If there is one thing I want you to take from this, it is that what you are feeling has a real biological explanation. You are not losing yourself — you are navigating a profound transition, and with the right support, most women come through it feeling better than they did before.

Alice Mackintosh, BSc (Hons), mBANT, CNHC — Equi's Co-Founder and Registered Nutritional Therapist, Equi London

Menopause Formula contains KSM-66 ashwagandha, rhodiola rosea, magnesium bisglycinate, active methylated B vitamins, L-tyrosine, and over 40 further clinically-dosed nutrients formulated to support women through every stage of the perimenopausal transition.

Shop HERE or take the quiz to find the right formula for you.

This article is for educational purposes only and does not constitute medical advice. If you are experiencing significant mood changes, anxiety, or symptoms affecting your daily life, please speak to your GP. Food supplements should not be used as a substitute for a varied, balanced diet or healthy lifestyle.

References

1. Mosconi L, Berti V, Dyke J, et al. Perimenopause and emergence of an Alzheimer's bioenergetic risk factor. PLoS One. 2021;16(10):e0258000.
2. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199–215.
3. Crockett C, Lichtveld G, Macdonald R, Newson L, Rampling KJ. Menopause and mental health: clinical evidence and public discourse. Adv Ther. 2026;43(1):98–108.
4. Kwa M, Plottel CS, Blaser MJ, Adams S. The intestinal microbiome and estrogen receptor-positive female breast cancer. JNCI J Natl Cancer Inst. 2016;108(8):djw029.
5. Peters BA, Lin J, Qi Q, et al. Menopause is associated with an altered gut microbiome and estrobolome, with implications for adverse cardiometabolic risk in the Hispanic Community Health Study/Study of Latinos. mSystems. 2022;7(3):e0027322.
6. Kabthymer RH, Karimi L, Livesay K, et al. Effect of Mediterranean diet on mental health outcomes: a systematic review. Nutr Res Rev. 2026;39:e9.
7. Shieh A, Epeldegui M, Karlamangla AS, Jones AC, Pacifici R, Greendale GA. Markers of compromised gut epithelial barrier integrity increase during the menopause transition. J Clin Invest. 2026;136(17).
8. Adherence to a Mediterranean-style diet and severity of menopausal symptoms in perimenopausal and menopausal women from Australia: a cross-sectional analysis. PubMed. 2024. PMID: 39026104
9. Yue H, Yang Y, Xie F, et al. Effects of physical activity on depressive and anxiety symptoms of women in the menopausal transition and menopause: a comprehensive systematic review and meta-analysis of randomized controlled trials. Int J Behav Nutr Phys Act. 2025;22(1):13.
10. Schuster J, Cycelskij I, Lopresti A, Hahn A. Magnesium bisglycinate supplementation in healthy adults reporting poor sleep: a randomized, placebo-controlled trial. Nat Sci Sleep. 2025;17:1391–1404.
11. Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255–262.
12. Ishaque S, Shamseer L, Bukutu C, Vohra S. Rhodiola rosea for physical and mental fatigue: a systematic review. BMC Complement Altern Med. 2012;12:70.
13. Smith-Ryan AE, Cabre HE, Eckerson JM, Candow DG. Creatine supplementation in women's health: a lifespan perspective. Nutrients. 2021;13(3):877.

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