Peri what???? Peri Menopause!

‘Peri menopause’ encompasses 8-10 yrs before the final menstrual cycle.

The term ‘menopause’ indicates a woman had no menstrual cycles for 1 year.

Over the age of 40, a woman’s menstrual cycle becomes less consistent. An egg may not be released every single month, and this interferes with the production of hormones such as estrogen and progesterone. Due to these hormonal changes happening they can result in significant health changes.

What are the common symptoms?

The initial changes in peri menopausal cycles may be subtle.

As you approach peri menopause, your total cycle length will begin to change. A 7-day change in either direction (shorter or longer) when you have had regular cycles before indicates the beginning stages of Peri menopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes to the volume of blood lost with each period. Peri menopausal cycles can be heavier than normal or lighter than normal.

You may also notice an increase in other symptoms when you approach peri menopause. You may find you have more difficulty sleeping, hot flashes, vaginal dryness or changes to your mood. You can track these symptoms against your cycle. Sometimes they occur all month long, or they may occur only during phases of your cycle. Estrogen and progesterone are the lowest right before your period and up to day 3 of your next cycle. This may be when you sleep the worst and have the most hot flashes.

‍ You may also notice that your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. This may indicate that you did not ovulate. You must ovulate to have PMS symptoms.

There will be changes to the body composition and weight. You may now notice that your body has difficulty loosing weight or you tend to put on more adipose fat on the gluteal/ Waist areas. This is due to increase in size of the adipose tissue due to lack of estrogen.

Upto 40 % of women face mood changes or depression in menopause.

The triggers are largely from body image and self-esteem, sleep deprivation, estrogen fluctuations and menopause symptoms themselves.  A predisposition to depression is seen in studies if women had prior history of depression.

There is increased risk of cardiovascular disease in the perimenopause due to oxidative stress mediated by lack of estrogen.

Fatigue is also another common symptom experienced during this phase and requires a multifactorial approach.

Hormonal tests are not very accurate during this phase.

Estrogen and progesterone have to be interpreted carefully because there is high estrogen levels stacking from previous cycles due to lack of ovulation.

Screening for thyroid, vitamin D and iron deficiency is essential.


We have many tools that can smoothen his transition for women. Herbs, nutrients, dietary changes can be very helpful.

For those who may need HRT, we do a deep dive on different hormonal treatments that are available out there and get fully informed about risks/ benefits from a solid evidence -based perspective before speaking to your provider.

Not everything works for every individual. Based on your goals, there needs to be a proper discussion with your provider and a health prevention plan for the next 5-10 years.

If you are looking for someone to help you figure this out, get in touch. Functional medicine in Singapore can help. Give us a call.


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Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).

Allshouse, A., Pavlovic, J. & Santoro, N. Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms. Obstet. Gynecol. Clin. North Am. 45, 613–628 (2018).

Hale, G. E., Hughes, C. L., Burger, H. G., Robertson, D. M. & Fraser, I. S. Atypical estradiol secretion and ovulation patterns caused by luteal out-of-phase (LOOP) events underlying irregular ovulatory menstrual  cycles in the menopausal transition. Menopause N. Y. N 16, 50–59 (2009).

   Timur, Sermin, and Nevin Hotun Sahin. “The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women.” Menopause (New York, N.Y.) vol. 17,3 (2010)

Xiang, Du et al. “Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress.” Oxidative medicine and cellular longevity vol. 2021 5523516. 28 Jun. 2021, doi:10.1155/2021/5523516

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