“Life wasn’t beyond my mental capacity but beyond my physical capacity”: how London experts helped me take control of perimenopause

This time last year I was presenting the Condé Nast Traveller Spa Awards, leading a conversation about wellbeing as the “cornerstone” of our existence, but I was far from the peak of health myself. I knew I had lost the thread of self-care – it just didn’t seem possible to make time for me. I wasn’t planning my eating, I wasn’t exercising and I wasn’t present as a (single) mother. I was exhausted, sleepless, fundamentally stressed in a sort of grinding and endless way and had lost interest in things that had always given me joy. I questioned whether there was something seriously wrong. My brain was a foggy maelstrom, and as I struggled through the days, I kept having a strange but persistent thought: that this life wasn’t beyond my mental capacity but beyond my physical capacity. As I ran from one appointment to another, I could feel my feet dragging. I was hauling myself through life – but I was 47, not 87.

So, I thought, this was the famous perimenopause. I might not have hot flashes, night sweats or uncontrolled rage, but I did want to shut down. Desperate, I blocked out my diary for five months and turned down travel. I needed to get better step by step – and get my hormones, body and mind back. But whatever approach I took, it needed to be holistic and gentle and slow – I wasn’t in a state for anything else. So I turned to the experts for help.

Understanding perimenopause

The Health Doctors, Marylebone

I first came across Dr Wendy Denning on the Happy Hormones podcast. She was answering questions I had been trawling the internet for, such as: what were bioidentical hormones, and why were they important? Could you get them on the NHS? Was there any way to measure hormones accurately? Did it matter?

Wendy was an NHS GP and now has a private integrated health clinic. As I sat in her office, weeping, she told me to test my hormones with the DUTCH test. This 48-hour multiple-stage urine test (which costs about £250) reveals a complete picture of hormones, as well as how you’re metabolising them. I would also need my thyroid comprehensively tested.

She told me all people who work through the perimenopause and menopause “would need HRT”. The main problem with the NHS approach is the decision “that they don’t want GPS measuring hormones,” Wendy told me. “It’s a cost issue, and hormones vary, but that doesn’t mean you shouldn’t measure them.”

GPs are prescribing hormones based on symptoms, but the years of perimenopause are a rollercoaster. Testosterone tends to dip first, then progesterone. When low oestrogen hits, you get the hot flushes and night sweats. But that comes and goes, for a couple of years. If women take extra oestrogen through this cycle, their levels can end up sky-high. The second problem, she said, was the one-size-fits-all approach. We are generally told they can have five years of HRT max, because of cancer risks. But they are not screened for particularities.

My DUTCH test revealed oestrogen and free cortisol levels off the charts but rock-bottom progesterone. Caught in a high cortisol, high oestrogen cycle, my weight was rocketing. The 4-OH estradiol result was also high – a cancer-inducing pathway.

Wendy was frank. First I needed to lose adipose tissue. Oestrogen loves to live in fat cells, so I needed to reduce them, but I needed to de-stress or it would be mighty hard. Aerobic exercise helps to metabolise oestrogen. “Whatever you are doing, double it,” she instructed. My progesterone being rock bottom was age-appropriate, but also, when the body is in a period of prolonged stress, it will make cortisol the priority over progesterone – it’s called the “cortisol steal”. Low progesterone causes bad sleep, bad mood and fatigue. She put me on a bioidentical progesterone made from yams to be applied for half the month.

She also put me on a resveratrol supplement (a plant compound found in red wine and in the skins and seeds of grapes and berries), which hampers the body’s ability to metabolise estradiol down the 4-hydroxy pathway. She told me to do “whatever it takes” to sort out work-life balance, then said my dopamine was on the floor. “Do things that make you happy,” she said. “You need joy.” I had a lot to absorb – and almost no bandwidth. But I started on progesterone, resveratrol and on ashwagandha for sleep and stress.

Website: thehealthdoctors.co.uk

How nutrition can impact the perimenopause

HealthMatters Group, Marylebone and Zoe Science and Nutrition

Sue Camp is Clinical Director of Nutrition Service at the HealthMatters Group, a whole ecosystem of integrative health solutions with teams working across nutrition, stress management, sleep disorders and functional medicine. Sue, a gentle and patient sort, sensed that I was in a state where incremental rather than radical change was best. She told me to eat protein with each meal and choose nutrient-dense foods – fruits, vegetables, whole grains, lean proteins, healthy fats, and phytoestrogen-rich foods to balance the hormones.

When I explained that I felt overwhelmed simply by the prospect of what to eat, she suggested Mindful Chef, which has been an amazingly convenient and tasty way of getting more plants onto my plate. She also suggested that I eat within a 10-hour window. She recommended adding flax into my daily diet to promote the excretion of oestrogens and increase dietary fibre to beef up the intestinal bacteria and increase SHBG (a protein made mostly in your liver that binds to sex hormones in your blood) to reduce free oestradiol. Cruciferous vegetables – broccoli, cauliflower, cabbages – contain indole-3-carbinol (I3C), which breaks down oestrogen. B vitamins, particularly B6, B12 and folate, also metabolise it; as do antioxidants in turmeric, brazil nuts and green tea. She also put me on glutathione – a master antioxidant that can bring down 4-OH metabolites.

The biggest mistake women make in midlife is to neglect self-care, Sue said. “They always come last on their list after family and work – there is no boundaried time for relaxation and recovery.” When the sleep cycle degenerates, it can cause a downward spiral of craving sugars and carbs and not moving. Women at this stage must try to reduce stress, go to bed earlier, move every day and take time to rest, she said. “The time for extreme eating and extreme fasting is past,” Sue advised. “Instead, you need to control your portion sizes and timings and go for targeted supplementation to sort out your imbalances.”

After a year of eating more (though certainly not wholly) in the direction of Sue’s advice, I joined Zoe Science and Nutrition, the much talked-out microbiome project Dr Tim Spector co-founded. I wanted to gather more information about my body, find out what state my microbiome was in, and to get personalised suggestions. It involved wearing a continuous blood sugar monitor for up to 14 days (though they captured everything they needed to know about you in about three), and testing my blood (though a finger-prick test) and microbiome (via a stool test). It was heartening to find out that I had a microbiome score of 93 out of 100 and a blood fat clearance rate of 97/100, but poor blood sugar control, at 35/100. With a diabetic father, simple carbs and sugars are not my friends.

As I’ve got a year’s membership of Zoe, I now have access to an entire library of meals that tick off my personalised needs and something even higher to aim for. A chat with their head nutritionist, postdoctoral medical scientist and author Federica Amati, was illuminating. It came up that I wasn’t eating enough fibre, so she suggested ways to bring fibre into my normal meals, and she also talked about how our bodies and circadian rhythms love alarm-clock consistency in terms of meal and sleep times, and that only diabetics needed to eat little and often, but instead two to three meals were sufficient, they just needed to be balanced and nutritious to prevent cravings.

Website: nutritionalmatters.co.uk; zoe.com

Why movement is crucial for midlife women

Fitology, Brockley and Personal Best London

I searched in vain for a gym in Peckham where I live. The neighbourhood specialises in testosterone-fuelled crossfit workshops and packed yoga studios where Gen Zers perform one-handed planks. There was nothing for women like me but then a friend told me about Fitology. The women-only gym in Brockley in southeast London does personal training and four-to-one training, and sells blocks of sessions to visitors. I was intrigued by its “mindful approach” to strength training and powerlifting, and sessions that started with pelvic floor exercises and breathwork before progressing to strength work, plyometrics and conditioning.

What I found was a very safe space, populated mainly by women aged 40-plus, led by a woman, Suzanne Keatley, who is very intentional. Why no men, I asked her? “Because I just wanted women to be able to be sweaty, talk about boobs, pelvic floors and wear what they wanted to wear,” she replied. I found I could turn up there in a pair of leggings and old boots and a regular jumper because I felt no one was judging me.

Suzanne believes in “women being kinder to themselves”. Four-to-one training with them is now one of the highlights of my week. Apart from the satisfaction of being stronger, it’s impossible to worry about a gnarly issue when you’re holding 40 kilograms of steel. Also I committed to twice-weekly 30-minute online functional fitness lives with Personal Best London. Michelle Clinton is a personal trainer and Pilates teacher whose daily sessions online during Covid saved my life. I’ll never give her up as her aim is to keep midlife women stronger and more mobile for as long as possible.

Website: fitologyhub.com; tribestronger.com

Why activating the parasympathetic nervous system saves us

Wonderbreath, London, Surrey and West Sussex UK and cranial sacral therapist Justine Clark

Knowing that external stress triggers will never relent, I needed to learn how to relax. I signed up for a one-day solo retreat with body psychotherapist Andrea Lucas and Justine Clement of Wonderbreath, one of Britain’s top experts in breathwork. Touching the Soul is a space for women who are feeling overwhelmed. As well as spoiling you with a restorative intuitive massage from Andrea, the aim is to teach you the basics of breathwork so you can create your own practice. I loved the phone-off day with Justine and Andrea in Andrea's pretty garden house in Harrow-On-The-Hill, with a break for a nutritious vegetarian lunch. Conscious Connected Breathwork is hugely growing in popularity as part of the toolkit for improving one’s physical and mental health. Before I met Justine, I had joined halls full of acolytes as they gasped away, but I couldn’t connect and found the sounds distracting and anxiety-inducing. Justine’s quiet patience and repeated gentle guidance enabled me to feel safe and relaxed enough to allow the oxygen to infuse me with peace. Breathing more consciously has helped to bring me back from extreme overwhelm. I have also reinstated daily walks and weekly sessions with my local cranial sacral therapist in Peckham, Justine Clark. She has been activating my parasympathetic system for a decade and has carried me through many crises, but now, instead of going to her when I’m broken, I’m choosing to prioritise myself enough to book Justine as a preventative.

Website: justineclarktherapy.co.uk; wonderbreath.co

A year later, did my multi-pronged efforts succeed? I think so, but learning to reframe the idea of success, here I turn to sensible Sue Camp’s words: “We’ve covered good ground and made some encouraging progress. We need to keep at it. It's a marathon, not a sprint.” I’ve made progress. My body is heading back into balance. I’m sleeping and feel more alive. I’m travelling again. When I think of the future, I don’t feel exhausted by the idea of more life. I’m seeing friends and am more present as a mother. So thanks to all those lovely women – for convincing me I’m worth it.