Why Perimenopause Feels So Unpredictable (And What Your Hormones Actually Need)

If you’ve been feeling more tired than usual, noticing changes in your cycle, struggling with mood, sleep, or weight and wondering if it might be your hormones — you’re not alone.

Perimenopause can begin years before your periods change, and for many women, it doesn’t feel the way they expected at all.

It struck me recently, when trying to explain perimenopause to a friend, just how much there is to it — and how poorly it’s often understood, even by us women experiencing it.

Because despite how complex it actually is, it’s still so often reduced to one simple idea: that it’s just a drop in estrogen.

And that’s where so many women get stuck. You might recognise this as:

• Feeling exhausted but wired

• Cycles becoming unpredictable or different to what you’re used to

• Bloating, headaches, or breast tenderness appearing out of nowhere

• Mood changes that don’t quite make sense

• Or just not feeling like yourself anymore

And yet, when you look for answers, everything still seems to come back to 'estrogen'. You go to your GP, explain the symptoms that you suspect might be hormonal, and if you’re lucky enough to find someone receptive - and you’re at a stage they consider appropriate (periods starting to change in frequency though it's about way more than this and so much happens before that stage!) ) you’re often given a fairly standard prescription for estrogen and progesterone and sent on your way. And then you’re left wondering why you don’t feel that much better. Because the issue isn’t usually just how much estrogen you have. It's how your whole system is communicating, responding, and processing those hormones.

The truth is, perimenopause is not a single hormone issue, and it’s not something that can be solved with a one-size-fits-all approach. There are multiple systems involved, multiple shifts happening at once, and a number of key factors that need to be understood and supported if you want to feel like yourself again.

I want to be really clear here: I am a fan of HRT. The right kind, used in the right way, can be incredibly supportive. But taking hormones without first understanding how your body is functioning, how you’re processing them, and what else might be contributing to your symptoms… is often why so many women feel disappointed with the results. And this is exactly why I wanted to write this article.

In reality, what I see in clinic - and in my own personal experience - is something much more nuanced. Because your hormones aren’t just about how much you have.

They’re about:

• how they’re produced

• how they’re transported

• how your body responds to them

• and how they’re cleared

And when you understand that, perimenopause starts to make a lot more sense. This is often when the body loses its ability to compensate — and underlying imbalances such as gut issues or nervous system dysfunction begin to show themselves more clearly.

The 5 Things That Quietly Determine Your Hormone Balance

When you look at hormones this way, you start to see that it’s not just about levels — it’s about how your whole system is working together.

These are the five key things that quietly determine how your hormones behave day to day: that influence hormone balance: production, transport, sensitivity, detoxification and conversion. In practice, I find it more helpful to break this down slightly differently — into five key areas that explain what’s really going on in the body.

The Functional Herbology Hormone Pillars

1. Signalling & Production

(Brain ↔ ovary communication)

This is often where things first start to shift, even before your cycle noticeably changes. Your brain is constantly signalling to your ovaries — and in perimenopause, that signalling becomes less consistent.

This is why you might notice:

• Irregular cycles

• Missed ovulation

• Feeling flat or unmotivated

Support here focuses on improving communication, things like:

• Maca

• Adaptogens

• Nervous system support

2. Transport & Binding

(How hormones move around the body)

This is why two women with the same hormone levels can feel completely different. Hormones don’t just float freely — they’re carried in the blood and influenced by proteins like SHBG, as well as insulin levels. This affects how much hormone is actually available to your tissues.

You might notice:

• Weight changes

• Energy dips

• Blood sugar fluctuations

Support here includes:

• Blood sugar balance

• Protein intake

• Strength training

• Metabolic support

3. Receptor Sensitivity

(How your body responds to hormones)

This is the piece that explains why symptoms can feel intense, even when tests look “normal”. Even if hormone levels are “normal”, your experience depends on how sensitive your receptors are. In perimenopause, this sensitivity can change.

You might notice:

• Mood swings

• Breast tenderness

• Headaches

• Feeling more reactive

Support here includes:

• Flax lignans

• Phytoestrogens (where appropriate)

• Anti-inflammatory support

4. Detoxification & Elimination

(How hormones are processed and cleared)

This is one of the most overlooked areas — and often where symptoms build up quietly over time. Your liver and gut play a key role in how hormones are broken down and removed from the body. If this isn’t working well, hormones can be re-circulated.

You might notice:

• Bloating or tummy pain

• Heavy periods

• Skin changes

• Hormonal symptoms that feel “stuck”

Support here includes:

• Broccoli sprouts / sulforaphane

• Calcium D-glucarate

• Fibre and microbiome support

5. Conversion & Balance

(How hormones are transformed into each other)

This is where the classic “estrogen dominance” picture often begins to emerge. Hormones don’t exist in isolation — they’re constantly being converted and balanced. In perimenopause, progesterone often declines first, shifting the balance.

You might notice:

• Anxiety

• Poor sleep

• Shorter cycles

• Feeling wired but tired

Support here includes:

• Magnesium

• Nervous system support

• Targeted herbal support

Bringing It Together

Most women are told they have a ‘hormone imbalance’. But what that actually means is rarely explained.

Because the question isn’t just:

“How much hormone do you have?”

It’s:

• How is your body producing it?

• How is it being transported?

• How are your cells responding?

• And how is it being cleared?

And when you start to look at your symptoms through this lens, things often begin to make a lot more sense.

Why This Matters

This is often why you might feel like you’ve “tried everything” — and still don’t feel quite right. Two women can have similar hormone levels… and feel completely different. Because their processing, sensitivity, and balance are different.

Where Testing Comes In

For some women, understanding this through symptoms and patterns is enough.

For others, testing can help fill in the gaps. This is where tools like the DUTCH test can be incredibly helpful. They allow us to look beyond levels, and understand:

• patterns

• metabolism

• imbalances in context

 So we can support your body in a targeted way.

A Different Way to Approach Perimenopause

Perimenopause isn’t something to fix. It’s something to understand. And when you understand the mechanisms behind your symptoms, you can support your body in a way that actually works.

There is nothing that makes me more concerned than seeing women given blanket prescriptions for estrogen. Often increased over time; without any real investigation into what’s driving their symptoms. When we layer hormones on top of an already dysregulated system, without addressing the underlying physiology, we risk compounding the problem rather than resolving it. Perimenopause deserves a far more thoughtful and individual approach than this.

When I’m working with someone in perimenopause, I don’t just look at hormones in isolation. I map everything onto a functional medicine framework, looking at how different systems in the body are interacting - from hormonal signalling and nervous system regulation, to gut health, detoxification and metabolic balance. This allows me to step back and see the full picture, rather than chasing individual symptoms. Because very often, what looks like a 'hormone issue' is actually being driven by something upstream — stress, digestion, blood sugar, or how the body is processing hormones.

As a herbalist and naturopath, I also look at a person through a more traditional lens — considering their constitution, patterns, and how their body tends to respond to stress, nourishment, and change over time. This helps me tailor support in a way that feels more intuitive and individual, using food, herbs, and lifestyle in a way that works with the body rather than against it.

Working in this way means we can be far more targeted and thoughtful in how we support the body, rather than relying on guesswork or one-size-fits-all solutions.

If you’re starting to feel like your body has changed, but you can’t quite piece together why, this is exactly the kind of work I support women with.

Looking at your hormones in context; alongside your gut health, nervous system, and metabolism, so we can understand what’s really driving your symptoms, and build a plan that actually feels clear and manageable.

Juliana x