This week perimenopause got to me. I have been in this territory for nearly a decade now, I know the landscape, I have the map, and yet I still found myself sitting with the intensity of it all thinking I completely understand why women get scared by this.
Because it is a lot. And one of the scariest parts, the one nobody prepares you for, is when your periods change completely. Closer together, then further apart. Heavier than anything you have experienced before. Flooding. Gushing. Stop-start bleeding that can go on for days and feel completely out of your control.
If this is where you are right now, I want to explain what is actually happening and why understanding the mechanism takes the fear down several notches.
Why periods change in perimenopause
Perimenopause is not a brief moment before menopause. It is a hormonal arc that can begin as early as 35 and extend into the early sixties, moving through distinct phases. In the early phase oestrogen can actually rise as the ovaries work harder, while progesterone begins to fall first. That imbalance, more oestrogen relative to progesterone, drives heavier periods, breast tenderness, sleep disruption and mood changes.
In the middle phase, roughly the mid forties to early fifties, oestrogen becomes erratic. Surging and dropping unpredictably. Cycles come closer together then space out into long gaps. This is the phase where fibroid symptoms tend to peak, because the erratic oestrogen environment provides the most intense and unpredictable stimulation to oestrogen-sensitive fibroid tissue.
What fibroids actually are and why they bleed
Fibroids are benign growths in the muscle wall of the uterus. They are not cancer and they do not become cancer. But they are complex, organised structures made up of smooth muscle cells and an extensive scaffolding of collagen and fibrous tissue that makes them dense, stiff and remarkably good at maintaining themselves.
They cause heavy bleeding through five converging mechanisms. They distort the surface of the uterine lining, creating more surface area to shed. They impair the blood vessels’ ability to clamp down and stop bleeding. They create a chronic low-grade inflammatory environment that delays clotting. They stimulate the growth of fragile, poorly regulated new blood vessels. And the erratic oestrogen surges of perimenopause feed them continuously, creating the perfect storm for flooding, gushing, stop-start bleeding that can feel genuinely overwhelming.
The metabolic picture nobody mentions
What most women are not told is that the metabolic picture is inseparable from the hormonal one. Insulin resistance, which becomes more common in perimenopause, drives fibroid growth directly via IGF-1 signalling. IGF-1 is insulin-like growth factor, and when insulin is chronically elevated the body produces more of it. One of the things it does is signal cells to grow. In a uterus already primed by oestrogen, that growth signal lands on fibroid tissue and feeds it.
The weight gain that tends to accumulate around the abdomen at this time is not simply a lifestyle consequence. It is partly the body’s attempt to maintain oestrogen production, because fat tissue converts androgens into oestrogen via an enzyme called aromatase. The body is trying to keep up with the hormonal demand. The problem is that this same process can tip into oestrogen excess if the other side of the equation, oestrogen excretion, is not equally well supported.
Before Metformin, and in some cases alongside it, medicine reached for surgery. Ovarian drilling, a laparoscopic procedure in which small holes are made in the ovary using heat or laser, was offered to women who were not ovulating and had not responded to medication. It worked for some women, at least temporarily. But the results were rarely sustained long term because it does not change the insulin environment and it does not change what the nervous system has learned. The ovary was never the origin of the problem.
Almost every woman with fibroids has also been told at some point that her weight or diet is the cause. It is one of the most damaging things medicine has done to this population consistently and at scale. Weight gain in PMOS and perimenopause is not a cause. It is a consequence. Telling a woman to diet harder is not a treatment plan. It is a misdirection that compounds the shame, increases the stress load and makes the underlying picture worse.
The nervous system is central to all of this
A chronically activated nervous system drives insulin resistance, disrupts progesterone production, alters the gut microbiome and keeps the inflammatory environment that sustains fibroids actively fed. Stress physiology actively changes the hormonal environment in your cells. This is not just about feeling stressed. It is about what chronic stress does to the biological terrain fibroids grow in.
And then there is the emotional dimension of living with this kind of bleeding. The unpredictability, the fear, the practical disruption, the exhaustion of managing it, all of this feeds back into the stress response and makes the whole picture harder to regulate. Tending to the nervous system is not a soft add-on to a fibroid support plan. It is foundational.
What actually helps
Each of the levers driving this picture is addressable.
Indole-3-carbinol and matcha support oestrogen metabolism toward its safer forms. Inositol improves insulin sensitivity and reduces the IGF-1 signalling that feeds fibroid growth. Berberine and alpha lipoic acid work at the same metabolic switch, improving insulin sensitivity, reducing inflammation and supporting cellular energy production, with evidence comparable to pharmaceutical intervention. Pine bark reduces the fibrotic tissue remodelling that makes fibroids stiff and self-sustaining. Magnesium supports progesterone production, calms smooth muscle cramping and tends to the nervous system simultaneously. Vitamin D plays a direct role in reducing fibroid cell proliferation. Tulsi and ashwagandha support the HPA axis and blood sugar regulation together. Adequate protein matters more in perimenopause than at almost any other life stage, for muscle maintenance, insulin sensitivity, tissue repair and hormone production.
Alongside nutrition, craniosacral therapy, somatic fascia release and lymphatic support tend to the nervous system and physical tissue simultaneously, creating the conditions for the body to regulate rather than react.
My crafted Wild Yam Balm, used as part of a warm abdominal self-massage with castor oil and magnesium oil, tends to pelvic congestion, supports lymphatic drainage and sends the nervous system a signal it rarely receives in a busy perimenopausal life. That it is safe to soften.
If your periods have changed and nobody has connected the hormonal, metabolic and nervous system picture for you, that conversation is available in my clinic in Kinsale, at The Natural Clinic in Cork and online.
Come and be curious about what changes when the whole system is tended to.
Book a first session at loulanatural.com/make-a-booking or here for The Natural Clinic, send me a message and tell me what is going on for you.
Serve Your Cells