Question 1

What is perimenopause and when does it start?

Accepted Answer

Perimenopause is the transition period leading up to menopause, typically beginning in your mid-40s but sometimes as early as your late 30s. It can last anywhere from 4 to 10 years. During this time, your ovaries gradually produce less oestrogen, causing fluctuating hormone levels that lead to various symptoms including irregular periods, hot flushes, sleep problems, and cognitive changes.

Question 2

What causes brain fog during perimenopause?

Accepted Answer

Brain fog during perimenopause is caused by several factors: fluctuating oestrogen levels affect neurotransmitter production and brain cell communication; reduced blood flow to the brain due to declining nitric oxide levels; poor sleep quality disrupting memory consolidation; and decreased autophagy (cellular cleaning) leading to accumulation of cellular debris in brain tissue. The good news is that these changes are often reversible with the right interventions.

Question 3

Is perimenopause brain fog permanent?

Accepted Answer

No, perimenopause brain fog is typically not permanent. Research shows that cognitive symptoms often improve after menopause when hormone levels stabilise. Additionally, lifestyle interventions like intermittent fasting (which activates autophagy), nitric oxide-boosting foods, quality sleep, and regular exercise can significantly improve cognitive function during perimenopause.

Question 4

Why am I so tired during perimenopause?

Accepted Answer

Perimenopause fatigue has multiple causes: declining oestrogen affects energy metabolism; reduced nitric oxide production means cells receive less oxygen; sleep disturbances from night sweats and hormonal changes prevent restorative rest; and fluctuating blood sugar levels cause energy crashes. Addressing these root causes through diet, sleep hygiene, and targeted supplements can significantly improve energy levels.

Question 5

What is nitric oxide and why does it matter for perimenopause?

Accepted Answer

Nitric oxide is a molecule your body produces that acts as a signalling compound, controlling blood vessel dilation, blood flow, and oxygen delivery to cells. During perimenopause, nitric oxide production naturally declines due to falling oestrogen levels. This reduced production contributes to fatigue, brain fog, cardiovascular changes, and reduced exercise capacity. Boosting nitric oxide through diet and lifestyle can help counteract these effects.

Question 6

How can I naturally increase nitric oxide levels?

Accepted Answer

You can boost nitric oxide naturally through: eating nitrate-rich foods like beetroot, spinach, rocket, and celery; nasal breathing (your sinuses produce nitric oxide); regular moderate exercise; getting adequate sunlight exposure; reducing mouthwash use (it kills beneficial oral bacteria that convert nitrates); and considering supplements like beetroot powder or L-citrulline if dietary changes aren't sufficient.

Question 7

What foods are highest in nitrates for nitric oxide production?

Accepted Answer

The highest nitrate foods include: beetroot and beetroot juice (top source), rocket/arugula, spinach, lettuce (especially butterhead), celery, cress, chervil, and radishes. Aim to include at least one serving of these foods daily. Note that cooking reduces nitrate content, so raw or lightly cooked is best. Beetroot juice is particularly effective—studies show it can improve blood flow within hours of consumption.

Question 8

What is autophagy and how does it help brain fog?

Accepted Answer

Autophagy (from Greek meaning 'self-eating') is your cells' natural cleaning and recycling system. When activated, cells break down damaged proteins, dysfunctional mitochondria, and accumulated debris, recycling the components to build new healthy parts. In the brain, autophagy clears the cellular 'rubbish' that contributes to cognitive decline and brain fog. Research shows that restoring autophagy levels can reverse age-related memory deficits.

Question 9

How long do I need to fast to trigger autophagy?

Accepted Answer

Autophagy begins to increase after approximately 12-16 hours of fasting, with more significant activation occurring between 24-48 hours. For most people, the 16:8 intermittent fasting protocol (eating within an 8-hour window, fasting for 16 hours) provides meaningful autophagy activation without being too extreme. You don't need to do extended fasts—even a consistent 14-16 hour overnight fast can provide benefits.

Question 10

Is intermittent fasting safe during perimenopause?

Accepted Answer

For most women, gentle intermittent fasting is safe and potentially beneficial during perimenopause. However, you should consult your healthcare provider before starting if you: have diabetes or blood sugar regulation issues; have a history of eating disorders; are underweight; take medications that require food; or have adrenal fatigue. Start gradually (12 hours) and listen to your body. The goal is time-restricted eating, not calorie restriction.

Question 11

What breaks a fast and stops autophagy?

Accepted Answer

Anything containing calories will technically break a fast and reduce autophagy activation. This includes: any food, milk or cream in coffee, sweetened drinks, and most supplements. However, black coffee, plain tea, and water are generally considered acceptable and may even enhance autophagy. Some experts suggest that very small amounts of fat (like MCT oil) have minimal impact, but for maximum autophagy benefits, stick to zero-calorie beverages during your fasting window.

Question 12

Why is hydration more important during perimenopause?

Accepted Answer

Oestrogen helps regulate how your body retains water. As oestrogen levels decline during perimenopause, you become more susceptible to dehydration. Hot flashes and night sweats also cause significant fluid loss. Dehydration can worsen brain fog, fatigue, joint pain, and even the frequency of hot flashes. Aim for 2-2.5 litres of water daily, more if you're experiencing frequent hot flashes.

Question 13

Does water quality matter during perimenopause?

Accepted Answer

Yes, water quality matters more than many women realise. Tap water can contain trace amounts of endocrine disruptors—chemicals that interfere with your hormonal system. PFAS ('forever chemicals') have been linked to earlier menopause onset, and synthetic oestrogens from pharmaceutical residues can add to hormonal confusion. A quality water filter can remove most of these contaminants. For guidance on choosing the right filter, visit Filter Authority at filterauthority.co.uk.

Question 14

What are endocrine disruptors and why should I care?

Accepted Answer

Endocrine disruptors are chemicals that can interfere with your hormone system. During perimenopause, when your hormones are already fluctuating, exposure to these chemicals may worsen symptoms. Common sources include certain plastics, pesticides, and contaminants in tap water like PFAS. Research from the Endocrine Society found that PFAS exposure may cause menopause to occur up to two years earlier. Reducing exposure through filtered water and avoiding plastic containers can help.

Question 15

What supplements help with perimenopause brain fog?

Accepted Answer

Several supplements may help with perimenopause brain fog: Omega-3 fatty acids support brain cell membrane health and reduce inflammation; Beetroot powder boosts nitric oxide for better brain blood flow; Magnesium glycinate supports sleep quality and nerve function; B vitamins (especially B12 and folate) support neurotransmitter production; and Lion's Mane mushroom may support nerve growth factor production. Always consult your healthcare provider before starting new supplements.

Question 16

Are the supplements you recommend safe?

Accepted Answer

The supplements we recommend are generally considered safe for most adults when taken as directed. However, supplements can interact with medications and may not be suitable for everyone. We always recommend: consulting your healthcare provider before starting any new supplement; starting with lower doses; purchasing from reputable brands with third-party testing; and discontinuing use if you experience adverse effects. We never recommend supplements as replacements for medical treatment.

Question 17

Do I need supplements or can I get everything from food?

Accepted Answer

In an ideal world, you'd get all nutrients from food. However, modern diets, soil depletion, and the increased demands of perimenopause mean supplements can fill important gaps. We recommend a 'food first' approach: optimise your diet with nutrient-dense foods, then consider targeted supplements for specific deficiencies or therapeutic purposes. Some nutrients (like therapeutic doses of omega-3 or beetroot nitrates) are difficult to obtain from food alone.

Frequently Asked Questions

About Perimenopause

About Nitric Oxide

About Autophagy & Fasting

About Hydration & Water Quality

About Supplements

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