Book in one sentence: A UK menopause specialist and a registered nutritionist make the case that perimenopause starts years earlier than most women suspect, that the symptoms are real and treatable, and that restriction is exactly the wrong response to what’s happening in your body.
- What Is The Perimenopause Solution About?
- Why Your Body Changed in Your Late 30s (Before You Had a Name for It)
- What Perimenopause Actually Does to Appetite, Metabolism, and Mood
- Why Eating Less Makes Everything Worse
- Is The Perimenopause Solution Worth Reading?
- Books Like The Perimenopause Solution
What Is The Perimenopause Solution About?
You’re in your early 40s. Your weight is doing something new, mostly around your middle. Sleep has gotten strange. Some mornings you wake at 3am, mind racing, no obvious reason. Your appetite feels unreliable, your mood snaps at things it never used to, and the brain that always felt sharp is suddenly foggy. You mention it to your doctor. Your periods are still regular, your bloodwork comes back normal, and you leave with a suggestion that maybe you’re a bit stressed.
What nobody told you is that you might already be in perimenopause. Not approaching it. Not “too young” for it. Actually in it, years before the hot flashes most people associate with the word.
The Perimenopause Solution was co-written by Dr. Shahzadi Harper, a UK women’s health physician and co-founder of The Harper Clinic, and Emma Bardwell, a registered nutritionist and member of the British Menopause Society. Both specialize in perimenopause. Both see these women in clinic every week. The book grew out of the conversations they kept having with patients who came in exhausted, dismissed, and convinced that what was happening to them was somehow their own fault, whether from stress they hadn’t managed well enough, weight they hadn’t controlled, or a general failure to hold things together.
It is a UK-focused book (the prescribing guidance references NHS and NICE, not FDA), but the underlying science travels. If you’ve been puzzling over changes in your body, appetite, or mood since your late 30s and no one has connected those dots for you, this book is likely to feel like an explanation you’ve been waiting for.
Why Your Body Changed in Your Late 30s (Before You Had a Name for It)
Here’s the thing most people don’t know: perimenopause and menopause are not the same event. Menopause is technically a single moment, the one-year mark after your last period, average age 51. Everything before that, often spanning four to ten years and sometimes starting in the early 40s, is perimenopause. It is the phase when hormones are actively fluctuating and declining, and it is when the vast majority of symptoms occur.
The confusion between the two words isn’t just semantic. It’s why a 43-year-old with regular cycles, crushing fatigue, and 3am waking gets told she’s “too young” instead of getting treated.
Blood tests often miss perimenopause entirely. Hormone levels fluctuate day to day during this phase, which means FSH can read normal on Tuesday and elevated on Thursday. In the UK, NICE guidelines now support diagnosing perimenopause on symptoms alone for women over 45, because the test result is not the diagnosis. The symptom picture is.
Testosterone is the hormone that falls first. By a woman’s 40s, testosterone levels have dropped roughly 50% from where they were in her 20s, a decline that predates the oestrogen drop most people associate with perimenopause. That fatigue that started years ago, the brain fog, the muscle loss, the flat energy that doesn’t respond to sleep: these are frequently testosterone deficiency symptoms, not character flaws, and not signs that you’re simply aging badly.
The timeline matters for ExcessMatters readers in particular. The weight changes, the hunger shifts, the mood-driven eating that might have started in your late 30s or early 40s, those weren’t random. They had a hormonal mechanism. Your appetite was not malfunctioning. Your body was changing in a way that had a name, and nobody had given you that name yet.
What Perimenopause Actually Does to Appetite, Metabolism, and Mood
Most people know about hot flashes and night sweats. What most people don’t know is that there are over 34 officially recognized perimenopause symptoms, spanning physical, psychological, cognitive, and urinary domains, and only about five of them get talked about. The gap between what women expect and what they experience is where years of misdiagnosis live.
The weight shift is real and documented. The book is direct about this: perimenopause causes changes to insulin sensitivity and metabolism that increase fat storage, particularly around the middle. Women who gained weight in a consistent pattern for years, then watched it start accumulating differently, are not imagining the change. The mechanism shifted.
Poor sleep compounds everything. As progesterone drops (one of the earliest declines in perimenopause), sleep quality deteriorates, and the 3am wake window becomes a signature symptom. Disrupted sleep elevates cortisol, which then disrupts progesterone further, which worsens sleep. The book points out directly that poor sleep increases hunger the next day, because of course it does.
The psychological symptoms are the piece most likely to go misdiagnosed. Menopausal Mood Disorder (MMD) is a hormonal phenomenon characterized by fluctuating (not persistently low) mood, loss of confidence, anxiety, cognitive slowing, and a flatness that women often describe as “not feeling like myself.” It gets misdiagnosed as clinical depression and treated with antidepressants. The authors are unambiguous: antidepressants are not first-line treatment for hormone-driven mood changes. For women who have spent time on SSRIs for symptoms that felt more physical than psychiatric, this chapter is worth reading.
“When you’re feeling low, you may tend to reach for carbohydrates and other high-sugar foods, so be aware of your personal triggers. Eat nutrient-dense food regularly throughout the day to maintain your food intake and energy balance. Not eating will depress your mood and further suppress the release of those happy hormones.”
The mood-food loop during perimenopause is not a willpower problem. Low mood drives carb cravings. Carb restriction depresses mood further and disrupts serotonin (90% of which is produced in the gut). The body asking for food is often the body trying to regulate hormones that have lost their footing.
Why Eating Less Makes Everything Worse
This is the section most directly relevant to anyone who has responded to perimenopausal body changes by restricting.
The book’s nutritional framework is built on one central mechanism: blood glucose instability amplifies every perimenopausal symptom. When blood sugar crashes, the body releases cortisol and adrenaline as a stress response. Cortisol disrupts progesterone (described here as the “grounding” hormone). Progesterone disruption worsens anxiety, disrupts sleep, increases irritability, and drives cravings. The resulting cravings, if met with refined sugar or simple carbs, spike blood glucose again and restart the cycle.
The practical intervention the authors recommend:
- Protein at every meal to slow glucose absorption and maintain satiety
- The Key 3 at each sitting: protein, fibre, and healthy fat together
- No sweet foods as standalone snacks (pair fruit with nuts, eggs with toast)
- Complex carbs replacing refined ones rather than carbs eliminated altogether
- A short walk after meals to blunt the postprandial glucose spike
Note what’s not on that list. Calorie counting isn’t there. Elimination isn’t there. The authors are explicit that very low-carb approaches backfire for perimenopausal women: carbohydrates support serotonin production and calm the nervous system, and removing them entirely raises cortisol, worsens sleep, and compounds the hormonal pressure already present.
“Perimenopause — a time when your body is undergoing significant adjustments — is not a time for deprivation. No good can come from punishing your body into submission because it doesn’t look or feel like it used to any more. On the contrary, this is a time for positive nutrition — a time for nourishing yourself, filling up on the good stuff and making small dietary and lifestyle shifts that stack up over time. It’s about adding in rather than taking away.”
The gut layer adds another dimension. The estrobolome (the gut bacteria responsible for metabolizing used oestrogen) means that gut health is directly hormonal health. When the microbiome is disrupted, metabolized oestrogen can be reabsorbed into circulation, adding oestrogen imbalance on top of the fluctuations already occurring. The prescription: 30+ different plant foods per week, fermented foods, prebiotic fiber. Not a detox, not a cleanse, just feeding the microbiome consistently.
The book’s exercise hierarchy is worth noting too. Resistance training comes first, because oestrogen has anabolic properties and its decline accelerates muscle loss. Muscle loss slows resting metabolism, worsens insulin sensitivity, and accelerates the body composition changes that perimenopause already drives. The authors argue strength training should be prescribed. Walking (second in the hierarchy) is cardioprotective, accessible, and weight-bearing. High-intensity work without adequate recovery raises cortisol and can make symptoms worse.
Is The Perimenopause Solution Worth Reading?
Read this if you are in your late 30s or 40s and something has shifted (energy, sleep, weight, mood, cognitive sharpness) and you haven’t found an explanation that fits. Read it if you’ve been told your bloodwork is normal but you don’t feel normal. Read it if you’ve been offered antidepressants for symptoms that feel more physical than psychiatric. Read it if you’ve been restricting food to address weight changes that restriction keeps making worse.
Skip it if you’re primarily looking for US-specific prescribing guidance (the book references NHS systems throughout), or if you want a deep single-topic treatment of sleep, gut health, or nutrition as standalone subjects. The book covers a lot of ground across 15 chapters, and some sections go shallower than others because of it.
One caveat: The book is UK-specific in its HRT prescribing detail, and it was published in 2021. The broad science holds, but anyone acting on specific HRT recommendations should cross-reference with current guidance from their national menopause society (the Menopause Society in the US, the British Menopause Society in the UK). Guidelines have continued to evolve.
For ExcessMatters readers with a complicated relationship to food and dieting: the book contains a fat loss chapter (Chapter 15) that is notably respectful. It names the Health at Every Size movement, acknowledges that not every reader wants to address weight, and frames the nutrition guidance throughout as “adding in” rather than “taking away.” The perimenopausal lens here is useful even if weight isn’t the primary concern, because it explains why the body changes in the ways it does, and why deprivation makes those changes worse, not better. The appetite shifts, the mood-driven eating, the cravings that started in your late 30s are not personal failures. They are a physiological event with a name.
Books Like The Perimenopause Solution
| Book | Author | Best For |
|---|---|---|
| It’s Not You It’s Your Hormones | Nicki Williams | Broader hormone picture including thyroid and adrenals alongside oestrogen |
| The Hormone Shift | Tamar Gur & Jessica Ritch | US-based, covers the full reproductive lifespan including perimenopause |
| Hormone Intelligence | Aviva Romm | Functional medicine approach, more alternative-medicine oriented |
| Menopause Bootcamp | Suzanne Gilberg-Lenz | Accessible, US-focused, integrative approach to the full menopause transition |
| The Menopause Brain | Lisa Mosconi | Deep neuroscience of oestrogen decline and cognitive health; the science behind brain fog |