What Doctors Don’t Tell You About Perimenopause — Probably Because They Don’t Know. The Hidden Impact of ACEs on Your Hormone Journey

One of my greatest gifts is my curiosity. And my relentless “why.” If something feels off, it usually is. And that’s exactly how I feel about the current perimenopause narrative.

Here’s what I keep seeing. Women in their forties — smart, capable, successful women — suddenly feeling like they are falling apart. They can’t sleep. They wake between 2am and 4am and cannot get back to sleep. They’re irritable, emotional, wired but exhausted. Their stress tolerance has evaporated. They don’t feel like themselves anymore.

They go to their GP and leave with HRT, antidepressants, sometimes both.

Every. Single. Time.

But what if hormones are only part of the story? What if the intensity of your perimenopause experience has less to do with estrogen alone and more to do with your nervous system history?

Let me introduce a missing piece: ACEs.

In the 1990s, the landmark Adverse Childhood Experiences Study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente found something revolutionary. Early life stress — abuse, neglect, household dysfunction — doesn’t just shape your psychology. It shapes your biology. High ACE scores were linked to increased risk of heart disease, autoimmune disorders, depression, metabolic dysfunction and chronic inflammation. Early stress calibrates your nervous system for life. It programs the HPA axis, alters cortisol patterns and shifts inflammatory responses.

Perimenopause is one of the biggest stress tests your system will ever go through.

Perimenopause is not simply about estrogen dropping. It is about fluctuation. Ovulation becomes inconsistent, which means progesterone — only produced after ovulation — is often the first hormone to decline. Estrogen then begins to swing unpredictably. Not just down, but up and down. And those swings are what many women feel.

Estrogen does far more than regulate your cycle. It enhances serotonin and dopamine activity, supports GABA (your calming neurotransmitter), improves synaptic plasticity and helps regulate the stress response. It also modulates activity in the amygdala — the brain’s threat detection centre. When estrogen is stable, the prefrontal cortex has stronger regulatory control over the amygdala. When estrogen fluctuates, that buffering effect weakens. The amygdala becomes more reactive. The stress response activates more easily. Old emotional imprints can feel closer to the surface.

Not because you are regressing. Because the buffering system has changed.

Progesterone plays a different but equally important role. It converts in the brain to allopregnanolone, which enhances GABA receptor activity. GABA quiets neural firing and promotes calm. When ovulation becomes irregular and progesterone declines, that calming influence reduces. Less progesterone means less GABA support and greater nervous system excitability.

Layer that onto a nervous system that may already have been shaped by early adversity and suddenly you are wide awake at 3am. Cortisol naturally rises between 2am and 4am as part of a normal circadian rhythm. But if progesterone is low and your stress system is primed, that normal rise feels like a threat. Your mind races. You replay conversations with your boss. You catastrophise parents’ evening. You rehearse arguments that haven’t even happened. Your brain scans for danger. Not because you are dramatic, but because your inhibitory buffering has shifted.

If you experienced early adversity, your HPA axis may already be more reactive. Cortisol itself isn’t the villain; it keeps you alive. But chronically dysregulated cortisol can show up as early waking, anxiety spikes, blood sugar instability, increased abdominal fat and that wired-but-tired exhaustion so many women describe. Estrogen normally helps regulate this stress response. When estrogen fluctuates, cortisol patterns can become more erratic. If your nervous system was calibrated for hypervigilance in childhood, perimenopause can feel like someone has turned up the volume.

Oxytocin also deserves attention. Often called the bonding or safety hormone, it dampens amygdala activation and buffers stress. Estrogen supports oxytocin signalling. As estrogen fluctuates, some women feel more disconnected, less socially buffered, more sensitive in relationships. If early life lacked consistent emotional safety, that system may already be sensitised. Perimenopause can amplify relational strain in ways that feel confusing and deeply personal.

You may be thinking, “But I’ve done the therapy. I’ve healed. Why is this coming back?” Because trauma is not just the event; it is what happens in the nervous system. As Gabor Maté explains, trauma is about what occurs internally, not simply what happened externally. Two people can live through similar experiences; one develops a dysregulated stress response, one does not. It depends on perceived safety and the nervous system’s capacity to process the experience.

Healing matters. But healing does not erase biological imprinting. If you had your appendix removed at fifteen, the wound healed, but the scar remained. Your nervous system has scars too. Perimenopause does not create dysfunction; it reveals what has been buffered for decades by hormonal support.

And this is where the narrative becomes too shallow. If we reduce this entire transition to “your estrogen is low, here’s a patch,” we miss the bigger picture. Some women sail through perimenopause. Others feel like they are psychologically unravelling. Hormones are universal. Nervous system history is not.

Perimenopause may be less about deficiency and more about exposure.

It is a systems recalibration involving ovarian hormones, adrenal hormones, metabolic shifts, thyroid signalling, neurotransmitters and immune pathways — all in constant conversation with the nervous system. If you had a stable, well-buffered stress response growing up, this transition may feel manageable. If your early years required hypervigilance, adaptation, emotional suppression or self-reliance, perimenopause can feel like the scaffolding has been removed.

So what do you actually do about this?

I am not here to sell you anything. The wellness industry is awash with everything from therapists offering massage to “containers” that cost hundreds of pounds. Often creating dependancy rather than empowerment. This is not about another supplement or protocol. If perimenopause is exposing nervous system vulnerability, then the work is not only hormonal; it is regulatory.

Therapies such as EMDR (Eye Movement Desensitisation and Reprocessing) have strong clinical evidence for trauma treatment. EMDR helps the brain reprocess distressing memories so they are stored as past experiences rather than present threats. Neuroimaging research shows it can reduce amygdala hyperactivation and strengthen integration with the prefrontal cortex, facilitating memory reconsolidation and reducing emotional intensity. In simple terms, it helps the nervous system update old survival coding. IEMT works on similar principles, using eye movements to reduce emotional charge and shift identity-level imprints.

Somatic approaches and trauma-informed yoga are also increasingly studied for their impact on autonomic regulation. While there is no evidence that trauma is literally stored in muscle tissue, there is substantial evidence that trauma alters nervous system patterning. The brain and body are not separate entities; they operate as one integrated system. Your autonomic nervous system connects brain, heart, gut, fascia and immune signalling in continuous feedback loops. If your early life involved chronic tension or bracing, those patterns can become embodied habits. Practices that improve vagal tone, increase interoceptive awareness and support parasympathetic recovery can reduce baseline stress reactivity and improve emotional regulation, particularly during times of hormonal fluctuation.

What if perimenopause is not something to “get through,” but an invitation to a new level of safety? For decades you may have performed, overridden, adapted, achieved and survived. Perimenopause may be the first time your biology refuses to compensate.

This phase of life is not just hormonal. It is neurological, metabolic, relational and historical. And most of all, it is individual.

If something feels off, it probably is. Not because you are broken, but because your system is carrying decades of adaptive wiring. Perimenopause doesn’t create dysfunction. It reveals it.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10527101/#:~:text=The%20current%20cross%2Dsectional%20data,than%20premenopausal%20and%20postmenopausal%20women.

https://www.nia.nih.gov/health/menopause/sleep-problems-and-menopause-what-can-i-do

https://www.christinajaniga.com/ptsd-perimenopause-menopause-trauma-therapy/

https://ftm.aamft.org/perimenopause-and-early-trauma-a-systemic-approach-for-mfts/?amp=1

Why brain fog is not normal

Glymphatic drainage, cognitive health & why brain fog should not be normalised

Brain fog is one of the most common — and most dismissed — complaints I hear, particularly from women over 40.

Poor concentration. Word-finding issues. Memory lapses. Mental fatigue that doesn’t improve with rest.

Too often, these symptoms are brushed off with a casual:

“It’s just perimenopause.”

Yes, hormonal shifts matter. But normalising cognitive dysfunction is not the same as explaining it.

Chronic brain fog is a signal that something in the system is not flowing, clearing or recovering properly — and one of the most overlooked contributors is the glymphatic system.

What is the glymphatic system?

The glymphatic system is the brain’s waste-clearance pathway.

It moves cerebrospinal fluid (CSF) through brain tissue to remove metabolic waste produced during normal brain activity, including:

• Amyloid-beta

• Tau proteins

• Inflammatory by-products

• Cellular debris

This process is most active during deep, high-quality sleep.

In simple terms: sleep is when your brain takes out the trash.

If glymphatic flow is impaired, waste accumulates — and cognitive clarity suffers.

Why glymphatic drainage matters for cognitive health

When the brain’s clearance system is compromised, people often experience:

• Brain fog

• Poor focus and concentration

• Memory lapses

• Slower processing speed

• Increased anxiety or low mood

• Waking unrefreshed despite adequate sleep

Over time, impaired clearance contributes to neuroinflammation, accelerated cognitive ageing and increased neurological risk.

This is not about productivity or pushing harder. This is about protecting the brain long-term.

Why brain fog in women over 40 should not be dismissed

Perimenopause can influence:

• Sleep architecture

• Nervous system regulation

• Vascular tone

• Inflammatory load

All of these affect glymphatic function.

But explanation is not permission to ignore the problem.

Telling women that cognitive symptoms are “just part of this stage of life” — without addressing sleep quality, stress physiology, posture, breathing or lymphatic flow — is medical minimisation disguised as reassurance.

Women deserve investigation, not invalidation.

What I look at when improving cognitive function

Brain health is never one-dimensional. When someone presents with brain fog, I assess the entire system that supports overnight brain clearance.

1. Sleep quality (not just duration)

Deep sleep is non-negotiable for glymphatic clearance. This includes:

• Circadian alignment

• Night-time awakenings

• Blood sugar stability overnight

• Alcohol and caffeine impact

2. Nervous system regulation

Chronic fight-or-flight states restrict lymphatic and glymphatic flow. I assess:

• Stress load

• Breathing patterns

• Vagal tone

• Recovery capacity

3. Inflammation & metabolic health

Neuroinflammation interferes with brain clearance. Key considerations include:

• Insulin resistance

• Gut health

• Micronutrient status

• Systemic inflammatory drivers

4. Posture, movement & lymphatic flow

The lymphatic system has no pump — it relies on movement, pressure changes and breathing.

This includes:

• Daily low-intensity movement

• Neck and thoracic mobility

• Sedentary load

• Breathing mechanics

Neck position & soft tissue tension

Forward head posture, jaw clenching and chronic neck tension can mechanically restrict venous and lymphatic outflow from the brain.

If drainage pathways are compressed, clearance efficiency drops.

The collarbone region (thoracic inlet)

Glymphatic outflow connects into deep cervical lymphatic vessels that drain into the thoracic duct and right lymphatic duct near the clavicles.

If the thoracic inlet is restricted by poor posture, shoulder bracing or fascial tightness, lymphatic congestion occurs.

Trying to clear brain waste through a restricted inlet is like emptying a sink with a blocked drain.

The thoracic cavity & breathing mechanics

Restricted rib cage movement and shallow breathing reduce the pressure gradients that drive lymphatic flow.

A stiff, stress-held thorax slows clearance and increases congestion.

5. Fascial tension around the cranium & TMJ

The cranium is not static — it is a fascially connected, dynamic structure.

Cranial fascial restriction can affect:

• Cerebrospinal fluid movement

• Venous and lymphatic outflow

• Pressure dynamics essential for glymphatic flow

Jaw tension and TMJ dysfunction add another layer.

Hypertonicity in the jaw muscles can:

• Increase compression around neurovascular structures

• Reinforce forward head posture

• Maintain a constant sympathetic stress signal

TMJ issues are not just about pain or clicking — they are drainage and nervous system issues.

Restoring flow so the brain can clean itself

When we address:

• Cranial and jaw fascial tension

• Neck mobility and soft tissue restriction

• Thoracic inlet openness

• Rib cage movement and diaphragmatic breathing

• Nervous system downregulation

We are not chasing symptoms.

We are restoring flow.

And when flow is restored, the body can do what it is designed to do:

Allow the brain to efficiently clear waste at night while you sleep.

Brain fog should never be dismissed as something you simply have to tolerate.

It is information.

And when we listen to it — rather than normalising it — we can protect clarity, cognition and long-term brain health well into midlife and beyond.

Blog Post

The Hidden Link: How Liver Lymphatic Stagnation Can Contribute to Chronic Leg Pain

When most people think of leg pain, they imagine muscular strain, nerve issues, or circulatory problems. However, a lesser-known — yet profoundly influential — factor lies within one of the body’s most vital organs: the liver. Specifically, lymphatic stagnation in the liver can create a domino effect that manifests as chronic discomfort and inflammation in the lower limbs.

Understanding the Liver’s Lymphatic Role

The liver is more than a detox powerhouse; it’s a central hub in your lymphatic system. Roughly one-third of the body’s lymph passes through the liver, where toxins, proteins, and metabolic byproducts are filtered before returning to circulation.

When the liver becomes congested — due to poor diet, chronic stress, dehydration, or toxin overload — the flow of lymph slows down. This stagnation prevents the efficient removal of waste products, leading to systemic inflammation and fluid retention.

What Happens When Lymph Flow Slows?

Think of your lymphatic system as a river network. If the main tributary (the liver) becomes blocked, the “water” backs up, flooding upstream and downstream areas. In the body, this means toxic buildup, swelling, and sluggish circulation in tissues far from the liver itself — including the legs.

Key consequences of hepatic (liver) lymph stagnation include:

• Edema and heaviness in the legs: Poor lymph flow leads to fluid accumulation, especially noticeable by the end of the day.

• Inflammatory pain: Waste buildup can irritate nerve endings and connective tissue, triggering pain and tenderness.

• Poor venous return: The lymphatic system works closely with veins; if lymph stagnates, blood flow can also suffer, worsening varicose veins and leg fatigue.

• Fascial tightness and restricted mobility: Chronic inflammation and fluid retention can make the fascia less pliable, leading to stiffness and discomfort.

Why the Liver Matters in Leg Pain

When lymph cannot move freely through the liver, the entire detoxification process slows. Toxins that should be processed through bile or lymph re-enter circulation, promoting a low-grade inflammatory state throughout the body. The legs — being the farthest from the heart and most gravity-affected — often show the earliest signs of this dysfunction.

Many holistic practitioners notice that clients with chronic leg pain, heaviness, or restless legs also present signs of liver congestion such as fatigue, bloating, hormonal imbalance, and skin issues. Supporting liver health often helps relieve these symptoms from the ground up — literally.

Supporting Lymphatic and Liver Flow Naturally

Improving liver lymph drainage is about encouraging natural detox pathways and restoring balance to the body’s circulatory systems. Simple but consistent lifestyle practices can make a major difference:

• Hydration: Adequate water intake keeps lymph fluid thin and mobile.

• Gentle movement: Activities like walking, rebounding, and yoga stimulate lymphatic pumping in the legs and core.

• Liver-supportive foods: Incorporate bitter greens (dandelion, arugula), beets, lemon water, and cruciferous vegetables to aid bile flow.

• Dry brushing or lymphatic massage: Manual stimulation helps direct stagnant lymph back toward the thoracic duct and liver.

• Breathwork: Deep diaphragmatic breathing naturally pumps lymph fluid through the abdominal region and liver.

• Reduce toxin load: Limiting alcohol, processed foods, and environmental toxins helps lighten the liver’s workload.

When to Seek Professional Support

Persistent leg pain or swelling may indicate deeper lymphatic or vascular dysfunction. A functional medicine practitioner, osteopath, or lymphatic therapist can help assess liver congestion, drainage pathways, and inflammation markers. Addressing the root cause — rather than just the symptoms — often brings lasting relief.

Final Thoughts

Your legs and your liver are more connected than you might think. By supporting healthy lymphatic flow through the liver, you can ease systemic inflammation, promote detoxification, and reduce chronic leg discomfort. The body is one integrated system — and when the liver flows, so does your vitality.

Blog Post

1. What is fascia?

In the simplest terms, fascia refers to the soft connective-tissue network that envelops muscles, organs, nerves, blood vessels — in short, just about everything except bone. Historically described as “sheets or bands of fibrous connective tissue,” the term fascia has evolved significantly in how it's conceptualised.

According to modern definitions, fascia is “the three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissues that permeate the body.”

What this means practically is that fascia is not just passive wrapping-material; it may play active and integrative roles in force transmission, proprioception, movement coordination, and even pain and chronic dysfunction.

2. A brief history: Where we started, where we are now

Early views:

The concept of fascia goes back a long way. References to membranous connective tissue appear in ancient Egyptian and Greek texts (as early as ~3000 BC) where such membranes were noted, though not necessarily named “fascia.”

By the Renaissance period, anatomists like Andreas Vesalius (1543) illustrated membranes and connective tissues, including what we now interpret as fascia—but still as passive structures.

19th & early 20th century:

The terminology began to solidify: anatomists distinguished superficial vs deep fascia, aponeuroses, etc. For example, in 1851 as Wilson described the dermis as fascia (excluding epidermis).

Yet in many standard anatomy texts well into the twentieth century, fascia was still seen largely as “packing material”: inert, passive, supporting the muscles, organs, and vessels rather than participating dynamically.

The modern shift:

Over the last few decades — especially since about the 2000s — a new wave of research began to view fascia as a dynamic and functionally significant tissue. The journal article “A morphological description and classification system …” (2012) states that the literature now “supports defining fascia as an innervated, continuous, functional organ of stability and motion.”

In 2007 the first international Fascia Research Society-backed congress (the Fascia Research Congress) convened, bringing together anatomists, physiologists, therapists and movement scientists to rethink fascia.

Thus, what we “knew then” and what we “know now” are very different.

Then → fascia = passive wrapping.

Now → fascia = integral part of the movement system, responsive to mechanics, neural input, hydration, gliding, and possibly a “sensory-organ” of its own.

3. Role in chronic pain

One of the most compelling areas of fascia research is in how it may contribute to, or be a marker of, chronic musculoskeletal pain.

As far back as 2006, Helene M. Langevin proposed fascia as a body-wide signalling network and explored how connective tissue remodelling might influence pain and inflammation.

The 2013 review “The Role of Fascia in Myofascial Pain Syndrome” argues that what had been called myofascial pain may in large part be a dysfunction of the fascial continuum rather than isolated muscle pathology.

Researchers note that fascia is richly innervated, has free-nerve endings, mechanoreceptors and may transmit force, shear and tension across multiple regions — which means dysfunction (densification, reduced glide, adhesions) could alter proprioceptive input, pain perception, and movement patterns.

In practical terms: if fascia becomes less mobile, more fibrotic or “stuck,” then muscles and joints may compensate, trigger points might develop, load distribution changes, etc. So, chronic pain is increasingly being understood not just in terms of muscle/joint issues, but also in terms of the fascial network as a contributor or maybe even driver.

4. Role in sports performance & pre-hab

Fascia is also making waves in the worlds of athletic performance, movement optimization and prehabilitation (pre-hab).

Force transmission and fascial chains:

Recent reviews argue that fascia transmits more than 30 % of mechanical force in muscular systems and links muscles in “myofascial chains” rather than treating each muscle in isolation.

Training implications:

Because fascia is viscoelastic and responsive to load, movement, hydration, and shear, training strategies that emphasise “fascial fitness” (plyometrics, elasticity, gliding, multi-directional movement) are becoming more common.

Also, pre-hab strategies now frequently include fascial release (foam-rolling, myofascial stretch), glide training, and movement patterns that emphasise fascial lines. Because if the fascia is healthy and gliding, the muscle–tendon units can work more efficiently and the kinetic chain is more robust.

Injury prevention & rehab:

Because fascia connects and envelops many structures, dysfunction in one area may influence remote regions (think kinetic chains). So from a performance standpoint, awareness and training of fascia may enhance resilience, reduce injury risk, and aid recovery.

Pre-habilitation:

Pre-hab is about preparing tissues to handle load, work and stress before they break down. If fascia is tuned (good glide, healthy hydration, good shear characteristics), then the system is arguably more robust. For example, foam-rolling, dynamic movement, multi-planar loading, fascial mobility drills. These complement classic strength training.Key Advocates and Books to Read

Pioneers and Influencers in the Fascia Movement

Ida Rolf, PhD – Founder of Rolfing Structural Integration, Ida Rolf was among the first to recognise fascia as a dynamic, plastic tissue that could be manipulated to improve posture and movement. Her work in the mid-20th century laid the foundation for viewing the body as an interconnected myofascial system rather than a collection of isolated parts.

John F. Barnes, PT – Creator of the Myofascial Release (MFR) approach, Barnes has been instrumental in bringing fascia awareness into mainstream physiotherapy and bodywork. Through his clinical teaching and his book Healing Ancient Wounds: The Renegade’s Wisdom, he highlighted how fascial restrictions can influence chronic pain, trauma, and whole-body function.

Tom Myers – Author of Anatomy Trains, Myers built upon the structural concepts introduced by Rolf and further explored the body’s myofascial “meridians,” mapping out the interconnected chains of muscles and fascia that influence posture and movement efficiency.

Robert Schleip – Researcher and fascia scientist whose laboratory work helped validate the active, contractile, and sensory properties of fascia.

Carla Stecco – Orthopaedic surgeon and anatomist responsible for some of the most detailed fascial dissections and atlases, helping bridge research with clinical application.

Luigi and Antonio Stecco – Founders of the Fascial Manipulation method, focusing on restoring fascial glide and functional integration throughout the kinetic chain.

Recommended Books

Anatomy Trains – Tom Myers

Healing Ancient Wounds: The Renegade’s Wisdom – John F. Barnes

Fascia in Sport and Movement – Robert Schleip et al.

Fascia: The Tensional Network of the Human Body – Carla Stecco, Schleip, Findley et al.

Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being – Ida Rolf