Plainly Her Answers

The questions, answered in the first forty words

Every answer here starts with the answer. Then what else could be causing it, then what to do next, then who reviewed it and when. If we have not covered something, we say so rather than filling the gap.

Fitness

What is the best exercise for perimenopause weight gain? Progressive resistance training, two or three times a week. It is the only intervention that directly counters the muscle loss driving the metabolic change, and it loads bone at the same time. Cardio is good for your heart and poor at this specific job. Read the answer →

Supplements

Is creatine good for women over 40? Yes, when combined with resistance training. Creatine monohydrate has the strongest evidence of any supplement in this category for muscle and strength in midlife women, with an emerging signal for mood and cognition. Without training, it does very little. Read the answer → Does magnesium help with sleep? The evidence is weak. A few small trials in older adults show modest improvement, but there is very little specifically in perimenopausal women, and the effect sizes are small. It is cheap and low risk, so a four-week trial is reasonable, but the trials do not support the claim on most labels. Read the answer →

Hormones and treatment

Is HRT safe? For most healthy women starting within ten years of their final period and under sixty, the benefits generally outweigh the risks. In November 2025 the FDA removed the broad boxed warnings on cardiovascular risk, breast cancer and dementia. It remains an individual decision made with a clinician. Read the answer →

Mood and mind

Can perimenopause cause anxiety? Yes. Anxiety that feels new, arrives without an obvious trigger, and does not match your usual temperament is commonly reported in perimenopause. Fluctuating oestrogen affects serotonin and noradrenaline regulation directly. It is not a character change. Read the answer →

Periods and cycle

Can you still get pregnant during perimenopause? Yes. Ovulation becomes unpredictable rather than absent, so pregnancy remains possible until twelve consecutive months without a period. Contraception is generally advised until then, or until age fifty-five if you are on hormone therapy and periods cannot be tracked. Read the answer → Why are my periods getting closer together? Shortening cycles are typically the first measurable sign of perimenopause. As the ovarian follicle pool declines, the first half of the cycle shortens, so a 28-day cycle becomes 25, then 23. It usually appears before hot flushes do. Read the answer →

Nutrition

How much protein do women over 40 need? Roughly 1.2 to 1.6 grams per kilogram of body weight per day, which for a 70kg woman is about 85 to 110 grams. That is well above the official minimum, which is set to prevent deficiency rather than to preserve muscle. Read the answer →

Sleep

Why am I waking up at 3am? Falling oestrogen and progesterone disrupt the second half of the night, when sleep is lightest. You fall asleep normally, then wake around 3am, often hot, alert and unable to settle. It is one of the earliest perimenopausal changes. Read the answer →

Body and weight

Can perimenopause cause weight gain? Partly. Ageing drives most of the weight gain, but falling oestrogen changes where fat is stored, moving it from hips and thighs to the abdomen, and accelerates muscle loss. That combination is why the approach that worked at thirty stops working at forty-five. Read the answer →

Signs & Sense, our weekly note

What changed in the evidence, what women are asking, and what is worth your attention. One email a week.

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