Female hormone health, perimenopause and menopause in Seville

What you're feeling is real, and it isn't only hormonal

In perimenopause hormones don't decline in a straight line. They swing, and that swing explains a good part of the broken sleep, the hot flushes and the mood shifts. But other things are happening at the same time. Muscle is lost when nothing asks it to stay. Bone gets less stimulus. And sleeping badly changes your appetite and your willingness to move the next day.

Which is why looking only at hormones falls short, and looking only at diet falls short too. The useful question isn't whether this is menopause. It's how much of it is the transition, how much is how you eat and move, and how much is something else worth ruling out.

Your history first. Blood tests only when they change something

The first appointment is long, and it's mostly listening. How your cycles have changed and since when. How you actually sleep. What you eat on an ordinary Tuesday. What medication you take, what you've already tried and how it went. That alone tells us a great deal, because the diagnosis at this stage is clinical: it's made from what you describe, not from a number.

We order bloods when the result will change a decision. In perimenopause, a single oestradiol or FSH reading moves from one week to the next and rarely alters the plan. What usually earns its place is what explains the fatigue and can also be corrected:

We don't order sprawling panels just in case. A result that changes nothing only adds noise. And if you've had bloods done recently, bring them and we won't repeat them.

• Thyroid, because fatigue, weight and mood overlap with this stage and are managed differently.
• Iron and ferritin, particularly if your periods have been heavier.
• Glucose and lipids, because these are the years to have a cardiovascular baseline on record.
• Vitamin D, and whatever your history or medication calls for — not a fixed list.

Strength isn't cosmetic here. It's structural

Muscle is lost over the years unless it's given a reason to stay, and that loss — sarcopenia — shows up first in small things: the shopping, the stairs, getting up off the floor. Bone works the same way; it responds to load. And muscle is where much of the glucose you eat gets handled, so having less of it changes your metabolism even when the scales say nothing.

So training here isn't advice offered on the way out of the room. It's prescribed, supervised and measured: what you lift today, and what you lift in eight weeks. You start from where you are, even if you've never set foot in a gym.

Eating well at fifty is not eating less

The reflex is to cut. And cutting hard, without enough protein and without training, is the fastest way to lose exactly the muscle you needed to protect: the weight goes down for a few months and comes back with a worse composition than before.

The work goes elsewhere. Enough protein at every meal. Fibre and calcium covered. An honest look at alcohol and caffeine, because in many women they make sleep and hot flushes worse and they're among the first things you can test. And food matched to the training you're actually doing, not to a generic plan that doesn't know whether you lift.

What belongs to your gynaecologist, and what we do here

This consultation doesn't replace gynaecology and isn't trying to. Bleeding that falls outside what's expected, your check-ups, cervical screening, mammography, and the prescription and follow-up of hormone therapy belong with your gynaecologist. If hormone therapy comes into the conversation, it's a medical decision made with them and with your full history on the table — not taken independently from here.

What sits here is everything else, which is not a small share: making sense of the symptoms, ruling out what overlaps, deciding what to measure, and holding nutrition and strength steady for months. Bring their reports to the first appointment. If you'd like, we'll write to them.