Perimenopause on the Frontline: Questions From Women in Policing.
Updated: 6 days ago
Perimenopause is easy to miss in shift-based, high-pressure jobs because its symptoms look like stress or fatigue. When I spoke to police and emergency services staff for World Menopause Day, their questions centred on six things: hormone therapy and family history, testosterone, night sweats, building muscle safely, food and weight, and how to raise it at work. Here's what the evidence says on each, plus a free tracker to help you take a clear picture to your GP.
For World Menopause Day, I presented Perimenopause on the Frontline to staff from New Zealand and Australian police and emergency services. The chat filled with questions faster than we could answer them. They were practical, specific and, in many cases, questions women had been carrying for months.
This post pulls together the most common themes and what current research says about each. It's general information, not medical advice: use it to walk into your GP appointment informed and with good questions.
Why perimenopause hits differently in policing and shift work
Hot flushes get the attention, but they aren't the most common symptom. A 2024 meta-analysis of more than 480,000 midlife women (BMC Public Health) found joint and muscle aches topped the list, reported by 65% of women.
Now put that, along with exhaustion and broken sleep, inside a job built on rotating shifts and fast decisions. In a 2023 survey by the Police Federation of England and Wales, 70% of members with symptoms had gone to work when they felt they should have been on sick leave, and 1 in 3 had considered leaving the job because of it.
There's very little equivalent data from New Zealand or Australia, but the pattern matches what I hear from women in policing: they keep turning up and performing, quietly, often without knowing that perimenopause is why everything feels harder.
What women asked most
1. "My mum had breast cancer. Can I still consider hormone therapy?"
A personal history of breast cancer usually rules out menopausal hormone therapy (MHT). A family history is different: Australasian menopause guidance says it isn't automatically a reason to avoid MHT. For women at average or moderately increased risk, MHT can still be appropriate. Your GP can assess your risk based on details such as how old your relative was when diagnosed.
If you'd rather avoid hormones, there are effective non-hormonal options. The Menopause Society's 2023 position statement recommends low-dose SSRI/SNRI antidepressants, gabapentin, oxybutynin and fezolinetant, plus cognitive behavioural therapy (CBT) and clinical hypnosis. It does not recommend herbal or supplement remedies for hot flushes.
2. "Should I add testosterone for fatigue?"
Testosterone has one well-proven use in women: low sexual desire that causes distress, after menopause. A global consensus statement endorsed by the major menopause and endocrine societies found it improves desire, arousal and satisfaction at female-range doses. It hasn't been shown to help fatigue, mood or brain fog, so if you're exhausted, start by checking more likely causes with your GP: broken sleep, night sweats, low iron, thyroid function or low vitamin D.
3. "What actually helps night sweats?"
Night sweats are hot flushes that happen while you sleep, so the same treatments apply. MHT is the most effective; the non-hormonal medicines above are the next option. Comfort measures, such as a cool room, a fan within reach, breathable sleepwear and layers you can throw off, don't stop sweats, but they make nights easier. Many women also notice that evening alcohol makes nights worse.
4. "How do I build strength if my pelvic floor is weak? Does running help my bones?"
Start with a women's health physiotherapist: pelvic floor muscle training is the first-line treatment for leaking, with strong evidence behind it. Then breathe out on the effort, build load gradually, and add impact once your pelvic floor is ready.
Running helps bones a little, but bones respond best to heavy, sudden loads. In the Australian LIFTMOR trial (Journal of Bone and Mineral Research, 2018), postmenopausal women with low bone mass did two 30-minute supervised sessions a week of heavy lifting and impact work for eight months. Their spine and hip bone density improved, with no fractures. Keep running if you enjoy it, and add one or two strength sessions a week.
5. "What should I eat? And do I need to 'fix my cortisol'?"
A Mediterranean-style pattern has the strongest evidence for midlife heart health, which matters because cholesterol tends to rise around menopause. On top of that: protein at every meal, fibre built up gradually (it helps bloating, regularity and appetite), calcium mainly from food, oily fish a couple of times a week, and a vitamin D check if you work indoors or on nights.
You don't need to "treat cortisol". It only needs medical treatment for rare, diagnosed conditions. Midlife weight change is mostly driven by falling oestrogen shifting fat to the middle and muscle loss, made worse by broken sleep and stress. Strength training, protein and sleep are what move the needle.
6."Which creatine should I take, and how long before it works?"
Look for plain, unflavoured creatine monohydrate. It's the cheapest form and the one used in almost all the research; other forms haven't been shown to work better. Choose an independently tested product, which matters if you can be drug-tested at work.
At 3–5 g a day, your muscles fill up with creatine over about three to four weeks. The benefit comes from pairing it with strength training: a 2025 meta-analysis of seven trials found that around 5 g a day plus resistance training gives small but real gains in muscle and strength in postmenopausal women. It didn't show a clear effect on bone density, and without strength training there's little to expect.
Creatine isn't something you feel, so judge it by whether your strength keeps improving over months, not day to day. Some people already have high natural stores and notice very little. Research on creatine for mood and brain function is promising but still early.
7."How do I raise this with my manager?"
Ask for a short one-to-one, keep it practical, and bring specific suggestions. You don't have to share medical details:
"I'm going through perimenopause. Some symptoms, mainly broken sleep and concentration, are affecting me at work at times. I've got a few small changes that would help me keep performing well. Can we talk about them?"
Useful, low-cost adjustments include a desk fan, easy access to water and toilets, some flexibility after a bad night, and key points in writing for meetings. In New Zealand, the Ministry for Women (women.govt.nz/menopause) publishes a menopause guide written for managers.
Track it before you see your GP
The single most useful thing you can bring to a GP appointment is a record of your symptoms over time. Perimenopause is usually diagnosed on symptoms, not a single blood test, and a few weeks of notes gives your GP a clear picture in minutes.
Two free tools can help:
Not sure what's going on yet? Take the 5-minute Peri/Menopause Symptoms Quiz to see which body systems are most affected.
Ready to track? The free VANTA symptom tracker runs on your phone and can be added to your home screen like an app. Log your symptoms, periods, sleep and mood daily for 4–8 weeks, then download a summary for your GP as a PDF or Excel file. Your entries stay private on your phone.
References
Fang Y, et al. Global prevalence of menopausal symptoms among middle-aged women: a systematic review and meta-analysis. BMC Public Health. 2024. Link
Police Federation of England and Wales. Menopause Survey 2023. Link
The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573–590.
Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Climacteric. 2019.
Watson SL, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. Journal of Bone and Mineral Research. 2018;33(2):211–220.
Creatine supplementation in postmenopausal women: a systematic review and meta-analysis of randomised controlled trials. 2025.
Australasian Menopause Society. Information on MHT and family history of breast cancer. menopause.org.au
Dorota Gancarz, MSc, is an Integrative Women's Health Coach and Perimenopause Specialist and founder of VANTA Coaching in Adelaide. If you'd like support working through your own symptoms, book a free clarity call.
