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The main differential diagnosis is alopecia areata

Option 1: Add 2mL of bacteriostatic water (recommended for most researchers) This creates a 5mg/mL concentration

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aim for 700 mg calcium daily and consider a 10 mcg (400 IU) daily vitamin D supplement, particularly during autumn and winter months, as recommended by NHS guidance Phytoestrogens : Foods containing plant oestrogens (soya, flaxseeds, legumes) may modestly help some perimenopausal symptoms, though evidence for weight management is limited Mindful eating practices : Addressing emotional eating patterns common during this transition Physical activity recommendations should combine multiple modalities, in line with UK Chief Medical Officers' guidelines: Resistance training : Two to three sessions weekly to combat muscle loss and maintain metabolic rate Cardiovascular exercise : 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity weekly High-intensity interval training (HIIT) : May help with fitness and metabolic health for some women, though evidence for superior effects on visceral fat is still emerging Flexibility and balance work : Yoga or Pilates can address stress whilst improving functional fitness Hormone replacement therapy (HRT) deserves consideration primarily for symptom management, though it may have modest effects on body composition: HRT is not licensed for weight management and should not be prescribed specifically for weight loss It may help reduce the tendency toward central fat deposition in some women By improving sleep, mood, and other symptoms, HRT may indirectly support healthy lifestyle behaviours NICE guidelines support HRT for perimenopausal symptom management when benefits outweigh risks Additional supportive measures include: Sleep hygiene optimisation : Addressing night sweats and insomnia through environmental modifications and, when appropriate, medical interventions Stress management : Cognitive behavioural therapy (CBT), mindfulness, or other evidence-based approaches Behavioural support programmes : NHS-funded weight management services or commercial programmes meeting quality standards These integrated approaches address the multifactorial nature of perimenopausal weight gain and support overall health beyond weight management alone