Since perimenopause began, food sounds a

Tonight, do not make dinner the test — put three small, already-cooked protein bites on a schedule in front of you, and put the doctor conversation on tomorrow's list. I can't tell you what is causing the food aversion or the nausea; that needs a clinician's assessment, and nothing below is a diagnosis or a change to any medicine.

One thing first: you skip meals, so if you are only nauseous when you eat and never actually vomiting, this is not an emergency tonight. It becomes one on the list in section 3, and I have put that list first in the decision tree at the bottom.

1. What you've tried vs. what tends to work better

Skipping all day, then forcing a big dinner. The problem isn't the dinner — it's the gap. After hours with nothing in you, a large meal is exactly what your stomach is refusing, and the nausea that follows gets logged as "food is the problem" when it was really the empty-then-huge pattern.

Better, same effort, less cooking:

Small protein bites on a clock, foods already at home (pick two you actually have):
boiled eggs · plain yogurt · cheese cubes with crackers · milk or soy milk · peanut butter on toast · tuna from a tin · tofu · leftover chicken or rice · a scoop of any soup you already made.

Three rules that make it survivable at 7pm with a school week running:

• Eat cold or room-temperature when you can — hot food smells stronger and puts you off before the first bite.
• Eat sitting down, seated, with the first five minutes screen-free. Ten minutes, no cooking, no dishes after.
• Keep a "bland shelf" you don't have to think about: crackers, plain toast, banana, rice, boiled potato, soup. Boring on purpose.

Nausea levers that are not medicine and not your call to make: small sips rather than gulps; cold drinks; a cool damp cloth on the back of the neck; sitting upright after eating rather than lying down; looser waistband; brushing teeth or a mint after eating if that usually helps you.

Track it for the doctor, not for you to judge. One line a day: time, what you managed, how much, sick yes/no, bowel, sleep the night before, where in your cycle you are. That log is what turns "food sounds awful" into something a clinician can act on.

2. Constraints and what to avoid

• No meal skipping as a strategy. It is the one thing on this page that reliably makes the next meal worse.
• No large meals to "catch up."
• No leftover anti-sickness tablets, someone else's prescriptions, acid-reflux leftovers, or anything bought online without a prescription. Also no powders or supplements — including anything sold as a menopause blend. Nothing new while you're trying to work out the cause; it hides the signal.
• Do not stop, start, or change your thyroid tablet, your blood-pressure tablet, or anything else on your own — including on a day when you feel unable to eat. Tell the doctor what you took and when; they decide.
• No fasting for blood tests or weight-loss reasons while you are eating this little.
• Don't let anyone else dose the kids, pets or the elder on your account — including "just a small amount." That stays with their own plan and their own prescriber.
• If you have alcohol in the house, note how much you have actually had. It's on the doctor's list, and it's an easy thing to forget under-tell.

Bring to the doctor, in this order:

1. The log above, plus when this started and whether it tracks your cycle, your sleep, or stress weeks.
2. Every medicine and supplement by real box name — including the thyroid tablet and the blood-pressure tablet — with the doses you take and the times. Also anything you have recently started or stopped.
3. The questions worth their time: Is this a medication effect, a stomach or gut cause, low mood or sleep, thyroid, anaemia, or something else — and what would you check first? Is anything on my list worth a trial or a change? Could hormone treatment help this symptom, and is it safe for me given my history? What should make me phone you before the next appointment?
4. Weight and blood pressure at the appointment — the two numbers a skipped-meal pattern moves first.
5. Say the caregiving out loud: I am the school-week and elder logistics, so I need a plan that survives a bad day, not just a good one. Ask for the smallest thing that helps, and ask what to do on the days I cannot manage it.

If you have the HRT questions sheet already written, add one line to it: *food aversion and nausea — is this expected, and is it treated differently?*

3. Red flags — stop the home routine and get help

Call your local emergency number now if any of these are true today:

• You cannot keep fluids down, or you are passing almost no urine
• Vomiting that is dark green, or anything like coffee grounds, or you vomit blood
• A belly that is swollen, hard, or extremely tender
• Dizziness or near-fainting when you stand up, a racing heart, or confusion or difficulty waking
• Severe abdominal pain, chest pain or pressure, or pain spreading to arm, jaw or back
• Black or tarry stools, or blood in the stool
• Any bleeding that is not the bleeding you were told to expect
• Thoughts of harming yourself — call for help and do not stay alone

Same-day clinic or urgent care, not tonight if:

• You have not managed a real meal for more than a day or two
• The nausea is new and worsening rather than settling
• You feel faint, or your weight has dropped noticeably
• You have a low mood or hopelessness that is worse than your usual
• A calf swells on one side only, or a new breast lump appears

Expectant, at home, only if none of the above: short nausea that comes and goes, no vomiting, you can drink, belly is soft and not tender, you are urinating normally.

Decision tree — screenshot this

```
Can you keep fluids down?
├─ NO → emergency number now. Do not eat, do not plan dinner.
└─ YES
└─ Any of: green/bloody vomit · hard swollen belly ·
black or bloody stool · near-fainting, racing heart, confusion ·
severe belly/chest pain · thoughts of harming yourself
└─ YES → emergency number now
└─ NO ↓
Is there a belly that is swollen, hard or very tender?
├─ YES → emergency now
└─ NO ↓
Have you eaten almost nothing for more than a day or two,
or has the weight dropped / you feel faint?
├─ YES → same-day clinic or urgent care
└─ NO ↓
Nausea mild, comes and goes, you drink, belly soft,
urine normal
└─ HOME ROUTE: small protein bites on a clock every ~3 hours,
bland shelf, cold or room-temp food, log one line a day,
book the doctor visit within the next few days.
```

What success looks like in 24 hours — without any cure promised

• You ate something small at roughly three separate times, instead of one forced dinner.
• You drank without nausea and did not skip for the whole day.
• You have one line of the log written down, so the doctor gets facts instead of a mood.
• You know the one number or question you'll bring, and when you'll phone.

If 24 hours in, only one of those happened, that is still information for the doctor — not a failure and not a cure either way. And if it goes the other way and none of it holds, use section 3 rather than trying harder at midnight.

I can't diagnose the cause from here, and I'm not changing any of your medicines. The honest short version: the food aversion is real and worth being taken seriously on its own terms, and you deserve a clinician to look at it rather than a tired evening's guess.