Perimenopause: What’s Really Happening, and How to Feel Like Yourself Again

Perimenopause can feel like hitting a brick wall without warning. Sleepless nights, brain fog, a cycle that makes no sense, and a body that suddenly feels unfamiliar.

When I went through it, I saw a highly recommended practitioner for a year and a half. She never tested my hormones, and my most embarrassing symptom, a leaky bladder, was never addressed, even though I repeatedly asked her for help. I was frustrated to say the least. So… I added to my already deep well of wisdom around women’s health, two mentorships in midlife hormone health to understand what was happening in my own body. I realized along the way, I wasn’t the only one struggling and frustrated and unable to find answers. So many other women were too.

Now I help women navigate this season with clarity instead of confusion.

Here’s what I want every woman to know.

What is perimenopause?

Perimenopause is the season when your reproductive years wind down. Your egg production is coming to a close and your hormones are declining to deficient levels. It usually starts in your mid-40s and lasts anywhere from 4 to 10 years. Some women have a multitude of symptoms, and some have just a few.

Whether you have symptoms or not, the body is changing internally and often externally.

Perimenopause, menopause and postmenopause: what’s the difference?

• Perimenopause: is usually mid-to-late 40s into the early 50s, lasting 4 to 10 years.
• Menopause: is technically just one day, the day after you’ve gone 12 months without a period. The average age in the U.S. is 51.
• Postmenopause: is every day after the 1 day of menopause, for the rest of your life.

Menopause before 45 is called early menopause, and before 40 it’s called premature menopause.

What’s happening with your hormones?

During perimenopause, estrogen and progesterone decline fairly quickly. Testosterone usually declines more slowly. As these hormones fall, the usual balance between them shifts.

You may hear this called “estrogen dominance,” but that term is often misused. Most perimenopause symptoms come from having too little estrogen and progesterone, not too much estrogen.

Your hormones touch every cell and tissue in your body. When they decline, it can feel like there’s no gas in the tank.

Common signs of perimenopause

Sleep disruption: insomnia, night sweats, fatigue, can’t stay asleep, can’t fall asleep
Low energy: exhaustion mentally and physically, lower stamina
Mood & mind: anxiety, depression, brain fog, memory lapses, anger and rage
Your cycle: irregular, shorter, longer, heavier or more painful periods; spotting; worse PMS
Body & metabolism: belly weight, harder to lose weight, insulin resistance, bloating
Pain increases: joint and muscle pain, frozen shoulder, headaches or migraines
Bladder & intimacy: urgency, leakage, UTIs, vaginal dryness, low libido, painful sex
The surprising ones: tinnitus, cracked teeth, histamine intolerance, hair loss, and melasma

See the full list of symptoms in my blog post, What is Perimenopause?

Why your labs can look “normal”

Testing in perimenopause can be inconsistent. First, there isn’t one specific test to tell you if you are in perimenopause. Additionally, some practitioners don’t test at all. Others test at the wrong time in your cycle, or use tests that aren’t the most reliable for this stage.

I prefer a fuller picture: DUTCH hormone testing, cortisol testing and FSH. If you’ve been told your hormones are “normal” but you don’t feel normal, trust that. Your symptoms are real information.

Why so many practitioners aren’t sure how to help

For decades, women were left out of medical research. In 1977, the FDA restricted many women from early clinical trials, and that wasn’t reversed until 1993. Midlife women are still under-studied today.

Then, in 2002, early results from a large study called the Women’s Health Initiative were widely reported as proof that hormone therapy was dangerous. But most of the women in the study were in their 60s and 70s, many years past menopause, and many had existing health conditions. The hormones used weren’t bioidentical. This was a deeply flawed study. And the press interpretations of the study were further flawed. This study has since been debunked.

Unfortunately, the damage of those headlines shaped women’s healthcare for more than 20 years. In November 2025, the FDA announced it would remove the black box warning from hormone therapy.

This is a step in the right direction, but it didn’t bring with it the depth of education we need around perimenopausal health. There are still quite a few practitioners practicing with out-of-date knowledge.

So finding a practitioner that is up to date with current midlife information can be difficult… And…. there are wonderful practitioners out there. I have one now. They can just be hard to find. So you may have to work harder to find that great partnership in your care that you deserve.

What can help you feel like yourself again?

We can’t inspire our bodies to make the hormones of our 20s and 30s again. But we can replenish and nourish our bodies so we feel like ourselves again.

• Optimize your sleep: aim for 7 to 9 hours, keep a consistent bedtime, finish eating by about 7 pm, and keep your phone away from your bed.
• Prioritize protein: blood sugar is harder to balance as estrogen drops. Aim for 30 to 40 grams of protein at each meal, and cut back on sugar and simple carbs.
• Heal your gut: gut health is central to hormone balance. A GI-MAP test shows what’s really going on. An unhealthy gut can drive so many midlife issues from blood sugar imbalance, sleep disruption, and even weight gain.
• Move your body: lift heavy 3 to 4 times a week, walk daily, and add balance work and jumps for your bones.
• Avoid xenoestrogens: switch to glass instead of plastic, choose cleaner skin and beauty products, and buy organic when you can.
• Get support: Find an up to date educated practitioner to support you so you can explore supplements and HRT if you so choose.

What about HRT?

Bioidentical hormone therapy doesn’t have to be feared. For many women, it can ease symptoms like hot flashes, poor sleep and vaginal dryness, and it helps protect bone health. Research suggests that starting within 10 years of menopause, it may also support heart health.

It’s a decision to make with a supportive prescriber. I’m not a prescriber, but I can help you understand your options, so you walk into that appointment informed and confident.

When to call your doctor

See your doctor if you have heavy bleeding, or unusual bleeding between periods or after menopause, or symptoms that are getting in the way of your daily life.

What women say after working with me

“I finally understand what perimenopause is, the benefits of HRT and my joy is back!” — Sonja, 53
“Thank you for helping me weed through all of the confusing mis-information in the perimenopause world!” — Nicole, 49

About Jen

I’ve worked in women’s wellness since 2005, and I’ve walked through perimenopause and menopause myself. I’m a Functional Hormone Health Coach and Certified Midlife Specialist, certified in DUTCH and GI-MAP test interpretation and Nervous System Balancing.

Ready for one-on-one support?

Your first step is a 75-minute Root2Rise Session, where we’ll go through your symptoms, your health history and what may be behind it all.

This information is for educational purposes only and is not medical advice. Always talk with your doctor or a qualified healthcare provider about your symptoms and treatment options.