Navigating Perimenopause: What You Need to Know
If you’re in your late 30s or 40s and starting to notice changes in your mood, energy, menstrual cycles, or sleep—you’re not imagining things. You may be entering perimenopause, the often-overlooked first chapter in the menopause transition.
What is Perimenopause?
Perimenopause is the transition leading up to menopause, when hormone levels start to fluctuate and decline. It can last 4 to 10 years and usually begins in the late 30s to early 40s, though symptoms may appear earlier.
Early perimenopause (progesterone decline) often brings:
Irregular periods, shorter cycles, or heavier bleeding
Sleep disturbances
Anxiety and mood changes
Later perimenopause (estrogen decline) may cause:
Hot flashes and night sweats
Skipped periods
Continued sleep and mood issues
Brain fog and memory lapses
Navigating Perimenopause
This phase is more than just irregular periods. It affects metabolism, bone health, and emotional well-being. The good news: you don’t have to just “deal with it.” There are real, effective ways to support your body and mind through this season of change.
Start with the Foundations
When addressing symptoms of perimenopause, I always begin with lifestyle foundations. These basics may sound familiar, but during perimenopause, they become essential.
🥗 Nutrition – Focus on quality protein and fiber for blood sugar stability, hormone balance, and detox support.
🏃🏻♀️ Exercise – Movement helps regulate mood, protect bones, and improve metabolism. Add strength training to offset bone and muscle loss.
🛌 Sleep – Essential for repair and balance, but often disrupted. A sleep “toolkit” might include magnesium, calming herbs, or amino acids.
😣 Stress management – Chronic stress worsens hormone swings. Tools like meditation, counseling, and targeted herbs can support adrenal health and improve mood.
With these foundations in place, many women notice significant improvements.
Testing Hormones in Perimenopause
When testing hormones in perimenopause, it’s essential to work with a practitioner who understands both the how and the when of testing. Because hormones fluctuate so much during this stage, timing makes all the difference in getting useful results.
Some helpful options include:
Blood test (day 3–5 of your cycle) for Estradiol and FSH.
Saliva test (3 samples in the luteal phase, days 19–23) for estrogen, progesterone, testosterone, and cortisol levels.
DUTCH urine testing (either a single test on day 21 or a full DUTCH cycle map).
When Lifestyle Isn’t Enough: Hormone Therapy
For some women, symptoms remain disruptive despite healthy habits. In these cases, hormone therapy can make a meaningful difference. This is never one-size-fits-all. I consider each woman’s symptoms, test results, and health history to create a tailored approach.
When prescribed appropriately, hormone therapy can restore quality of life—helping you feel energized, clear-headed, and emotionally steady again.
The Bottom Line
Whether you’re just starting to wonder if your symptoms are “normal,” or you’ve been quietly struggling for a while, you are not alone. Perimenopause is a powerful transition, but with the right support, you can move through it with strength, clarity, and vitality.
Are you ready to supercharge your health and wellness journey? I can help! As a board-certified Integrative & Functional Medicine physician and Certified Menopause Specialist, I can help you “think outside of the box and dig deeper with a variety of laboratory testing to help uncover the underlying root causes of your symptoms and create a plan personalized for you that goes beyond the prescription pad to incorporate diet/lifestyle change, nutritional supplements, holistic therapies, health coaching and more! Contact us to get started!