You’re not alone if lately you’ve been wondering: “Is this just stress, or is it perimenopause?” The truth is, perimenopause is a curveball many of us don’t see coming — but understanding it early is a powerful step in reclaiming control of your hormones. Here’s the honest, no-fluff guide to what perimenopause is, when it often starts, the signs to watch for, and what you can do now. Let’s break down what’s actually happening in your body and how to start supporting it
What is perimenopause and when does it start?
Perimenopause is the transition between regular ovulatory cycles and the final menstrual period (menopause!), when your ovaries gradually produce less estrogen and progesterone. During this time, hormone levels fluctuate—some months you’ll ovulate, and others you won’t—which is why symptoms and cycle patterns can feel so unpredictable. It typically begins in the mid-40s, though some start noticing changes in their late 30s or early 40s. The transition can last anywhere from a few years to a decade, and no two experiences look the same—some move through it with mild changes, while others feel every fluctuation along the way. There’s no single lab test that confirms perimenopause, since hormone levels can swing widely from day to day—what matters most are your symptoms and menstrual patterns.
Key signs and symptoms to watch for
These are not guaranteed, and they often overlap with other life stressors or health issues—but when several appear together, it’s worth paying attention. Here are some of the most common ways hormone fluctuations can show up during this time.
Menstrual changes: Irregular periods, heavier or lighter bleeding, spotting, or shorter/longer cycles. You might find your periods aren’t predictable anymore—sometimes heavier, sometimes you skip one.
Hot flashes and night sweats: Sudden heat waves, sweating, flushing, or waking up drenched.
Sleep and fatigue: Trouble falling asleep, waking frequently, nonrestorative sleep, or daytime tiredness.
Mood and cognition: Mood swings, irritability, increased anxiety or depression, memory or concentration issues (brain fog).
Sexual and urogenital changes: Vaginal dryness, thinning tissues, painful sex, lower libido, more UTIs or bladder sensitivity.
Body changes: Weight gain (especially around the midsection), joint aches, muscle loss, thinning skin or hair.
Other symptoms: Heart palpitations, headaches or migraines, changes in vision, skin, or taste.
Symptoms often fluctuate, some good days, some not-so-good days, because your hormones are on a rollercoaster during this transition.
What to do now
If you’re noticing changes that feel different from your usual rhythm, the first step is to start tracking your cycles and symptoms. This gives valuable insight into how your hormones are shifting each month and it’s often the key to identifying where your body needs support.
While estrogen and progesterone are the main players in perimenopause, they’re rarely the only hormones involved. Fatigue, mood swings, weight changes, and disrupted sleep can also stem from thyroid imbalance, cortisol dysregulation, insulin resistance, or nutrient deficiencies such as iron, vitamin D, or B12. That’s why comprehensive blood work—including testing beyond what’s routinely ordered—is so important (Heres a peak at why I run my blood work yearly!). Naturopathic doctors can help you take a deeper look at these underlying patterns so your plan is individualized, not generic. Taking a deep dive with blood work is one of the first steps in my Hormone Cornerstone Method!
Foundational support always begins with the basics. Before jumping to complex interventions, focusing on these cornerstones can make a significant difference:
1. Track your cycles and symptoms: note changes in flow, sleep, mood, and energy.
2. Prioritize sleep hygiene: aim for a consistent bedtime, a cool dark room, and screen-free wind-down time.
3. Support your nervous system: focus on daily practices that calm your stress response, like deep breathing, gentle movement, or acupuncture.
4. Exercise regularly: strength training, walking, and low-impact cardio help maintain bone and muscle health, balance blood sugar, and stabilize mood.
5. Add targeted herbs and supplements: options like magnesium, B vitamins, omega-3s, and adaptogens can be incredibly supportive when chosen strategically for your unique hormone picture.
Every person’s experience is unique, but with the right strategy, it’s possible to feel balanced, energized, and confident through this transition.
What about HRT?
For some, lifestyle and natural supports provides great relief. For others, additional options can help. Hormone therapy can be helpful for managing hot flashes, sleep issues, or significant mood changes, but it’s not a one-size-fits-all solution. When we assess your hormones, we’ll also discuss whether HRT could complement your broader plan.
If you’ve been feeling out of sync and suspect perimenopause might be part of the picture, now’s the time to get clarity. Together, we can pinpoint what’s really going on, run the right tests, and create a plan to help you feel like yourself again.
Disclaimer: Any information is for informational purposes only and is not intended to be used in place of professional medical advice. Always seek the advice of a qualified health care practitioner with any questions or health concerns you may have and before starting any new treatments (including supplements).
