Understanding Perimenopause: Your Next Chapter

Have you been feeling different lately? Maybe your periods are changing (getting longer, shorter, or irregular), or you’re experiencing mood swings and fatigue without a tangible reason? Perhaps you’re waking up in the middle of the night, drenched in sweat, or finding it harder to fall asleep than before. These changes might seem puzzling, but they actually are your body’s way of signaling a new chapter called perimenopause.

What is perimenopause?
Perimenopause is the transition phase leading up to menopause, marked by hormonal changes that affect periods, mood, sleep, and body functions. It typically starts in a woman’s 40s and can last several years.

Why Does it Happen?

It all begins in the womb. Not yours, but your mother’s, where around 6 to 7 million eggs are formed in your developing ovaries. By the time you are born, this number drops to about 1 to 2 million. Each egg is held inside a follicle, which is like a tiny nest. Starting in puberty, your brain sends a signal (initiates a chat) to your ovaries using Follicle-Stimulating Hormone (FSH). FSH encourages a few follicles to grow and mature, each holding one egg.

As the follicles develop, they produce estrogen. Once an egg is fully mature, Luteinizing Hormone (LH) triggers ovulation—the release of the egg from its follicle, ready to begin its journey. After ovulation, the now-empty follicle starts producing progesterone to prepare your body for pregnancy. This communication between your brain and ovaries is called the Hypothalamic-Pituitary-Ovarian (HPO) axis.

Spotlight on Biology

Imagine a conversation between your brain and ovaries:

As you near menopause, the conversation between the brain and your ovaries begins to slow down. The slowing down marks the beginning of perimenopause. Perimenopause usually begins in your 40s, but it can start earlier for some women 1, 2, 3, 4, 5, 6, 7. It can last anywhere from 1 to 12 years5.

With fewer eggs remaining, the follicles become less responsive to FSH, and estrogen and progesterone production starts to decline2, 4. This creates a vicious cycle: fewer eggs lead to less hormone production, which leads to irregular cycles, and this cycle repeats until ovulation and hormone production stop completely9, 10, 11. These changes affect not just your periods but many parts of your body, causing new and sometimes surprising symptoms.

The Stages of Perimenopause

Perimenopause can be divided into three stages: late reproductive stage, early menopausal transition, and late menopausal transition12, 13.

Note: Other conditions can cause menstrual irregularities, such as thyroid disease, pregnancy, or hormonal contraceptive use. Always consult a healthcare provider to rule out other possibilities.

Indications & Challenges

Perimenopause can manifest in various ways, from clear physical symptoms to more subtle changes that you might not immediately connect to hormonal shifts. Understanding the signs—both the obvious and the hidden—can help you recognize what’s happening and take proactive steps toward feeling your best.

The Obvious: What You Feel and See

You might notice one, many, or none of the signs of perimenopause, and those symptoms can come in different intensities. Sometimes, it’s hard even to connect them to perimenopause. Many women often feel isolated and think something is wrong with them when they start feeling “off” instead of appreciating it as their body goes through natural biological changes14.

Have you experienced any of the below?

• Mood swings: feeling happy one moment and irritable the next15
• Brain fog and difficulty concentrating: trouble focusing or remembering things15
• Fatigue: feeling tired even after a good night’s sleep15
• Hot flashes and night sweats: sudden feelings of heat affect about 60% of women16
• Sleep problems: difficulty falling or staying asleep
• Vaginal dryness and painful intercourse: due to decreased estrogen levels7
• Joint and muscle pain: stiffness or discomfort in joints and muscles
• Urinary issues: trouble controlling urine.

Here’s a full list of symptoms that you, like many perimenopausal women, might experience.

The Hidden: Symptoms You Might Not Notice

Not all perimenopause symptoms are immediately noticeable, but they can still have a big impact on your health:

• Decreased estrogen can lead to weaker bones, increasing the risk of osteoporosis3
• Hormonal changes can affect your heart and blood vessels2
• Levels of cortisol, the stress hormone, may rise during late perimenopause17, 4

Curious Facts

• In a survey of nearly 1000 women over 40.61% did not feel informed about menopause, and 90% had never been taught about it in school15. No wonder you might feel confused and lack information!
• Up to 86% of women experience symptoms significant enough to seek medical care18, 19. Have you talked to your health provider about your symptoms?
• Only 6.8% of medical trainees in the USA felt ready to handle menopausal symptoms, and 20% received no training on menopause during residency20. It’s not surprising if your doctor hasn’t recognized that the changes you are worried about might be perimenopause symptoms. They just don’t know. They are not trained for that.

What You Can Do Today?

• Start learning about your body now, and don’t wait for symptoms to become overwhelming. Understanding what’s happening can reduce anxiety and help you make informed decisions. After all, “It’s all biology, baby!”
• Regular check-ups with your healthcare provider can help monitor changes and rule out other conditions, such as thyroid issues or hormonal imbalances.
• Adopt healthy lifestyle habits:
  • Exercise regularly to help yourself with mood swings, strengthen bones, and support heart health.
  • Balance your diet.
  • Manage stress—techniques like deep breathing, yoga, or meditation can help lower cortisol levels17.
  • Quit smoking and limit alcohol. Smoking is linked to more severe hot flashes16.
  • Explore supplements.
• Connecting with others and sharing experiences can provide emotional support and practical tips.
• Educate yourself on Hormone Replacement Therapy (HRT) to see if it’s right for you.

By taking these steps, you’re not just easing current symptoms—you’re investing in your long-term health. You’ll reduce the risk of serious conditions like heart disease, osteoporosis, and certain cancers. Plus, you’ll feel more empowered and in control of your life.