Perimenopause Symptoms: Signs, Causes & Treatment Options for Women 35+
I've been talking about hormones for some time now, both from a perspective of what our hormones are and what they do, and what women should be considering when it comes to hormone replacement therapy, and when.
Today, I want to get a bit more granular and give you some food for thought.
Often in my practice, I get a new female patient who, over the course of their intake discussion, reveals a host of maladies that have plagued them for years. It can look like this: a 48-year-old patient, still cycling though irregular, with chronic joint pain diagnosed eight years ago as fibromyalgia, fatigue, very poor sleep with an overactive mind, increased anxiety in her 40s, a depression diagnosis four years ago, weight gain even with sustained effort through diet and exercise, substantial brain fog, and increasing right-sided shoulder pain and stiffness.
Now, you might read all of those things and think, wow, that's a lot.
You might also think, wow, that's me!
But what it really is is a very standard depiction of the constellation of symptoms that can all, whether directly or indirectly, be tracked back to hormones.
The Root Cause No One Is Talking About
The most basic way to describe it is this: as women age, our declining sex hormone levels drive increasing inflammation in the body. This is going to show up as different symptoms for each woman, but it often stretches across multiple organ systems and can affect everything from the brain to the bladder to the skin.
If you go to your GP, they will refer you out to a series of different specialists to do further testing on all of these organ systems. Endocrinology, psychology, orthopedics, physical therapy, neurology - maybe a sleep study or an obesity drug.
But what if the first thing you could do was support your declining hormones for a few months and see which of those symptoms lessened or disappeared altogether?
And at the same time - what if you were encouraged to prioritize eight hours of sleep, walk at least 8,000 steps a day, eat at least 100 grams of protein each day, and hydrate?
Do you think that would help?
(Hint: it would.)
Perimenopause Starts Earlier Than You Think
Perimenopause can start as early as our mid-30s, but almost no one is given any warning, or reminded to keep it in the back of their mind as they go into their late 30s and 40s and weird symptoms start popping up.
Consider this your reminder.
The power of lifestyle tools to allow your body to move through perimenopause and menopause with more ease is profound. With good sleep, movement, nutrition, and hydration, your body will be more resilient and able to withstand the changes with less upset.
But none of those things - important as they are - will fully compensate for the loss of sex hormones that we all go through.
If you want to do that, you should consider hormone replacement therapy.
It's worth saying clearly: this is not about waiting until you feel like you're falling apart. These tools - lifestyle and hormonal support together - work best when you start paying attention early. Your late 30s and 40s are not too soon to start asking these questions.
What Educated Doctors Are Doing Differently Now
Instead of pushing the debunked science that estrogen therapy causes breast cancer, educated doctors today are realizing that you can harness the advantages of progesterone and estrogen to help women - and you can often do it before their periods even end.
That's right - still-cycling women can harness progesterone and estrogen to help manage their cycles, manage their PMS symptoms, manage their perimenopause symptoms, and sail into full menopause without feeling like they fell off a cliff.
Supplemental progesterone - the hormone produced after ovulation that theoretically carries us through the second half of our cycle smoothly and produces a pain-free, drama-free period - can be supplemented by women in their 20s and beyond if the circumstances warrant it.
That's right: instead of being put on a birth control pill (synthetic progestin, which will not produce the type of full-body benefits that bioidentical progesterone will) to manage their PMS or perimenopause symptoms, women could be taking 50–100mg of bioidentical progesterone at night.
In addition to lightening and easing period and PMS symptoms, bioidentical progesterone will ease anxiety and promote deeper sleep.
These are often the two big complaints of women in their late 30s and 40s.
Do know that only birth control pills and IUDs will prevent pregnancy, so if that is still a goal for you, be aware. You can layer bioidentical progesterone over existing IUDs, though, and an educated provider can help you with this.
Estradiol Before Menopause? Yes, Really.
I know more and more women who are utilizing bioidentical estradiol patches - and usually progesterone as well - before their cycles cease.
This is for a variety of reasons, most of them related to daily symptoms of inflammation. These are as varied as joint and muscle pain, brain fog, fatigue, depression and anxiety, night sweats, hot flashes, skin itching, and even digestive symptoms.
Most of these women are fairly close to menopause, in their 40s or beyond.
This is the part that surprises most people: you do not have to wait until your period has stopped to seek hormonal support. The perimenopausal years - when hormones are fluctuating most unpredictably - are often when symptoms are at their worst and when intervention can make the most meaningful difference.
Waiting until you've hit full menopause to address what your hormones are doing means suffering through years that you didn't have to.
What to Do If This Sounds Like You
All of this is to say: if you're over 35 and have started to feel not like yourself, with new symptoms and increased inflammation, while you are seeking out an answer through the western medical system, consider the fact that your hormones might be driving much of it.
That doesn't mean blowing off every other specialist or ignoring other avenues of care. It means that when you are building your team and seeking answers, your hormonal health deserves a seat at that table - ideally near the front.
Find a provider who takes a complete symptom history, who understands perimenopause and menopause medicine, and who is willing to explore bioidentical hormone therapy as part of your care plan.
In the meantime, build the foundation: sleep, protein, movement, hydration. Not because it will fix everything, but because - as I said - it will make everything else work better.
You don't have to keep collecting diagnoses while the real picture goes unaddressed.
The constellation is there. Let's start connecting the dots. If you want specific help, join me in the Very Peri Coaching Program! We will work on your foundational pieces, structured and specialized just for your needs.
Frequently Asked Questions
What is the difference between perimenopause and menopause?
Perimenopause is the transitional phase leading up to menopause, during which hormone levels - particularly progesterone and then estrogen - begin to fluctuate and decline. It can begin as early as the mid-30s and last anywhere from a few years to over a decade.
Menopause is defined as the point at which a woman has gone 12 consecutive months without a menstrual period.
Can I start hormone therapy if I'm still having periods?
Yes. Still-cycling women can absolutely begin bioidentical progesterone and, in some cases, estradiol if their symptoms warrant it. Perimenopause is often when symptoms are at their most disruptive, and many women benefit from hormonal support well before their periods stop.
Is hormone replacement therapy safe?
For most women, current evidence supports that bioidentical hormone therapy is safe and that the benefits meaningfully outweigh the risks. The fear around HRT and breast cancer largely stems from science that has since been debunked.
As with any medical decision, an individualized conversation with an informed provider is essential.
What is bioidentical progesterone and how is it different from synthetic progestin?
Bioidentical progesterone has the same molecular structure as the progesterone your body produces naturally. Synthetic progestin - found in birth control pills and some other hormonal medications - has a different molecular structure and will not produce the type of full-body benefits that bioidentical progesterone will, particularly around sleep and anxiety.
Will hormone therapy help with joint pain and inflammation?
It can, yes. As women age, declining sex hormone levels drive increasing inflammation in the body - and that shows up differently for every woman. Joint and muscle pain is one of the most common presentations.
Many women find meaningful relief with hormonal support, especially when paired with the lifestyle foundations of sleep, protein, movement, and hydration.
How do I find a provider who understands perimenopause and HRT?
Look for practitioners who specialize in women's hormonal health, integrative medicine, or menopause medicine. It's absolutely appropriate to ask a potential provider directly about their approach to bioidentical hormones and perimenopause before committing to their care.
An educated provider will take a full symptom history and look at the whole picture - not just one piece of it.
Can lifestyle changes alone manage perimenopause symptoms?
The lifestyle tools are powerful - with good sleep, movement, nutrition, and hydration, your body will be more resilient and able to withstand the changes with less upset.
But none of those things, important as they are, will fully compensate for the loss of sex hormones that we all go through. For many women, hormonal support is necessary to truly address what's driving their symptoms.
What are the most common early signs of perimenopause?
They are often the two big complaints I hear most from women in their late 30s and 40s: worsening sleep and increased anxiety. But the full picture can also include changes in cycle length or flow, worsening PMS, brain fog, fatigue, and new or worsening joint pain.
Because these symptoms stretch across so many organ systems and overlap with other conditions, perimenopause is frequently missed - which is exactly why keeping it in the back of your mind matters.
Weight loss medications have changed the landscape of health and weight management. GLP-1 medications are helping people lose weight, reduce inflammation, and, in many cases, decrease reliance on other medications. For many, they feel like a long-awaited solution.
But for many, this solution isn’t the full story. New research shows that 50-80% of people report gaining back between 25 and 60% of the lost weight within two years of stopping medication. What does that tell us? For many, supportive lifestyle pieces were likely missing.
Lasting success requires a plan. Many people are never taught the lifestyle strategies needed to preserve muscle, support metabolism, and nourish their body while appetite is suppressed. Muscle loss during weight loss is one of the biggest predictors of regain—and it can be prevented.
The GLP-1 Companion is about setting you up for long-term success. Together, we’ll focus on how to eat and move in a way that supports fat loss while protecting muscle, energy, and overall health. No gimmicks, no fads—just science-based guidance, common sense, and consistent support.
I’ll be with you every step of the way. We’ll tailor our calls to your goals, your body, and your lifestyle, so you leave this program confident in how to care for yourself both on and beyond your GLP-1 medication.
Program Details
Length
5 weeks
Meetings & Ongoing Support
Coaching Calls:
Five 60-minute one-on-one calls
Total Calls: 5 (5 total hours)
Email Support:
Weekly email support for questions and guidance throughout the program
Additional Support:
Additional consultation hours available at $175/hour
Areas of Focus
We’ll focus on the foundational habits that support sustainable weight loss and long-term metabolic health, including:
How weight loss occurs in the body
Fat loss vs. muscle loss—and why it matters
The role of movement and exercise while on GLP-1 medications
Protein, carbohydrates, and fats: how to balance them with reduced appetite
Practical strategies for managing decreased hunger cues while meeting nutritional needs
Investment
$1,075
We plan ahead to optimize outcomes—weddings, vacations, and job interviews. Why wouldn’t we plan to optimize our health before pregnancy? Don’t wait until you’re nauseous and exhausted to realize you need a strategy to eat better, sleep more, and stress less. Pregnancy can be an immense drain on the body, especially one that begins the journey stressed, undernourished, underslept, and exposed to a high level of environmental toxins.
Fertility Foundations is about controlling what we can control. Together, we’ll reduce lifestyle factors that may hold you back from feeling your best and do the work in advance so your body is prepared, resilient, and supported when pregnancy occurs.
This program is ideal for anyone on a fertility journey and is most effective if we have at least 3–6 months before you’d like conception to occur—but it’s also a powerful starting point if you’re earlier in the planning phase. Every change we make together supports your health, the health of your partner, and the health of your future child (and any children already in your home).
I’ll be with you every step of the way. We’ll identify the supports you need, tailor our calls to your priorities and unique situation, and adjust as life or plans shift. Entering pregnancy with a nourished, rested, and less inflamed body can make a meaningful difference in how you feel during pregnancy itself.
This program is not testing-dependent, though functional medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the baseline program cost.
Program Details
Length
3.5 months
Meetings & Ongoing Support
Initial Setup Call:
One 60-minute onboarding sessionOngoing Calls:
Two calls per month for the first three months (45–60 minutes each)
One final call in month four (45–60 minutes)
Total Calls: 8
Email Support:
Weekly email support, as needed, for questions and ongoing guidance
Areas of Focus
We’ll focus on preparing your body—and your home—for pregnancy by improving nutrition and lifestyle factors that support fertility and a healthy conception or implantation. Topics may include:
Nutrition, optimized for fertility
Exercise
Stress management
Sleep
Environmental toxins
Supplements
Cycle regulation, if needed
Investment
$1,7000
Some of us may have a new friend in our lives. She’s… unpredictable. A bit chaotic. It doesn’t seem like she’s leaving anytime soon, and we need to figure out how to deal with her.
Meet Peri.
All jokes aside, perimenopause is often described as a time of hormonal chaos—and for many women, that’s exactly what it feels like. In today’s world of full-time jobs, aging parents, kids, school schedules, activities, and running a household, feeling “off” can sneak up on you. Perimenopause can begin 10 or more years before menopause, which is wildly inconvenient, considering these are often the years when women have the least amount of time to stop and figure out what the h*ll is going on.
Let me help.
Spend a little time with me each month, and together we’ll make sense of what’s happening in your body, reduce the overwhelm, and create a plan that actually fits your life.
If you’re in your 30s and suspect you’re just entering perimenopause, we’ll troubleshoot current symptoms, make sure the foundational lifestyle pieces are in place, and prepare you for what’s coming. If you’re in your 40s or 50s and right in the thick of it, we’ll evaluate what’s going on now, troubleshoot symptoms, refer out when appropriate, and focus on the strategies you need right now to feel better.
Areas of Focus
Our work together may include:
Understanding your current symptoms
Understanding the hormonal shifts occurring
Knowing what’s happening now and how things may change over time
Optimizing nutrition
Appropriate and effective exercise for this stage of life
Sleep hygiene
Hormone Replacement Therapy (HRT) education and discussion
Stress management strategies
How to minimize toxins
How to optimize supplements
This program is not testing-dependent. Functional Medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the baseline program cost.
Program Details
Duration
3 months
Meetings & Support
Introductory Call:
One 60-minute onboarding sessionOngoing Calls:
Two calls per month for three months (45–60 minutes each)
Total Calls: 7
Email Support:
Weekly email support, as needed, for questions and ongoing guidance
Investment
$1,525
Would you rather do this with a friend? Check out the Add a Friend program instead!
This is the same Very Peri program—just designed for two people instead of one.
Do you have a friend who’s at the same stage of life? Move through the Very Peri coaching experience together and share the journey. You’ll receive the same education, guidance, and support as the one-person program, with the added benefit of a built-in accountability partner who truly gets it.
The topics, framework, and core content are exactly the same as the individual Very Peri program. The difference is that this option is structured to support two participants at once, with individual onboarding and expanded communication support for both people.
You’ll move through the same discussions, education, and practical guidance—together—while still receiving individualized support within the shared sessions.
How the Two-Person Program Works
Both participants attend all coaching calls together
You must be available at the same time (you may join from separate locations)
Coaching is tailored to each individual within the shared sessions
You’ll gain insight into your own perimenopause experience and learn through your friend’s perspective
What We’ll Cover
(Same as the One-Person Very Peri Program)
Understanding current symptoms
Understanding the hormonal process occurring
What’s happening now—and how things may change going forward
Optimizing nutrition
Appropriate and effective exercise for this stage of life
Sleep hygiene
Hormone Replacement Therapy (HRT) education and discussion
Stress management strategies
How to minimize toxins
How to optimize supplements
This program is not testing-dependent. Functional Medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the base program cost.
Program Details
Duration
3 months
Meetings & Support
Introductory Calls:
Two 60-minute onboarding sessions (one per participant)Ongoing Calls:
Two shared calls per month for three months (45–60 minutes each)
Total Calls: 8
Email Support:
Up to two emails per week, as needed, for questions and ongoing support
(Emails may be submitted jointly or individually)
Investment
$2,000 total
($1,000 per person)