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Signs of Perimenopause & How to Navigate Through This Transition

Updated: Mar 17

a girl wearing pink long sleeves sleeping on a gray couch

As women, there’s a lot of talk about menopause as we age. Truth is, it doesn’t happen overnight. There is no one-size-fits-all for symptoms, timing, and what helps get us through this transition. There is though one common denominator: Perimenopause. Defined as, “around... menopause,” perimenopause refers to the timeframe when a woman’s ovarian function starts to decline, as do her hormones, mainly estrogen, progesterone, and testosterone.

Most women experience menopause somewhere between the ages of 45 and 55 with 51 being the average. A woman is said to be postmenopausal when her menstrual cycles have ceased for 12 months. Each woman’s perimenopausal experience is unique. The pendulum of the negative effects on our bodies due to these hormonal shifts seem to vary from minor symptoms to more severe issues that can affect our daily life, and can last anywhere from two to 10 years, with many women starting to experience perimenopausal symptoms as early as their late 30’s.

Here are 10 common issues that you may experience with perimenopause:

1. Insomnia. Difficulty falling asleep, staying asleep, or waking earlier than intended. Decreasing levels of progesterone and hot flashes can contribute to increased incidence of insomnia.

2. Hot Flashes. A sensation of warmth in the chest or face that may last anywhere from a few seconds to minutes. Many women have triggers such as warm weather, caffeine, alcohol, or stress that can intensify hot flashes.

3. Irregular Periods. As ovulation becomes more unpredictable, the length of time between periods may be shorter or longer, your flow may be light to heavy, and you may start to skip periods.

4. Weight Gain. Weight gain, especially around your waist and hip area, is a common side effect of changing hormones.

5. Mood Shifts. Many women experience increased incidence of anxiety and depression during perimenopause which may be related to difficulty sleeping and declining hormones.

6. Memory Loss. Have you found yourself searching for a word or someone’s name in conversation? Not to worry, this is fairly common and usually transitory due to declining estrogen.

7. Vaginal & Bladder Changes. As estrogen levels decline, your vaginal tissues may lose elasticity and lubrication making intercourse painful. Low estrogen levels can also make you more susceptible to urinary tract infections or incontinence issues.

8. Hair Changes. You may notice thinning on the front, sides, and/or top of your head. This is due to declining estrogen and progesterone. On the other hand, a rise in testosterone during this time may also contribute to hair loss.

9. Shift in Cholesterol Levels. You may see unfavorable changes to your cholesterol levels. Declining estrogen may cause a shift which contributes to rising LDL (aka “bad cholesterol”) and decreasing HDL (aka “good cholesterol”). This may be a contributing factor for women being at an increased risk of heart disease as the enter into menopause.

10. Bone Loss. With estrogen levels declining, you lose the protective effect it has on your bones causing us to start to lose bone mass more quickly than we replace it. This can lead to Osteopenia (weak bones) and Osteoporosis (frail bones).

Some factors that make it more likely for you to start perimenopause earlier include having a hysterectomy, cancer treatment, family history, or smoking. Having irregular periods during perimenopause is common, however, if you are experiencing extremely heavy periods (having to change tampons/pads every hour or so), bleeding that lasts longer than seven days, or periods occurring less than 21 days apart, you should consult with your health care provider.

Can diet and lifestyle changes help?

Absolutely! Diet and lifestyle changes can make a big difference in helping your body transition through perimenopause. Although everyone has their own bio-individual needs in regard to diet and metabolism, there are some general factors to consider and challenges such as weight gain that can be met as we age.

What should I prioritize in my diet?

Focus on prioritizing quality proteins, healthy fats, fiber, fruits, and veggies. Limit carbohydrates, processed foods, refined sugar, and alcohol. Carbohydrates have the biggest impact on your blood sugar and by prioritizing protein and healthy fats, you will feel more satiated and minimize blood sugar spikes.

Exercise is important throughout life, but especially during this transition. These hormonal shifts can affect your metabolism which can contribute to weight gain and increased risk of cardiovascular disease. Walking and strength training are very beneficial to overall body health. Walking is one of the best exercises for keeping your bones strong and entirely heal your body and strength training will help with insulin sensitivity, which is favorable to your metabolic health.

Managing your stress and focusing on quality sleep during this transition is also extremely helpful. Engaging in activities like yoga, deep-breathing techniques, and taking time for self-care will benefit you now… and in the long run. Sleep helps balance many hormones including your appetite regulating hormones and strengthens your immune system. Sleep is foundational to our health, and in my opinion, just as important as diet and exercise.

Does hormone replacement help?

Although perimenopause is a natural process that signals the end of a woman’s reproductive years, this transition may be difficult for some, and treatment options may be helpful.

Many women find bioidentical hormone replacement therapy beneficial. Supplements like magnesium glycinate, Omega-3’s, vitamin D or adaptogens such as Ashwagandha, Rhodiola, and Astragalus have been found to alleviate symptoms, manage stress, improve endurance, or assist with sleep. See my Adaptogens blog for more information.

Working with a health care provider who can assess your hormones and is knowledgeable about supplements and nutrition can be very helpful as you transition through perimenopause and into the next phase of life.

Meghan Punda, CRNP, is a nurse practitioner and functional nutritionist with a focus on women’s health. With a passion for identifying and treating the root cause of health issues, Meghan works one-on-one with her clients to develop personalized dietary and wellness plans to fit each patient’s lifestyle and ultimately reach their full wellness potential.


Perimenopause: Age, Stages, Signs, Symptoms & Treatment, October 5, 2021.

Signs and Symptoms of Perimenopause, by Tracee Cornforth. Medically reviewed by Anita Sadaty, MD. July 20, 2020.

Perimenopause: Rocky Road to Menopause, April 14, 2020.

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