Perimenopause 101: Here’s What’s Happening
Perimenopause is finally in the spotlight, and yet there is still a knowledge gap about what is really happening to women as they transition from regular cycling into menopause.
In this blog post, learn about what is really happening to your body and your hormones during the perimenopause transition.
Perimenopause Myths and Misconceptions
The narrative around perimenopause and menopause is that suffering is inevitable and that this is the end for women.
When thinking about perimenopause, many think of hot flashes, night sweats, and low libido, but the truth is perimenopause is so much more.
Perimenopause completely restructures your brain as your hormones begin to shift and change.
Perimenopause requires the right tools and strategies so that you can feel supported and thrive.
Suffering is optional. With knowledge and the right tools, you can thrive as you transition or prepare to transition) from regular cycling into menopause.
What is perimenopause?
Perimenopause is the 6 - 10 year transition that occurs between regular cycling and menopause (the cessation of ovulation and the menstrual cycle).
Medically speaking, menopause is diagnosed as going 12 consecutive months without a menstrual bleed.
Perimenopause Quick Facts:
Can begin as early as age 35
Can last 6 - 10 years
Average onset of menopause is 51 years old
The Phases of Perimenopause
Perimenopause can be broken down into two broad phases.
Perimenopause Phase 1
In phase 1, your ovaries begin to slow down, but the signs can be subtle.
Some subtle signs include:
Anovulatory cycles (cycles where no ovulation occurs)
Shorter menstrual cycles
Earlier ovulation
Irregular bleeding patterns such as
Heavy periods
Spotting
The reason for these changes is because ovarian sex hormones begin to decline.
Additionally, egg quality declines with age, which results in lower levels of progesterone. Less progesterone compared with estrogen can result in estrogen dominance.
Did you know that your estrogen and progesterone can both decline, and you can still experience symptoms of estrogen dominance?
This is because estrogen and progesterone are a team and when the ratio is off, you may experience estrogen dominant symptoms like:
Heavy periods
Irregular bleeding patterns ( such as heavy one month, light the next)
Spotting
Menstrual migraines
A quick note about estrogen dominance
It is not just due to ovarian function declining.
Estrogen dominance is a full-body, multi-organ system issue that can be related to poor detoxification in the liver and gut, thyroid dysfunction, stress, and even imbalances blood sugar, in addition to imbalanced hormones.
Perimenopause Phase 2
In phase 2, key sex hormones continue to decline.
The brain urges the ovaries to ovulate by releasing more FSH (follicle stimulating hormone) and LH (luteinizing hormone), but the ovaries do not respond, and ovulation becomes less likely each cycle.
The result? Longer cycles and fewer (and often lighter) menstrual bleeds until the ovaries stop producing estrogen.
Common Symptoms of Perimenopause (that can occur during either phase)
Hot flashes & night sweats
Difficulty sleeping
Fatigue
Menstrual migraines
Increased PMS
Exacerbated period-related conditions like cramps, endometriosis, adenomyosis, fibroids
More frequent mood changes - anxiety, depression, difficulty coping
Heart palpitations
Memory loss
Vaginal dryness and pain with sex
More UTIs
Unexplained weight gain
Hair loss
Unwanted body and facial hair
Achy joints
Muscle weakness
There are actually more than 100 symptoms of perimenopause. These are just a few.
Key Hormone Shifts
Just like in puberty when key sex hormones begin to come online, the reverse is happening in perimenopause as key sex hormones begin to shift and wind down as ovulation and egg quality decline.
These hormones play numerous roles in the body beyond just reproduction. For the sake of simplicity, this section only highlights how these hormones work in the menstrual cycle and impact perimenopause.
Estrogen
Estrogen is produced by the ovaries and drives ovulation, along with help from the brain. Estrogen builds the uterine lining in preparation for a potential pregnancy. After ovulation, estrogen begins to slowly decline.
When ovarian function begins to decline in perimenopause, less estrogen is produced. Ovulation occurs less frequently and symptoms of low estrogen like hot flashes and night sweats may become more noticeable.
Progesterone
Progesterone is the “keep calm” hormone. It is produced by the corpus luteum after ovulation occurs. The length of the luteal phase is dependent upon the health of the corpus luteum and the amount of progesterone it releases.
As the frequency of ovulation decreases, progesterone levels will decrease. (No Ovulation = No Progesterone). Low progesterone may result in symtoms of progesterone deficiency or estrogen dominance like heavy periods, increased PMS, more anxiety, and migraines.
Testosterone
Just like estrogen, testosterone rises as ovulation approaches, and then drops after ovulation. Testosterone can be converted into estradiol, which can result in estrogen dominance, when progesterone levels are simultaneously declining.
Testosterone is important for energy, endurance, and sex drive. Symptoms of fatigue, muscle weakness, and low libido are due to low testosterone.
Thriving in Menopause
Your hormones don’t just fall off a cliff once you enter menopause. Hormones are produced in other areas of the body, like the adrenal glands, liver, brain, and fat cells, but in much smaller quantities.
For this reason, it is really important to have a healthy body, and support it with nutrition and lifestyle.
Let’’s work together to create a personalized, holistic and achievable plan for you to thrive in perimenopause and beyond.
About the Author:
Nicole Gilmore is a certified nutritionist and women’s health coach specializing in blood sugar balance, hormone health, and sustainable nutrition habits. She helps women improve energy, metabolism, and overall wellness through practical, science-backed nutrition strategies.