If you’re a woman between 35 and 45 and your health is bothering you, you’ve probably been told that nearly every symptom you’re experiencing has one simple answer:
“You’re in perimenopause.“
Cycles changing? Perimenopause. Energy crashing? Perimenopause. Anxiety worse than ever? Weight gain, low libido, insomnia, hair loss, emotional overwhelm, aging, PMS? You guessed it: it’s all perimenopause!
For many women, this explanation feels validating and deeply discouraging at the same time. It’s comforting to have a label, to feel seen. But it’s also discouraging, because it implies this experience is the inevitable path we’ll all endure once we hit our late thirties or forties.
We’ve been inundated our whole lives with messages that our periods are a curse and our hormones are unruly saboteurs of our sanity. Now we’re being inundated again, this time with messages about what it means to “age out” of our prime reproductive years.
What troubles me most is that these messages rarely offer us any real agency over how we feel. Instead, they often breed helplessness in us. They validate our symptoms as normal and inevitable, and they reassure us that our bodies randomly break, don’t age well, and require medical solutions as the only path to relief.
The unspoken message: this is just what happens as women age, and there’s not much you can do except medicate your way out.
These messages, reinforced through memes, advertising, and endless social media content, create a desperation that leaves women vulnerable to whatever we’re sold next: HRT, antidepressants, obscure anti-aging supplements, procedures, and gadgets promising to bring back our youth.
I’m not minimizing the struggle, btw. I know how real it is, because I’ve spent my whole life on the receiving end of messages that spoke to real hormonal symptoms and imbalances but offered no root-cause solutions and no agency over my own experience. And now that I’m 40, I’m swimming in the perimenopause meme soup alongside many of you!
Many of us have spent years trying to be healthy: eating clean, exercising, avoiding cigarettes and excess alcohol. But somewhere around our late thirties, the things that used to work stop working the same way, and whatever never worked starts getting worse. Suddenly it’s all labeled perimenopause, and women are telling each other in comment sections and forums how HRT changed their lives, because perimenopause was killing them. Didn’t you know?!
This was my experience a few years ago, when decades of stress and trauma patterns finally caught up with me and brought me to my knees.
The silver lining for me was that I’d struggled with insomnia, blood sugar swings, and painful periods since my twenties. I’d been living with the symptoms now blamed on perimenopause looong before I could reasonably apply that label to myself. I knew my patterns were extensions of earlier patterns, not something new, and I knew them too well to believe they were simply a product of age.
If this resonates with you, you’re not alone. And you’re likely not dealing with perimenopause alone, either. How we experience any natural hormonal shift, whether it’s our first period, the monthly shifts through our cycle, or the transition into menopause, is always shaped by metabolic functions upstream of our sex hormones.
The more disrupted and depleted we are upstream (meaning our adrenals, thyroid, blood sugar, immune system, and digestion), the harder any hormonal transition will be. That’s also why women who have debilitating periods in their twenties and thirties tend to be the same women who are miserable in their forties. And the longer these upstream disruptions go on, the more our bodies adapt to running on low hormone levels.
What Is Perimenopause, Actually?
Perimenopause is the transitional period leading up to menopause.
During this time, the ovaries gradually produce fewer reproductive hormones, ovulation becomes less predictable, cycles may become irregular, and fertility naturally declines. Menopause itself is defined as 12 consecutive months without a period, and on average it occurs around age 51 to 52.
Perimenopause can begin in the late thirties for some women and in the mid-to-late forties for others. It can last anywhere from a few years to more than a decade.
The critical point is that perimenopause was never meant to be a diagnosis explaining every symptom a woman experiences after 35. It describes a normal biological transition, not a set of pathologies.
Yet pathology is exactly what it’s become, both in modern medicine and in pop culture. And what often gets lost is a much bigger question: how healthy is the woman entering this transition in the first place?
Perimenopause symptoms don’t appear overnight. They’re patterns that develop over time through life experiences, personal choices, available resources, and, most importantly, whatever was left unaddressed in earlier years.
What’s Actually Happening Inside Us
Unfortunately, most women in our culture don’t enter their late thirties and forties in optimal health. I know my lens is biased, since my career revolves around working with, talking about, and researching women’s chronic illness. But the statistics back this up.
Many women arrive at my age carrying years, sometimes decades, of accumulated stress, cellular malnourishment, blood sugar instability, disrupted sleep, unresolved trauma, and hormonal imbalances. These aren’t new problems that appear during perimenopause. They’re foundational issues that perimenopause amplifies.
When I work with women, I address three overlapping layers at once. These are the same layers that need attention in women who are being told their struggles are “just perimenopause.”
Layer 1: The Physiological Foundation
By her late thirties, a woman usually has several physiological patterns that are well established and often years in the making. They can be even harder to recognize if she spent any meaningful time on hormonal contraceptives, which can mask many of these imbalances and make some of them worse over time.
Progesterone is already compromised. Ovulation becomes less consistent under chronic stress, undernourishment, inflammation, or blood sugar dysregulation. Progesterone is produced mainly by the corpus luteum, which only forms after ovulation, so irregular or absent ovulation means low progesterone, sometimes for years before perimenopause even begins. Progesterone is one of our most protective hormones: it calms the nervous system, supports deep sleep, and maintains fertility. When it’s chronically low, stress compounds.
Estrogen metabolism isn’t working well. Many women struggle to clear estrogen efficiently because of sluggish liver function, nutrient deficiencies, chronic inflammation, or poor digestion. So even when estrogen is produced, it may not be cleared properly and can recirculate in the body. This can happen years before perimenopause, as it did for me. Add in the estrogen produced by fat tissue, which tends to increase under chronic stress, and the picture gets confusing: some women have symptoms of estrogen deficiency, others have symptoms of estrogen dominance, and many have both at once.
Blood sugar regulation is disrupted. About 80% of the women who come to me struggle with blood sugar dysregulation: low blood sugar, blood sugar swings, or metabolic inflexibility. This isn’t about carbs. It’s about stress physiology, nutrient depletion, and eating patterns compounded over time. Blood sugar instability disrupts sleep, raises cortisol, drives inflammation, and interferes with reproductive hormone signaling. It’s upstream of everything else. (I recorded a full podcast episode on this topic here.)
Thyroid function is declining. Even subtle drops in thyroid function ripple through every cellular process, including ovulation, progesterone production, metabolic rate, mood, digestion, energy, and fertility. Low thyroid function causes fatigue, weight gain, depression, hair loss, brain fog, and irregular cycles, all of which look remarkably similar to what we now call perimenopause.
Sleep is fragmented. Years of poor sleep disrupt circadian rhythm, HPA axis function, immune resilience, and stress recovery. This isn’t new in perimenopause; it’s been building. I’ve struggled with sleep my whole life, and I can tell you from experience that if you don’t establish good sleep hygiene and healthy light exposure in your earlier years, this one WILL become a problem as you get older.
So what ties all of these patterns together?
Stress.
Most of these patterns stem from chronic stress physiology, a concept I explore throughout my work because it sits at the root of nearly every health issue women struggle with today.
When the body perceives an ongoing threat, whether from actual trauma, a relentless pace, undernourishment, relationship conflict or insecurity, or environmental exposures, it habitually shifts resources away from reproduction and toward survival.
Sex hormones are always downstream of a woman’s survival mechanisms, so they become less of a priority when her more basic needs aren’t met. And if that perceived threat lasts long enough, the body moves deeper into stress adaptation. The vital processes we rely on to function well, feel well, and stay fertile begin to shut down.
Layer 2: The Nervous System and Psycho-Emotional Layer
Whether it’s intentional or a survival reflex, many of us file our emotional health in a separate category from our physical health, until something big happens that makes it obvious how intertwined they are.
I can’t tell you how many times a client was clearly struggling emotionally, socially, or psychologically, yet focused exclusively on her physiology, diet, and labs, playing detective about what in her body might be driving her struggles.
I’ve been there myself. When the circumstances and unmet emotional needs in my life felt too big to tackle, I became so fixated on my physiology that those needs stopped being visible to me most of the time.
Many of us have spent decades in survival mode without knowing it. I’ve been working on my metabolic health and my trauma for decades at this point, and I’m still peeling back layers of patterns I developed in response to stress I didn’t even know I had. (And I had an objectively traumatic childhood, so I knew I had a lot of stress!)
We live in a stressful culture, and for many of us, stress physiology is the water we swim in.
If you grew up with trauma, as I did, whether you were parentified, neglected, or had to navigate a complicated world alone, you likely developed exceptional coping skills. You learned to adapt to stress and chaos, and that ability served you for a while.
But it may also have wired your nervous system for an unsustainable pace, while your body never got the message that it was safe enough to truly rest. Underneath the competence and productivity you’ve built, you might find a body that doesn’t feel safe enough to slow down, rest, or receive the care and replenishment it needs each day. Many of us have to work really hard just to relax, unplug from screens, and stop distracting ourselves!
This matters enormously for perimenopause, because the nervous system doesn’t separate emotional stress from physical stress. A threat is a threat, whether it’s real danger, a work deadline, a relationship conflict, or financial uncertainty. When the nervous system is chronically stuck in a sympathetic (fight-or-flight) state, the body stays in survival mode.
I’m usually not talking about conscious danger here. I mean the brain-to-body signals from our stress physiology that tell our cells we must be in danger if we’re moving this fast and burning through our resources this quickly. The body picks up on what the subconscious mind buries.
That’s why a woman’s stress patterns, trauma history, and current nervous system state must be assessed alongside her labs and nutrition. You can’t separate mental health from physical health, because your body certainly doesn’t.
The path forward involves creating genuine safety. That doesn’t mean the absence of stressors (a good life always contains some). It means the consistent presence of:
- Adequate nourishment and consistent eating
- Slower-paced days with time outside, especially around sunrise and sunset
- Work that doesn’t lead to burnout or dissociation
- Healthy boundaries with people, technology, and yourself
- The ability to feel and express emotions as they arise
- Repair and processing of unresolved experiences
- Movement and rest that feel good, not punishing
As we create more internal safety, many of us discover that symptoms we thought were purely hormonal begin to shift on their own. I’ve seen this in myself and in many of my clients.
That’s because many “hormonal” symptoms are actually adaptations to stress: the body’s intelligent response to ongoing perceived threat. And whatever has been disrupted downstream, which may still need attention of its own, responds far better to treatment once we’ve removed the upstream stressors that drive us to burn through our resources so quickly.
Layer 3: Relationships and Spiritual Integration
Here’s something that doesn’t show up on lab work but profoundly affects health: we’re relational creatures, and women especially are wired for connection.
Historically, women couldn’t afford to be alone. We relied on family and community for survival, child-rearing, and meaning-making. Today, in the modern developed world, many of us spend far more time alone than ever before, and we’re replacing the oxytocin of connection with dopamine from screens, work, and intellectual stimulation.
My theory is that many modern women live in low-oxytocin states that have become so normal we can’t even name them. (I explore this more deeply in The Missing Piece in Women’s Health: Loneliness, Oxytocin, and the Need for Connection.) Those states can show up in our mental health, our immune systems, our capacity for pleasure and joy, and our fertility. The deficit deepens when years of managing our health lead us to step back from shared experiences like group meals, celebrations, intimate friendships, and social events we now find overstimulating.
Sometimes we’re justified in skipping those events. But the cost can be loneliness, and a body that feels less safe.
We can have a perfect supplement protocol, a perfect diet, and perfect lab work and still feel disconnected and helpless, because information alone doesn’t make a woman metabolically and hormonally vital. We need relationships that nourish rather than deplete us. We need to feel seen, supported, touched, engaged, and emotionally safe. We need people we can lean on through grief, celebration, and transition. We all do.
And we need pleasure from many sources. Sexual intimacy and touch are one big source among many.
Beyond relationships, many of us also need a spiritual dimension to our health, something that reminds us we’re part of something larger than ourselves. This doesn’t require specific religious beliefs. It simply means recognizing that we’re connected to nature, to cycles, and to other living beings, and that health isn’t something we can think or will our way into entirely, even though both play a role.
The paradox is that we can’t force our bodies into compliance or understand everything that troubles us with our rational minds alone. The pressure to try, to be in control 24/7, to have all the right data, to optimize constantly, becomes its own form of stress and depletion.
Learning to listen, trust, slow down, and receive wisdom our rational minds don’t have a place for can be a crucial part of creating the safety our bodies need to thrive, even as the natural decline in hormones comes for all of us.
I’ve been actively seeking spiritual growth since my late teens, through whatever experiences I had access to at the time. In my late teens, I discovered parts of myself through my struggles with mental and physical health, and through writing, painting, and traveling internationally on my own for months at a time. I learned to be my own best friend, even when it was hard. In my twenties, I lived in a yoga ashram, went on meditation retreats, explored altered states of consciousness through cannabis and psychedelics, and explored alternative relationships, all with the intention of understanding myself and changing how I felt inside.
Somewhere along the way, I came to believe we’re all on a spiritual path, whether we’re aware of it or not. The experiences that challenge our egos and our sense of who we are, the ones that push us into surrender, are what remind us we’re on it. Without those reminders, we can get trapped in vanity, consumerism, and otherwise shallow ways of living.
This is why I see a woman’s struggles with her body, her health, her aging, and her fertility as spiritual in nature. I can’t think of anything more challenging to our egos, our sense of self, and our sense of control than losing aspects of our health, bodily function, youth, appearance, and fertility.
That’s what can happen when we struggle through perimenopause. We find ourselves grieving things we may have taken for granted, or hidden behind, for years. And we’re asked to re-examine how we’ve been living, who we’ve been living as, and what’s been happening beneath the surface that we may have been asleep to.
It can be humbling. But if we approach it this way, it can also be a catalyst for SO much growth.
Why This Distinction Matters
Imagine two women, both 42, both experiencing irregular cycles and fatigue.
Woman A entered her late thirties in excellent health: regular, painless cycles, deep sleep, stable blood sugar, robust thyroid function, strong metabolic flexibility, and no history of hormonal dysfunction, depression, anxiety, or chronic illness. Her pregnancies and postpartum recoveries were uncomplicated, and her body has consistently shown resilience.
Woman B entered her late thirties carrying a decade of accumulated challenges: painful periods and irregular cycles, years of disordered eating, chronic stress and poor sleep, unresolved childhood trauma, and years on hormonal birth control without ever addressing the issues that got her prescribed it in the first place.
Both women are experiencing the hormonal shifts of perimenopause.
But would we expect Woman A to suddenly develop severe exhaustion, insomnia, anxiety, depression, and metabolic collapse? No. If she did, I’d want to know what acute trauma or stressor triggered such a dramatic shift.
Woman B? This is what perimenopause on top of unresolved depletion looks like.
The distinction matters because it changes what each woman needs and how she understands her symptoms. Woman A might benefit from targeted support through the hormonal transition. Woman B needs foundational work: restoring metabolic health, rebuilding her nervous system’s sense of safety, replenishing years of accumulated nutrient depletion, and possibly processing trauma.
Unfortunately, most women in the modern world are closer to Woman B than Woman A.
That isn’t because they’re broken. It’s because they were never taught how their bodies work, were given no real solutions to the struggles they had earlier in life, and were often taught to ignore, suppress, or pathologize their body’s signals.
Many of us learned that health is simply the absence of symptoms, so when symptoms appear, we treat them as threats to be eliminated as quickly as possible. And in roll the medication ads, the wellness trends, and diet culture, telling us exactly what to buy to make them go away. None of us are immune to this.
My Professional Root-Cause Approach
Rather than asking, “How do I fix my declining hormones?” (which accepts the narrative that decline itself is the problem), I ask: What kind of environment have these hormones been operating in for the last 20 years, and what needs to be addressed upstream first?
Asking a different question changes everything.
This doesn’t rule out hormone support like bioidentical progesterone. (I’m still not a big fan of estrogen therapy, and I’ll be doing a deep dive on this soon, in either an article or a podcast episode.) But whether or not we add hormones, my approach always starts upstream.
Step 1: Assess the Whole Picture
This means looking past symptom-chasing to identify patterns and asking: what is your body trying to communicate?
In this first step, I typically look at:
- Comprehensive health history and current symptoms
- Nutritional status, eating patterns, and daily calorie intake
- Sleep quality and circadian rhythm
- Movement and exercise habits
- Energy levels throughout the day
- Menstrual cycle patterns and changes
- Stress levels, pace of life, and recovery capacity
- Relationship quality and sense of support
- Lab work that shows the whole picture. I rely heavily on HTMA (hair tissue mineral analysis) because it’s accessible and reveals mineral status, stress patterns, and metabolic function, but I’ll also interpret and integrate any conventional or functional labs a client brings.
The goal isn’t perfection or getting everything dialed in at once. It’s finding the most important leverage points, where small shifts create the biggest ripple effects in your metabolism.
For most women, the biggest ripples come from balancing minerals and blood sugar, increasing overall nutrients (and often calories), lowering stress, and increasing pleasure.
Step 2: Address What’s Upstream of Sex Hormones
Once a woman’s patterns are identified, we build the foundations she needs for lasting improvement.
Metabolic restoration: stable blood sugar through adequate, nutrient-dense food and consistent meal timing
Nervous system recovery: building genuine safety through a slower pace, boundaries, and consistent rest
Nutritional rebuilding: addressing the mineral and vitamin deficiencies that have accumulated over years
Sleep: protecting circadian rhythm and sleep quality as non-negotiables
Stress recovery: processing unresolved experiences and building resilience
These aren’t new, sexy interventions. They’re foundational, and they work because they address the root rather than the symptoms.
Step 3: Integrate the Emotional, Relational, and Spiritual Dimensions
As I’ve described above, health isn’t purely physiological. It also involves:
- Processing trauma and building capacity for safety
- Developing emotional regulation skills
- Creating or improving relationships that genuinely nourish you and leave you feeling safe and connected
- Rediscovering pleasure, joy, and play, and using them for daily stress relief
- Connecting to something larger than yourself, and embracing rituals and practices that help you face existential fears, grief, and questions of purpose
These elements don’t show up on lab work, and they can make my more pragmatic clients uncomfortable because they’re harder to track. But they profoundly influence whether the body can actually use the nutritional support and rest we’re giving it. They’re what make all the practical, testable steps work.
We’re not improving our health just to be healthier. We’re improving it so we can live our lives more fully.
So, Is Perimenopause Real?
Yes, and no.
Perimenopause is absolutely real: a biological transition we all move through on the way to the second half of life, as hormone production gradually changes on the approach to menopause. But many women also enter this phase carrying years of unresolved depletion, stress, and imbalance, often without the lifestyle, or the view of their aging bodies, that would make the transition more manageable and graceful.
The symptoms we experience in perimenopause aren’t purely about declining sex hormones. They reflect accumulated physiological, nervous system, and relational stress, amplified by an otherwise natural hormonal transition.
Both realities are true at the same time: the hormonal transition is real, and the accumulated health challenges that make it harder than it needs to be are real too. That’s why distinguishing between them matters so much.
Rather than treating aging as a pathology to fight, we can ask, “What does my body need to move through this transition with more ease?” Not only pharmaceutically, but physiologically, emotionally, relationally, and spiritually.
I’ve noticed something on social media lately: women describing perimenopause as the point when they stop accepting what doesn’t serve them and finally hold their boundaries. I love this framing! Whether we’re becoming more principled because we’ve been around long enough to know what we won’t tolerate, or because we finally understand our real energetic limits, it’s a testament to women finding agency in aging.
Ideally, we’d prepare for perimenopause in our earlier years by building more of what we need: being nourished, self-attuned, and discerning, respecting our limits, staying connected to ourselves and our cyclical nature, and being able to rest when we need to.
But if your story is like mine, and that wasn’t possible earlier because you simply had too much on your plate, it’s not too late.
Perimenopause is your body asking for a different level of care.
Your Next Steps
Whether or not you ultimately choose HRT, the physiological, emotional, and spiritual patterns upstream of your hormones still deserve attention. Your relationships, pace of life, eating patterns, and spiritual growth matter more than ever now.
These deeper patterns influence how well your body handles stress, supports fertility, regulates hormones, and stays resilient as you age. They’ll shape how you age and how you adapt to life’s inevitable changes and challenges.
If you’re ready to explore your health through a root-cause lens, one that addresses the physiological, emotional, relational, and spiritual factors shaping what we now call perimenopause, I invite you to learn more about my HTMA sessions or book a free chat with me to learn how my coaching containers work.
Together, we can explore the deeper patterns influencing your health and create a personalized path toward greater vitality and well-being.
You deserve more than symptom management. You deserve a relationship with your body built on understanding, trust, and genuine support. Every woman does.
