If you’re a woman between 35 and 45 and your health is bugging you, then you’ve likely been told that nearly every symptom you’re experiencing has a simple answer: “You’re in perimenopause.“

Cycles changing? Perimenopause. Energy crashing? Perimenopause. Anxiety worse than ever? Weight gain, lost libido, insomnia, hair loss, emotional overwhelm, aging, PMS — you guessed it, it’s all perimenopause!

In fact, for many women, this explanation might feel simultaneously validating and also deeply discouraging because it provides two seemingly contradictory things at once; it comforts us to have a label — to feel seen.

But it’s also discouraging because it implies that this experience is the inevitable path we’ll likely endure once we hit our late thirties or forties.

Just as we’ve been inundated our whole lives with messages about our periods being a curse and our hormones being an unruly saboteur of our sanity, now we’re being inundated again with messages about what it means to be a woman “aging out” of her prime reproductive years.

And here’s what troubles me the most about this: these messages about our female bodies rarely offer us any real agency over how we feel.

Instead, they induce helplessness in us — validating our symptoms as normal and inevitable, reassuring us that we truly do have bodies that randomly brake, don’t age well, and require medicalized solutions as the sole path to relief.

The unspoken message being: this is just what happens as women age, and there’s not much you can do about it except medicate your way out.

These messages — reinforced through internet memes, advertisements, and recycled constantly on social media — create desperation in women that renders us vulnerable to whatever solutions we’re then sold on: HRT, antidepressants, obscure anti-aging supplements, procedures and gadgets promising to bring back our youth.

I’m not minimizing the struggle here, btw. I know how real it is because I’ve spent my entire life at the receiving end of such messages — messages that speak to real hormonal symptoms & imbalances, yet offered me no real root-cause solutions; no agency over my own experience.

So I’ve been primed to listen for explanations to suffering that I’m all-too familiar with…and now that I’m 40, I’m also 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 what never worked to begin with began getting worse.

uddenly it’s all labeled as perimenopause, and women are telling each other in comment sections and forum chats about how HRT changed their life… because perimenopause was killing them — didn’t know 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.

However, the silver lining for me is that I’d struggled with insomnia, blood sugar swings, and painful periods since my twenties, so I saw the perimenopause narrative (simply called chronic illness) looong before I could reasonably apply that label to myself or my symptoms.

I knew my patterns were extensions of *earlier* patterns with my body, and not something new. I knew my patterns too well to fall for a simple label, or to believe they were the mere product of age.

Here’s what I’ve grown to understand: if this article resonates with you, you’re not alone.

And you’re also likely not dealing with only perimenopause because what dictates how we experience our natural hormonal shifts — whether it be our menarche, our monthly transitions from one phase to another, or our transition into menopause — will always be mediated by metabolic functions upstream of sex hormones.

The more disrupted and depleted our metabolism is upstream of our sex hormones (upstream meaning: adrenals, thyroid, blood sugar, immune system, digestion), the more difficult ANY hormonal transition will be — which is 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 adapted our bodies become to low levels of these hormones.

First, 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 menstrual cycle, occurring on average around age 51-52.

Perimenopause can begin in the late thirties for some women and the mid-to-late forties for others. Research suggests it may last anywhere from a few years to over a decade.

A critical point here though is that perimenopause was never intended to be a diagnosis explaining every symptom a woman experiences after age 35.

It was intended to describe a normal biological transition — not a set of pathologies.

But pathology is exactly what it’s become in modern medicine and in our larger pop culture. And what’s often lost in this conversation is a much larger question: What’s the overall health of the woman entering this transition in the first place?

Because the symptoms women experience during perimenopause don’t start overnight — they’re patterns that evolve over time through life experiences, personal choices, available resources, and—most importantly—what was left unaddressed in earlier years.

What’s Actually Happening Inside of Us

Unfortunately, most women in this culture don’t enter their late thirties and forties with optimal health. I know I have a biased lens, having a career where I work with, talk about, and research women’s chronic illnesses… but the statistics don’t lie.

Instead of optimal health, many women arrive at my age carrying years — sometimes decades — of accumulated stress, cellular malnourishment, blood sugar instability, disrupted sleep, unresolved trauma, and various hormonal imbalances.

These aren’t new problems showing up within the transitional phase we call perimenopause, these are foundational issues that perimenopause simply amplifies.

When I work with women, I work with three overlapping layers simultaneously, and it’s these same layers that need to be addressed in the women who are being told that their struggles are all perimenopause. These three layers are:

• Layer 1: The Physiological Foundation

By the time a woman reaches her late thirties, several physiological patterns are usually well-established, and have often been going on for years. These patterns will be even harder to recognize if she spent any meaningful length of time on hormonal contraceptive, as this not only masks a lot of these imbalances, but can make them progressively worse over time. These patterns are as follows:

Progesterone is already compromised. Ovulation becomes less consistent due to chronic stress, undernourishment, inflammation, or blood sugar dysregulation. Since progesterone lives in the corpus luteum (which only develops after ovulation), low or absent ovulation means low progesterone—sometimes for years before perimenopause even begins. Progesterone is one of our most protective hormones; it regulates our nervous system, supports deep sleep, and maintains fertility. When it’s been chronically low, the stress compounds in us.

Estrogen metabolism isn’t working. Many women struggle to metabolize estrogen efficiently due to poor liver function, nutrient deficiencies, chronic inflammation, or weak digestive. So even when estrogen is produced, it may not get cleared properly, thus it recycles in the body and builds up in our tissues. This can happen years before perimenopause, as it did with me. Combined with estrogen production shifting to fat tissue when we’re chronically stressed, you get a confusing picture: some women experience estrogen deficiency symptoms while others experience estrogen dominance symptoms. Many experience both simultaneously.

Blood sugar regulation is disrupted. About 80% of the women who seek my support struggle with blood sugar dysregulation—either low blood sugar, blood sugar swings, or metabolic inflexibility. This isn’t about carbs; it’s about stress physiology, nutrient depletion, and poor eating patterns compounded over time. Blood sugar instability disrupts sleep, increases cortisol, drives inflammation, and fundamentally disrupts reproductive hormone signaling. It’s upstream of everything else. I recorded a full podcast on this topic here, btw.

Thyroid function is declining. Even subtle reductions in thyroid function ripple through every cellular process, including ovulation, progesterone production, metabolic rate, mood, digestion, energy, and fertility. A woman with low thyroid function will experience symptoms—fatigue, weight gain, depression, hair loss, brain fog, irregular cycles—that look remarkably similar to what we now call perimenopause.

Sleep is fragmented. Years of poor sleep quality disrupt circadian rhythm, HPA axis function, immune resilience, and stress recovery. This isn’t new in perimenopause; it’s been building. This was one that I’ve struggled with my whole life, and I can say from experience that if you don’t establish good slight hygiene and proper 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.

Yep, most of these patterns stem from chronic stress physiology — a concept I’ve explored in depth throughout my work because it’s at the root of just about every issue women struggle with in their health these days.

When the body perceives an ongoing threat (whether from actual trauma, relentless pace, undernourishment, relationship conflict or insecurity, or environmental exposures), it habitually reallocates resources away from reproduction, and toward survival.

Sex hormones are always downstream of a woman’s survival mechanisms, thus less of a priority if her higher-order needs aren’t met first. And if this perceived threat goes on long enough, the body moves progressively more into stress adaptation states where vital processes that we rely on to function well, feel well, and remain fertile begin to shut down.

• Layer 2: The Nervous System & Psycho-Emotional Layer

Whether we intentionally do this or it’s a habitual survival reflex, many of us naturally tend to place our psycho-emotional health into a separate category from our physical health unless something big happens that makes it obvious how much these actually intertwine.

I cannot tell you the amount of times I’ve had a client who was clearly struggling with her emotional, social, or psychological well-being, but was zeroing in exclusively on her physiology, diet, and labs — playing detective around what in her physical health might be driving her struggles.

I’ve been in this place myself when the circumstances and psycho-emotional unmet needs in my life felt too big to tackle, thus I became fixated on my physiology to an extent that those unmet needs were no longer even visible to me most of the time.

Many of us have spent decades operating in survival mode without even knowing it.

For example, I’ve been working with my metabolic health and with my trauma or decades at this point… and yet I’m still peeling back the layers of patterns that I developed as a survival 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!)

My point here is that we live in a stressful culture and for many of us, stress physiology the water we swim in.

If you grew up with trauma, as I did — where you were parentified, neglected, or had to navigate a complicated world alone — you likely developed exceptional coping skills (as I also did.)

You learned to adapt to stress and chaos, and this ability to survive served you for a while.

But it also might’ve left your nervous system wired for moving at an unsustainable pace, while your body never got the message that it was safe enough to truly rest. Even now, underneath the competence and productivity you’ve likely built in your life, you might find a body that doesn’t feel safe enough to slow down, rest, or receive the genuine care and consistent replenishment it needs each day.

Many of us have to work really hard just to relax, unplug from screens and stop distracting ourselves with unnecessary drama!

This process matters enormously for the topic of perimenopause because our nervous systems don’t separate emotional stress from physical stress.

A threat is a threat, whether it’s a real danger, a work deadline, a relationship conflict, or financial uncertainty; when our nervous system is chronically activated into a sympathetic state, our body remains in survival mode.

I’m usually not referring to real conscious danger here, but to the neurosomatic (brain-to-body) signals coming from our stress physiology that tell our cells we must be in danger to be moving this fast, and burning through our resources this quickly. The physiology picks up on what our subconscious mind buries.

This is why a woman’s stress patterns, trauma history, and current nervous system state must be assessed alongside her labs and nutrition — you cannot separate mental health from physical health because your body certainly doesn’t.

The path forward involves creating genuine safety — not as the absence of stressors (because a good life always contains stressors), but as the consistent presence of:

•  Adequate nourishment and consistent eating
•  Slower-paced days with time outside, especially around sunrise and sunset
•  Work that doesn’t cause 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 punitive

As we create greater internal safety, many of us discover that symptoms we thought were purely hormonal actually begin to shift on their own, and this has been my experience with myself and many of my clients.

This happens because many of our “hormonal” symptoms are actually adaptations from higher stress levels, the body’s intelligent response to ongoing perceived threat. And what’s been disrupted downstream of our stress response that needs attention all it’s own will also be more responsive to treatments when we’ve removed the stressors upstream that drive us to burn through our vital resources so quickly!

• Layer 3: Relationships & Spiritual Integration

Here’s something that doesn’t show up on lab work, but profoundly impacts health: we are relational creatures, and women especially are wired for connection.

Historically, women couldn’t afford to be alone; we relied on family units and communities for survival, child-rearing, and meaning-making.

Now, in the modern developed world, many of us spend far more time alone than ever before. We’re replacing oxytocin—our primary female regulatory hormone—with dopamine from screens, work, and intellectual stimulation, and it’s showing up in our hormones.

I have a theory: modern women are oxytocin-deficient in ways we can’t even name because it’s become our new normal.

And the low oxytocin states many of us live with each day show up in our mental health, our immune systems, our capacities for pleasure and joy, and our fertility. This deficit compounds when we’ve spent years managing our own health and potentially stopped participating in the same shared experiences — group meals, collective celebrations, intimate friendships, social events we now find over-stimulating.

We can feel justified in these choices to abstain from social events (and sometimes we are), but the cost can also mean loneliness and lower hormonal states.

We can have a perfect supplement protocol, perfect diet, and perfect lab work, but still feel disconnected and helpless because information alone isn’t enough to be a metabolically and hormonally vital woman. We need genuine relationships that nourish rather than deplete. We need to feel seen, supported, touched, engaged, and emotionally safe.

We need meaningful connections we can lean on through life’s grief, celebration, and transition — we all do.

AND…we need pleasure, from multiple different sources, sexual intimacy and touch being only one source, albeit a big one.

But 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 spiritual dimension doesn’t require specific religious beliefs; it simply means recognizing that we’re intricately connected to nature, cycles, and other living beings—and that health isn’t something we can think or will our way into entirely, even if these do play a role in being well. 

The paradox is often that we can’t force our bodies into compliance, we can’t understand every little thing that troubles us with our rational minds alone. And the pressure to try to — to try and 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 we don’t have a place for in our rational mind can be a crucial ingredient for living with the safety our female bodies need to thrive, despite the natural decline in hormones that’s coming for all of us.

Personally, I’ve been actively seeking spiritual growth since my late teens through a variety of experiences, depending on what I had access to internally and externally. In my late teens, I discovered parts of myself through my struggles with my mental and physical health, 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 felt hard.

Throughout my twenties, I lived in a yoga ashram, went on meditation retreats, explored alternative states of consciousness through cannabis and psychedelics, and explored alternative relationships — all of this with the intention of learning more about myself and shifting the way that I felt inside.

Somewhere along the way I developed the belief that we’re all on a spiritual path, whether we’re aware of it or not.

But the experiences that challenge our egos, our sense of who we think we are, and push us into states of surrender... are the experiences that remind us that we’re on this spiritual path. Without those reminders, we can get trapped in vanity culture, consumerism, and otherwise shallow paths in life.

This is why I view a woman’s struggles with her body, her health, her aging, her fertility as intrinsically spiritual in nature.

I cannot think of anything more challenging — to our egos, our sense of self, our sense of control — than to lose aspects of our health, bodily functions, youth, appearance, and fertility.

This is what happens to us when we’re struggling with perimenopause — we often find ourselves grappling with the loss of things we may have spent years taking for granted or hiding behind, and now we’re being asked to re-examine how we’ve been living, who we’ve been living as, and what’s been happening under the surface that we may have been asleep to for years.

It can be humbling, but it’s also a catalyst for SO MUCH growth if we approach it in this way.

Examples: Why The Distinction I’m Making Matters

Imagine two women, both 42, both experiencing cycle irregularity and fatigue.

Woman A entered her late thirties with exceptional health. Regular painless cycles, deep sleep, stable blood sugar, robust thyroid function, excellent metabolic flexibility, no history of hormonal dysfunction, depression, anxiety, or chronic illness. Her pregnancies and postpartum recoveries were uncomplicated, and her body has consistently demonstrated resilience.

Woman B entered her late thirties carrying a decade of accumulated challenges. History of painful periods and irregular cycles, years of disordered eating patterns, chronic stress and sleep disruption, unresolved childhood trauma, and years on hormonal birth control without ever addressing the underlying issues that got her prescribed it in the first place.

Both of these women are experiencing the hormonal shifts of perimenopause.

But would we necessarily expect Woman A to experience severe exhaustion, insomnia, anxiety, depression, and metabolic collapse? No.

If she suddenly began to have these symptoms, 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 here matters enormously because it changes what each woman actually needs, and it changes how they view their symptoms.

Woman A might benefit from some targeted support around the hormonal transition, while woman B needs foundational work: restoring metabolic health, rebuilding her nervous system’s sense of safety, addressing years of accumulated nutrient depletion, possibly processing trauma.

Unfortunately, most women in the modern world are closer to Woman B than Woman A.

This isn’t because they’re broken, it’s because they were never taught how their bodies actually work, were given no real solutions to difficulties they experienced earlier in life, and were often taught to ignore, suppress, or pathologize these signals from their bodies.

Many of us are taught to believe that health is merely the absence of symptoms, which means that if we develop any symptoms, we’re likely to view the symptoms themselves as threats to our survival, to be gotten rid of as quickly as possible!

And then in rolls the medication adverts, the wellness trends, and diet culture to tell us exactly what we need to buy to get rid of those symptoms. None of us are immune to this.

My Root-Cause Approach

Rather than asking “How do I fix my declining hormones?“—which accepts the narrative that decline itself is the problem—we ask: *What kind of environment have these hormones been operating within for the last 20 years, and what do I need to address upstream of hormones first?”

This process of asking ourselves different questions shifts everything.

It doesn’t necessarily disqualify women from using bio-identical progesterone (still not a big fan of estrogen, and I’ll be doing a deep-dive on this either in an article or podcast soon!) But regardless of whether we add in some hormone treatments or not, the root-cause approach I take always starts upstream of this!

Step 1: Assess the Whole Picture

This means looking beyond symptom chasing to identify patterns, and then asking, what is your body trying to communicate?

During this first step, I typically examine:

• 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 generally interpret and integrate any Western and functional labs a client brings to the container.

The goal isn’t perfection or getting everything dialed in immediately, the goal here is identifying where the most important leverage points are—where small shifts create the biggest ripple effects in your metabolism.

Usually the biggest ripples happen for women through balancing their cellular minerals, their blood sugar, getting their overall nutrients–and possibly their calories–up, lowering stress, and increasing pleasure.

Step 2: Address What’s Upstream of Sex Hormones

Once a woman’s patterns are identified, we work on the foundations she’ll need for sustainable long-term improvements:

• Metabolic restoration:stable blood sugar through adequate nourishment, nutrient-dense food, and proper meal timing
• Nervous system recovery: building genuine safety through slower pace, boundary-setting, and consistent rest
• Nutritional rebuilding: addressing: mineral depletion and vitamin deficiencies that have accumulated over years
• Sleep optimization: protecting circadian rhythm and sleep quality as a non-negotiable
• 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 Emotional, Relational & Spiritual Dimensions.

As I’ve already gone over above, health isn’t purely physiological, it’s also about:

• Processing trauma and building capacity for safety
• Developing emotional regulation skills
• Creating or improving relationships that genuinely nourish us and leave us feeling safe and connected
• Rediscovering pleasure, joy, and play. Leveraging this for literal stress relief each day.
• Connecting to something larger than yourself, embracing rituals and practices that address existential fears, grief, and purpose

These elements don’t show up on lab work and can make my more pragmatic clients uncomfortable because they’re far less easy to track, but they have profound influence over whether our body can actually use the nutritional support and rest we’re offering it.

And they make all of the practical, rational, testable steps we take in improving our health work it. We’re not improving our health for the sole sake of being more healthy — we’re improving our health so that we can live our lives more fully.

How We Can Best Relate To Perimenopause

So, is perimenopause real, then?

Well, yes—and no.

Perimenopause is absolutely real as a biological transition we go through on our way to our second half of life.

Women will experience gradual changes in hormone production as they move toward menopause, but what’s also true is that many women enter this phase carrying years of unresolved depletion, stress, and imbalance. They’re often not living lifestyles or holding views of their aging bodies that make aging manageable and graceful, either.

The symptoms we experience in perimenopause aren’t purely about declining sex hormones—they’re about accumulated physiological, nervous system, and relational stress being amplified by an otherwise natural hormonal transition.

These two realities can and do occur simultaneously; the hormonal transition is real, and the accumulated health challenges that make it harder than it needs to be are also quite real.

This is why distinguishing between them matters so much, and why I prattled on repeating the same points throughout this article, with the hope that repetition will enhance my points to where they land deeper.

Rather than viewing aging itself as a pathology to fight, we can begin to ask, “What does my body actually need in order to navigate this transition with greater ease?” Not just pharmaceutically, but physiologically, emotionally, relationally, and spiritually.

I’ve noticed something on social media lately: I’ve heard women say that perimenopause is the point in their life when they stop accepting things that don’t serve them — when they finally uphold 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 limitations—this framing is a testament to women finding agency in aging.

I believe we can improve perimenopause once we arrive here by first creating, in our earlier years, more of the experiences we actually need: nourished, self-attuned, discerning, respecting of our limitations, connected to ourselves and our cyclical nature, able to rest and relax when needed…

But if your story is similar to mine and these experiences weren’t possible earlier, as it wasn’t for so many of us that simply had too much on our plate, it’s not too late now!

Perimenopause means your body is simply asking for a different level of care now.

Your Next Steps

Whether you ultimately choose HRT or not, the physiological, psycho-emotional, and spiritual patterns sitting upstream of your hormone production still deserve your attention. Your relationships, pace in life, eating patterns, and spiritual development still matter — more than ever now.

These deeper patterns influence how well your body manages stress, supports fertility, regulates hormones, and maintains your overall resilience as you age. They will influence how you age and how you adapt to the inevitable changes and challenges of life.

If you’re ready to explore your health through a root-cause lens—addressing the physiological, emotional, relational, and spiritual dimensions that are influencing your experience of what we’re now calling in the zeitgeist perimenopause—I invite you to learn more about my HTMA sessions or set up a free chat with me if you’d like to learn more about how my coaching containers work.

Together, we can explore the deeper patterns influencing your health and create a personalized path toward greater vitality and wellbeing.

You deserve more than symptom management — you deserve a relationship with your body built on understanding, trust, and genuine support. Every woman does.