Perimenopause: What’s Happening to Me and What Can I Do About It?

(Courtesy of JOWMA) With variable timing, sometimes in a woman’s third or fourth decade, the once predictable period may start playing tricks on you. Sleep becomes unreliable, and moods are more intense than they’ve been in years. Maybe you’ve started to forget words mid-sentence, snap at your family for chewing too loud, or cry unexpectedly. You’re not going crazy — and you’re definitely not alone.

This is perimenopause, and it’s not just “getting older” or “a rough patch.” It’s a real, measurable hormonal transition that affects your brain, body and daily functioning. It’s biology, and you can handle it once you understand what’s going on. Perimenopause is the transition leading up to menopause, when your ovaries begin producing less estrogen and progesterone. These hormones don’t decline in a steady way; they fluctuate wildly. One day your hormones (primarily estrogen and progesterone) may spike, and the next day they may crash. Similar to puberty, this may result in mood swings, irritability and unpredictable periods.

The symptoms vary from woman to woman, but some of the most common include irregular cycles, hot flashes, poor sleep, brain fog, discomfort during intimacy, weight gain, and mood swings that seem to come out of nowhere. What makes it tricky is that many women still get semi-regular periods during perimenopause, so they assume it can’t be hormonal. But if your symptoms cluster around your cycle, or seem to flare and fade unpredictably, hormones are almost certainly in the mix. If bleeding or spotting resumes after a full year of not having a period, see your ob-gyn.

One of the most powerful tools you can use right now is symptom tracking. Use a journal or app to log your cycle, sleep, mood and energy levels over the course of several weeks. Patterns will emerge — and knowledge is power. When you bring this to your medical care team, you’re not just saying, “I feel off,” you’re saying, “Here’s what I’ve noticed, and here’s how it’s affecting me.” That can drive the conversation.

Sleep tends to be one of the first casualties of perimenopause. Even women who used to fall asleep easily and stay asleep all night suddenly find themselves wide awake at 3 a.m. for no reason. That’s because estrogen supports REM sleep, and when it drops, your nervous system doesn’t get the same calming signals. Cooling your bedroom to 65–68 F, dimming lights an hour before bed, and avoiding screens late at night can all help. Some women also benefit from magnesium. If sleep is consistently disrupted, don’t wait it out; hormone therapy can be a game-changer.

And yes, we need to talk about caffeine, sugar and alcohol. These three often sneak in as coping tools, but they can quietly make everything worse. Caffeine after late morning can amplify anxiety and disrupt your cortisol rhythm. Sugar spikes can affect your insulin, which can amplify mood swings and hot flashes. Alcohol might help you fall asleep, but it fragments your sleep and intensifies night sweats. If you’re not ready to cut them out entirely, try dialing them back and evaluate if your symptoms improve.

Exercise becomes even more important in this phase, not only for burning calories, but for building muscle, bone and stabilizing your mood. Estrogen loss contributes to muscle loss, bone density loss and insulin sensitivity. Regular exercise can offset these effects. You can gradually start strength training with resistance bands or body weight twice a week. Then slowly build up using heavier weights. The goal is consistency, not perfection.

Marital relations may get more uncomfortable or painful due to natural changes in your body. There are over the counter moisturizers for this area or medications that can help. You don’t need to suffer in silence and your ob-gyn is here to help.

One of the most effective treatments for hot flashes, sleep problems and mood swings is hormone therapy (HT). When started within 10 years of your final period, it can also protect your bones and cardiovascular health. While not for everyone, it can be a powerful tool for overall symptom relief. Other non-hormonal options (like Vezoah) can also ease this transition, especially for hot flashes.

Perimenopause is a time of recalibration. It’s your body asking for new strategies, better boundaries, and more attention. With the right support, this can be a powerful transition, one that helps you tune in, recenter, and strengthen your long-term health.

You’ve spent years taking care of everyone else. This is your moment to take care of yourself! Speak to your gynecologist or primary care team about how best to approach this new phase of your life.

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