What Is Perimenopause & Which Treatments Will Help Symptoms?


I know it can feel scary to consider yourself in perimenopause.

So many women think we don’t hit peri until our late 40s or early 50s. But, that information is simply wrong.

We actually start perimenopause around age 35. This is when our progesterone naturally begins to decline (and why it is called a “geriatric pregnancy” if you get pregnant in your late 30s).

I think a lot of women consider perimenopause scary because it’s been associated with being “older” and dealing with some pretty drastic changes.

But the reality is, those changes occur slowly over a 10-15 year period. And wouldn’t you rather be empowered in navigating the process, rather than it navigating you?

Plus, you get a chance to support your body in the ways that it needs, so the second half of your life will run a lot more smoothly, you’ll have more vitality, energy, a healthy lifestyle, and sex appeal as compared to sticking your head in the sand!

In this article, we are giving you an introduction to peri, so that you are able to spot the first signs of this life stage, begin to understand treatment options (including hormone therapy), and be able to support your physical, emotional, and mental health in the process.

What’s commonly the first sign of perimenopause? An increase in anxiety as progesterone levels decrease, followed by a good night’s sleep going out the window!

Common Perimenopause Symptoms

Other perimenopause symptoms can vary widely from person to person, but some of the common symptoms include:

Irregular periods: Changes in menstrual cycle length, flow, and timing are common during perimenopause. Periods might become shorter or longer, and the time between periods can vary.

    • Hot flashes and night sweats: Sudden feelings of intense heat, often accompanied by sweating, can be experienced during perimenopause. Night sweats are hot flashes that occur during sleep, leading to disrupted sleep patterns.
    • Mood swings: Hormonal fluctuations can lead to mood changes, including irritability, anxiety, depression, and emotional sensitivity.
    • Poor sleep: Changes in hormones can impact sleep patterns, leading to difficulties falling asleep, staying asleep, or experiencing restful sleep.
    • Vaginal and sexual changes: Decreased estrogen levels can lead to vaginal dryness, discomfort during intercourse, and a decreased libido
    • Changes in menstrual bleeding: Perimenopause can cause heavier or lighter menstrual bleeding, as well as changes in the duration of periods.
    • Changes in skin and hair: Reduced estrogen levels can lead to changes in skin texture, elasticity, and moisture. Hair may also become thinner and more brittle
    • Weight gain: Hormonal changes can contribute to weight gain, particularly around the abdomen.
    • Fatigue: Hormonal fluctuations and sleep disturbances can lead to increased feelings of tiredness and fatigue.
    • Cognitive changes: Some women may experience difficulty with brain fog, memory, concentration, and cognitive function during perimenopause.
    • Breast tenderness: Hormonal changes can cause breasts to become tender or sore.
    • Urinary changes: Decreased estrogen levels can lead to changes in the urinary tract, causing increased frequency of urination and an increased risk of urinary tract infections.

As we make our way into the menopausal transition (which occurs after a full year without a period), women experience increased risk factors for heart disease, higher cholesterol levels, dry vaginal tissue and vaginal atrophy, heart palpitations, depressive symptoms, bone loss, and severe hot flashes.

There are a variety of treatment options, both herbal and pharmaceutical, when it comes to working with the symptoms of perimenopause.

Herbs To Support You In Perimenopause

Let’s begin with the herbs that can support you, and what they do:

    • Black Cohosh (Cimicifuga racemosa): This herb is commonly used to relieve hot flashes and night sweats. It is thought to have estrogen-like effects on the body, which can help balance hormone levels.
    • Dong Quai (Angelica sinensis): Also known as “female ginseng,” dong quai is used in traditional Chinese medicine to help regulate hormonal imbalances and relieve menstrual discomfort. It may provide some relief from perimenopausal symptoms.
    • Red Clover (Trifolium pratense): Red clover contains compounds called isoflavones, which help boost levels as we star to deal with less estrogen. It’s often used to manage hot flashes and other menopausal symptoms.
    • Chasteberry (Vitex agnus-castus): Chasteberry, or vitex, is used to help regulate hormone levels and balance the menstrual cycle. It may be useful for managing mood swings, breast tenderness, and other perimenopausal symptoms. This is one of my favorites to begin with. 
    • Ginseng: Both American and Asian ginseng are known for their adaptogenic properties, which can help the body adapt to stress. Ginseng may provide support for fatigue, mood changes, and cognitive function during perimenopause.
    • Evening Primrose Oil: This oil contains gamma-linolenic acid (GLA), an essential fatty acid that can help maintain hormonal balance and support skin health. It may help alleviate breast tenderness and other symptoms.
    • St. John’s Wort: This herb is often used to manage mood-related symptoms such as anxiety and mild depression, which can sometimes accompany perimenopause. Caution: do not use if you are on antidepressants. 
    • Valerian Root: Valerian is known for its calming effects and is used to address sleep disturbances and anxiety, which can be common during perimenopause.
    • Licorice Root: Licorice root contains compounds that have estrogen-like effects, which may help with hormonal imbalances and associated symptoms.
    • Sage: Sage has been used traditionally to manage excessive sweating and hot flashes.
    • Maca: Maca root is believed to help balance hormones and alleviate symptoms like fatigue, mood swings, and decreased libido. Best used once your estrogen begins to decline, and not before. 

Other Things That Can Help With Perimenopause

    • The foundations of hormone health are imperative to hone in on when you enter peri. Start here with a healthy diet, regular exercise, enough sleep, hydration, rest & connection.
    • Hormone replacement therapy (both estrogen therapy and progesterone, as well as testosterone and sometimes DHEA).
    • Lifestyle changes, including stress reduction as a major one.
    • We dive much more into all the specifics in our live program, Perimenopause Like A Boss, providing you a life line through the journey.

Towards the end of perimenopause, you’ll start to go months at a time without a period. This is often the toughest stage of peri, and one where it’s a really good idea to consider BHRT to help level out the hormonal ride. Rememeber, the average age of menopause is 50, so things can start to get pretty crazy around 48.

​Though perimenopause can be a wild ride, if we focus on supporting our bodies in the way we need to, it can truly be the most empowering time of your life.

You have the opportunity to begin protecting your bone health, heart, and brain for the rest of your days, based on how you set things up in peri. This is also the best time to determine:

    • Your boundaries
    • What is and isn’t working for you in your life
    • Your deeper sense of purpose and reason
    • How to navigate your inner and outer worlds, setting up a balance between the two
    • How to appreciate your body, even as it changes from what you’ve long known

We know that many women need help with navigating through this process, which is why we set up Perimenopause Like A Boss.

This four week program will guide you through dealing with your symptoms, the foods to eat, best ways to move your body, and how to institute lifestyle changes.

We also dive into the basics of bioidentical hormone replacement, so that you can understand if and when you may be ready for it (and how to talk to your doctor about it!). Our next session begins on Sep. 11th.

What's Your Hormone Issue? Take this 2-minute quiz to find out!


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