Perimenopause & Menopause: What’s Actually Happening and What to Do About It
First, let's clear something up
You've probably heard the narratives: your cycle is a burden, perimenopause is chaos, and menopause means everything gets harder and goes to shit. I'm going to push back on that… not to sugarcoat what's real, but because the fear-based story doesn't actually help anyone.
Here's what I want you to know upfront: hormonal shifts are real, they can be challenging, and there's a lot you can do. This isn't about toxic positivity or pretending nothing changes. It's about giving you actual information so you can make empowered decisions instead of just bracing for impact.
Let's get into it.
Just because something is common doesn't mean it's "normal" or that you have to survive through it. A lot of what women experience during cycles, perimenopause, and menopause has been normalized to the point where so many women don’t ask questions, and that’s a problem.
Hormonal changes absolutely create challenges. But what's driving your specific symptoms is rarely just one thing. Aspects like lifestyle, digestive health, dieting history, sleep, stress load, and body composition all factor in. That's actually good news, because it means you have more leverage than you think.
I feel the need to insert something very REAL here that isn’t common knowledge: "Normal" on lab results and "optimal" are not the same thing. If you've been told everything looks fine, but you feel like garbage, that's worth exploring further. Normal ranges are compared to the general population… and I don’t know about you, but I don’t want that to be my comparison. Also, general labs that are run give us a decent amount of information, but are often missing key aspects that could tell us more about internal health and what’s going on (which would give us direction on how we can better support our systems).
A quick hormone lesson
You've got a lot of hormones doing a lot of things: sex hormones (estrogen, progesterone, testosterone), stress hormones, hunger hormones, thyroid hormones, and more. They're all in conversation with each other in various ways. Hormones are often blamed for a lot without knowledge of what they even are, what they do, and how they work. This post isn’t a full hormone lesson- I do want to give a slight overview of the hormones involved in cycles, perimenopause, and menopause.
Here's how your cycle phases work when things are running optimally:
Menstrual phase: Estrogen and progesterone are at their lowest. (think about how one may feel in the first few days of their period… pretty blah… this is due to estrogen and progesterone being low)
Follicular phase: FSH signals follicles to mature; estrogen rises.
Ovulation: LH surges, and the egg is released.
Luteal phase: Progesterone rises to prepare for pregnancy. Estrogen and progesterone drop in the late luteal phase if there is no pregnancy.
Worth noting: this looks different if someone is on hormonal birth control. Also, not everyone ovulates every cycle, even outside of perimenopause.
Perimenopause vs. menopause and what’s happening
Perimenopause can start in your mid-30s, but more commonly shows up in your 40s. It can last anywhere from 4 to 12 years…yes, years. The ovaries begin to lose their function, cycles start changing, and more cycles occur without ovulation.
Here's where it gets real: progesterone declines sharply. For some women, this feels gradual; for others, it feels like going from 40 to 65 overnight. Estrogen can initially trend higher (hello, estrogen dominance symptoms) before it eventually declines too. Your brain is signaling the ovaries and not getting the response it expects… this is where those "WTF is happening to my body" moments have a physiological explanation.
Menopause is defined as 12 consecutive months without a period, marking the permanent cessation of menstruation (for natural occurrence). Some women may enter menopause medically through surgeries or medications. In menopause, estrogen and progesterone are both low, and FSH is elevated.
*It’s worth noting that some women who have had surgeries like ablations or partial hysterectomies may have more difficulty deciphering when they are in menopause without regular hormone testing.
Symptoms that can show up during these transitions are things like hot flashes, night sweats, and mood shifts. These are real, and they're worth addressing. If you’re experiencing these, you don't have to just deal.
Why this matters beyond just "feeling off"
Progesterone and estrogen do a lot more than regulate your cycle. Here's what's actually worth noting:
Progesterone affects: mood and cognitive function, neuroplasticity, bone density, thyroid function, and cardiovascular health.
Estrogen affects: gut microbiome and digestion, muscle production, bone density, skin and tissue integrity, and metabolic function.
Two things I want you to sit with here. Starting around age 40, women begin losing bone at 0.3–0.5% per year, and during menopause that rate can jump to 3–5% per year for 5 to 7 years. Muscle loss can start as early as age 35, with a potential loss of 10–20% over time if left unaddressed.
These aren't scare tactics. They're reasons to be proactive and intentional.
What actually helps
Movement… and not just any movement
Walking is great, and it's not enough on its own to protect your muscle and bones… even with a weighted vest. Resistance training with a real focus on building muscle, balance, and stability. Add in some jumping movements and depth drops (like stepping off a box and landing athletically) for bone stimulus. Make this non-negotiable. Purposeful strength training, even 2x per week, has been shown to support muscle and bone.
Protein and nutrition
Aim for 0.6–1g of protein per pound of body weight. Eat regular, balanced meals throughout the day. Get 20+ grams of fiber daily. Eat whole foods as 75-80% of your diet. Stay hydrated. If you're drinking alcohol regularly, it's worth an honest audit as it impacts sleep, body composition, and even hormonal processing. While you’re at it, do a caffeine audit, as this can impact sleep, nutrient absorption, and hormones like cortisol.
This isn't about a diet. It's about eating in a way that supports what your body is doing.
Practical tip: Higher sugar foods don't have to be off the table (nor do I think they should be if they bring you enjoyment and experience). Pair them with protein, fiber, and/or movement to support blood sugar regulation and insulin sensitivity. Context matters more than food rules.
Sleep
Sleep disruption is one of the most common and most impactful symptoms during perimenopause and menopause, and it creates a downstream effect on everything else. A few things that actually move the needle:
Cool, dark, comfortable sleep environment
Real wind-down time before bed (not just going from screen to pillow)
Sunlight first thing in the morning. This supports the natural circadian rhythm. Also, go for sunlight in those afternoon slump times vs. caffeine.
Honest audit of your caffeine timing (cut it off earlier and see if this helps)
Magnesium glycinate before bed is one of the higher-impact supplements for sleep quality
Body composition and stress
With declining estrogen, fat tends to redistribute toward the midsection, hips, and thighs... and metabolism can slow. This is frustrating, and it's also workable. Resistance training, purposeful rest days, stress management, and sleep hygiene are the levers here. HRT (Hormone Replacement Therapy) is also something worth discussing with your doctor if you're not already having that conversation.
Supplements worth knowing about
Labs and nutritional awareness come first — blind supplementation is expensive and often unnecessary. That said, these are the ones with the most research behind them for this stage of life: Vitamin D3 + K2, creatine, magnesium glycinate, omega-3s, B vitamins, and calcium. You can get more information on what these supplements do, how to take them, considerations, and recommended brands HERE.
Get your labs done — and actually have somewhat go through them with you
Full labs, not just the standard panel. If you want a full list of suggested labs, email me, and I will send them to you. And remember: "normal" range means you're within a statistical average, not that you're functioning optimally. If you've been dismissed by a provider or told everything looks fine when it doesn't feel fine, advocate for yourself or find someone who will actually dig in with you. I do offer consultation coaching calls where I can order labs for you, go through them with you, and go over suggestions of what to do next- if you’re interested in this, you can also email me to get the conversation started.
The bottom line
Perimenopause and menopause involve real hormonal changes with real downstream effects. They're not a death sentence, and they're not something you just have to white-knuckle through. The goal is to go into this phase informed, supported, and building habits and behaviors now that protect your muscle, bone, brain, and energy for the long haul.
You have more agency here than the narrative gives you credit for.
If you're ready to stop guessing and start getting support, I work with women navigating exactly this — nutrition, body composition, behaviors, and the real-life stuff that makes all of it harder. No cookie-cutter plans, no BS. Learn more about 1:1 coaching, apply for coaching and book an initial call, or email me to book a consultation.