Navigating Perimenopause: What I'm Doing to Prepare (and Why You Should, Too)

I recently turned 45.

Over the past six months, I've started noticing subtle yet definite changes: irregular menstrual cycles, my first-ever urinary tract infection (ouch!), trouble recalling words, and stubborn mid-section weight that wasn’t there before.

These shifts have me paying close attention to my hormones—and to what's coming next.

I’ll admit, I’ve become more aware and curious—hormones are everywhere right now: on podcasts, in social media feeds, and in conversations with friends navigating perimenopause.

And as happy as I am to have more focus on menopause (it's been ignored for way too long), it can sometimes go too far: blaming every health hiccup in our 40's on perimenopause.

It's not always that simple.

That’s why I’ve been diving into the science of hormones and menopause—to better understand what to expect and how to respond.

I know I’m not alone in wondering what to expect and how to stay well during this natural—yet often challenging—transition.

In this newsletter, I'll cover:

• What perimenopause really is (and isn't)

  
  

• How to know if what you're experiencing is hormonal

  
  

• The long-term health implications of this transition

  
  

• Practical strategies I'm implementing to support my body

My goal? To help you navigate this significant life transition with evidence-based approaches that reduce your risk of additional chronic conditions.

Many of us are in the same boat—wondering how to stay healthy, resilient, and informed through it all.

What Is Perimenopause, Anyway?

Before we jump in, let's get some terminology out of the way.

Perimenopause is the transitional period when your body's production of estrogen and progesterone—two sex hormones made primarily by the ovaries during reproductive years—begins to decline and fluctuate.

Think of it as the runway to menopause, which is officially defined as the point when you haven't had a period for 12 consecutive months (with no other medical cause).

According to the landmark study of Women's Health Across the Nation (SWAN), this transition typically lasts about 4 years on average, though it can extend up to 10 years for some women.

Research shows that perimenopause among U.S. women begins at a median age of 47 years, with menopause itself occurring around age 51 to 52 years. Global data shows slightly earlier menopause between 48.8 and 50 years.

After this milestone, you enter what's known as the postmenopausal period.

Interestingly, research has revealed that women who enter perimenopause at an earlier age often experience a longer transitional period.

Various factors including ethnicity, smoking status, and weight can significantly influence both the timing and duration of this journey.

Understanding these timeframes helps set realistic expectations, but remember that your personal timeline may differ—and that's perfectly normal.

How Do I Know If I'm In Perimenopause?

Here’s the tricky part: there’s no single test that can definitively tell you you're in perimenopause.

Hormone levels fluctuate so much during this transition that even a blood test can’t always give you a clear answer.

You might still have regular cycles or hormone levels that fall within a “normal” range—even while your body has its final menstrual period.

That’s why perimenopause is diagnosed based on your symptoms—not a lab result.

And those symptoms? They vary wildly from one woman to the next.

While most people know about hot flashes (experienced by at least half of women worldwide), there’s a much longer list of possible changes.

What many women don't realize is how wide-ranging the effects can be.

Estrogen receptors exist in virtually every cell in your body, influencing your brain, digestive system, bones, muscles, skin, and much more.

This explains why the hormonal shifts of perimenopause can trigger such diverse symptoms across multiple body systems.

The Wide Range of Perimenopause Symptoms

Symptoms related to hormonal changes during perimenopause may include one or more of the following:

• Menstrual changes: Irregular cycles, heavier or lighter bleeding, or skipped periods. In early perimenopause, shorter cycles (with a 7+ day shift) are common. Later on, you might go 60 days or more without a period.

  
  

• Vasomotor symptoms: Hot flashes, night sweats, and temperature swings—often linked to sleep disruption and increased cardiovascular risk.

  
  

• Musculoskeletal: Joint and muscular discomfort, reduced muscle and bone mass. In a global meta-analysis, joint and muscular discomfort was the most common symptom reported.

  
  

• Sleep disturbances: Trouble falling asleep, staying asleep, or waking up too early.

  
  

• Mood changes: Increased irritability, anxiety, or even new-onset depression—even in women with no prior mental health history.

  
  

• Cognitive shifts: Difficulty concentrating, memory lapses, and that infamous “brain fog.”

  
  

• Urogenital changes: Vaginal dryness, more frequent UTIs, yeast infections, or incontinence. This happens as estrogen loss alters the vaginal microbiome and reduces tissue resilience.

  
  

• Skin and hair: Thinning hair, dry or sagging skin.

  
  

• Digestive symptoms: New or worsening reflux, bloating, constipation, or gut sensitivity due to shifts in microbiota and hormone signaling.

  
  

• Fatigue and low energy

  
  

• Migraines or more frequent headaches

  
  

• Reduced libido or painful intercourse

  
  

• Heart palpitations or changes in heart rate

  
  

• Weight gain, especially around the midsection (visceral fat)

  
  

• Worsening blood sugar, cholesterol, and blood pressure

  
  

• Onset or flare of autoimmune conditions

  
  

• New sensitivities to foods, as immune tolerance and microbiome balance shift

  
  

Symptoms can vary dramatically based on your diet, lifestyle, reproductive history, stress, genetics, and even cultural attitudes toward menopause.

What you feel may not be what your sister, mother, or best friend experiences—and just because you're 40-something with some of these symptoms doesn’t automatically mean it's perimenopause.

Don’t Assume It’s Just Perimenopause (A Word Of Caution)

There’s a growing tendency to blame every new symptom on “perimenopause” - especially if you’re in your 40s.

I recently heard a nutrition professional like myself say, “If you're in your 40s, it’s probably perimenopause.” 

Here's another good example of this exact same message on repeat:

But here’s the problem: That kind of blanket statement can be misleading—even dangerous.

It’s easy to fall into the trap of self-diagnosis, especially with so much conflicting information online.

But symptoms like fatigue, missed periods, or bloating could signal something other than hormonal shifts.

If we don’t investigate further, we may miss important diagnoses.

Let’s take a look at some other common causes:

• Heavy bleeding? It might be uterine fibroids or polyps.

  
  

• Missed periods? Could be stress, under-eating, over-exercising, or thyroid dysfunction—any of which can suppress ovulation.

  
  

• Bloating or discomfort? Might signal a digestive disorder or, more seriously, a reproductive tumor.

  
  

• Fatigue and hair loss? Might be iron deficiency anemia or low B12.

  
  

• Mood swings or anxiety? May be driven by thyroid issues, blood sugar instability (up to 32% of adult U.S. women have prediabetes), or nutrient deficiencies.

  
  

• Urinary symptoms? Could stem from an actual infection or pelvic floor dysfunction.

  
  

• Digestive changes? Recent antibiotic use, travel, or a gut infection might be the culprit.

  
  

This is why it’s so important to consult with a qualified health provider—especially someone who takes a whole-person, root-cause approach.

A qualified professional will consider your complete health picture, conduct proper assessments, and rule out other potential causes before attributing symptoms solely to perimenopause.

A More Thoughtful Approach

Rather than assuming every symptom is hormonal after 40, consider perimenopause as one possibility among many.

Track your symptoms, note their timing and potential triggers, and bring this information to a knowledgeable healthcare provider.

The right approach isn't dismissing perimenopause OR assuming everything is caused by it—but rather finding the right balance of awareness, investigation, and appropriate care.

Understanding the Health Risks of Declining Estrogen

As someone already managing an autoimmune condition, I'm acutely aware that being female is a major risk factor for developing multiple autoimmune conditions.

What many women don't realize is just how protective estrogen is for our overall health.

In fact, researchers have coined the term “inflammopause” to describe the inflammatory state triggered by the loss of estrogen and progesterone.

This isn’t just about hot flashes or mood swings.

It’s about real physiological changes that raise your long-term disease risk:

• Blood sugar dysregulation and insulin resistance. Estrogen supports insulin sensitivity. As estrogen drops, so does pancreatic beta-cell function—and peripheral tissues like muscle, fat, and liver become less responsive to insulin, making blood sugar harder to control. 

  
  

• Central weight gain and increased visceral fat. Many women notice weight shifting to the midsection with increased waist-circumference, waist-to-hip-ratio, and body mass index. This isn’t just aesthetic—it’s metabolically active fat that increases inflammation and cardiometabolic risk.

  
  

• Lipid changes. You might see higher LDL (“bad”) cholesterol, total cholesterol, and apolipoprotein B—even if your diet hasn’t changed.

  
  

• Oxidative stress and reduced antioxidant capacity. Estrogen has antioxidant properties. Its loss increases oxidative stress, damaging cells and tissues.

• Immune system shifts. Estrogen helps regulate immune tolerance. Without it, the balance between different immune responses creates an upregulation of inflammatory cytokines like IL-1, IL-6, TNF-alpha and a breakdown in oral and self-tolerance. That’s why autoimmune flares or new diagnoses (like Hashimoto’s, RA, or MS) often appear or worsen around menopause. And also why you might find yourself reacting to certain foods.

• Unfavorable shifts in the gut microbiome. Menopause significantly alters your gut microbiome, reducing diversity (a key indicator in gut microbiome health), increasing risk of dysbiosis (more harmful bacteria and fewer beneficial ones) and affecting the "estrobolome"—the collection of gut bacteria that help metabolize and regulate estrogen recirculation in your body.

  
  

• Sympathetic nervous system overactivity. The decline in estrogen can shift menopausal women into a more activated “fight or flight” state, increasing the risk of cardiovascular issues and amplifying symptoms like hot flashes or anxiety.

  
  

All of this adds up to a higher risk for:

• Type 2 Diabetes and Pre-diabetes

  
  

• Cardiovascular Disease (heart disease, stroke, high blood pressure)

  
  

• Osteoporosis

  
  

• Sarcopenia (loss of muscle mass and strength

  
  

• Depression and Mood Disorders

  
  

• Dementia and Alzheimer’s Disease

  
  

• Autoimmune Conditions (flares or new diagnoses)

  
  

This may sound scary—but it’s also incredibly empowering when you realize how many of these risks are modifiable.

Which brings us to the next question: what can you actually do about it?

What Can You Do About It? A Lot More Than You Might Think

There's a common misconception that menopause is something that "just happens to you"—that women simply have to endure whatever symptoms come their way and accept the increased health risks as inevitable.

This couldn't be further from the truth.

While you can’t stop your hormones from changing—you can influence how your body adapts.

Your daily habits—how you move, sleep, eat, manage stress, and connect with others— shape your body's ability to adapt to changing levels of estrogen, progesterone, and other hormones.

5 Things I'm Doing to Prepare for Menopause

Rather than waiting to see how perimenopause might affect me, I've developed a proactive approach based on the latest research.

Here are the specific strategies I'm implementing to make my transition smoother and protect my long-term health:

1. Prioritizing High Intensity Resistance and Impact Training (3x per week)

   
   

I want strong bones and muscles to keep doing the activities I love—and to reduce my risk of falls, fractures, and chronic disease.

Research shows that high-intensity resistance and impact training is especially effective for stimulating bone mass preservation and growth.

It’s also been shown to reduce hot flashes, improve blood sugar regulation and support cardiovascular and cognitive health.

Personally, I’ve been consistently strength training 3–4 times per week for nearly a year. I follow Lindsey Bomgren of Nourish Move Love, whose workouts helped me recover postpartum and now support my perimenopause goals.

They’re fun, heart-pumping, and include jumping, intervals, and progressive weight training—exactly what Dr. Stacy Sims recommends in Next Level, a great resource I’ve been referencing. If you want a deep dive with Dr. Stacy Sims listen to this interview.

2. Tracking My Menstrual Cycle More Closely

During perimenopause, your menstrual cycle often becomes the first and most reliable indicator of hormonal changes.

I’ve always tracked my cycle, but now I’m paying even closer attention.

Why? Subtle shifts in cycle length—especially if they vary by 7+ days from one cycle to the next—can be an early indicator of perimenopause.

I use the Garmin Connect app, but there are many tools available. Tracking helps me notice patterns, catch changes early, and feel more in tune with what my body is doing.

If you're in your 40s and haven't been tracking your cycle, I highly recommend starting now to establish your baseline before more significant changes occur.

3. Keeping A Closer Eye On My Blood Sugar

One of the less discussed consequences of declining estrogen and progesterone is its impact on blood sugar regulation.

With estrogen’s decline, insulin resistance becomes more likely—so to counter this, I'm taking two approaches:

First, I'm being more mindful about carbohydrate quality and quantity.

Research shows that women who eat more vegetables and fruits and fewer ultra-processed foods (refined carbohydrates) experience lower severity and frequency of vasomotor symptoms like hot flashes. (This supports not just blood sugar but gut health, too.)

I recently wrote about how I choose carbs for better blood sugar control and gut health in, which applies even more importantly during perimenopause.

Second, I'm measuring my glucose responses. 

I spot-check my blood glucose levels (fasting and after meals)—using a finger-prick meter. If you have access, a continuous glucose monitor (CGM) provides even more insight.

No matter what tool you use, I recommend working with a trained health provider to interpret your readings.

4. Supporting My Gut Microbiome

Nourishing my gut microbiome is a key part of managing my digestive autoimmune condition.

Knowing that it is likely to be negatively affected during menopause, I'm even more focused on:

• Eating a wide variety of colorful fruits and vegetables (rich in polyphenols, antioxidants, and rich in detoxification-supporting nutrients).

  
  

• Consuming a wide variety of plant foods including herbs, spices, nuts, and legumes for resistant starch, prebiotics, and polyphenols to feed my good gut microbes.

  
  

• Including prebiotic-rich foods like legumes, seeds, nuts, and intact whole grains.

  
  

• Prioritizing fermented foods like kefir, kimchi, and kombucha to support my immune health and gut ecosystem.

  
  

• Adding in phytoestrogens like soy (soy isoflavones) and seeds like flax, pumpkin, sunflower, and sesame which contain beneficial lignans to reduce menopause symptoms like hot flashes and cognitive issues, improve antioxidant capacity, and reduce inflammation.

  
  

• Limiting ultra-processed, high-sugar, inflammatory foods, and alcohol—all which negatively alter the gut microbiome.

  
  

I’m also exploring different types of microbiome testing methods to get insight into my microbial diversity, butyrate producers, estrogen-metabolizing bacteria, and beta-glucuronidase activity.

What makes this approach particularly relevant to perimenopause is that certain gut bacteria are required to convert plant compounds into their active forms.

• For example, specific bacterial strains transform the soy isoflavone daidzein into equol, a more potent estrogen-like compound.

  
  

• Similarly, other bacteria convert lignans from seeds into the active forms enterodiol and enterolactone.

With targeted testing, I'll be able to identify specific imbalances and then use tailored probiotics, prebiotics, and dietary adjustments to optimize my gut microbiome for better hormone metabolism and immune function during this transition.

5. Finding a Menopause-Trained Healthcare Provider

Sadly, many physicians—including OB/GYNs—aren’t trained in menopause care. A recent study found that only 6.8% of U.S. medical residents felt prepared to manage it.

That’s why I’m seeking a provider through The Menopause Society, which certifies clinicians with specialized knowledge in menopause transition and midlife women’s health.

(I learned about this Menopause Society resource from Dr. Marie Claire Haver's book, The New Menopause, another great resource.)

I don’t want to write off symptoms as “just perimenopause” without evaluating other causes.

And I also want a balanced, evidence-based conversation about whether menopause hormone therapy (MHT) is right for me.

✨Final Thoughts

The menopause transition isn’t just something that happens to you.

It's a natural transition - and one you can navigate with intention, knowledge, and support.

You can’t stop your hormones from shifting.

But you can influence:

• How severe your symptoms are

  
  

• How it affects your mood, sleep, energy, and daily life

  
  

• Your long-term risk for chronic conditions like heart disease, osteoporosis, autoimmune disease, and cognitive decline

Starting healthier practices now—whatever this means for you, before symptoms become intense, gives you the best chance at a smoother transition and a healthier, more vibrant decades beyond menopause.

The key is finding the right balance between accepting this natural life stage and taking concrete steps to support your changing body.

Have you started preparing for perimenopause or menopause?

What strategies have helped you? I'd love to hear your experience.

Until next time,

April

P.S. If you'd like help developing your own personalized plan for perimenopause or menopause, I'm here to help. Schedule a call here.