Perimenopause: What Women Need to Know

Written by: Ryah Nabielski, MS, RDN

If you’re in your late 30s or 40s and don’t feel like yourself, you’re not too young for perimenopause. Many women complain that the nutrition and exercise strategies that have helped them manage weight no longer work, and new symptoms like insomnia and anxiety are popping up. 

You’re not imagining it. As the menstrual cycle hormones fluctuate and eventually decline, they affect more than fertility; these hormones affect every system in the body. Understanding perimenopause can help you navigate the transition with more ease. Luckily, perimenopause isn’t as taboo as it once was, and more women are empowered to advocate for themselves in the healthcare space. 

Today’s article will walk you through perimenopause, what you can expect, and lifestyle solutions for supporting your health. The habits you put in place today can shape your perimenopause experience and set you up for future health and longevity. 

Keep reading as we explore: 

  • What is perimenopause? 
  • When does perimenopause occur?
  • What to expect with perimenopause
  • Perimenopausal symptoms 
  • Long-term implications 
  • Action steps for navigating perimenopause

This topic is so critical for women – let’s jump in! 

Perimenopause Definition 
Perimenopause is the transition to menopause. It’s sometimes referred to as the menopausal transition or “reverse puberty,” as reproductive hormones fluctuate and then eventually decline as the ovaries go offline. 

Menopause is the one-year mark without a period. It’s a day, an arbitrary snapshot in time.

Post-menopause is the day after menopause and the rest of a woman’s life. Women can spend 30 to 40% of their lives post-menopausal. 

When Does Perimenopause Occur? How Long Does It Last?
The average age of menopause in the U.S. is 51, but any time between ages 45 and 55 is considered normal. Early menopause occurs before age 45, and premature menopause occurs before age 40. You can also experience surgical menopause when the ovaries are removed or menopause due to chemotherapy or radiation treatments. 
While menopause is just a single day, perimenopause can be a long transition spanning several years to over a decade. Many women will be in perimenopause for 5 to 10 years before they hit their last menstrual cycle, and some will have a shorter or longer transition. The experience varies greatly. 
It’s not unreasonable to begin perimenopause in your mid-to-late 30s or early 40s. It may seem like this is too early to start the transition, but many women notice new hormone-related symptoms during this time, which your doctor can miss if they aren’t looking for it.

What to Expect
There is some debate about the official start of perimenopause. Some say it begins at the first irregularity in the menstrual cycle, but it’s also possible to have symptoms of changing hormones before cycles become irregular. 
Typically, in early perimenopause, progesterone levels begin to decline, and estrogen can fluctuate more with both high and low levels. Many women report shorter menstrual cycles. 
In later perimenopause, estrogen and progesterone are lower, and there will be fewer ovulatory cycles (cycles where an egg is released). Many women report longer menstrual cycles and skipped periods. Symptoms can also ramp up during this time. 

Perimenopausal Symptoms 
Many of the symptoms associated with menopause occur in the perimenopausal years and into the first year or two post-menopause. Most women in Western countries experience some degree of perimenopausal symptoms, although it’s important to note that women in some cultures experience far fewer symptoms. In the U.S., up to 80% of women will experience vasomotor symptoms, including hot flashes and night sweats. 
While hot flashes are what we think of most during this time, they’re just the tip of the iceberg. Perimenopause affects metabolism and increases inflammation. The brain and body undergo significant rewiring away from reproduction and its demands, and the transition can have some glitches that cause symptoms. 

Symptoms of perimenopause can include: 

  • Irregular menstrual cycles
  • Heavy periods 
  • Painful periods 
  • Breast pain 
  • Hot flashes
  • Night sweats 
  • Heart palpitations
  • Headaches and migraines
  • Worsening PMS (pre-menstrual syndrome)
  • Irritability
  • Anxiety
  • Depression 
  • Sleep disturbances
  • Weight gain (especially belly fat)
  • Muscle and joint pain
  • Muscle and bone loss
  • Brain fog
  • Changes in memory and cognition
  • Low libido
  • Vaginal dryness
  • Increased urinary tract infections (UTIs)
  • Changes in digestion 
  • Fatigue
  • Reduced stress resilience 
  • And more 

Over 50 symptoms are associated with the changing hormonal landscape, even ones that might sound strange, like burning mouth, itchy ears, frozen shoulder, or skin crawling sensations. 
The specific symptoms, intensity, and duration of symptoms vary widely. For some women, they can significantly affect their quality of life. Thankfully, there are lifestyle and medical solutions, and women don’t need to suffer. 

Long-Term Implications
Every woman who is lucky to live long enough will experience perimenopause and the loss of ovarian function. As if the symptoms aren’t enough, the post-menopausal hormone state also affects health markers and disease risk. 
After menopause, women are at greater risk for chronic diseases, including diabetes, heart disease, dementia, cancer, and osteoporosis. Disease risk increases because estrogen and progesterone play crucial health-promoting and protective roles throughout the body. Without these hormones on board, aging accelerates. 
It’s not all doom and gloom, however. Many symptoms decline or resolve after the early post-menopause years, and the body finds new stability. Women may enjoy not having the regular hormonal swings associated with the menstrual cycle and feeling more grounded. Many people report more freedom and care less about what others think, stepping into their true selves. 
There was likely an evolutionary advantage to perimenopause and menopause. The grandmother hypothesis suggests that post-menopausal women played a vital role in the tribe’s survival by requiring less food, gathering food for the community, and caring for grandchildren to ensure the survival of their lineage. 
However, today, most of us don’t live in tribal societies or multigenerational homes. We experience more stress, industrial food, sedentary time, and toxin exposures, which impact hormones and symptoms. The modern woman may need more support to feel like herself, improve disease risk, and maintain a good quality of life. 
Luckily, there are many tools, including hormone replacement therapy, herbal medicine, and lifestyle support, to improve perimenopause symptoms and overall wellness. 

Perimenopause Action Steps 
Perimenopause is a window of opportunity for long-term health. Many find they can no longer “get away with” poor health habits and need a new approach to carry them forward. It’s the perfect time to dial in the foundations by focusing on nutrition, sleep, exercise and stress management. Then, layer on any additional support with your healthcare team. 

Here are some specifics to provide foundational support in perimenopause, midlife, and beyond: 

  • Prioritize whole food. With the metabolic changes that occur with perimenopause, there is less room in the diet for ultra-processed food and excess sugar. Build meals around whole food, cook more at home, and eat to promote healthy digestion, muscle strength, and balanced blood sugar.  
  • Meet protein needs. Protein needs may vary, but 100 grams daily is an excellent first goal for many women. (Read more about how much protein you need here). Eating enough protein helps prevent muscle loss, promote muscle growth, and support metabolic health. Protein also helps you feel satiated from meals and reduces sugar cravings. 
  • Get more fiber. Eating more whole plant foods will naturally increase fiber intake. Shoot for at least 25 grams daily from vegetables, starchy veggies, fruit, legumes, seeds, nuts, and whole grains. 
  • Get enough sleep. Many women begin to experience sleep disturbance in perimenopause, including insomnia and disruptions from night sweats. Yet good sleep is also essential for improving symptoms of perimenopause. Dial in good sleep hygiene and add in sleep support supplements as needed. 
  • Start strength training. If there ever was a time to start strength training, it’s now. Strength training helps combat muscle decline that begins accelerating in perimenopause. It can also help counteract metabolic changes in perimenopause that affect body composition and help protect bones. For strength training guidance, join Hannah Bower’s community
  • Take creatine. Creatine supports strength and exercise performance before, during, and after perimenopause. It’s especially effective when combined with resistance training. New research suggests creatine may have benefits for brain health as women age. Twenty2 Nutrition Creatine Complex supplies the recommended 5 grams of creatine per serving (from creatine monohydrate and magnesium creatine chelate) along with HMB

If you start noticing new symptoms or don’t feel like yourself in your late 30s or early 40s, having perimenopause on your radar can save you a lot of time and confusion. Perimenopause is inevitable, but suffering isn’t. It’s an incredible opportunity to find the lifestyle that supports a long, healthy life. 

This article is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider before changing your diet or beginning a new supplement, especially if you are pregnant or breastfeeding, take medication, or have a medical condition. 

Ryah Nabielski, MS, RDN is a Registered Dietitian, functional nutritionist, writer, and recipe creator. Ryah helps clients use a natural, food-as-medicine approach to improve fertility, pregnancy, hormone balance, autoimmunity, and discover a healthy relationship with food and body. Learn more about Ryah and her private practice at