Picture your hormonal cycles during your reproductive years as a kiddie roller coaster. You have predictable peaks and valleys, generally in regular intervals. If you track your periods during this time, they are usually the same length of days from the start of one cycle to the next. 

Enter perimenopause. Suddenly, your adorable kiddie coaster morphs into one of those heart-stopping, stomach-dropping loop-de-loops. At one time, you could predict that one week out of the month when you had to pack your bags and move to a deserted island with a stockpile of tampons. Now, it’s as random as the Wheel of Fortune spinner—with no polite warning! 

Why We Feel Crazed & Off Our Game in Perimenopause

If you were to have your hormone levels checked during this time, you might find that they fluctuate significantly and unpredictably from day to day, making it difficult to get a clear picture of what’s happening. These hormonal shifts can manifest in a number of disturbing physical and emotional symptoms, including hot flashes, night sweats, brain fog, memory problems, achy joints, erratic cycles, trouble sleeping, low libido, hair thinning, depression, anxiety, and vaginal dryness.

Now combine all of that with the life of a typical middle-aged woman who is already juggling a ton of competing priorities. Many women enter perimenopause just as they’re hitting their stride in very demanding careers. If you have children, you could be in the throes of parenting challenges, or at the start of your pregnancy journey as the number of women having children in midlife is growing steadily. Or perhaps you’re caring for aging parents with serious health concerns.

Life at this stage is beyond overwhelming, and if you’ve set your biological clock to auto-pilot, the sudden onset of all of these symptoms while you’re still getting periods will leave you frazzled, confused, and questioning your own sanity. Well, you’ll be relieved to know that what feels like puberty part two means you’re not unraveling at the seams but likely going through perimenopause. And with over 1 billion women worldwide expected to go through perimenopause in 2025, you are definitely not alone. 

Perimenopause Starts Earlier Than You Think

The average onset of menopause is between 45-55 years old, with North American women, on average, entering menopause at 51. This means by that age, women have gone twelve consecutive months without a period. Most women don’t realize that perimenopause can start a full decade before that. If you currently land in that age group, you belong to Generation X and will surely remember The Magic School Bus. Well, here’s the menopause edition: 

Ms. Frizzle will tell you that our bodies are rife with hormone receptors. We have them, among other places, in our brains, joints, gastrointestinal system, and vaginal tissues. During perimenopause, fluctuations in hormone levels can contribute to a variety of physical and emotional symptoms. Specifically, these hormonal shifts can affect how our brain cells and the blood vessels surrounding them function. It’s not necessarily the overall decline in hormones that seems to be the issue, but rather the alternating and unpredictable fluctuations in estrogen and progesterone.

How Fluctuating Estrogen Levels Affect the Midlife Brain

Some women are more vulnerable to these hormonal swings than others. Certain problems that may have been lying dormant for years can suddenly reappear. If, for example, you’re among the 1 in 5 women who experience postpartum depression or the 1 in 10 who experience postpartum anxiety, be on the lookout for worsening moods during perimenopause. The same type of hormonal fluctuations that occur during the postpartum period can also trigger anxiety and depression during perimenopause.

For many of us Generation X women who pride ourselves on being resourceful, independent self-starters, anything that slows us down can be extremely distressing. We’ve turned the Baby Boomer mentality of family versus career on its head and somehow found ways to balance both (most of the time!). When you’re killing it at home and work, it can be wildly disorienting when perimenopause suddenly throws you into a hormonal tsunami. One minute, you’re in the driver’s seat; the next, you’re pulling over to catch your breath.

Make A Plan & Get Back in the Game: Managing Your Changing Cycle

If you’re under 40 or still having monthly periods, one of the simplest things you can do is start tracking your menstrual cycle. This can be especially useful if you’re not using hormonal birth control, since the bleeding you experience while taking the pill is a withdrawal bleed and doesn’t necessarily reflect your natural menstrual cycle.

Pay attention to the length of your cycles, whether they suddenly become shorter or longer, changes in flow, skipped periods, or bleeding that seems different from your usual pattern. These changes can provide valuable clues that your hormones are beginning to shift and that you may be approaching perimenopause.

Tracking your cycle also gives you a baseline to look back on when other symptoms begin to appear. Suddenly experiencing hot flashes, night sweats, sleep problems, mood changes, brain fog, or a libido that seems to have packed its bags and left? Having a record of your cycles can help you, and your healthcare provider, connect some of those dots and keep you from being completely blindsided.

Maintain Healthy Habits During Perimenopause

Midlife can be an opportune time to grab the bull by the horns and take charge of your health. One of the great things about living in these times is that we’re surrounded by a bevy of highly successful women rocking their midlife experience. Many women are coming into their fitness primes, and there’s no reason you should have to grit your teeth and bear the unsettling symptoms that often come with this transition. Experts have found tremendous benefits from making important lifestyle changes.

These habits include staying socially connected, keeping both your body and brain active, eating a nutrient-rich Mediterranean-style diet with plenty of natural sources of omega-3 fatty acids and essential vitamins, and avoiding smoking. Moderating alcohol intake and managing cardiovascular risk factors, including high blood pressure, diabetes, and elevated cholesterol, are also important. Regular physical activity has some of the strongest evidence for supporting cognitive health and slowing age-related decline.

The most important of these changes are regular exercise and social networks. One study found that women who were part of a group that met at least once a month were less likely to experience bothersome menopausal symptoms and depression. Moving your body to increase your heart rate at least 150 minutes a week, along with strength training two to three times a week, can help support bone health, cardiovascular health, and mental well-being while slowing some of the physiological changes associated with aging. So start that amateur tennis team! Join that book club!

Don’t Go It Alone: Talk to Your Doctor

Lastly, come prepared with a list of questions to discuss with your OB-GYN or, better yet, consider finding a Menopause Society Certified Practitioner (MSCP) who specializes in menopause and midlife women’s health. The Menopause Society offers a searchable directory of certified practitioners who have demonstrated specialized knowledge in menopause care.

A knowledgeable menopause practitioner can help you understand which treatment options may be appropriate for your individual situation and what steps you can take now to protect your health as you move through the transition. They can also explain which symptoms may—and may not—improve with hormone therapy or other medications, while helping you identify the preventive screenings and lifestyle changes that deserve a place on your midlife to-do list. In other words, it’s time to get those metaphorical ducks in a row.

Final Thoughts: Breaking the Silence Around Women’s Reproductive Health

It’s important to remember three things: you are not alone, you are not going crazy, and there are options to help ease your symptoms and get you back in the game. Thankfully, as menopause becomes more mainstream, we have celebrities like Oprah, Drew Barrymore, Halle Berry, and Michelle Obama talking openly about their menopause experiences. You don’t have to be a celebrity to share your journey. Talk to your friends, talk to the checkout clerk, talk to your neighbors, talk to your daughters and sons. Perimenopause is a normal part of life, and there is nothing to gain by suffering in silence.

Alexandra Sherman is a board-certified Women’s Health Practitioner with over ten years of experience. She has been a North American Certified Menopause Practitioner since 2017. She’s lived in Massachusetts, California, and today calls the suburbs of Atlanta her home. When she’s not helping her patients navigate the trials and tribulations of womanhood, she enjoys spending time with her husband, three kids, a dorky dog, and a chunky cat. She loves travel, baking, and any time outdoors, especially by the water.