By Jen Wu
Perimenopause, also known as the menopausal transition, is the period of a woman’s final reproductive years. It begins with the first onset of menstrual irregularity and ends after one year of the final menstrual period. Menopause is the date one year after the last menstrual cycle. The average age of menopause is 51, though perimenopause can start anywhere from the 30s to the 50s and typically lasts 4–10 years.
During perimenopause, estrogen levels fluctuate. There are two stages to the perimenopause: the early transition, where cycles are mostly regular, and the late transition, where cycles are longer, the period may be absent for at least 60 days or more to the final menstrual period (FMP).
Despite being a universal stage of life, perimenopause is often misunderstood and misdiagnosed. There is no universally accepted definition or specific diagnostic criteria of perimenopause. There is no standard screening, no one-time blood test that can tell an individual “You are now in perimenopause.” Hormone levels can vary widely from week to week, so blood test results may not correspond to the reported symptoms. At the same time, many healthcare professionals receive minimal training on this transition, so they may not recognize that different symptoms, such as insomnia, anxiety, palpitations, or irregular periods, can share the same hormonal root. As a result, women are frequently referred to multiple specialists: a psychiatrist for mood changes, a sleep doctor for insomnia, a cardiologist for palpitations, and an OB-GYN for irregular periods. Each specialist may offer appropriate care, but without viewing symptoms together, women often end up with multiple diagnoses and treatments. In many cases, recognizing and supporting the hormonal changes of perimenopause can ease several symptoms at once and significantly improve quality of life.
Perimenopause can affect many systems in the body. Common symptoms include irregular periods, hot flashes, night sweats, poor sleep, mood changes such as anxiety or depression, brain fog, weight gain, fatigue, vaginal dryness, heart palpitations, and headaches. Some women notice increased body odor, brittle nails, thinning hair, dry or itchy skin, tingling or “electric shock” sensations, changes in sexual function, or recurrent urinary tract infections. Metabolic shifts can show up as insulin resistance, higher cholesterol, and loss of bone density, while other women report asthma flare-ups or ringing in the ears.
Certain factors can increase the likelihood of entering perimenopause earlier than average. Smoking, family history of early menopause, some types of cancer treatment, and hysterectomy. These women may notice symptoms in their 30s or early 40s and may be particularly vulnerable to feeling dismissed because their age does not meet the typical menopausal age.
A variety of conventional medical treatments can help manage symptoms. Hormone replacement therapy can alleviate symptoms by replenishing declining hormone levels. Can support hot flashes, sleep, mood, and vaginal dryness. Local vaginal estrogen, delivered as a cream, ring, or tablet, can relieve dryness, pain with sex, bladder symptoms, and urinary infections. Some antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) can support mood and also reduce the frequency or intensity of hot flashes. Newer, hormone-free medications such as fezolinetant (Veozah) work at the level of the brain’s temperature- regulation pathways to treat vasomotor symptoms. Other drugs, including oxybutynin, often used for bladder issues, and gabapentin, commonly prescribed for nerve pain or seizures, have also been shown to ease hot flashes and may be helpful for women who cannot or prefer not to take estrogen, especially when insomnia, pain, or migraines are present.
Beyond conventional medicine, many women find relief through a broader, integrative approach that includes lifestyle, herbal, and nutritional support.
• Regular exercise, including aerobic movement and strength training, can improve mood, sleep, metabolic health, and bone density.
• Prioritizing and getting quality sleep can help the body recover, regulate stress, and maintain hormone balance.
• Herbal therapeutics can target specific needs, such as:
• Relieve symptoms like hot flashes and night sweats – black cohosh and chaste tree berry.
• Adaptogens to help the body cope with stress, fatigue, and mood changes – ashwagandha, tulsi, and reishi.
• Nutritive herbs to support healthy body function – nettle, alfalfa, and burdock.
• A balanced, anti-inflammatory diet rich in whole foods, healthy fats, adequate protein, and plenty of fiber can support hormone and blood-sugar balance.
• Acupuncture can support by balancing hormones and reducing symptoms like hot flashes, mood swings, and sleep disturbances.
The menopausal transition often arrives at a time when many women are at the peak of their careers and simultaneously carrying caregiving responsibilities for children, partners, and aging parents. With so many competing pressures, it is easy for perimenopausal symptoms to be viewed as simple “stress,” both by women themselves and by their providers. This can leave women feeling isolated, confused, and sometimes ashamed of what they are experiencing. Increasing public awareness and clinical education is essential so that perimenopause is recognized as a natural biological transition, not a personal shortcoming or a psychological issue. With the combination of herbal and integrative therapeutics, lifestyle changes, and community support, women can move through perimenopause more smoothly.
To learn more about the natural and herbal therapeutics, register for the Perimenopause: What is Happening and Ways to Support the Transition workshop on April 7, 2026.
Sources:
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3. Berman, K. “After Decades of Misunderstanding, Menopause Is Finally Having Its Moment.” Yale School of Medicine, 14 Apr. 2025, https://medicine.yale.edu/news-article/ after-decades-of-misunderstanding-menopause-is-finally-having-its-moment/
4. “Perimenopause.” The Menopause Society, 2025, https://menopause.org/patient- education/menopause-topics/perimenopause
5. Haver, MC. The New Menopause. 2024.
6. Kubala, J. “10 Herbs and Supplements for Menopause.” Healthline, 28 Mar. 2025, https://www.healthline.com/nutrition/menopause-herbs