What to Expect During Perimenopause

If you’re in your 30s, then perimenopause is just around the corner—and you might’ve even begun to notice some hormonal changes already. Shifting hormones cause perimenopause symptoms like irregular periods, hot flashes, difficulty sleeping, irritability, and weight gain—but is this transition really as bad as people say?

When you begin to spot the early signs of menopause, reading this blog will let you know how perimenopause affects your body, as well as basics like the best diet for perimenopause, as well as natural supplements for perimenopause.

What to expect during perimenopause

Most people know menopause as the time when your period stops, hormones shift, and you can no longer get pregnant. 

But shifts don’t happen overnight, and that’s the period of transition known as perimenopause, which literally means “around menopause”. 

Perimenopause usually lasts an average of four years, though some women may be in this transition phase for only a few months, and others longer than four years. Each woman’s perimenopause experience (and symptoms) will be different.

But simply put, perimenopause is the time between a woman’s reproductive years and menopause. 

Your cycles may be irregular, and your period may feel differently than it has before due to declining estrogen and progesterone. Other symptoms may pop up as well, like acne, mood swings, or weight gain. This is what makes menopause a struggle for many women, but symptoms vary greatly.

Hormones driving you crazy? Learn more about the holistic support in Hormone Helper>>>

What are the stages?

During perimenopause is when many women begin to feel the first symptoms indicating that menopause is on the horizon, as your body prepares to stop ovulating and decreases hormone production. This process happens in three main stages.

Perimenopause: Cycles become irregular, but periods haven’t stopped. Most women experience this in their mid-forties, but some women see hormonal changes as early as their 30s.

Menopause: This occurs when you have your final menstrual cycle. Around this time, symptoms like hot flashes, mood swings, and weight gain are common.

Postmenopause: Once you’ve got one full year without a period, you’re considered postmenopausal. 

Related: The 7 Hormones You Should Know

What are the first signs of perimenopause starting?

A few of the most common early signs of perimenopause include longer menstrual cycles, sleep disturbances, or changes in your mood such as irritability or increased anxiety.

Other common symptoms of perimenopause:

  • Weight gain (especially around your middle)
  • DepressionIs it perimenopause?
  • Anxiety or irritability
  • Low libido
  • Irregular menstrual cycles (shorter periods, more time between periods)
  • Hot flashes
  • Insomnia or difficulty sleeping
  • Fatigue or brain fog
  • Hair loss or thinning hair
  • Hot flashes or night sweats
  • Heavy menstrual bleeding
  • Urinary tract infections

It’s important to note, though, if you begin experiencing these symptoms prior to age 40, you’ll want to check in with your doctor and test hormone levels to rule out other more serious causes.

Less than 1% of women experience early menopause before age 40 (1).

Read more: Is it perimenopause or a thyroid problem?

What is the average age for perimenopause?

The average age in the U.S. for menopause is 51. For some women, perimenopause can begin as little as a few months before menopause, or as long as several years. The average age for perimenopause is about 47 (2).

While early menopause isn’t common, menopausal symptoms can occur in some women as early as their late 30s, so it’s important to become familiar with your body to identify what’s normal, and when you should speak with your doctor.

Learn more: 5 Signs of Hormonal Imbalance in Women

How periods change during perimenopause

Menstrual changes are the hallmark sign that menopause is coming. During perimenopause, estrogen levels are often high in relation to progesterone (even though both hormones are in the process of decreasing). Estrogen causes your uterine lining to build, which means you may notice heavy bleeding or abnormal menstrual flow during your period. 

A missed period can also result in heavy bleeding in the following period. 

Related: Estrogen Detox and Your Estrobolome

Is it normal to have irregular periods in your 40s?

Perimenopause often begins in your 40s, and this means that you might start to notice changes in your cycles as a result of shifting hormones.  

During perimenopause, hormones like estrogen are decreasing, and FSH increases, but they often don’t do so in an organized manner–sometimes fluctuating drastically from cycle to cycle.

This means sometimes your period may be very heavy, other times you may miss a period entirely, or they’ll just be unpredictable. 

It can be frustrating, but mostly normal considering the hormone changes. If you notice extremely heavy bleeding, or experience significant pain, speak with your doctor to rule out any underlying health issues.

Should I get tested for menopause?

It’s not necessary to be tested for menopause, but some women do so. Your integrative medicine doctor will most likely test your estrogen levels and another hormone called follicle-stimulating hormone (FSH).

Estrogen is the most important hormone for menstrual cycle regulation, while FSH helps support estrogen production. If FSH is high, it can be because the ovaries are producing less estrogen, and your body is making more FSH to try to correct this, indicating that you’re approaching menopause.

Health risks that increase during and after menopause

Your doctor may evaluate your individual risk for health issues that commonly develop during or after menopause, like (3):

  • Type 2 diabetes
  • High blood pressure
  • Heart disease
  • High cholesterol
  • Metabolic syndrome

Other health issues driven by estrogen and progesterone like endometriosis, polycystic ovarian syndrome, uterine fibroids, or fibrocystic breasts can sometimes improve after menopause.

How to improve perimenopause or menopause symptoms

Many women can manage perimenopause with natural interventions, including a healthy diet and lifestyle changes. For perimenopause and menopause, there are also several supplements that can help improve symptoms and your overall comfort:

Vitamin D: Vitamin D is essential for calcium absorption as well as the health of your bones and immune system. Low vitamin D levels are associated with increased risk for some cancers, including breast cancer (4).

Black Cohosh: This herb has been used for centuries in North America and Europe by both the Native Americans and early American settlers. The root of black cohosh contains substances called triterpene glycosides that are thought to be responsible for its beneficial effects on perimenopausal depression, hot flashes, and night sweats (5,6).

Chaste berry (vitex): This herb has been used for perimenopause symptoms like irregular menstrual cycles or  PMS, breast tenderness before periods, and hormonal acne. It supports a balance between estrogen and progesterone (7). 

Soy isoflavones: Soy isoflavones contain a phytoestrogen called genistein which can help relieve perimenopause symptoms like hot flashes and night sweats, plus mood swings by acting as an estrogen mimic–though without stimulating breast or uterine tissue (8). 

Maca root: Many woShop Hormone Helpermen use maca to support healthy hormone levels during menopause transition. In a study of newly postmenopausal women, given either a placebo or 2 grams of maca root powder per day, women in the maca group reported a reduced discomfort compared to the control group (9).

Evening primrose oil: Many women use evening primrose oil to support overall hormone balance, but proponents also suggest that direct application of evening primrose oil can produce a more local affect–alleviating vaginal dryness and making intimacy much more comfortable.

Sleep: While not a supplement, many women underestimate the importance of quality sleep. Adequate, consistent sleep during perimenopause is key. If you’re not sleeping well, menopausal symptoms like hot flashes, anxiety, and mood swings can be a lot worse. 

Quiet cortisol and rest peacefully all night with Sleep Savior>>>

Slow down your workouts: Prolonged or intense cardio may overwork already tired adrenals, which can place more stress on your hormones. Listen to your body–and don’t be surprised if fewer workouts or just a decrease in intensity serves your body better during this time.  

The best diet for perimenopause

The best diet to improve menopausal symptoms accounts for your changing needs as your hormone levels fluctuate. The peri/post-menopausal diet should include foods that are high in nutrients like:

  • Calcium, vitamin D, magnesium, selenium, and iodine
  • Omega-3-rich fish for mood support
  • Lean protein for bone and muscle health
  • Whole grains to provide fiber
  • Antioxidant-rich fruits & veggies
  • Phytoestrogen foods like flaxseeds,
    chickpeas, or organic soy
  • Cruciferous vegetables to support estrogen detox

What about hormone therapy?

Hormone replacement therapy (HRT) is a treatment intended to replace the decline in estrogen and other sex hormones. HRT is normally administered in a pill, patch, injection, or cream.

Hormone therapy involves synthetic or bioidentical hormone replacement, although many integrative or holistic doctors choose bioidentical hormones, which are more similar to the body’s own hormones. 

Bioidentical hormones reportedly lead to greater patient satisfaction and come with a reduced risk of potential side effects posed by synthetic hormone replacement.

Hormone therapy is a common choice to relieve most menopause symptoms, and it can also help reduce the factors which lead to osteoporosis (bone loss). 

DHEA and perimenopause

One helpful supplement for perimenopause is DHEA. If perimenopausal symptoms like low libido and fatigue are affecting your comfort, taking DHEA can help balance hormones in peri/post menopausal women with adrenal insufficiency or diminished ovarian function. 

DHEA works by stimulating the production of testosterone and estrogen, helping symptoms like vaginal dryness, mood, and weight gain.

What to remember

Perimenopause symptoms can be a challenge, but they’re also one of the most natural things for all women. We can’t change this shift, however, perimenopause isn’t something you have to suffer through. The best way to support your body is with knowledge and action. Knowing how your hormones work and when symptoms might occur will help you make informed decisions about what foods and supplements to eat, how much exercise or sleep your body needs at this stage in life, and which habits can help reduce discomfort.

Join me for more holistic support around perimenopause and holistic women’s health.



  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634232/ 
  2. https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal 
  3. https://www.womenshealth.gov/menopause/menopause-and-your-health
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802611/
  5. https://ods.od.nih.gov/factsheets/BlackCohosh-HealthProfessional/
  6. https://pubmed.ncbi.nlm.nih.gov/17194961/
  7. https://pubmed.ncbi.nlm.nih.gov/12852933/ 
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893524/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614576/