What’s Going On With Your Hormones And Perimenopause

We used to think of menopause as something that happened much later in life–that you wouldn’t have to worry about the dreaded “change” until at least 50+, right? 

Enter perimenopause. 

If you’re in your late 30s or early 40s and something feels “off”—your periods are irregular, your moods are erratic, and your energy is fluctuating—then you may be entering this transitional phase.

But what does that mean? Below, we cover what it is, symptoms to expect, and what you need to know about hormones and perimenopause, so you’re fully prepared.

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What Is Perimenopause, Really?

“Perimenopause” literally means “around menopause.” It’s the transitional phase before you hit menopause (defined as 12 consecutive months with no menstrual period). Think of menopause as one moment in time, and peri and post-menopause as the two other parts of what experts call the “menopausal transition.”

Here’s some key details about perimenopause:

• Most women will start perimenopause in their 40s, between 45 and 55, though it’s not unheard of for some women to start as early as their 30s.
• It can last several years (on average, 3-4 years, though it may stretch longer).
• During perimenopause, you may still have periods intermittently, you can get pregnant, and you’ll likely deal with the worst of menopause symptoms, like hot flashes.

In perimenopause, you’re not quite done with hormones or menstrual cycles; you’re right in the messy middle.

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Early vs Late Perimenopause

While not clinically recognized, understanding the perimenopause stages can help contextualize your journey and find supplements, remedies and treatments for symptoms. The two stages are:

• Early perimenopause: Typically starts in your 40s (but can start earlier), the menstrual cycle may vary by 5-7 days, and you’re still regularly getting a period. Your flow may be lighter or heavier, and symptoms aren’t as pronounced.
• Late perimenopause: During late perimenopause, your cycle length is, on average, about 60 days or longer, and menopause is between 1 and 3 years away. Symptoms like hot flashes, vaginal dryness and mood swings ramp up.

Everyone’s journey is different, but both stages of perimenopause combined last anywhere between 4 and 10 years. 

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Meet The Hormones in The Mix

All of the changes and symptoms that take place during perimenopause are due to one thing: hormones. During the menopausal transition, your hormones are unpredictable, which causes the symptoms. 

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Estrogen

You’ve likely heard about estrogen. It’s a reproductive hormone that regulates your period, among many other bodily functions, including the vascular and immune systems. Declining estrogen is what stops ovulation and your menstrual cycle, but it doesn’t decline steadily. Instead, estrogen levels fluctuate during perimenopause, sometimes spiking above normal levels, then plummeting. That’s what causes menopause-related symptoms.

Your body produces different forms (estradiol, estrone), and as the ovaries lose efficiency, the balance shifts.

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Progesterone

Progesterone, another reproductive hormone, is closely tied to ovulation. During a regular menstrual cycle, after an egg is released, levels of progesterone increase to support a possible pregnancy. During the menopause transition, as ovulation becomes erratic or stops, progesterone becomes unpredictable, low, or absent in many cycles.

Less progesterone means less “balancing” against estrogen’s effects, contributing to mood swings, irregular bleeding, and more.

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FSH & LH (Follicle Stimulating Hormone & Luteinizing Hormone)

During your menstrual cycle, the levels of FSH and LH rise and fall according to signals sent from the brain’s pituitary gland. During the menopause transition, FSH can be unpredictable, so while some recommend it as part of a hormone panel, it doesn’t actually provide any helpful data. LH also plays a role, but FSH is more often tested clinically.

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Testosterone

We often overlook the importance of testosterone balance due to fear, especially if you have PCOS. Androgens (male sex hormones) are attributed to PCOS symptoms like Hirsutism (excessive hair growth), thinning hair, and acne. 

However, women naturally produce testosterone, and during perimenopause, declining levels can cause decreased libido, unexplained fatigue and even decreased muscle strength.

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How Hormones Affect Common Perimenopause Symptoms

Because hormone levels are in constant flux, perimenopause symptoms are as well. Let’s break down the common ones you might see, and how they tie to the amount of estrogen you have on any given day:

• Menstrual changes and irregular bleeding: Cycles may shorten or lengthen; bleeding may be heavier or lighter; you might skip ovulation or skip periods entirely. 
• Hot flashes and night sweats: Classic signs of menopause, bouts of intense heat caused by the unstable estrogen’s impact on the hypothalamus (the body’s temperature regulator).
• Insomnia and fatigue: Night sweats, stress and changes in mood can disrupt your sleep, amplifying every other symptom
• Mood changes: Estrogen and progesterone fluctuations influence brain chemistry (e.g., serotonin). Mood symptoms may resemble PMS but occur out of sync with cycles. ~40% of women see mood symptoms. 
• Brain fog: Many women report forgetting words, difficulty concentrating or focusing, and a slower time processing things.
• Vaginal dryness: As estrogen dips, vaginal tissues lose lubrication, elasticity, and resilience, resulting in vaginal and bladder issues. You may have painful sex, incontinence or an increase in infections.
• Hair, skin, and nails: Along with the natural decrease in collagen that occurs with age, menopause can cause hair loss, skin issues, and even brittle nails. 
• Weight gain: Estrogen also helps regulate fat distribution, insulin sensitivity, and metabolism. Along with metabolism slowing down with age, this can cause the dreaded “meno belly,” where fat increases around the midsection.
• Joint and muscle stiffness and aches: Inflammation and a drop in estrogen’s protective effects can contribute to aches and pains.

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Should You Test Hormone Levels?

Most doctors don’t need hormone tests to diagnose menopause–they tend to go off your symptoms, cycle length and duration. However, some women may opt for testing to try to chart their symptoms and make the connection between hormone levels and symptom intensity.

A single FSH or estradiol test really isn’t helpful because levels vary so much month-over-month. However, testing may be helpful if:

• You want to exclude other causes for your symptoms (thyroid, anemia, pituitary issues)
• You are in the later stage of perimenopause and want to chart how close you are to menopause
• You are considering hormone therapy or specific interventions 

Alternatively, you can use a journal or app to log the dates, length, flow, and symptom severity over several menstrual cycles. Having more data points can often yield more insight than a one-time lab read-out.

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Fertility & Contraception 

Yes, you can still get pregnant during perimenopause–until you have 12 consecutive months with no period, you are still fertile, though the closer you get to menopause, the less likely it will happen.

If you don’t want to become pregnant, you need to continue contraception during perimenopause. Some opt for hormonal contraception, while others choose to track their cycle or basal metabolic rate. Just keep in mind that during perimenopause, your cycle is incredibly unpredictable, so accurate tracking can be challenging.

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Perimenopause Treatment Options

The symptoms of perimenopause can throw a wrench into your everyday life; it’s hard to ignore insomnia, mood swings, and brain fog. The thing is, unlike other hormonal conditions, menopause is a part of every woman’s life, and there’s no “root cause,” so most treatments are aimed at symptom management. 

The good news is, after menopause, most symptoms taper off drastically. You just have to find things that help in the meantime.

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Hormone Therapy

Hormonal therapy, or HRT/MHT, is the gold standard for menopause treatment. Synthetic estrogen and/or progesterone are delivered via patches, pills, sprays or a ring to counter fluctuating hormone levels. 

In the last 20+ years, MHT got a bad rep for some older research, but now experts and researchers say that the safety of MHT depends on the types of hormones, your age, and other risk factors (i.e., a family history of breast cancer, etc). It’s essential to work with a doctor to fully understand the risks vs benefits in your unique situation.

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Natural Remedies For Menopause Symptoms & Perimenopause Supplements

If you’re earlier in the menopause transition or just don’t want to use synthetic estrogen, there’s some evidence that specific nutrients or supplements can help:

• Omega-3 fatty acids support heart and brain health, reduce inflammation, and may ease hot flashes and depression during menopause.
• Magnesium plays a crucial role in over 300 bodily processes, helping to regulate energy and blood sugar levels, and supporting better sleep and reduced fatigue.
• Choline is essential for metabolism, cognition, and nervous system health, and may help counter brain fog linked to declining estrogen levels. Allara’s Hormone Equilibrium includes choline and Vitamin D, both of which are related to hormonal balancing. 
• Vitamin D and Calcium are vital for bone strength, with deficiency during menopause linked to an increased risk of osteoporosis.
• Collagen peptides decline with age, and replenishing them may support skin, hair, nails, bones, and joint health.

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Incorporating Diet & Lifestyle Changes

Don’t rely solely on supplements or medication; there are several wellness habits you can adopt that can support you during this transition:

• Move your body: strength training + cardio help with mood, bone health, metabolism
• Whole foods, fiber, healthy fats: focus on anti-inflammatory, nutrient-dense eating
• Stress management: mindfulness, breathing, therapy
• Limit triggers: caffeine, alcohol, spicy foods may worsen hot flashes

These changes often improve symptoms or reduce the dose of medical interventions you need.

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When to Seek a Doctor

While the menopausal transition is a natural part of life, not all symptoms are “just perimenopause.” If you have any of the following, seek medical attention ASAP:

• Bleeding so heavy you soak through pads/tampons every 1–2 hours, with large clots, or bleeding that lasts far longer than usual
• Bleeding after sex
• Sudden, drastic changes in symptoms
• Unintended weight loss, pain, fevers, abnormal labs

These may signal an underlying condition, such as fibroids, polyps, endometrial pathology, or thyroid disease.

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FAQs

Q: What are the first signs of perimenopause, and how do fluctuating hormones cause them?

A: Irregular periods, hot flashes, mood changes, and sleep issues are common, driven by unpredictable levels of estrogen and progesterone.

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Q: Should I get a hormone test to confirm perimenopause?

A: You can, but hormone levels fluctuate too much for one test for confirmation. Doctors usually rely on age, cycles, and symptoms for a diagnosis.

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Q: How do estrogen and progesterone levels change during perimenopause?

A: Estrogen ebbs and flows, while progesterone steadily drops with less frequent ovulation.

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Q: Can you still get pregnant during perimenopause?

A: Yes, you can, so you should use a contraception method if you do not want to become pregnant.

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Q: How can I manage hormonal changes in perimenopause?

A: Better sleep, exercise, and nutrition help, and you may choose natural supplements, non-hormonal medication or MHT when appropriate.

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Navigating the Hormonal Peaks & Valleys of Perimenopause

Perimenopause is a transition, not a disease or condition, but that doesn’t mean you have to just deal with the symptoms.

While lifestyle changes are a strong first step, you may also benefit from non-hormonal or hormonal therapies or the right combination of nutrients and supplements. The “right” approach to symptom management may even evolve as your needs change over time, so keep a log of your experience and regularly check in with yourself.

What if it's not menopause? One in three women lives with a chronic hormonal condition, and what you’re experiencing could be related to another imbalance. If you’re unsure, don’t suffer in silence; make an appointment with an Allara specialist who can help you get real answers and a plan tailored to you.

Whether you’re looking to regulate your cycle, manage weight, or feel more in sync with your body, we’re here to help.