Perimenopause & menopause
What is happening in your body, what you might notice, and what you can do about it.
It is not a slow decline. It is a rollercoaster.
Perimenopause is the stretch of years leading up to your final period. Your ovaries do not simply wind down — they fire erratically. Estrogen can surge to three times its usual peak, then drop sharply. Progesterone falls earlier and more steadily as ovulation becomes unpredictable.
This matters: it is the swing, not a low level, that causes most symptoms. It also explains why you can feel fine for weeks and then not fine at all. Some people describe it as a second puberty, running in reverse.
Mood and thinking often change first
The most-missed part of perimenopause: these symptoms frequently start while your periods are still regular. If you have been told your cycles look normal so this cannot be hormonal, that is not correct.
"I do not feel like myself" is a real symptom. It belongs in your visit, not filed away as stress.
They peak in late perimenopause, around age 49, and last a median of 7.4 years — continuing about 4.5 years past your final period. They tend to last longer if they start early in the transition, and with a higher BMI or a smoking history.
Testing, treatment, and what comes next
PerimenopauseThere is no blood test for perimenopause
Hormone levels swing so much day to day that one result cannot confirm or rule it out. The diagnosis is made by listening to your story.
What labs are actually for
To check look-alikes such as thyroid disease or low iron, and to gauge your risk ahead. It is often everything at once.
Your options — there are more than you may have been told
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A window, not just a phase
The years around your final period are when bone, heart, and brain decisions carry the most weight.
General education, not medical advice for your specific situation. Sources: The Menopause Society; Harlow et al., Menopause 2012; Avis et al., JAMA Intern Med 2015; Levy & Simon, Obstet Gynecol 2024.