Perimenopause is the time in a woman’s life prior to entering menopause. Most people are familiar with menopause, which is when the ovaries stop producing hormones and women stop their periods. There are many options to deal with menopause (which is an entirely different podcast and blog). But perimenopause is a completely different animal compared to menopause. Perimenopause is usually between the ages of 40-50. I have seen some women enter perimenopause in their late 30s and well as in their early 50’s. But on average, perimenopause usually hits between the 40 -50. It can last for years. Which is unfortunate because the symptoms can really affect the quality of life. Many women have come to see me and tell me how their hormones are ruining their life. They have been to their general practitioners, gynecologists, PCP only to be told there is nothing wrong. These women end up feeling disregarded and frustrated because they are not finding answers or help. This is because perimenopause is not often discussed. Like I mentioned, everyone is familiar with menopause. But women in perimenopause are dismissed because many do not realize what perimenopause is. When I talk to these women and explain to them, yes it is your hormones causing your unwanted symptoms. They are stunned to find out there is a name for what they are experiencing. It’s called perimenopause.
So let’s get to it! Learn about the top five most common symptoms of perimenopause.
(I tried to put these in order of the most common. But honestly, these five symptoms are all equally common)
Women in perimenopause are often repeating over and over how tired they are. They are tired of complaining about how tired they are. I’ve had many patients remark on their family members (mainly kids, because they can be so honest), tell them they are repeating over and over how tired they feel.
But it is a different kind of tiredness. It’s more of a mental fatigue. I will ask my perimenopausal patients, ‘if I were to make you take a 3 mile hike with me right now, could you do it’? Which they reply, they could. How can you hike 3 miles and say you’re tired? It is because it is more of a mental fatigue. Yes, they could do the work/activity physically, but mentally they are just not into it.
Speaking of just ‘not into it’. Perimenopausal women often say their libido has not only left the building, it left the stratosphere. There are no physical issues going on here like you would see in menopause. In menopause when the estrogen has dropped dramatically, that can cause vaginal dryness, vaginal atrophy and pain with intercourse. In perimenopause, the estrogen has not declined that dramatically, so the libido issue is more of a mental one. Sex is just not on the brain. Perimenopausal women will say they are not interested or even thinking about sex. A hot-human can strut across your path, and it was like you didn’t even notice them.
Weight gain is a common complaint of both perimenopause and menopause. Women in their 40’s will often comment that it felt like they gained 15 pounds overnight. And the sad fact is that this weight gain was not due to any changes in their diet or lifestyle.
This is a very common issue in perimenopausal women. They have no trouble falling asleep. Your head hits the pillow and you are out in minutes, seconds even. But 3-4 hours later, you are up like it’s morning. And it can take hours to fall back to sleep. And of course by the time you do fall back to sleep, you need to wake up shortly. By morning, you are so tired.
As mentioned earlier, in perimenopause the estrogen has not dropped that much (as you see in menopause). But the progesterone has dived in perimenopause. This can cause period changes. It can cause days and days of spotting. It can cause heavier periods, which then can cause low iron (anemia). And/or it can cause two periods in one month, or changes in cycle length. Which of course makes it hard to predict when you next period will start, so make sure to keep some of those menstrual products around (everywhere…car(s), purse(s), pockets, even your grocery bags).
Other:
I have to say, there are more than just 5 symptoms of perimenopause. So I wanted to include some of the other changes that women might not attribute to their hormones when in perimenopause.
Hair changes: The change in hormones in perimenopause can cause your hair to get more curly (in my case, frizzy). It also makes your hair more vulnerable to damage (no more cheap drugstore shampoo/conditioner, here comes super expensive salon products). It can make your hair thinner and increase the shedding phase of hair.
Skin changes:
Why are we breaking out on your 40’s? The change in hormones, mainly the drop in progesterone levels can cause the androgens (testosterone and DHEA) to become the leaders of the hormonal pack. So it can cause more acne, pimples, and even cystic acne prior to your period.
Short term memory, Forgetful:
No, it’s not dementia. In perimenopause we can become forgetful, absentminded, and seriously feel a little ‘out to lunch.’ Post it notes, lists, alarms on your phone become the norm (they are great helper tools to be honest). Even people, mainly family, because they have no manners (my own perimenopause head rearing) will remark, ‘you just asked that question!’ Short term memory can fly out the window. Not the long term memory. You can easily remember the dress you wore to a wedding 15 years ago (and what size it was, sigh). It is the short term memory that just won’t stick.
Mood Changes:
I don’t like to blame mood on hormones. There are so many factors in our lives that can drop a mood or change our moods. So I don’t like hearing others remark, ‘oh you’re in a mood, are you pms-ing, getting your period?” But between you and me, hormone changes in perimenopause can make us more irritable. In perimenopause when the progesterone drops and the estrogen and androgens are left in charge. Plus cortisol is not balanced, that can really cause irritability, or patience is short. Sure, not sleeping well and being tired can make you crabby, but the drop in progesterone can also wreck a mood.
I really could go on and on about the symptoms of perimenopause. Of course that doesn’t mean that perimenopause is really that horrible. I wanted to just show you that the reason you might be feeling the way you are, is because of your hormones. In fact, perimenopause is a great time of life. Trust me, I would not want to be 20 again (using plastic cutlery with only campbells soup in my cupboard). I really like my life right now at 49. But these symptoms can be helped and your hormones can be balanced.
If this resonated with you or you feel like you are in perimenopause, we have other blogs and podcasts about balancing your hormones.
Have questions? All questions are welcome. Just click on the link: Ask the Dr
All content found in this blog, including: text, images, audio, video or other formats were created for educational purposes only. The purpose of this website and blog is to promote consumer/public understanding and general knowledge of various health topics. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concern regarding this topic then it is time to find a new doctor.
Other Related Episodes:
Episode 116 How Do I Stop Weight Gain During Perimenopause?
Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
Protecting your `heart health` is crucial, especially during `menopause`, when risks can increase. In this `women’s health` episode, Dr. Valorie Davidson and Dr. Robert Maki share essential `health tips` and insights into how `hormones` impact cardiovascular well-being. Learn about important lab tests and supplements to safeguard your heart. You’ll learn: ● Why heart disease in women is often a “silent” problem until it’s serious ● The difference between general “heart disease” and atherosclerosis ● Coronary calcium scores: what they are, what the numbers mean, and when to consider one ● Why total cholesterol alone is useless (and often scary for no reason) ● The key markers that matter more: ○ Triglycerides ○ HDL ○ Triglyceride HDL ratio (and why 1.5 is a powerful insulin-resistance clue) ○ ApoB ○ Lp(a) ○ hs-CRP (cardio CRP) ○ Blood pressure & insulin resistance ● How estrogen decline in perimenopause & menopause affects cholesterol, visceral fat, inflammation, and heart risk ● How rhythmic dosing and thoughtfully prescribed HRT can support metabolic and cardiovascular health ● Visceral fat vs “roly poly” fat: why where you store fat matters more than the scale ● Foundational supplements for heart protection (education only, not personal medical advice): ○ Omega3s (EPA/DHA) ○ Vitamin D 2 ○ CoQ10 ○ Curcumin/turmeric ○ Magnesium Red yeast rice, bergamot, berberine & more metabolic support ○ Nitric oxide support (beet root, citrulline, etc.) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Can You Do Rhythmic Dosing After a Hysterectomy? Short answer: Yes, but there are some other factors to take into consideration to make sure someone is a good candidate. In this episode, Dr. Valorie and Dr. Maki explain how rhythmic dosing works without a uterus, why it can be an excellent option after total hysterectomy (with oophorectomy) or surgical menopause, and when a simpler static approach might be better. We cover candidates, myths (like “no uterus = no progesterone”), brain and bone benefits, and how to personalize dosing for real-life outcomes—sleep, mood, cognition, libido, and long-term bone strength. What you’ll learn ● Rhythmic dosing 101 (mimicking a 26–28-day cycle) ● Hysterectomy types: uterus-only vs. total (with ovary removal) ● Why rhythmic dosing can still help—even without a period ● Customizing estrogen + progesterone to symptoms and goals ● Brain fog & sleep: why declining estradiol hits cognition ● Bone density protection in the first 5–7 years post-menopause ● Endometriosis & fibroids: nuance, not one-size-fits-all ● When rhythmic dosing may not be ideal (e.g., 60 and off HRT for many years) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Confused by your DEXA scan results? Not sure if your T-score is “normal,” “osteopenia,” or “osteoporosis”or what to actually do about it? In this episode, Dr. Valorie Davidson and Dr. Robert Maki walk through three real viewer examples to show You exactly how to interpret bone density scores in your 50s and beyond. You’ll learn: ● How to read your DEXA scan: T-score vs Z-score in plain English ● The cutoffs: ○ 0 to -0.9 → normal bone density ○ -1.0 to -2.4 → osteopenia ○ ≤ -2.5 → osteoporosis ● Why two women in their early 50s can have completely different bone density ● What a T-score of -3.7 or -3.8 really means—and whether it’s reversible ● How surgical menopause, long-term steroids, vitamin D deficiency, RA, and genetics impact bone health ● Why your 50s are really about protecting your 70s (fracture risk, independence, and longevity) ● How weight loss, GLP-1 meds, and low muscle mass affect bones ● Practical foundations to protect and improve bone density: ○ Smart movement: walking, weighted vests, strength & resistance training ○ Protein targets & why bone = “calcified protein” ○ Stress, cortisol & steroid impact on bone loss ○ Vitamin D + K2, food-based calcium & targeted bone support formulas ○ Where HRT—and rhythmic dosing—fit into a long-term bone strategy If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Many women confuse cycling static HRT with rhythmic dosing, but they’re not the same thing. In this episode, Dr. Valorie Davidson and Dr. Robert Maki from Progress Your Health break down the difference between the two, why it matters for your safety, and how to do hormone therapy the right way. In this video, you’ll learn: ● What “rhythmic dosing” actually means ● Why cycling your static HRT is not rhythmic dosing ● How improper dosing can impact mood, energy, and breast tenderness ● The risks of trying to adjust hormones on your own ● Why rhythmic dosing must follow the body’s natural ovarian rhythm ● How men and women can use synchronized rhythmic dosing safely If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In Part 2, we go symptom-by-symptom so you can sleep through the night again. Dr. Valorie and Dr. Maki cover night sweats, frequent urination, heart palpitations, muscle cramps, headaches, itchy skin, vivid dreams, and when to suspect sleep apnea (under-recognized in women). You’ll hear practical tactics—electrolytes, targeted magnesium types, phosphatidylserine timing, glycine, L-theanine, and smart melatonin use—plus when HRT helps and how to pair data (CGM, wearables) with your sleep plan. You’ll also discover practical, science-backed fixes like: 💧 Smart electrolyte balance & targeted magnesium types 🧠 Phosphatidylserine timing for cortisol control 😴 Glycine, L-theanine, and optimal melatonin use 💊 When HRT makes sense—and how to pair it with CGM or wearable sleep data What you’ll learn ● What nighttime urination signals (estrogen & ADH, electrolytes, cortisol) ● Palpitations in midlife: estrogen link, when to see cardiology, calming strategies ● Cramps/headaches/itchy skin—common causes & quick fixes ● How/when to test for sleep apnea at home (and why it’s missed in women) ● Fine-tuning supplements & dosing; when HRT is the lever Still not sure what’s really causing your sleepless nights? Find out if you’re in the In-Between stage of perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Why midlife wrecks your sleep—and how to fix it naturally. In Part 1, Dr. Valorie and Dr. Maki unpack the hormone triad behind women’s insomnia: shifting estrogen/progesterone, cortisol dysregulation, and blood sugar/insulin resistance. You’ll learn the difference between trouble falling vs. staying asleep, how low progesterone affects GABA (hello 2–3 a.m. wake-ups), and the daily habits that reset your circadian rhythm. What you’ll learn ● The hormone triad driving midlife sleep loss ● “Vampire / Zombie / Ghoul” sleep patterns—what they mean ● Why blood sugar swings trigger nighttime cortisol spikes ● Morning fixes that help nights: protein breakfast, light exposure, movement, temperature ● Starter supplements & how to think about them: magnesium (glycinate, L-threonate), L-theanine, glycine, phosphatidylserine, melatonin If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
