02/03/2026
Perimenopause often starts years before periods stop, which is why so many women are confused by what they’re feeling.
I see this constantly in practice - patients come in saying, “My labs are normal,” or “I’m still getting my period, so I didn’t think this could be hormonal.”
But perimenopause isn’t defined by when periods end. It’s defined by hormonal fluctuation and imbalance, not absence.
Estrogen fluctuations commonly show up as brain fog, word-finding difficulty, and changes in focus.
Progesterone changes often affect sleep quality, anxiety, and irritability, especially in the second half of the cycle.
Testosterone plays a role in libido, motivation, confidence, and overall vitality, and declines can be subtle but impactful.
And for many women, perimenopause also comes with metabolic shifts - increased insulin resistance, cravings, weight gain, and “food noise” which is where metabolic support, including GLP-1–based therapies, may be appropriate for the right patient.
This is why perimenopause rarely has a single solution.
