If you’ve recently found yourself crying over a toothpaste commercial, forgetting why you walked into a room, or lying awake at 3 a.m. even though you’re utterly exhausted—welcome to the club. You’re not going crazy. You might just be in perimenopause.
What Exactly Is Perimenopause?
Perimenopause is the hormonal rollercoaster that leads up to menopause—the time when your ovaries begin to slow down, but haven’t stopped producing hormones entirely. It usually starts in your late 30s to early 40s, though for some women it can begin earlier (and for others, much later). It can last years—yes, years—before you reach menopause, which is defined as 12 full months without a period.
Common Symptoms (aka, Why You Feel Like You’re Losing It)
The symptoms of perimenopause can be sneaky, wide-ranging, and frustratingly inconsistent. You might have a few mild changes, or feel like a walking hormonal mystery. Common culprits include:
- Irregular periods (shorter, longer, heavier, lighter… it’s a hormonal free-for-all)
- Mood swings or anxiety
- Brain fog and forgetfulness
- Sleep disturbances or full-blown insomnia
- Hot flashes or night sweats
- Fatigue and low energy
- Decreased libido
- Vaginal dryness
- Weight changes, especially around the middle
It’s not all in your head—and you’re not alone.
Why It Gets Dismissed
Perimenopause is wildly underdiagnosed. Many women are told they’re “too young” or it’s just stress, parenting, or life. And yes, those things can contribute—but hormonal changes during this phase are real, measurable, and absolutely affect your quality of life.
Unfortunately, medical training around perimenopause is minimal for most doctors, which means many women suffer unnecessarily or are offered antidepressants or sleeping pills instead of actual hormone management.
What You Can Do
Here’s the good news: help exists. You don’t have to grit your teeth and power through.
Start by tracking your symptoms—write them down, even if they seem random. Then talk to a clinician who’s trained in menopause and midlife hormone care (hi, that’s me!).
Treatment options may include:
- Hormone therapy (yes, it’s safe and effective when done right)
- Non-hormonal medications for certain symptoms
- Lifestyle shifts to support sleep, nutrition, and stress
- Education so you understand what’s happening and feel empowered
The Bottom Line: Perimenopause is real, it’s disruptive, and no—you’re not losing your mind. But you deserve better answers and expert care tailored to this season of life.
You’re not broken. You’re in transition—and with the right support, you can feel like yourself again.
👉 If you’re nodding along to every symptom in this post—it’s time to stop wondering and start getting answers. Book your 15-minute call today and let’s figure it out together.
Dr. Aoife O’Sullivan is a family physician, board certified by the American Board of Family Physicians and a menopause specialist, certified by the North American Menopause Society, dedicated to empowering women through their midlife health journeys. She is the founder of Portland Menopause Doc, co-founder of the Portland Menopause Collective, podcaster on The Dusty Muffins, and an expert speaker, frequent podcast guest and active contributor to midlife women’s health research.
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