The term “perimenopause” sometimes gets thrown around when a woman isn’t feeling like herself. In general, it means that a woman’s hormones are imbalanced. Depending on her age and symptoms, a woman may be told she’s experiencing perimenopause. But, sometimes it’s perimenopause and sometimes it isn’t.
Here’s the thing— what may appear to be perimenopausal symptoms may occur due to other health conditions, such as adrenal fatigue or thyroid imbalance. With so many demands and stressors in our daily lives, it may not be clear right away what exactly is causing this hormonal imbalance and the solution must address the underlying condition.
It’s important to do blood tests and confirm all hormone levels, plus assess adrenal function to determine the causes of imbalance and restore balance. Stress and other conditions such as thyroid disorders can also impact hormone levels.
That being said, it’s helpful to understand perimenopause symptoms, plus the differences between perimenopause vs. menopause.
Below I explain the stages of menopause. I also share information on treatment options as well as some natural remedies for perimenopause that you can do on your own to help make your symptoms more manageable. The “change of life,” as it’s often called, doesn’t have to be miserable!
What Is Perimenopause?
Perimenopause means a woman’s body is beginning to transition to menopause. Menopause is the end of a woman’s reproductive years.
During perimenopause, a woman’s hormones begin to become unbalanced as her body moves toward menopause. No one hormone is responsible for this shift and the accompanying symptoms. Rather there is a dance taking place, primarily among estrogens (estradiol, estrone, and estriol), progesterone, and testosterone.
Our endocrine system is all connected! Think of this like a scale—if the scale tips to one side, it raises the other, right? Our body will always attempt to balance out the scales, and this is where these dreaded perimenopause symptoms arise from.
Most people associate the term perimenopause with declining estrogen levels, but in actuality, I find that the first hormone to decrease is typically progesterone. This results in a state of “estrogen dominance” as the estrogen levels are higher in proportion than progesterone. Symptoms experienced are commonly excessive bleeding (spotting, heavy periods, inconsistent cycle), weight gain, irritability, insomnia, and anxiety.
Contrary to the belief that hot flashes are a sign of low estrogen, I do occasionally see hot flashes if the estrogens are storing in the body excessively as well, especially if progesterone is fluctuating.
Why does progesterone drop first? There are many possible reasons, but I have seen a strong correlation between adrenal fatigue and early onset of perimenopause. This is because cortisol and progesterone can convert into each other. So, if cortisol is inconsistent, as in adrenal fatigue, progesterone will be as well (that darn scale!).
When does perimenopause start?
Most women begin to move toward perimenopause around age 40, usually beginning in their early to mid-40s. Sometimes it can start earlier. Each woman is different, but the average age of perimenopause is about 45 years old.
The average duration of perimenopause is three to four years, but it can be as little as a few months to up to a decade.
Stages of Perimenopause and Menopause
The time before menopause—including both perimenopause and before it begins—is known as premenopause. An easy way to differentiate between premenopause and perimenopause is by remembering that “pre-” means before and “peri-” means around.
Although it’s not officially a medical term, perimenopause is recognized as the time period when a woman can still become pregnant because she is still ovulating, but her body is beginning to transition to menopause.
At this time, a woman begins to experience a lot of hormonal changes, which can cause a variety of perimenopausal symptoms, including irregular periods.
Keep reading because I discuss many more perimenopause signs and symptoms in more detail in the next section.
The official menopause definition means that a woman has not had a period for 12 months (and doesn’t have a medical condition that might influence her cycle) and her follicle-stimulating hormone (FSH) levels are consistently 30 mIU/mL or higher. FSH is the hormone that stimulates ovarian follicles, helping to lead to the release of an egg(s) each cycle.
This means that any situation other than confirmation of these two factors, such as low estrogen levels, and a variety of symptoms, are still considered perimenopause and are not always the first signs of menopause. When a woman has reached menopause, she can no longer become pregnant. [1, 2]
The average age of menopause is 51 years old.  Some of the menopause symptoms that are most common include hot flashes and night sweats.
Note that menopause and the symptoms of menopause also occur as a result of a hysterectomy.
What Are the Symptoms of Perimenopause?
Below I’ve included many of the common symptoms of perimenopause.
1. Hot flashes
Hot flashes are not always due to low estrogen levels! Hot flashes occur because the balance between estrogen and progesterone is impacted. A hot flash means you suddenly feel a wave of intense heat, usually originating around the face or chest area. During perimenopause, when progesterone is changing, these flashes are most commonly felt at night.
2. Trouble sleeping
It’s estimated that roughly 40 percent of perimenopausal women experience disturbed sleep. Think about it—if cortisol and progesterone balance is changing, you will have trouble falling asleep from the elevated cortisol levels, and difficulty staying asleep because of lack of progesterone, which calms our body and allows for rest. This may also be aggravated by nighttime hot flashes and perimenopause night sweats.
3. Erratic uterine bleeding
Hormonal fluctuations may cause heavier or lighter menstrual bleeding or other changes in a woman’s menstrual cycle. Perimenopausal bleeding patterns can vary and light spotting during perimenopause is common.
During perimenopause missed periods are also common. In fact, because perimenopausal bleeding can be so irregular—yet it’s still possible to get pregnant— sometimes a woman may not be sure if a missed period is because she’s going through perimenopause or pregnant!
On the other hand, while going through perimenopause, long periods and/or heavy periods can often occur. This is especially common if estrogens have yet to drop, or if they are storing in the body due to stress or other underlying conditions that cause estrogen dominance.
Be sure to contact your healthcare provider if you experience any unusual uterine bleeding. Causes of abnormal uterine bleeding can also be due to other medical conditions, including fibroids, ovarian cysts, or cancer. It is always a good idea to rule out significant pathology before assuming perimenopause.
4. Mood changes
This is likely my number one concern amongst women who are entering perimenopause. Perimenopause mood swings due to hormonal changes are prompting an increased use of antidepressants and antianxiety medications, not to mention causing strain on the family relationships. 
A correlation between perimenopause and anxiety is common and perimenopausal depression often occurs during this time as well. This goes hand in hand with the symptoms of adrenal fatigue, where cortisol levels are fluctuating, causing moments of panic and resultant depressions.
This is no coincidence — remember that progesterone levels are balancing with cortisol — and those under stress will likely have an earlier presentation of perimenopausal symptoms. Not to mention how these highs and lows impact sleep, which results in feeling run down and depressed.
5. Brain fog
Some perimenopausal women experience short-term memory problems and trouble concentrating. This “fuzzy” thinking is known as brain fog.
Other symptoms of perimenopause may include weight gain, bloating, fatigue, headaches, nausea, and breast tenderness.
Bioidentical Hormone Replacement Therapy (BHRT)
Your healthcare provider may recommend hormone therapy to help manage your perimenopausal symptoms.
Conventional hormone replacement therapy (cHRT) has experienced a lot of controversy due to associations with an increased risk of breast and endometrial cancer, and blood clots. cHRT is typically derived from chemically created hormones, some of which are made from equine estrogens.
However, a plant-based alternative known as bioidentical hormone replacement therapy (BHRT) can also provide relief. Bioidentical hormones are synthesized from yam and soy and are structurally similar to the hormones produced in the human body, hence the term “bioidentical.” 
But before you reach for any hormone therapy during perimenopause, remember that each woman is different, so hormone therapy is often as much an art as it is a science.
If you’re experiencing perimenopausal symptoms, be sure that your healthcare provider checks your stress response as well as your hormone levels to ensure that you are receiving a comprehensive evaluation before making any decisions regarding hormone therapy.
Oftentimes, women are given estrogen supplementation based solely off FSH levels. In my opinion, this is a mistake! Unless all three estrogens (estrone, estradiol, and estriol) are tested low, it is not worth the risk of adding estrogen, even if it is bioidentical in origin.
Consider simply adding progesterone in the evening — especially if you are noticing sleep irregularities, increased agitation, anxiety, poor stress response, and indifference (mild depression). Adding estrogen (including the birth control pill for perimenopause) to someone who has adequate estrogen levels can cause unwanted side effects and significant health risks.
10 Natural Remedies for Perimenopause
As I’ve described (and as you may already know from personal experience) perimenopause can be an uncomfortable and difficult time in a woman’s life, both physically and emotionally. But there are steps you can take to make it less difficult.
Here are a few tips for self-care and natural remedies for perimenopause to help you take care of yourself during perimenopause (and beyond!):
1. Eat a healthy, plant-based diet. You don’t have to stop eating meat altogether. Just eat mostly vegetables and fruits. If you’re wondering how to lose weight during perimenopause, a healthy diet is a good place to start.
A healthy, balanced diet, plus getting enough exercise each day, can also help boost cardiovascular health and help prevent heart disease, which becomes a greater risk for women as they age. 
2. Drink plenty of water. Staying hydrated will help your body function properly.
3. Get enough rest. Try some natural sleep and relaxation remedies such as lavender essential oil, chamomile tea, or a valerian tincture.
4. Take time for hobbies and interest you enjoy. Making time for things you like to do can help to relieve stress and boost your spirits.
5. Exercise daily. This can be as simple as taking a walk. Losing weight during perimenopause can be a challenge but eating healthy foods and getting some aerobic exercise each day can help. Your body is changing, and it needs more support! Staying active can be key to minimizing symptoms.
6. Spend time with people and pets you love.
7. Try yoga and meditation to relax and unwind.
8. You may want to try some herbal remedies. Some of the best perimenopause supplements include dong quai, red clover, chasteberry (also known as chastetree and vitex), and black cohosh.
Note that women with hemophilia or fibroids or who are taking blood thinners such as warfarin (Coumadin) should not take dong quai. [9, 10, 11] Research has shown that black cohosh specifically can help with reducing hot flashes in those with low estrogen levels. 
Wild yam (Dioscorea villosa) is also a remedy often used to relieve menopausal symptoms. Yam is the primary base in bio-identical hormones.
A study on the use of bioidentical hormones showed improvement of mental symptoms in 90 percent of subjects, loss of weight in 60 percent, and the side effects compared to traditional hormone therapy (equine estrogens/medroxyprogesterone) were not reported. 
Another study showed improvement in symptoms, improved cardiovascular health, lowering of inflammation, and there were no adverse effects as compared to traditional therapies. 
In addition, yam-based hormones have been shown to combat osteoarthritis (a common concern of perimenopausal women) and have been found to actually slow the progression of estrogen-based cancers. [15, 16]
These herbal remedies typically do not cause side effects if used correctly among healthy women. However, check with your healthcare provider first before taking herbal remedies or trying a new dietary supplement.
9. Get plenty of vitamin D, one of the most important vitamins for perimenopause, both from spending some time outside each day and supplementing if necessary. Vitamin D, along with getting enough calcium in your diet and exercising regularly, helps to prevent osteoporosis. 
10. Keep a journal. Writing about your day and your feelings can help you process your emotions and relieve stress.
- Perimenopause is the time during a woman’s life when her body begins to transition from her reproductive years to menopause, when she can no longer get pregnant.
- Perimenopause is different for each woman, but it usually begins around the mid-40s.
- The hormonal shifts that occur during perimenopause can cause many different symptoms.
- Eating a healthy diet, getting enough exercise, and making time for self-care care important, natural ways to help make perimenopause more comfortable.