Understanding Perimenopause: The Often Overlooked Journey
by Jessica Anne Pressler, LCSW
When conversations about women's hormonal health arise, they typically center around menopause or post-menopause. Yet there's a crucial phase that receives far less attention despite affecting millions of women worldwide: perimenopause. This transitional period, which can last many years, deserves our focus and understanding. That's why this blog is dedicated to shedding light on perimenopause and providing the comprehensive information women need to navigate this important life stage.
I dedicate this blog to Dr. Mary Claire Haver, whose work has revolutionized how we understand and discuss menopause and perimenopause. After listening to her enlightening podcast interview with Mel Robbins, I was deeply impressed by her evidence-based approach and dedication to women's health and did a deep dive into her work.
Dr. Haver is the author of multiple groundbreaking books: "The Galveston Diet," "The New Menopause: Navigating Your Path Through Hormonal Changes with Purpose, Power and Facts," and her upcoming book "The New Perimenopause," available in spring 2026. As a board-certified OB/GYN, Menopause Society certified practitioner, and #1 New York Times bestselling author, Dr. Haver has become a trusted voice for millions of women seeking answers about their hormonal health.
The Silent Struggle: Years of Misunderstood Suffering
For too many years, countless women have endured a lonely and confusing journey through perimenopause, often suffering in silence without understanding why their bodies and minds felt so different. Imagine experiencing brain fog so severe you question your own competence, mood swings that feel completely foreign to your normal temperament, or physical symptoms that seem unrelated but somehow feel connected—all while being told by healthcare providers that "it's just stress" or "it's all in your head."
Until very recently, much of society—including many within the medical community—failed to recognize the profound impact of hormonal changes during perimenopause. Women spent years seeking answers, visiting multiple doctors, receiving partial diagnoses, or worse, being dismissed entirely. They were often prescribed antidepressants for mood changes that were actually hormonal, told their fatigue was due to "getting older," or advised that their weight gain was simply a lack of willpower. Many women began to doubt themselves, wondering if they were losing their minds or if this was just their "new normal."
The isolation was particularly painful. Without widespread awareness or open conversations about perimenopause, women often felt they were the only ones experiencing these changes. They might have attributed their symptoms to personal failings, poor lifestyle choices, or unavoidable aspects of aging, never realizing that millions of other women were going through the exact same hormonal upheaval.
Dr. Haver's personal experience reflects this broader struggle. As she notes, "when Dr. Haver started to experience perimenopausal symptoms, she was shocked by the complete void of information and solutions available" —and this was a board-certified OB/GYN. If a medical professional specializing in women's health felt lost and unsupported, imagine how the average woman must have felt navigating this transition alone.
Thankfully, we are now in the midst of a revolution in women's health awareness. The silence is being broken, the symptoms are being validated, and women are finally getting the answers and support they deserve. But it's important to acknowledge the years of unnecessary suffering that could have been prevented with better education, awareness, and compassionate care.
Perimenopause, literally meaning "around menopause," is the transitional period leading up to menopause when a woman's body begins to produce less estrogen. This phase can begin as early as a woman's 30s but more commonly starts in the 40s. During perimenopause, hormone levels fluctuate dramatically, causing a wide range of symptoms that many women don't realize are connected to their changing hormonal status.
Unlike menopause, which is defined as the point when menstruation has stopped for 12 consecutive months, perimenopause is characterized by irregular menstrual cycles. Women may experience periods that are heavier, lighter, longer, shorter, or more frequent than usual. This unpredictability is one of the hallmarks of the perimenopausal experience.
What is the definition of Menopause? What is the definition of Perimenopause?
Perimenopause: Perimenopause is defined as the time period during which your body makes the transition to menopause. Perimenopause is marked by erratic fluctuations in estrogen and can last up to 10 years. Dr. Haver emphasizes that a woman can begin experiencing perimenopausal symptoms in her mid 30's and notes that as health care providers, we do not have a great test to diagnose perimenopause due to these daily fluctuations. Officially – the diagnosis is usually made by listening to the patient's symptoms and ruling out other causes.
Menopause: Menopause is one day in your life. It's when you hit the one-year mark after your final period. Everything after that is post-menopause, and your body will be affected in some way by that loss of estrogen. She emphasizes that menopause represents the end of ovarian function and very little sex hormone production from ovaries with the average age of menopause is about 51-52 years of age but the normal range is 45-55.
Dr. Haver's definitions are notable for their emphasis on the broader impact of hormonal changes beyond just menstrual cessation. She stresses that we have estrogen receptors in every single organ system of our body and those organs are being chronically affected by that deficit and warns against oversimplification: do not define menopause symptoms as simply being the presence or absence of a hot flash — the effects are much more profound than that.
Her approach focuses on the comprehensive health implications and the need for proactive management throughout the transition, making her definitions particularly valuable for understanding the full scope of these life stages.
Both perimenopause and menopause can bring a constellation of physical symptoms that Dr. Haver has extensively documented. The symptom list is surprisingly comprehensive and includes many that women might not initially connect to hormonal changes.
Common Physical Symptoms Include:
Hot flashes and night sweats
Irregular menstrual cycles (perimenopause) or cessation of periods (menopause)
Sleep disturbances and insomnia
Brain fog and memory issues
Joint pain and muscle aches
Weight gain, particularly around the midsection
Dry skin and hair changes
Breast tenderness
Headaches and migraines
Heart palpitations
Changes in body odor
Frozen shoulder
Dental problems
Dry or itchy eyes
Dr. Haver notes that "when Dr. Haver started to experience perimenopausal symptoms, she was shocked by the complete void of information and solutions available", which led her to dedicate her practice to filling this knowledge gap.
The Psychological Landscape
The psychological symptoms of perimenopause and menopause are equally significant and often underestimated. The dramatic fluctuations in estrogen don't just affect the body—they profoundly impact mental and emotional well-being.
Psychological and Emotional Symptoms May Include:
Mood swings and irritability
Anxiety and panic attacks
Depression
Difficulty concentrating
Memory problems
Feeling overwhelmed or "not yourself"
Decreased motivation
Changes in libido
Social withdrawal
Emotional sensitivity
The connection between hormonal changes and mental health is profound. Estrogen plays a crucial role in regulating neurotransmitters like serotonin, which affects mood, sleep, and appetite. As Dr. Haver emphasizes in her work, "Estrogen does so much more than regulate your menstrual cycle", highlighting the hormone's far-reaching effects throughout the body and mind.
The Impact on Romantic Relationships
One of the most significant yet rarely discussed aspects of perimenopause and menopause is how these hormonal changes can profoundly affect romantic relationships. Whether you're in a long-term partnership or navigating the dating world, the physical and emotional symptoms of this transition can create unexpected challenges in intimate connections.
For Women in Existing Relationships:
The hormonal fluctuations of perimenopause and menopause can strain even the strongest partnerships. Decreased libido, vaginal dryness, and painful intercourse can make physical intimacy challenging or uncomfortable, leading to avoidance and potential misunderstandings with partners. Meanwhile, mood swings, irritability, and emotional sensitivity might create tension or communication difficulties that weren't present before.
Sleep disturbances from night sweats or hormone-related insomnia can affect both partners' quality of life, while brain fog and memory issues might make a woman feel like she's not showing up as her usual self in the relationship. Partners may struggle to understand these changes, especially if they're unfamiliar with perimenopause and menopause symptoms, sometimes interpreting behavioral changes as relationship problems rather than hormonal transitions.
The key to navigating these challenges lies in open communication and education. Sharing information about what's happening hormonally can help partners understand that these changes aren't personal rejections or relationship failures, but rather natural biological processes that can be addressed and managed together.
For Women Who Are Dating:
Entering the dating world during perimenopause or menopause brings its own unique set of considerations. Physical symptoms like hot flashes, unpredictable periods, or changes in body composition might affect confidence and comfort levels in new romantic situations. The emotional volatility that can accompany hormonal changes might make it challenging to present oneself authentically or to accurately gauge compatibility with potential partners.
There's also the question of when and how to discuss these life changes with new partners. Some women worry about being perceived as "too old" or "high maintenance," while others struggle with whether to disclose their use of hormone replacement therapy or other treatments. The decreased libido that often accompanies this transition can make it difficult to build physical connections with new partners.
However, this life stage can also bring unexpected gifts to romantic relationships. Many women report feeling more confident, self-aware, and clear about what they want in relationships. The freedom from concerns about pregnancy can enhance spontaneity and intimacy. With proper support and treatment, many women find that addressing their hormonal health actually improves their overall relationship satisfaction and emotional availability.
Building Understanding and Support:
Whether in existing relationships or new ones, education is crucial. Partners who understand the science behind perimenopause and menopause are better equipped to provide support rather than take symptoms personally. Couples therapy or counseling can be invaluable during this transition, providing a safe space to discuss changes and develop strategies for maintaining intimacy and connection.
The romantic relationship doesn't have to suffer during this transition. With proper medical care, open communication, and mutual understanding, many couples find that navigating perimenopause and menopause together actually strengthens their bond and deepens their intimacy in new ways.
The Metabolic Connection
One of Dr. Haver's significant contributions to menopause understanding is her concept of what she calls the "Metabolic Syndrome of Menopause." As stated on her platform, "The Metabolic Syndrome of Menopause is real, measurable, and treatable. Naming it gives us power". This syndrome encompasses the various metabolic changes that occur during this transition, including increased insulin resistance, changes in body composition, and elevated risk for cardiovascular disease.
A Call for Better Understanding
Dr. Haver's mission aligns with a broader movement to improve women's healthcare. As she notes, "From menstruation myths to menopausal neglect, women's health has been sidelined. That ignorance creates suffering". Her work emphasizes that understanding these transitions empowers women to advocate for themselves and seek appropriate care.
The perimenopause and menopause journey doesn't have to be suffered through in silence. With proper education, lifestyle modifications, and when appropriate, medical intervention, women can navigate this transition with greater ease and maintain their quality of life.
Moving Forward with Knowledge
Dr. Haver's approach emphasizes that "Menopause is inevitable, but suffering through it is not!" This empowering message reminds us that with the right information and support, women can take charge of their health during this pivotal life stage.
Understanding perimenopause and menopause is the first step toward better health outcomes. By recognizing symptoms, understanding the underlying hormonal changes, and working with healthcare providers who are knowledgeable about these transitions, women can navigate this phase of life with confidence and vitality.
The conversation around women's hormonal health is evolving, thanks to advocates like Dr. Haver who are dedicated to providing science-backed information and breaking down the barriers that have long kept women's health concerns in the shadows. It's time we give perimenopause the attention it deserves—because every woman's journey through this transition matters.
Choose a healthcare provider who truly listens to you, validates your experiences, and creates a safe space where you feel comfortable discussing all of your symptoms openly. The right doctor will take your concerns seriously and, if they're unable to provide the specialized care you need, will connect you with practitioners who can. Remember, you have every right to seek the best possible care for yourself—you're not obligated to stay with a provider who isn't meeting your needs. Your health and well-being deserve a healthcare team that supports and advocates for you.
For more comprehensive information about perimenopause and menopause, consider reading Dr. Mary Claire Haver's "The New Menopause: Navigating Your Path Through Hormonal Changes with Purpose, Power and Facts" and look forward to her upcoming book "The New Perimenopause," available in spring 2026. Explore the resources available through her platform, The 'Pause Life, for ongoing support and evidence-based guidance.
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