Your Hormones in Perimenopause: What’s Really Happening Behind the Symptoms
Something feels off.
You’re gaining weight—even though you’re eating the same.
You wake up sweating at 3 a.m.
Your brain feels foggy by 3 p.m.
And your motivation? Gone.
If this sounds familiar, you might be in perimenopause—even if no one ever told you what that really means.
The truth is: most of us were never taught how our hormones work, let alone what happens when they start shifting. That lack of knowledge leaves women feeling confused, dismissed, and often like they’re “doing something wrong.”
Here’s the reality: your hormones are changing. And once you understand how each of them works, the symptoms start to make more sense.
What Is Perimenopause (and How Is It Different from Menopause)?
Perimenopause is the transition stage leading up to menopause. It usually starts in your early-to-mid 40s, but some women notice changes as early as their late 30s.
Menopause = when you’ve gone 12 full months without a period.
Perimenopause = the years before that, when your hormones are swinging up and down like a rollercoaster.
Some days you feel fine. Other days, your body feels foreign. That unpredictability? That’s perimenopause.
The Three Hormones That Run the Show
Estrogen: The Balancer
Estrogen is like the conductor of an orchestra—it coordinates over 400 functions in your body. It affects your brain, bones, skin, heart, metabolism, and mood.
During perimenopause, estrogen doesn’t just decline slowly. It swings up and down unpredictably.
On high-estrogen days → you may feel bloated, moody, anxious, or irritable.
On low-estrogen days → you may feel flat, tired, foggy, or struggle to sleep.
What you might notice: hot flashes, night sweats, belly weight gain, mood swings, brain fog, vaginal dryness, or even joint pain.
Progesterone: The Calmer
Progesterone is your body’s natural calming hormone. It helps you sleep, soothes anxiety, and balances estrogen.
Here’s the kicker: progesterone usually drops earlier and more steadily than estrogen. That means estrogen gets “louder” and more dominant—even while it’s fluctuating.
What you might notice: heavier or irregular periods, poor sleep, more anxiety, bloating, and water retention.
If you feel like your body lost its built-in sense of calm, progesterone is often the reason.
Testosterone: The Forgotten Hormone
Yes, women produce testosterone too! Though in smaller amounts than men, it’s powerful for women’s health. It fuels muscle strength, energy, sexual desire, and even your sense of drive and confidence.
As testosterone gradually declines, you may feel:
Less motivated.
Weaker or more fatigued in workouts.
Lower sexual desire.
It’s subtle, but when this hormone drops, it can feel like your spark has dimmed.
How Hormonal Shifts Show Up in Real Life
Here’s how these hormone changes connect to the everyday struggles women notice in perimenopause:
Weight Gain (especially around the belly): Estrogen shifts + insulin resistance make your body more likely to store fat in the midsection—even if your diet hasn’t changed.
Hot Flashes & Night Sweats: Estrogen dips confuse your body’s thermostat, so it thinks you’re overheating when you’re not.
Sleep Issues: With less progesterone, staying asleep gets harder. Add in night sweats and you’re up at 3 a.m. wide awake.
Fatigue: This isn’t just “tired.” It’s bone-deep exhaustion from disrupted sleep, blood sugar swings, and hormonal chaos.
Mood Swings/Anxiety: Less estrogen and progesterone means less serotonin and GABA (your brain’s calming chemicals). Hello, emotional rollercoaster.
Brain Fog: Forgetting names, losing your train of thought, or rereading the same line three times? That’s estrogen affecting your brain’s neurotransmitters.
Libido & Vaginal Changes: Less estrogen + testosterone can mean dryness, discomfort, and lower interest in intimacy.
Joint Pain: Estrogen normally protects tissues and joints. As it drops, stiffness and aches creep in.
Why Haven’t You Heard This Before?
Because most healthcare providers get very little training in perimenopause or menopause.
Some dismiss symptoms as “just stress” or “just aging.”
Others say you’re “too young” if you’re under 45—even though many women start noticing changes in their late 30s.
And lab tests? They can rule out thyroid or other issues, but hormone levels fluctuate so much that one blood draw can’t give the full picture.
👉 The most important diagnostic tool isn’t just labs—it’s your symptoms and your story.
What to Do Next
You don’t need to overhaul your life overnight—but you do need to start paying attention.
Track your symptoms. Write down what you notice with sleep, mood, cycles, energy, and weight. Patterns matter.
Talk to your doctor. Bring your notes. Ask about thyroid, insulin resistance, and hormone changes. Don’t settle for “you’re fine.”
Advocate for yourself. If one provider dismisses you, it’s okay to find another who listens.
💡 To make this easier, I created the Perimenopause Action Plan—a free tool that gives you:
A simple symptom tracker.
Conversation starters to use at your next appointment.
A way to feel more confident and prepared when you speak to your doctor.
Want Ongoing Support?
Perimenopause doesn’t come with a manual—but I’m doing my best to create one for you.
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Final Thought
Perimenopause isn’t just about hot flashes—it’s a whole-body hormonal shift. Once you understand what’s happening with estrogen, progesterone, and testosterone, the symptoms stop feeling random and start making sense.
Knowledge is power. When you know your body, you can speak up, ask better questions, and make changes that actually help you feel like yourself again.
Hi, I’m Dr. Jaime Lynne
A women’s health advocate and educator passionate about helping women navigate the confusing and often overlooked journey of perimenopause. Through my work and resources, I empower women to recognize their symptoms, speak up, and get the care they deserve.