Perimenopause: No Way but Through

Introduction

What’s a middle-aged guy supposed to say about Perimenopause? The truth is, no matter how much I try, I’ll never truly empathize. I don’t menstruate, I don’t have the same hormonal profile, and I won’t experience the dramatic physiological changes that more than 50% of the world’s population will face: Menopause. But I’ve committed myself to understanding this major life milestone that, for too long, has received minimal attention. Let’s not mince words—historically, society has largely ignored menopause. Recently, however, there’s been a slow awakening, and I’m ready to stand on the front lines as a champion, if you’ll have me.

What is Perimenopause?

The first misunderstanding I encounter when discussing Perimenopause is what it actually is. Aside from men’s confusion, I often find women mix up Premenopause and Perimenopause in casual conversation. This speaks to how poorly medicine and science have communicated with us non-experts in the past. Judy Blume’s character in Are You There God? It’s Me, Margaret prays to start her first period which is the start of Premenopause—a term that doesn’t exist in the book. Premenopause starts in puberty, not adulthood. Leave it to the experts to come up with confusing terminology.

The second source of confusion I see is mixing Perimenopause with Menopause itself. All those wild stories you’ve heard from the matriarchs in your life? If they weren’t silenced by shame, they’re probably about Perimenopause, not Menopause. Perimenopause can begin as early as 30 but usually starts in the mid-40s. It’s defined by changes in the menstrual cycle—periods may become longer or shorter, and menstrual flow may become heavier or lighter. These fluctuations are due to significant hormone disruption, which leads to a wide range of symptoms, not just unwanted weight gain. The key here: pregnancy is still possible. That’s what makes awareness of Perimenopause so important. A strategist prepares for all outcomes and doesn’t rely on hoping for a specific one.

Menopause, on the other hand, has a strict definition: 365 days with no menstrual flow, typically occurring around age 52. The hormonal disruption of Perimenopause intensifies until the moment of Menopause. After that, pregnancy is no longer possible (though the possibility of having a child at that age is another matter). A woman’s hormone profile shifts permanently into a non-cyclical pattern, with estrogen (estradiol) dropping significantly. At that point, a heterosexual couple in their mid-50s could flip a coin to decide who has more estradiol—the man or the woman. That’s right—your father or grandfather could have more estradiol than your mother or grandmother.

After the year of Menopause we have Postmenopause, the hormone profile remains different. We all know hormones affect behavior and how we feel, but the risks change. Women are more vulnerable to heart issues like ASCVD (atherosclerotic cardiovascular disease) because estradiol is believed to be cardioprotective and a longevity aid. Imagine entering the third act of your life with an entirely new hormonal state. I can’t personally relate, but my mother can.

Prepare For, Lest Avoid

If reading about the stages of Menopause has left you a bit overwhelmed, I promise there’s a light at the end of the tunnel. But when people say, "I have bad news and good news," they tend to want the bad news first. So let’s talk symptoms, which go far beyond just changes in the menstrual cycle and weight gain. Perimenopause symptoms may include, but are certainly not limited to: hot flashes, night sweats, gastrointestinal distress, joint pain, dry skin, vaginal dryness, muscle loss, emotional disturbances, vertigo, frozen shoulder, tinnitus, lipid cholesterol disruption, diabetes and insulin resistance, chronic inflammation, and bloating. Whew—what a list! Some of these symptoms may occur outside of Perimenopause, but when paired with menstrual fluctuations, they’re a strong indicator that you’re in the early stages.

In this era of self-diagnosing via WebMD or social media, I encourage you not to jump to conclusions or prematurely diagnose yourself with Perimenopause. Instead, prepare yourself for the inevitable.

Now, the good news. Despite how underappreciated Menopause has been historically, we’re in the midst of a new era. For the first time in history, we have the tools to not just survive Perimenopause but to thrive. Breakthroughs in endocrinology—the study of hormones—equip women with the knowledge to understand what’s happening to their bodies and what each hormone does. Science, medicine, and their communicators are doing a better job of getting the word out. For example, the Women’s Initiative Study, one of the largest studies on these topics, has been recently reanalyzed and properly discussed, even though it was conducted in the '90s. Medical practitioners are learning through lifelong education initiatives, ensuring they don’t dismiss women presenting with symptoms.

We’ve come a long way from the days when Dr. Martha Walsh, an OBGYN turned Menopause awareness activist, heard the coined term “WW”—or “whiny woman”— being used to dismiss those going through Perimenopause. Today, health and wellness strategies incorporate the growing knowledge about hormones, fitness, and nutrition. Less exploitation from snake oil salespeople means women are in a better position to thrive. Like the Viking women who raided and explored over a thousand years ago, I urge you to gird your loins, grab your axe and shield, and prepare for what life throws your way. I’ll support you however I can.

Thrive and Support

The Stoics, ancient Greek and Roman philosophers, had a Latin mantra: Premeditatio Malorum, which translates to "prepare for all outcomes." By actively imagining potential setbacks and challenges, Stoics believed they could develop resilience and better manage adversity. This practice applies not just to relationships, careers, and life milestones, but specifically to Menopause, no matter where you are on the journey. With all the advancements we have, it’s possible to navigate Perimenopause with grace and poise. Think of it like first responders—equipping yourself with the right tools first allows you to help others.

As your own primary advocate, when you take care of yourself, you’ll be better equipped to help others. It won’t be easy to push past the temptation to avoid awareness, but once you embrace it, you’ll face Perimenopause’s challenges head-on. Through physical activity, proper nutrition, and the right resources, you’ll be in a strong position to advocate for yourself to medical practitioners. The tools you need—lifestyle strategies, hormone replacement therapy, and treatments for symptoms—are at your disposal. What was once seen as a vulnerability can become your strength, empowering you to support other women. Slowly but surely, women everywhere will embrace Perimenopause in ways previous generations never could. I see a future where Menopause is treated with the care and attention it deserves.

Conclusion

Though I’ll never experience Menopause myself, I’ve dedicated myself to understanding it—not just from a fitness and nutrition standpoint, but from a hormonal perspective. Awareness pulls the challenges out of the shadows and into the light. The more we understand the challenges ahead, the better prepared we’ll be. The goal isn’t just to survive Menopause, but to thrive through it. This resilience will serve as a beacon for all women, creating momentum for a self-reinforcing cycle of support and understanding. It’s already begun, and I’m here to help. So, what do you say? Are you ready to board the train to Menopause prosperity?