Perimenopause: The In-between That No One Prepared You For

Perimenopause is not a diagnosis you walk out of a doctor’s office with. It is a slow realization. A quiet unraveling. A feeling that your body is no longer responding the way it used to, even though on paper everything looks “normal.”

Most women I meet don’t come in saying, “I think I’m in perimenopause.” They come in saying something feels off.

They’re more tired than usual, but sleep doesn’t fix it. Their mood feels thinner, more reactive, less forgiving. Their weight has shifted without explanation. Their periods are still coming, yet nothing feels predictable anymore. Anxiety shows up out of nowhere. Confidence feels shakier. Patience runs out faster.

And often, they are told they are too young for menopause, their labs are fine, or this is just stress.

Perimenopause is the long transitional phase before menopause, and it can begin much earlier than most women expect. For many, it starts in the late 30s or early 40s and can last years. This is the stage where hormones don’t decline neatly. They fluctuate. Estrogen rises and crashes. Progesterone quietly fades. Cortisol gets wilder. The nervous system becomes more sensitive.

This is why perimenopause can feel so confusing.

You may still be ovulating sometimes, but not consistently. You may bleed monthly, but the cycle feels different. You may feel like yourself one week and completely unrecognizable the next. These shifts are not random. They are hormonal, neurological, and deeply physiological.

One of the most misunderstood parts of perimenopause is that symptoms are not just physical. Yes, there can be hot flashes, night sweats, sleep disruption, and joint aches. But just as often, the earliest signs show up emotionally and mentally. Increased anxiety. Low mood. Brain fog. Irritability. A sense of being overwhelmed by things you used to manage with ease.

This stage of life often collides with real-world pressure. Careers peak. Parents age. Children need more. Time feels scarce. Many women are holding everything together while their internal resilience is quietly thinning. When hormones begin to fluctuate on top of that load, the body eventually speaks up.

Perimenopause is not a failure of your body. It is a transition that requires a different kind of support.

This is where care often falls short. Many women are offered quick fixes or told to wait until things get worse. But waiting it out is rarely kind to the nervous system, metabolism, or long-term health. Perimenopause is a window of opportunity. How you support your body during this phase influences cardiovascular health, bone density, cognitive function, and emotional wellbeing for decades to come.

Support during perimenopause is not one-size-fits-all. It may include understanding hormone patterns rather than single lab values. It may involve stabilizing blood sugar, restoring sleep, addressing nutrient depletion, calming inflammation, and supporting stress physiology. For some women, hormone therapy can be a thoughtful and appropriate tool. For others, lifestyle, nutrition, botanicals, and nervous system regulation create meaningful change.

What matters most is that symptoms are taken seriously.

You do not need to be at the breaking point to deserve support. You do not need to wait until periods stop. And you do not need to accept feeling disconnected from your body as the new normal.

Perimenopause is a powerful transition. It asks for listening, recalibration, and care. When supported properly, many women feel more grounded, more clear, and more at home in themselves than they have in years.

If you are in that in-between space where something feels different but you cannot quite name it, know this. You are not imagining it. And you are not alone.

This phase deserves more attention, more nuance, and more respect. And so do you.

Dr. Reem Sharhan is a perimenopause specialist in the Pasadena area with a practice solely focused on women's health through the lifespan.