Feeling Off? It Might Be Perimenopause—Here’s What to Know
Perimenopause is the transitional phase before menopause, and for many women, it feels like a hormonal rollercoaster.
While it’s a natural part of life, it often catches women off guard—especially when the symptoms start showing up in your late 30s or early 40s.
Perimenopause means "around menopause" and refers to the years leading up to the end of your menstrual cycles. During this time, your ovaries gradually begin producing less testosterone and progesterone, but the process isn’t linear. Hormone levels can spike and dip unpredictably, especially estradiol, creating a range of symptoms that may feel confusing or frustrating.
You’re not imagining things—and no, you’re not too young.
Let’s break down what’s really going on and the most common symptoms to look out for.
1. Irregular Periods
One of the first signs is a change in your cycle—periods may become heavier, lighter, shorter, or more spaced out. You might skip a month or two, then have your period return with a vengeance. Many women are offered oral birth control, uterine ablations, and hysterectomies to help. Those are not your only options!
2. Mood Swings + Irritability
Thanks to fluctuating estrogen and deficient progesterone, many women notice increased anxiety, sadness, or irritability—often feeling emotionally “off” without knowing why.
3. Sleep Disruptions
Trouble falling asleep, staying asleep, or waking up at 3 a.m. wide-eyed and restless? Yep, that can be perimenopause thanks to the loss of progesterone.
4. Hot Flashes + Night Sweats
These classic symptoms can sneak up earlier than expected. You might notice sudden warmth, sweating, or flushing, especially at night.
5. Brain Fog
Can’t remember why you walked into the room? Many women report forgetfulness, difficulty concentrating, or feeling mentally sluggish.
6. Low Libido + Vaginal Changes
Shifts in estrogen can lead to vaginal dryness, discomfort during intimacy, and a lower sex drive—all of which are common (and treatable).
7. Fatigue + Low Energy
Even with a full night’s sleep, many women feel depleted. This can be related to hormone changes, blood sugar issues, and stress on your adrenal system.
8. Weight Gain (especially around the midsection)
As hormones shift, metabolism slows, and insulin sensitivity changes—making it harder to maintain weight, even with the same habits.
9. Breast Tenderness, Headaches, Joint Aches
These are lesser-talked-about symptoms but can also be related to hormonal fluctuations during this phase.
The good news? You don’t have to suffer through it.
I help women navigate perimenopause with clarity, compassion, and personalized care. Through advanced lab testing and holistic treatment plans—including nutrition, lifestyle strategies, and bioidentical hormone therapy—I can help you understand what’s happening in your body and how to support it.
Hi, I’m Emily Koska, your women’s hormone expert based in Fargo, ND.
I’m passionate about helping women feel like themselves again.
As a nurse practitioner, mom, and fellow woman in the thick of midlife, I know what it feels like to be dismissed or told 'everything looks normal' when nothing feels normal. That’s why I created The Hormone Hangout Blog —to help women advocate for the care, answers, and support they deserve.
With love,
Emily
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