Menopause Transition: Expert Advice on Managing Perimenopause

Perimenopause is the transitional phase around menopause, often beginning in your mid-30s. Brenda Johnson provides a clear explanation of this hormonal stage, including its erratic symptoms, and how Bio-Identical Hormone Replacement Therapy (BHRT) can help you find stability and balance. For more information, contact us or request an appointment online. We are conveniently located at 8233 Fredericksburg Rd, San Antonio, TX 78229.

What is perimenopause? I see all kinds of stuff on TikTok about it. I just turned 35.

Thank you for the question. Let’s review the hormonal stages related to perimenopause as well as the symptoms. Remember you are not alone and we are here to help you!

Hormonal Stages: Premenopause vs. Perimenopause vs. Menopause

Stage	Definition	Hormone Pattern	Ovulation & Fertility	Typical Onset

Premenopause	Reproductive years with regular cycles and predictable hormones	Monthly estrogen-progesterone fluctuations	Regular ovulation; high fertility	Menarche (~12–13)
Perimenopause	Transitional phase “around menopause,” marked by erratic hormones	Fluctuating, generally declining estrogen/progesterone	Irregular or skipped ovulation; declining fertility	Mid-40s (can start 30s–50s)
Menopause	Point after 12 consecutive months without menstruation	Low, stable estrogen/progesterone	No ovulation; fertility ends	Average age 51

Stage

Premenopause

Definition

Reproductive years with regular cycles and predictable hormones

Hormone Pattern

Monthly estrogen-progesterone fluctuations

Ovulation & Fertility

Regular ovulation; high fertility

Typical Onset

Menarche (~12–13)

Stage

Perimenopause

Definition

Transitional phase “around menopause,” marked by erratic hormones

Hormone Pattern

Low, stable estrogen/progesterone

Ovulation & Fertility

Irregular or skipped ovulation; declining fertility

Typical Onset

Mid-40s (can start 30s–50s)

Stage

Menopause

Definition

Point after 12 consecutive months without menstruation

Hormone Pattern

Fluctuating, generally declining estrogen/progesterone

Ovulation & Fertility

No ovulation; fertility ends

Typical Onset

Average age 51

Premenopause

Premenopause spans the bulk of a woman’s reproductive life. Monthly cycles last 21–35 days, with predictable follicular and luteal phases. Hormones rise and fall in a tight feedback loop between the hypothalamus, pituitary, and ovaries.

Common features:

• Cycle regularity: Consistent bleeding patterns and flow intensity.
• Mood & energy: Mild, premenstrual shifts but overall stable focus, motivation, and resilience.
• Body composition: Maintenance of lean muscle, bone density, and resting metabolic rate.
• Libido: Correlates with mid-cycle estrogen peaks; lubrication and sexual desire remain robust.
• Exercise & weight: Performance in strength and endurance is consistent; weight management responds predictably to diet and activity.

Women in premenopause can benefit from Bio-Identical Hormone Replacement Therapy (BHRT) to ease the symptoms of PMS. Optimize testosterone level and improve overall energy and focus. 

Perimenopause

Perimenopause is the menopausal transition when ovarian hormone output becomes erratic and gradually declines. It typically lasts 4–8 years but can range from a few months up to 10 years.

Causes

• Age-related decline in ovarian follicles leads to unpredictable estrogen and progesterone secretion
• Accelerated by smoking, family history of early menopause, chemotherapy, pelvic surgery, or oophorectomy

Age Range & Duration

• Onset: mid-40s on average (can begin mid-30s to mid-50s)
• Duration: ~4 years (range few months to 10 years)

Signs & Symptoms

• Irregular cycles (shorter, longer, heavier, or skipped)
• Hot flashes & night sweats
• Sleep disturbances (insomnia, early awakening)
• Mood swings, anxiety, depression, “menopause rage”
• Cognitive changes: brain fog, concentration difficulties, forgetfulness
• Vaginal dryness, decreased lubrication, and dyspareunia
• Variable libido (often decreased)
• Fatigue and low energy
• Weight gain, especially abdominal; fluctuating appetite

Risks

• Accelerated bone loss and osteoporosis
• Unfavorable lipid shifts: ↑ LDL, ↓ HDL
• Insulin resistance and metabolic syndrome
• Heightened risk of mood disorders and cardiovascular disease

Impact on Function & Well-Being

• Focus & Energy: Estrogen dips disrupt serotonin and dopamine, leading to mental fog and fatigue.
• Mood: Hormonal swings heighten irritability and depressive symptoms; risk of major depressive episodes is 2–4× higher in perimenopause.
• Body Composition: Lean mass declines, visceral fat rises; metabolic rate slows, promoting central adiposity.
• Exercise: Strength training critical to preserve muscle and bone; cardio supports heart health but won’t fully prevent fat gain.
• Weight: Hormonal shifts—not just aging—drive abdominal fat accumulation; careful nutrition and resistance work can mitigate gains.
• Libido: Declines due to estrogen loss, vaginal atrophy, and mood fluctuations; testosterone also modulates desire (see below).

Impact of Other Hormones: Testosterone

Although primarily viewed as a male hormone, testosterone in women is produced by ovaries and adrenals. It influences muscle strength, bone density, mood, cognition, energy, and libido.

• Premenopause: Testosterone levels can vary greatly, impacting mood, energy levels, fatigue, body composition, libido and sexual function. 
• Perimenopause: Total testosterone gradually declines, but relative levels may fluctuate due to sharper estrogen drops. This can exacerbate fatigue, low libido, muscle weakness, and mood swings.
• Menopause: With estrogen markedly reduced, relative testosterone’s influence rises. Some women report transient increases in sexual desire, but excessive testosterone can trigger acne, hirsutism, insulin resistance, and emotional irritability.

Menopause

Menopause is reached when menstruation ceases for 12 consecutive months. Hormone production stabilizes at low levels, marking the end of reproductive capacity.

Key characteristics:

• Age: Average 51 years (range 40–58)
• Symptoms: Persistent hot flashes, night sweats, sleep disturbances, vaginal dryness, urogenital atrophy, thinning hair, dry skin, mood changes, weight gain, and accelerated bone loss
• Health Risks: Higher incidence of osteoporosis, cardiovascular disease, and cognitive decline

Women in Menopause will benefit from BHRT and optimization of their hormones to improve the quality of their life..

Summary

Premenopause offers predictable cycles and stable hormonal support for physical and mental health. Perimenopause ushers in hormonal volatility, giving rise to irregular bleeding, vasomotor symptoms, mood lability, cognitive fog, and adverse body-composition changes. Menopause marks a permanent low-hormone state, with sustained risks to skeletal, cardiovascular, and urogenital health. Recognizing each stage—and the roles of estrogen, progesterone, and testosterone—empowers targeted lifestyle, nutritional, and therapeutic strategies to preserve vitality, function, and well-being.

Treatment options through Bio-Identical Hormone Replacement Therapy (BHRT) allow optimization of hormones, reduction and in many cases resolution of symptoms associated with perimenopause and menopause. While treatment is individualized and results are never guaranteed we offer expert hormone replacement therapy options. Women come to us from all over the nation for help! We help them find their joy and happiness again. 

Call for your appointment today!