The Complete Guide to Perimenopause: Symptoms, Risks, and Functional Medicine Solutions

Dr. Meredith Rusthoven
Oct 1
4 min read

Updated: 3 days ago

Perimenopause Symptoms: Complete Guide to Signs, Risks, and Solutions

Menopause gets all the headlines, but here’s the truth: menopause itself lasts one day. That’s it - twelve months after your last period. The real rollercoaster - the one that leaves women wondering if they’ve lost their minds or their bodies - is perimenopause.

These years are often dismissed, misdiagnosed, or gaslit by providers who say all they can do is give you a prescription for an SSRI or birth control. Meanwhile, you’re struggling with mood swings, brain fog, weight gain, and nights where sleep feels impossible. Sound familiar?

Perimenopause isn’t just about hot flashes and irregular cycles. It’s about hormonal chaos colliding with long-term health risks like bone loss, cardiovascular disease, and cognitive decline. In other words - it matters. A lot.

The good news? With the right care, you can not only survive perimenopause, but use it as a launchpad into vibrant health for decades to come. It can serve as a timely reminder to get your health in order before you move into your 50s, 60s, and beyond.

This guide will walk you through what perimenopause really is, the symptoms that signal you’re in it, why it matters for your long-term health, and how functional medicine can help you feel incredible again.

And if you’re nodding along, thinking “this is me,” your first step is our Health & Hormone Deep Dive - a 60-minute consult with advanced labs included, where we finally connect the dots and create your personalized plan.

What Is Perimenopause?

Perimenopause is the transition leading up to menopause. It usually starts in your late 30s or 40s and can last anywhere from 4 to 10 years.

Here’s the interesting part: with menopause technically being one day (the one-year anniversary of your last period), everything before that day - the irregular cycles, the hot flashes, the sometimes crazy bleeding, the mood swings - is perimenopause.

What’s happening behind the scenes? Your ovaries are winding down hormone production, but not in a straight, predictable line. Progesterone tends to decline first, estrogen starts to fluctuate wildly, and testosterone steadily drops. This creates the hormonal chaos that defines perimenopause.

Early Signs and Symptoms of Perimenopause

Perimenopause doesn’t announce itself politely. One month your cycles are predictable, your moods are steady, and sleep feels easy. The next month? Chaos.

Here are the most common signs:

Menstrual changes: Cycles may get shorter, longer, heavier, or lighter. Unpredictable is the new normal.
Hot flashes and night sweats: Classic, yes - but not always the first symptom to show up.
Mood changes: Anxiety, irritability, or depression can flare when hormones shift.
Brain fog: Losing your keys, trouble concentrating, memory slips.
Sleep disruption: Many women wake at 3 AM for no reason. (Hint: progesterone normally helps you sleep.)
Weight changes: Shifts in estrogen and thyroid can slow metabolism.
Libido changes: Lower testosterone + estrogen can impact sexual health and desire.

Pro tip: If you’re experiencing even two or three of these, you could be in perimenopause - even if your provider tells you your labs are “normal.”

Why Perimenopause Matters

Perimenopause isn’t just about annoying symptoms. It’s also when major long-term health risks begin to accelerate.

Cardiovascular health: Estrogen protects blood vessels and cholesterol metabolism. As it fluctuates, heart disease risk rises.
Bone health: Estrogen is critical for bone density. Women can lose up to 20% of bone mass during perimenopause and into the first few years after menopause.
Cognitive health: Estrogen supports neurotransmitters and protects the brain. Fluctuations can contribute to brain fog, mood issues, and increased risk of dementia.

This isn’t just about periods - it’s about protecting your brain, bones, and heart for the long haul.

Hormones in Perimenopause - What’s Really Happening

Think of your hormones like a team of coworkers. During perimenopause, they don’t all quit at once - they call in sick on random days, and the whole office suffers.

Progesterone: The first to decline. Low levels mean anxiety, poor sleep, and irregular or heavy cycles.
Estrogen: Fluctuates wildly before eventually dropping. This leads to hot flashes, mood swings, and brain fog.
Testosterone: Declines steadily. Low levels contribute to low libido, decreased muscle mass, fatigue, and low motivation.

When these three hormones are out of balance, thyroid and adrenal function often get pulled down with them - creating a domino effect of symptoms. And it can feel rough!

The Functional Medicine Approach to Perimenopause

Conventional medicine often says: “You’re fine. Come back when you’ve officially hit menopause.” That leaves women untreated for years.

Functional medicine takes a different path:

Advanced lab testing: Instead of just a CBC, cholesterol, and maybe a TSH, we run comprehensive bloodwork, a complete thyroid panel, salivary cortisol testing, and functional labs like DUTCH for deeper hormone mapping.
Lifestyle rituals: Sleep optimization, nutrient-dense eating, stress management, circadian alignment, and gut health are non-negotiables.
Bioidentical Hormone Replacement Therapy (BHRT): Safely replace what’s missing, using hormones identical to what your body makes. Far safer and more effective than outdated synthetic HRT.
Personalized protocols: Supplements and nutrition tailored to lab results, not cookie-cutter recommendations.

What to Do If You Think You’re in Perimenopause

Track your symptoms - use a journal or app. Patterns matter.
Get comprehensive labs - not just the basics.
Consider BHRT - don’t wait until you’re miserable. Starting earlier protects your health.
Support your gut, thyroid, and adrenals - because they’re all connected.
Work with a provider who listens - this is not the time to settle for “you’re fine” or “everything looks normal”.

If you are ready to find the root cause of your symptoms, see what is actually going on in your labs, and start feeling better ASAP, book your Health & Hormone Deep Dive now.

Conclusion: Thriving Through Perimenopause

Perimenopause is not a sentence to years of suffering. It’s a transition - and with the right support, it can become an opportunity to rebuild, reset, and optimize your health for the decades ahead.

Perimenopause Symptoms: Complete Guide to Signs, Risks, and Solutions

Menopause gets all the headlines, but here’s the truth: menopause itself lasts one day. That’s it - twelve months after your last period. The real rollercoaster - the one that leaves women wondering if they’ve lost their minds or their bodies - is perimenopause.

These years are often dismissed, misdiagnosed, or gaslit by providers who say all they can do is give you a prescription for an SSRI or birth control. Meanwhile, you’re struggling with mood swings, brain fog, weight gain, and nights where sleep feels impossible. Sound familiar?

Perimenopause isn’t just about hot flashes and irregular cycles. It’s about hormonal chaos colliding with long-term health risks like bone loss, cardiovascular disease, and cognitive decline. In other words - it matters. A lot.

The good news? With the right care, you can not only survive perimenopause, but use it as a launchpad into vibrant health for decades to come. It can serve as a timely reminder to get your health in order before you move into your 50s, 60s, and beyond.

This guide will walk you through what perimenopause really is, the symptoms that signal you’re in it, why it matters for your long-term health, and how functional medicine can help you feel incredible again.

And if you’re nodding along, thinking “this is me,” your first step is our Health & Hormone Deep Dive - a 60-minute consult with advanced labs included, where we finally connect the dots and create your personalized plan.

What Is Perimenopause?

Perimenopause is the transition leading up to menopause. It usually starts in your late 30s or 40s and can last anywhere from 4 to 10 years.

Here’s the interesting part: with menopause technically being one day (the one-year anniversary of your last period), everything before that day - the irregular cycles, the hot flashes, the sometimes crazy bleeding, the mood swings - is perimenopause.

What’s happening behind the scenes? Your ovaries are winding down hormone production, but not in a straight, predictable line. Progesterone tends to decline first, estrogen starts to fluctuate wildly, and testosterone steadily drops. This creates the hormonal chaos that defines perimenopause.

Early Signs and Symptoms of Perimenopause

Perimenopause doesn’t announce itself politely. One month your cycles are predictable, your moods are steady, and sleep feels easy. The next month? Chaos.

Here are the most common signs:

Menstrual changes: Cycles may get shorter, longer, heavier, or lighter. Unpredictable is the new normal.

Hot flashes and night sweats: Classic, yes - but not always the first symptom to show up.

Mood changes: Anxiety, irritability, or depression can flare when hormones shift.

Brain fog: Losing your keys, trouble concentrating, memory slips.

Sleep disruption: Many women wake at 3 AM for no reason. (Hint: progesterone normally helps you sleep.)

Weight changes: Shifts in estrogen and thyroid can slow metabolism.

Libido changes: Lower testosterone + estrogen can impact sexual health and desire.

Pro tip: If you’re experiencing even two or three of these, you could be in perimenopause - even if your provider tells you your labs are “normal.”

Why Perimenopause Matters

Perimenopause isn’t just about annoying symptoms. It’s also when major long-term health risks begin to accelerate.

Cardiovascular health: Estrogen protects blood vessels and cholesterol metabolism. As it fluctuates, heart disease risk rises.

Bone health: Estrogen is critical for bone density. Women can lose up to 20% of bone mass during perimenopause and into the first few years after menopause.

Cognitive health: Estrogen supports neurotransmitters and protects the brain. Fluctuations can contribute to brain fog, mood issues, and increased risk of dementia.

This isn’t just about periods - it’s about protecting your brain, bones, and heart for the long haul.

Hormones in Perimenopause - What’s Really Happening

Think of your hormones like a team of coworkers. During perimenopause, they don’t all quit at once - they call in sick on random days, and the whole office suffers.

Progesterone: The first to decline. Low levels mean anxiety, poor sleep, and irregular or heavy cycles.

Estrogen: Fluctuates wildly before eventually dropping. This leads to hot flashes, mood swings, and brain fog.

Testosterone: Declines steadily. Low levels contribute to low libido, decreased muscle mass, fatigue, and low motivation.

When these three hormones are out of balance, thyroid and adrenal function often get pulled down with them - creating a domino effect of symptoms. And it can feel rough!

The Functional Medicine Approach to Perimenopause

Conventional medicine often says: “You’re fine. Come back when you’ve officially hit menopause.” That leaves women untreated for years.

Functional medicine takes a different path:

Advanced lab testing: Instead of just a CBC, cholesterol, and maybe a TSH, we run comprehensive bloodwork, a complete thyroid panel, salivary cortisol testing, and functional labs like DUTCH for deeper hormone mapping.

Lifestyle rituals: Sleep optimization, nutrient-dense eating, stress management, circadian alignment, and gut health are non-negotiables.

Bioidentical Hormone Replacement Therapy (BHRT): Safely replace what’s missing, using hormones identical to what your body makes. Far safer and more effective than outdated synthetic HRT.

Personalized protocols: Supplements and nutrition tailored to lab results, not cookie-cutter recommendations.

What to Do If You Think You’re in Perimenopause

Track your symptoms - use a journal or app. Patterns matter.

Get comprehensive labs - not just the basics.

Consider BHRT - don’t wait until you’re miserable. Starting earlier protects your health.

Support your gut, thyroid, and adrenals - because they’re all connected.

Work with a provider who listens - this is not the time to settle for “you’re fine” or “everything looks normal”.

If you are ready to find the root cause of your symptoms, see what is actually going on in your labs, and start feeling better ASAP, book your Health & Hormone Deep Dive now.

Conclusion: Thriving Through Perimenopause

Perimenopause is not a sentence to years of suffering. It’s a transition - and with the right support, it can become an opportunity to rebuild, reset, and optimize your health for the decades ahead.

You don’t have to accept fatigue, brain fog, and mood swings as “normal.” And you definitely don’t have to wait until menopause to get help.

With functional medicine, advanced testing, and hormone optimization, you can thrive - not just survive - in midlife and beyond.