Navigating Perimenopause and Healing Mid-life
Welcome to perimenopause: the thrilling sequel to puberty, where the plot twists are hotter, the mood swings wilder and the main character (you) has fewer f***s to give.
In fifth grade health class we’re introduced to our changing bodies. The school we attend even hosts a special event where boys and girls separately learn about puberty. Girls learn about menstruation and sexual health, and each receives a “parting gift” that includes coupons and brochures for pain relief like Midol or Pamprin, for our anticipated menstrual cramps, as well as tampons and maxi pads.
Later, our first visit to the gynecologist might happen due to age or as a result of our first sexual experience. Here we learn about Pap smears, routine gynecological checkups, STD’s and other aspects of health relevant to this stage of life. Gynecologist offices are filled with brochures on women’s health and the importance of regular routine exams that might detect cancer.
When it’s time to have a baby, we’re guided through pregnancy and the changes it brings, by our doctors, midwives and even doulas. We have also had the ever so popular resource “What to Expect When You’re Expecting,”
As Women reach 40, we’re advised to get annual mammograms, but after that, the information seems to taper off. Menopause and perimenopause are often seen as taboo or uncomfortable topics, with little more than occasional mentions of hot flashes or the end of menstruation. I realize we live in a time where social media is overflowing with endless topics of interest. Perimenopause posts, ads, reels- you name it – have flooded my social media pages ever since I began this life transition. But when it comes to understanding my changing body, I’d rather rely on trusted, evidence-based sources than reels on Instagram or Facebook, or advice from some random person on TikTok. My health deserves better than quick soundbytes or questionable trends.
In this blog, I’ll explore the range of symptoms women experience during perimenopause to help you feel less alone and more informed. We’ll cover practical coping skills and also touch on how perimenopause can affect eating disorder recovery. My own recovery journey was deeply influenced by this life transition, and I hope to offer insights that can help others approach this time with greater self-compassion and ease, oh, and a little humor.
Mid-life: where the warranty on your hormones expires, and your body starts freelancing chaos. So what the hell is perimenopause anyway? Perimenopause is a phase when a woman’s progesterone and estrogen levels begin to drop. A woman is considered to have reached menopause once she hasn’t had a period for twelve consecutive months. Before this, she goes through perimenopause, a transition that can last anywhere from four to ten years. During these years women may experience a wide range of symptoms impacting the quality of their lives in varying degrees. Think of perimenopause as nature’s way of saying ‘you’ve earned the right to lose your filter and your patience at the same time. Some women I’ve spoken to report experiencing mild to moderate symptoms while others are more severe. Over the last several years, as I began this next transition in life, I became more curious about certain symptoms I was experiencing as well as the ones my female clients in mid- life were reporting. For some, my own journey and curiosity has helped them become more in tuned with their changing bodies. My hope was that if I could help them, maybe I could help others going through this same phase of life.
Is it Hot in Here or is it Me?!
During perimenopause, estrogen and progesterone levels fluctuate unpredictably, causing a variety of symptoms. This hormonal rollercoaster can make it difficult to feel balanced. I remember when my hot flashes started- they were relatively mild at first. But eventually, I was having up to 30 a day and at least 40 a night. Yes, I even started counting, unsure of what was “normal” or above average. I’ll never forget my friend Maureen looking at me during one of these flashes, saying “it’s hard to look at you,” as sweat dripped down my face. ‘Thank you, Maureen.’ Just as quickly as the heat surged, my body temperature would settle back to normal. And that pretty much sums up a hot flash. Women experience them at different levels of intensity. Some women have shared that they aren’t bothered by them at all. Mine were incredibly difficult to manage.
Sleeping on the Job
Fatigue experienced in perimenopause isn’t your average tired. It’s the kind of exhaustion where napping becomes both a survival tactic and your new favorite hobby. Quality of sleep is significantly impaired during perimenopause. As estrogen and progesterone levels fluctuate and eventually decline, they disrupt several systems that impact sleep quality. I remember thinking something was seriously wrong with me because I was taking 10-minute power naps in between each therapy session because I was finding it hard to make it through each day.
Hot flashes, which I discussed above, causes fragmented sleep because you are waking up feeling uncomfortable.
Estrogen plays a role in regulating mood, sleep cycles and body temperature. Lower estrogen levels can interfere with the release of serotonin and melatonin, both of which are crucial for sleep quality and maintaining a consistent sleep-wake cycle.
Increased stress and anxiety because of hormonal shifts make it harder to fall asleep and stay asleep.
Lower estrogen levels also affect our bladder, increasing the urge to urinate more frequently at night- it doesn’t help that I have a 72 oz water bottle. I cannot tell you how many times a night I was waking up!
As hormone levels change, the body may spend less time in deep restorative sleep phases which can result in feeling less rested. Learning more about how my changing body and fluctuating hormone levels were impacting my sleep gave me some relief. At least I knew why I was experiencing such extreme and sudden fatigue.
The World Feels Like It’s Coming to an End
Mood swings and the overall emotional experience of perimenopause can feel like you’re being trapped in a group chat with your hormones- nobody’s on the same pages and someone’s always yelling or crying. Thank goodness for my mother during this time, especially in the early stages. I imagine it’s common to experience perimenopause symptoms similar to our mothers, given genetics. I remember calling her one day and saying, “I feel like I’m losing it-everything feels overwhelming. I’ve dealt with bigger major life stressors in my life, and now even the smallest things are throwing me off. I can’t handle anything!” She gently asked, “Does it feel like the world is coming to an end?” I replied, “YES!” She said, “Sweetheart, it’s perimenopause. You’re not crazy, I went through the same thing.”
Hormonal shifts can affect brain chemistry leading to emotional ups and downs. Even without a prior history, some women experience heightened anxiety or depressive episodes. Irritability or mood swings occur, and the smallest trigger can feel overwhelming. Rage and irritability become these emotional intruders, leaving you to snap and the slightest thing gets on your nerves. It can seriously feel like some evil being has taken over your body, because under normal circumstances, you’d typically never respond in such extreme ways.
It's Not Early Onset Alzheimer’s, it’s Brain Fog
Brain Fog is often a common symptom described as mental cloudiness, forgetfulness, or difficulty concentrating which can also contribute to anxiety. I have always had a great memory. In my personal life this was sometimes a blessing and a curse and professionally, it always served me well. In the early stages of perimenopause, I still remembered details of each client’s lives, but I’d walk into a room and forget why I walked in there. As time went on, I would forget words mid-sentence and blank on client’s names and eventually details of their lives. It really started to scare me. I think this symptom probably had me most concerned and is one many women don’t typically associate with perimenopause. Once I learned this was a symptom, and I wasn’t in early onset Alzheimer’s I felt relieved. I also felt more equipped to validate and educate my mid-life female clients when they’d express their fears around memory loss and feeling “foggy.”
Not by the Hair of my Chinny -Chin- Chin
I’ve been told that my sense of humor and the ability to laugh at myself has been what’s saved me on so many occasions in my life. This time has been no different. So one day as I looked in the mirror agonizing over the hair on my head that was thinning, I realized I was growing a beard. Along with my pre-existing hair on my upper lip, I officially had a goatee. I had no idea perimenopause could make me feel like a carnival sideshow act.
As estrogen levels decline, the effects of androgens—like testosterone, which women naturally have in small amounts—become more noticeable. With less estrogen to balance things out, these androgens can lead to unexpected hair growth in areas like the chin, upper lip, and cheeks. In other words, just when we think we’re done with surprises, perimenopause brings another one!
Physical Changes- What’s Up with all the Bloating?
Bloating and weight gain in perimenopause are like an uninvited guest, showing up out of nowhere, making you uncomfortable, refusing to leave no matter how nicely you ask.
Fluctuating hormone levels can lead to water retention and gastrointestinal changes. I researched this lovely phenomenon tirelessly, exploring multiple interventions/products to help relieve this very uncomfortable symptom. I learned more about gut biomes and gut health and now my social media feed is loaded with the next best pill that’s going to address this issue!
Weight gain and body composition change during perimenopause. Many women tend to gain weight around their abdomen due to slower metabolism and hormonal changes. It’s part of this stage of life. Regardless of what types of interventions you might implement to help reduce these symptoms, you may still experience them but in a lesser degree or they may fluctuate throughout the month.
Let’s Talk About Sex
Ah, sex in perimenopause: where foreplay includes adjusting the thermostat, locating the good lube, and convincing your hormones to stop acting like a bad roommate. During perimenopause, many women experience changes in libido and sexual health due to hormonal fluctuations, physical symptoms, and emotional factors. Hormonal shifts can lead to vaginal dryness, lower libido, and painful intercourse. Alongside these physical changes, the emotional experience of entering this stage of life—combined with the challenge of adapting to a shifting self-identity and body image—can create added stress. In a society that often doesn’t celebrate aging, feeling as if your body is no longer fully your own can understandably affect your desire for sex and physical intimacy.
Eating Disorder Recovery & Perimenopause
Perimenopause brings a host of changes to the body, often leaving women feeling as though they’ve lost control over what was once familiar. This sudden and often unpredictable life transition can be particularly challenging—and even triggering—for individuals in recovery from eating disorders, as it may amplify feelings of uncertainty and disconnect with their bodies.
Hormones such as estrogen and progesterone affect mood and hunger cues. These shifts can sometimes lead to increased cravings for sugar or carbohydrates. Changes in appetite can feel unpredictable. As mentioned earlier, women also experience weight changes and fat distribution especially around the abdomen even without changes to eating or activity. Hormonal shifts can heighten anxiety, depression or mood swings. Many women may feel frustrated by the sense that they are losing control over their emotions or body.
Whether these changes feel sudden or gradual, any one of these symptoms or a combination of all can trigger eating disorder thoughts and behaviors.
I’ve tackled my eating disorder twice in my life thus far. After my last and pretty serious relapse, I worked hard to get to a place of full recovery. Since, I have developed a wonderful relationship with food, and movement has evolved into something that includes a lot more variety - enjoying what my body has been able to do and the benefits to my whole self. I had settled into my recovered body and the ‘set point’ I believed my body was meant to be in. For many years now, I was embracing the me I had finally become.
When perimenopause began to rear its ugly head, I was also going through one of the most stressful, painful periods of my life. It was a time when my eating disorder could have easily resurfaced as that familiar, dysfunctional “frenemy,” ready to “rescue” me from the chaos. But there was no room for it. Instead of letting my eating disorder pull me under, my survival instincts kicked in and took the helm, steering me through the storm.
It wasn’t until about a year and a half to two years later when the storm finally settled, that my peri-symptoms came on even stronger, and I felt like I woke up one day in a different body. Outside of my eating disorder, I have never felt more out of control in my own body. I hadn’t made changes to my lifestyle, yet my body felt like it had a mind of its own. Eating disorder thoughts found a place in my head again and that fight became all too familiar. I spent many days and nights challenging these thoughts and sitting with the discomfort in this body that felt foreign and unbearable at times. I was so frustrated to have found myself back in this place again.
I finally took a step back and reminded myself of everything I tell my clients in our sessions. They all experience this discomfort and are fighting through it, with my support. I also have an amazing daughter who witnessed me go through this once before. Though she was younger then and didn’t fully understand what was happening, she will now. My job is to be the best role model I can for her. That doesn’t mean I can’t struggle or even relapse—I’m grateful I haven’t—but it does mean I’m responsible for doing everything I can to take care of my mental, emotional, and physical health. And that’s exactly what I did.
Thriving in Perimenopause
Navigating this stage of life can be challenging, whether or not you have an eating disorder. Many women experience struggles with their bodies, and this transformative period can bring varying levels of difficulty.
In a recent episode of the podcast Food Psych with Christy Harrison, guest Dr. Gregory Dodell discussed myths and facts about hormones, sharing insights that were particularly impactful. Dr. Dodell acknowledges the difficulties women face during this time, especially around weight gain. He explains that as estrogen production decreases, the body tries to retain some fat since estrogen is partly stored in fat cells. He further points out that research shows having a bit more body fat as we age can actually be protective, helping to support our bodies as bones become more fragile.
Dr. Dodell emphasizes that our bodies are designed to protect us through these changes and encourages a focus on overall health rather than restriction. “Restricting at this point, just like at any other stage of life, can make people sicker,” he advises, highlighting the importance of prioritizing a healthy lifestyle over strict dietary limits.
Drawing from my own journey of navigating perimenopause while managing eating disorder thoughts, as well as my experience supporting clients through this life transition, I’ve discovered strategies that have been beneficial not only for me but also for others seeking guidance and support.
Prioritize Sleep Hygiene & Stress Management: Establish consistent bedtime routines and avoid screen time before bed. Incorporate stress-reducing activities like meditation, journaling or yoga. I often suggest Yoga with Adriene https://www.youtube.com/@yogawithadriene/playlists
She offers a wide variety of meditative yoga practices that are gentle on the body and cater to different needs. Ie; yoga for sleep- some videos are only 10 minutes long. It’s a wonderful way to end a long and stressful day.
Reconnect with Intuitive Eating: Trust that your body will adjust to new hunger and fullness cues. It’s normal for appetite to shift during this time. Focus on nourishing yourself rather than restricting certain foods. Pay attention to how certain foods make your body-not your mind feel. Cravings are a part of the body’s response to hormone fluctuations, not a sign of failure.
Embrace Body Neutrality: Recognize that body changes are normal and inevitable during perimenopause. Body neutrality encourages appreciating what your body can do- such as providing strength, mobility or pleasure without obsessing over it. Avoid focusing on numbers, especially the scale. Instead, track how you feel-more energetic, balanced or rested. Tracking calories, steps, numbers, weight will further disconnect you from your body and keep you in an unsustainable cycle that will be more harmful in the long run. If you need to restrict yourself to a certain weight or size, you aren’t meant to be in that body.
Movement: Engage in movement that feels good, rather than exercise driven by weight control. Since muscle mass decreases during perimenopause, adding strength training can be beneficial- not to change appearance, but to maintain strength and bone health. Focus on how exercise makes you feel- calmer, stronger, or more energized -rather than using it as a way to manage weight.
Seek Support from Professionals: Eating disorder or not, having a space to discuss this transition of life while wearing multiple hats can offer guided support and reduce stress. If you are struggling in your eating disorder recovery, a therapist specializing in eating disorders can help you stay grounded and unpack stressors that may be contributing to these disordered thoughts.
See a Registered Dietitian: Finding a dietitian familiar with hormonal health as well as eating disorder recovery can be useful for anyone needing guidance on nutrition without falling into restrictive patterns. Again, eating disorder or not, a dietitian that is eating disorder informed and one that takes a Health at Every Size approach is most beneficial to anyone needing this kind of support.
Stay Connected: Share your experiences with friends, partners, family or support groups to feel less isolated. I’ve recently downloaded the app Balance https://www.balance-menopause.com/balance-app/ It was developed by Dr. Louise Newson, a physician and menopause specialist. It tracks mood, symptoms, movement, sleep, and menstrual cycle. It also offers a library of articles and community support. She offers a free trial and a $4.99 monthly subscription. Rely on resources that are evidence-based, researched or supported by a reputable following, rather than placing trust in random reels or TikTok creators who may lack expertise or credible information.
Disconnect- Detox, Restrict, Eliminate: The only time you’ll hear me using these words in an encouraging way is when it comes to social media. Although I’ve encouraged staying connected, staying connected with the right support is important. Social media, eating disorder or not, can be so triggering. We are so flooded with information that has mixed messages and for the most part makes you feel bad about being you. So do a detox from social media, or restrict those accounts that aren’t benefiting you, or do an “elimination diet” of the ones that make you feel bad.
Consider Medical Support: Hormone Replacement Therapy (HRT) or non-hormonal treatments may help with symptoms. It’s very important that you voice your concerns and advocate for what you need. I happen to be very fortunate to have a doctor who listens to me and is willing to go the extra mile in her work. She ran extensive blood work and supported me during my ambivalence over starting HRT. I tried everything natural under the sun; creams, supplements, OTC treatments meant to support perimenopause. Unfortunately, nothing worked for me. Eventually she sat me down after reviewing the risks//benefits of HRT and said to me, “do you want a quality of life, or do you want to continue as you’re going?” As dramatic as this is going to sound, she saved my life that day. She has on multiple occasions but for me, HRT was a game changer. I realize people’s experiences with their doctors vary and it’s important to educate yourself and advocate for what you need. I know HRT isn’t for everyone, but make sure you have a doctor that is willing to listen and take the time to cater to ‘YOUR ‘‘needs, and not just satisfy their own agenda.
Conclusion
Perimenopause is a challenging yet transformative time. It can be frustrating to feel out of sync with your body. This can be an especially challenging time for women in eating disorder recovery, but for all women, eating disorder or not, it also offers an opportunity to reassess priorities, embrace self-care and redefine health and well-being. It means moving away from rigid expectations and embracing flexibility. Understanding that these struggles are valid and common can make the journey feel less lonely. It isn’t always easy, make space for the hard and learn to laugh, especially at yourself. If you are struggling with eating disorder recovery, by sticking to recovery practices, being kind to yourself and seeking support when needed, you can navigate perimenopause with resilience and thrive through this transition.
Above all, remember you are more than your body-you are a whole person deserving of care, love and compassion at every stage of life.
*I need to say thank you to my loved ones who have supported me and continue to do so during this journey.
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