Understanding Perimenopause: When Experience Meets Evidence

Even as a healthcare provider who works with women’s hormones daily, I found myself on the other side of the exam table a few years ago. I knew exactly what was happening, my symptoms lined up perfectly with perimenopause, but finding a clinician who would treat me wasn’t easy.

When I first reached out for help, my gynecologist told me I was “too young for perimenopause.” After I reminded her of my background as a nurse practitioner specializing in hormone optimization, she kindly offered a short course of estradiol and micronized progesterone but explained that she didn’t practice what she called “feel-good medicine.”

Her approach wasn’t wrong, it was simply rooted in a more traditional framework. That exchange made me realize how many women must feel when they finally seek help and are told their symptoms are “in their head,” or that they should just wait until menopause passes.

What Perimenopause Really Is

Perimenopause is the transition leading up to menopause, marked by fluctuating estrogen and progesterone levels. It can begin years earlier than most expect, sometimes as early as the mid-30s and symptoms often appear long before periods stop.Women may experience:

• Irregular or heavier cycles

• Night awakenings and sleep disruption

• Mood changes or anxiety

• Weight gain or bloating

• Decreased libido

• Brain fog and fatigue

These changes aren’t imaginary, they’re the physiologic result of hormone variability that affects everything from the brain to metabolism to emotional regulation.

When It’s Not “Just Perimenopause”

It’s also important to remember that not all hormonal symptoms mean perimenopause. Other conditions, such as polycystic ovarian syndrome (PCOS), endometriosis, and thyroid disorders, can cause similar shifts in mood, cycle length, or weight. For example, thyroid dysfunction can mimic hot flashes and fatigue; PCOS can create irregular cycles long before perimenopause; and endometriosis often complicates the hormonal landscape further. Because of these overlaps, bloodwork is debated but valuable.

Some symptoms can be treated based on history and presentation alone, yet having labs helps rule out other causes and prevents inappropriate treatment. In my practice, I use bloodwork to confirm hormone trends, assess thyroid health, and build a clear picture.

Individualized Treatment: Beyond “Endure It”

Once I confirmed my hormonal changes, I began a personalized bioidentical hormone replacement therapy (BHRT) plan, one that mirrored the same protocols I use with my patients. Balancing estradiol and micronized progesterone provided stability for sleep and mood, while low-dose DHEA and testosterone restored energy, motivation, and libido.

While DHEA and testosterone aren’t FDA-approved specifically for perimenopause, they are well-studied and safely used under professional supervision. The goal is not to replace what’s “missing” but to restore the natural rhythm of hormones that support vitality, strength, and mental clarity. Every woman’s chemistry is unique. BHRT should always be monitored with follow-up labs and symptom tracking to ensure balance rather than excess.

Why Compassionate Care Matters

Perimenopause shouldn’t feel like a guessing game, or worse, an endurance test. Women deserve to have their symptoms validated and their care tailored to their physiology, not dismissed because of age or lab ranges. When we listen to what the body is communicating and treat the whole person, not just the hormone levels, we can bridge the gap between evidence and empathy.

Reclaim Your Balance

If you’ve been told “it’s just stress” or “you’re too young,” know that relief is possible. At Aurora Total Wellness, I specialize in helping women navigate hormonal transitions through individualized BHRT, nutrition, and holistic lifestyle support, all from the comfort of home.

✨ Call or Text 803-830-6477 to book your telehealth visit today to begin your journey toward balance, energy, and renewed confidence.

Written by:Alyssa Hodge, FNP-BC,

Founder, Aurora Total Wellness

Specializing in Hormone Optimization, Weight Management, and Integrative Health