Women’s health is having its moment with the big word in healthcare right now being ‘menopause.’ For years menopause was not spoken openly about, we knew about hot flashes and mood swings, and that happened in your 50s, right? Wrong, perimenopause, the first phase of menopause, begins in your 40s, sometimes even earlier and can last anywhere from 4-10 years.
We interviewed doctors and women to learn more about the symptoms and how to best care for your body and mind during this life transition.
“During perimenopause our cycles become closer together and lighter,” says Eleanor Murray, MD, a menopause specialist. “Our estrogen levels are changing and that comes with an array of physical and mental changes. We have dry skin, dry hair, dry eyes, we begin to have weight gain around the middle. Brain fog, anxiety, depression can develop. And some women even experience joint pain and frozen shoulder.”
Dr. Murray continues, “Hot flashes and night sweats are the classics. The hypothalamus is the organ in our brain that tells us to sweat in the desert or shiver in the cold water to save our lives. Without estrogen in the bloodstream it becomes very inaccurate so that's when we feel like it's 1,000,000° outside, our internal heater make our chest and face feel very, very warm sometimes there is a wave of anxiety during these sweat. That's the point when most women know and they say sign me up coach, I need help.” Murray explains, “These symptoms typically last 4-5 years prior to ages 50, 51, but they can last longer and happen earlier.”
The most important thing Dr. Murray recognizes is that so often women just want to know that it’s normal. “Ok this is a phase my body is going through and I’m not losing it.”
At 44, Georgia began having symptoms, “At had never heard the word perimenopause before, but I told a friend that some strange things were happening with my body and she said, 'You may be in perimenopause.” She continues, “This was an epiphany to me. I thought menopause happened in your 50s and how on earth am I just now learning that there’s a whole phase leading up to menopause that can begin in your 40s?”
Stephanie Cashin, an integrative therapist says, “This is one of my favorite topics as a therapist because emotional well-being is just as important as physical health during this transition. Cognitive-behavioral strategies can help women step off the emotional roller coaster, and simple sleep hygiene practices—like getting natural light first thing in the morning, limiting screen time at night (yes, even leaving your phone outside the bedroom), and creating a calming nighttime routine—can make a significant difference. Managing stress with regular movement, a balanced diet, and self-compassion can further support mood stability and sleep quality.”
Cashin does believe that the answer is not one size fits all. “Hormone therapy can be highly effective in relieving symptoms like hot flashes, vaginal dryness, and sleep disturbances. However, it’s not a one-size-fits-all solution. Potential risks—such as an increased likelihood of blood clots, stroke, or certain cancers—depend on an individual’s health history. My best advice? Consult with a provider who specializes in menopause care to explore the risks and benefits specific to you.”
Dr. Murray says, “When it comes to hot flashes we have seen that hormone replacement therapy is 90% effective, but with other symptoms it may or may not help. When it comes to weight gain, strength training is your best bet over intense cardio.” Murray continues, “There is also a new medication called Viza. That instead of replacing the estrogen works with the hypothalamus.”
Dr. Murray is a proponent of lifestyle adjustments as well. “We recommend dressing in layers so you can easily help your body recover from hot flashes and night sweats. We recommend weight loss. I tell patients to avoid hot liquids, alcohol, which can be triggers. Instead choose cold coffee or cold brew.”
Cashin also believes in lifestyle changes. “I’m passionate about lifestyle changes. They’re simple in theory but not always easy to implement. This is where therapy can be incredibly beneficial. When your body and mind aren’t functioning the way they used to, it can feel like you’re losing control, like the strategies that once worked are now failing you. That frustration is real. Therapy can provide a structured space to process these changes, grieve what’s shifting, and develop new strategies for navigating this stage with confidence and clarity. You’re not broken—you’re evolving.”
Maria, 49, began strength training and hormone replacement therapy. “I’ve been on hormone replacement therapy (HRT) for about a year and a half now. The only downside is the patch itself—it’s visible when wearing a bathing suit, and sometimes it itches or irritates the skin. But I’ll gladly take that over feeling the way I did before.” Maria states, “My doctor prescribed the Combipatch, a combination of estrogen and progesterone, and it worked almost immediately. Hot flashes were the first to go, followed by increased energy, better sleep, and a more balanced mood. My mom laughed and said, I told you so.” At 49 Maria just competed in her first body building competition.
Cashin also speaks on nutrition and strength training. “Optimizing nutrition, engaging in regular movement, and prioritizing stress management can have a profound impact. Strength training supports bone health, while a diet rich in protein, fiber, and healthy fats stabilizes blood sugar and energy levels. Mindfulness practices and deep breathing techniques can help regulate mood and improve resilience. The key is consistency—small, sustainable changes over time lead to big results.”
As all women will go through this phase in life, it is important to find a provider who will listen and take the time to understand. Pay attention to your body, learn about it, analyze you lifestyle, and seek the options that work for you. It also helps to have a great support system and hear stories of other women.
AM
“I’m passionate about lifestyle changes. They’re simple in theory but not always easy to implement. This is where therapy can be incredibly beneficial."
"I thought menopause happened in your 50s and how on earth am I just now learning that there’s a whole phase leading up to menopause that can begin in your 40s?”