Understanding Perimenopause: What’s Happening to My Body—and What Can I Do?

If you are like me in your 30s or 40s and feeling like something has shifted—but you’re not quite in menopause—you’re not imagining things. That phase is called perimenopause, and it can feel like puberty (in reverse): emotional, unpredictable, and sometimes downright confusing. Let’s break down what’s going on, what symptoms are most common, and what over-the-counter supplements may actually help.

What Is Perimenopause, Exactly?

Perimenopause is the transitional window before menopause, when your ovaries begin to slow down production of hormones—especially estrogen and progesterone. This hormonal shift can start 8–10 years before your periods stop completely, and it usually begins subtly in your mid-to-late 30s or 40s.

Your hormones don’t decline in a straight line. That would be nice! Instead, they fluctuate—sometimes wildly—from month to month. That’s why one cycle may feel “normal” and the next feels like a rollercoaster. One month you have energy, you have libido, you feel on top of the world. The next month, you have no drive, fatigue, and the last thing you want to do it be intimate.

Common Symptoms of Perimenopause

Every woman’s experience is different, but here are the most common concerns we see in the clinic related to perimenopause:

• Irregular periods (shorter, longer, heavier, or skipped cycles)

• Sleep disturbances—waking up at 3 a.m. For no good reason.

• Mood swings, irritability, or anxiety

• Brain fog or difficulty concentrating

• Night sweats or hot flashes

• Weight gain, especially around the middle and hips

• Breast tenderness

• Low libido

• Fatigue that does not improve with rest

You don’t need to have all these symptoms to be in perimenopause. Even just one or two can be a clue your hormones are shifting.

Why Does It Happen?

As we age, the ovaries gradually reduce their hormone output. Emphasis on “gradual!” The first hormone to decline is usually progesterone, which can make you feel sleepless, anxious, or irritable. Later, estrogen begins to fluctuate and decline too, triggering hot flashes, brain fog, and changes in metabolism, skin, and sexual health.

Some women breeze through these years. Others feel like they’ve been hit by a truck. If you’re in the latter group, know this: you are not alone, and support is available to you.

Supplements That May Help

While every woman is different and no supplement is a magic fix, several over-the-counter options have been shown to help ease perimenopause symptoms. Here are some we commonly recommend:

Magnesium Glycinate

• Supports sleep, mood, and muscle tension

• Also helpful for hormone-related headaches and anxiety (used in pregnancy also for headaches)

Vitamin B6

• Supports mood and neurotransmitter balance

• May reduce PMS-like symptoms during perimenopause

Omega-3 Fatty Acids (EPA/DHA)

• Helps with brain fog, mood swings, and inflammation

• Also supports heart and joint health as we age

Chaste Tree (Vitex agnus-castus)

• A plant-based option that may help regulate cycles and improve progesterone levels

Ashwagandha

• An adaptogen that helps the body cope with stress, supports cortisol balance, and may improve sleep quality

DIM (Diindolylmethane)

• A compound from cruciferous vegetables that helps support healthy estrogen metabolism

Calcium + Vitamin D

• Important as estrogen declines, to support bone density and prevent osteoporosis

• Specifically, vitamin D3 with K2

✅ Always check with your healthcare provider before starting new supplements—especially if you’re on other medications or managing chronic conditions. Come see us, we would love to help you start a new supplement.

You Don’t Have to Go Through This Alone

At Her Health, we see women every day who are navigating perimenopause and just want to feel like themselves again. We believe in a personalized, root-cause approach—whether that includes lifestyle shifts, targeted supplements, or hormone therapy. If you’re ready to feel better, we’re here for you.

Want to learn more about your hormones?

Schedule a consultation or explore our concierge care plans designed to support women through every season of life.

Her Health Gynecology — Thoughtful. Personalized. Rooted in You.