Rethinking Perimenopause: Finding Stability in the Chaos
For so many women, the years leading up to menopause can feel like losing yourself. You get stuck in your own head. You start to wonder: What’s wrong with me?
Here’s what I want you to know right from the start: your symptoms are real. The brain fog. The anxiety. The emotional reactivity. That overwhelming sense of, “I just can’t cope with my day-to-day responsibilities anymore.”
And it doesn’t just stay internal. It spills into your work, your relationships, and perhaps most deeply, your sense of self.
The truth is, it’s not just stress. It’s not simply a workload issue. And it’s not burnout in the traditional sense. What you’re experiencing is biology. Once we understand that—once we see the patterns underneath—we can begin to take back a sense of control.
Perimenopause 101
So, how do we know if it’s perimenopause?
First, timing. Perimenopause often starts earlier than most people expect—sometimes in the mid-30s, occasionally even earlier. It’s the two to ten years leading up to menopause.
Here’s something that may surprise you: unlike menopause, perimenopause is defined by symptoms, not by lab results.
And those symptoms can be profoundly volatile and chaotic—like being strapped into a rollercoaster you didn’t sign up for. Weight gain, changes in your menstrual cycle, breast tenderness, night sweats, hot flashes, mood swings, disrupted sleep, even migraines and allergies—all of these can show up during this time.
As Professor Jerilynn Prior, a Canadian endocrinologist, reminds us:
“Women need to know that the turbulent time of perimenopause ends in a kinder and calmer phase of life called menopause.”
The big takeaway here is this: it’s not all in your head. These shifts are real. They’re being driven by hormonal fluctuations—especially estrogen spiking and crashing quickly and unpredictably.
I hear from my patients all the time, “I don’t even recognize myself anymore.” That loss of self isn’t imagined—it’s the ripple effect of your brain and body working overtime to adapt to instability.
Supportive tools can help—herbs and adaptogens to calm the nervous system, mind-body therapies like EMDR or breath work, or talk therapy to provide perspective. But here’s where these tools and approaches miss the mark: they’re overlooking how fluctuating estrogen is rewiring the body’s ability to cope.
Reframing Perimenopause: It’s About Instability
The old model of perimenopause said it begins in your late 40s, and the problem was either too much or too little estrogen. But here’s what we now understand: the real issue isn’t simply high or low. It’s instability. It’s the constant up-and-down swings.
Think of it this way. Instead of moving steadily, like on a gentle escalator, estrogen levels are fluctuating unpredictably. And here’s the thing: your brain and body don’t thrive on chaos—they thrive on rhythm. That’s why even “normal” estrogen levels can still feel overwhelming if they’re changing too quickly.
If your internal physiology is swinging from one extreme to another, it’s no wonder you feel like you’re unraveling.
Without stabilization, those fluctuations show up in daily life:
- Mood & stress: women in perimenopause have a 2–4x greater chance of experiencing mental-emotional challenges like anxiety, irritability, or depression, even if they’ve never struggled before.
- Energy & focus: brain fog, forgetfulness, and a reduced capacity to juggle as much as you used to.
- Body symptoms: blood sugar crashes, weight gain, worsened allergies, inflammation, and sleep disruption.
Here’s something I see often in practice. A patient comes to me and says, “I know how to eat healthy. I know I need to walk more. I want to do these things.” I know they intend to follow through...
But then brain fog makes them forget, emotional overwhelm leads to shut-down, or guilt and shame creep in, which keeps them from rebooking appointments.
This is why the tools you’ve relied on in the past—willpower, diet changes, even therapy—sometimes don’t stick. Not because you’re incapable, or lack the willpower. But because the foundation isn’t stable enough to support integration and transformation.
The empowering part? Once estrogen is stabilized, everything else starts to work better. The practices you know are good for you finally have a solid ground to stand on.
Creating Stability: Foundations First
So, what can we actually do to create more stability? How do we buffer the highs and lows? The answer lies in building a strong foundation, because hormones don’t work in isolation — they interact with many systems in the body.
It’s not just about taking progesterone for sleep, or testosterone for bone and muscle health. It’s also about insulin and blood sugar, the immune system and inflammation, mitochondrial energy, gut health, and liver detoxification.
In other words, it’s never this or that. It’s this and that.
Now, bioidentical hormone therapy—or MHT (menopause hormone therapy)—can be incredibly helpful. Some people benefit from hormonal support like estradiol patches (I won’t go deep into prescriptions today, but I want you all to know that options exist). But hormones aren’t magic on their own. If the foundation isn’t strong, it’s like layering therapy on top of chaos. The foundation—that stability piece, has to come first.
From my experience, there are three essential pillars to supporting this transition: Insulin, Immune System, and Hormones.
1. Blood Sugar & Insulin
Insulin resistance becomes more significant during perimenopause and menopause — and it’s a major driver of symptoms like hot flashes, night sweats, and genitourinary symptoms. In fact, women are three times more likely to develop diabetes and metabolic dysfunction during this phase.
The interplay between insulin, cortisol, and estrogen also explains common changes in body composition during perimenopause: increased intra-abdominal and truncal fat, with decreased subcutaneous fat. These changes can affect not only how your clothes fit, but how your body feels, your energy, and even your hormone balance.
The takeaway? Stabilizing blood sugar through balanced meals rich in protein and fibre, regular eating patterns, and consistent movement isn’t just about weight — it’s about giving your hormones a steady foundation to work from.
2. Inflammation & Immune Function
Perimenopause is, biologically speaking, a transitional state of chaos. Hormonal fluctuations cause an increase in pro-inflammatory markers, heightened immune responses, and reduced ability to clear infections efficiently.
It’s also the most common period for the onset of autoimmune conditions.
On top of this, the dramatic drop and fluctuation in estrogen levels make perimenopause a histamine-dominated state, contributing to symptoms such as brain fog, anxiety, migraines, and allergies.
That means immune system balance — through stress, inflammation, and gut support — is a key pillar of perimenopause care.
3. Hormones & Nervous System Health
Estrogen is a powerhouse hormone. It doesn’t just regulate the menstrual cycle — it influences brain chemistry, mood, sleep, energy production, and even the gut microbiome.
Fluctuating estrogen affects serotonin and norepinephrine, which explains why anxiety, depression, and emotional reactivity are common. Estrogen receptors are also present in brain areas associated with memory and cognition — so when levels drop or spike, brain fog and concentration difficulties often follow.
Beyond mood, estrogen plays a vital role in mitochondrial health — your body’s energy producers. When estrogen fluctuates and mitochondrial function is compromised, oxidative stress increases. That means less energy, more fatigue, and more inflammation.
The Inner Work Must Come First
Supporting hormonal balance is therefore not just about replacing estrogen — it’s about creating a stable system where hormones can work effectively.
Once those systems are steadier, then hormone therapy—if it’s right for you—can have its full impact. At that point, it’s not one or the other, but one layered on top of the other. That’s when people often begin to feel like themselves again.
So remember: hormonal therapy can be an amazing tool. But it’s not about replacing the inner work your body needs—it’s about amplifying it once the foundation is strong.
Worth & Empowerment
Perimenopause is a transition—and transitions are powerful.
The very symptoms that make you feel like you’re losing yourself are also signals from your body, asking for support, rhythm, and care.
When you stabilize your hormones, you create a foundation strong enough to support transformation. From that place, your nervous system and hormone axis can finally integrate all the hard work you’re doing around blood sugar, inflammation, therapy, and lifestyle.
When you understand your biology, you quiet the self-doubt. And when you feel stable again, you can step more fully into your worth.
So if you’ve been second-guessing yourself, or feeling like you’re unraveling—it’s not you. It’s your hormones. And there is so much we can do to support you through this chapter so you can live fully, confidently, and with joy.
Real-Life Insights from a Health Coach
While scientific understanding provides a solid foundation, personal experiences can offer invaluable insights. Margot Rutigliano, a good friend and colleague, shares practical strategies that have helped her manage perimenopause symptoms effectively.
With over two decades of experience in fitness, nutrition, and wellness, Margot Rutigliano—founder and owner of Vita Vie Retreat—brings a rare blend of practical coaching and neuroscience expertise. A certified health coach, nutrition coach, and personal trainer, Margot specializes in behavior change and mindset coaching, helping people not just make lifestyle shifts, but actually sustain them in ways that feel empowering and sustainable.
In her blog post, she emphasizes the importance of hydration, noting that drinking at least 3 liters of water daily significantly aided her in regulating body temperature, enhancing digestion, boosting energy, and improving mental clarity.
She also highlights the role of movement, particularly walking and cardio intervals, in managing hot flashes, improving mood, and maintaining physical strength. Additionally, she discusses the impact of nutrition, focusing on whole-food carbohydrates and mindful eating, as well as the benefits of quality sleep and stress management techniques.
One of my personal favourite strategies? Protein. Not only does protein play a crucial role in protecting against osteoporosis and sarcopenia — concerns that become more important during perimenopause and menopause — it’s also a powerful tool for regulating appetite. Those pesky cravings that pop up when hormones are fluctuating? Protein can help tame them, keeping blood sugar steadier and your energy more consistent throughout the day.
For a more detailed account of Margot's personal journey and the strategies that have worked for her, I encourage you to read her full article. Her experiences may resonate with you and offer practical tips to incorporate into your own routine.
