It’s Not You. It’s Perimenopause.

Perimenopause: Transitional Phase With Erratic Brain-Ovary Signals Causing Hormonal Chaos

Mary Claire Haver explains that perimenopause is marked by a disruption in the communication between the brain and the ovaries. Normally, during the pre-menopausal years, about 80% of women experience regular monthly periods. This regularity is governed by signals from the brain that direct the ovaries to ovulate each month. The process begins in the brain, which releases stimulating hormones when it detects a drop in estrogen after ovulation. These hormones signal the ovaries to produce more estrogen and progesterone, initiating a new cycle roughly every 28 days. This cycle follows a predictable pattern, with hormonal levels rising and falling steadily, much like an EKG’s regular waveform.

In perimenopause, however, the brain's signals no longer elicit the same reliable response from the ovaries. The brain reacts to the unpredictable drop in estrogen by sending stronger and more frequent hormonal signals, attempting to stimulate the ovaries. The previously predictable hormonal cycles become erratic—Haver describes this as the “zone of chaos,” akin to spaghetti thrown at the wall in terms of hormone levels. During this phase, estrogen levels can surge as high as in pregnancy or dive for several months, creating both extremely high and low hormonal states. This period of chaos can last seven to ten years and may even occur while women continue to have regular periods, with the hormonal instability existing in the background. Contrary to the belief that menopause is a gentle decline, Haver emphasizes that “the ovaries go out kicking and screaming,” resulting in significant brain and hormonal turmoil until the body transitions to the calmer post-menopause stage. ...

Perimenopause represents a significant transition in a woman's life, often bringing a host of disruptive physical, mental, and emotional symptoms that are frequently misunderstood or dismissed. Both medical experts and women experiencing this stage describe a range of health challenges that can deeply affect daily life and well-being.

Perimenopause Causes Disruptive Physical and Mental Symptoms

During perimenopause, women commonly encounter a broad array of physical changes. Sleep disruptions are frequent, with difficulties falling asleep, waking in the middle of the night, and insomnia. Insomnia not only impacts daily functioning but is now recognized as a risk factor for cardiovascular disease and is associated with conditions such as obesity, heart disease, and diabetes.

Skin changes are widespread, including sudden dryness, oiliness, acne, and even phenomena like itchy ears or formication—the sensation of ants crawling on the skin. Some may experience skin inflammation, and while acne may clear up for some, others may develop it anew.

Hair loss is another key symptom, occurring in areas where hair is wanted, while unwanted hair may appear on the chin or upper lip.

Respiratory issues can worsen, with asthma being affected, and conditions such as sleep apnea become more common.

Gastrointestinal changes also take place. The gut microbiome shifts to resemble that of a man's, affecting nutrient and medication absorption and altering the brain-gut connection.

Musculoskeletal symptoms include joint pain, back pain, and a potential emergence or worsening of fibromyalgia.

Sexual function is also impacted. Mary Claire Haver explains that dropping estrogen levels, which act as an anti-inflammatory hormone for the genital urinary system, can cause vaginal dryness, loss of lubrication, and a significant decline in libido. Many women love their partners and previously had a healthy sex drive but find themselves unable to summon the will, experiencing these changes as a serious problem.

Collectively, these symptoms can accumulate, leading to a feeling that "all the processes you had put in place that you could manage the life you built start failing," as Haver puts it. Even with no shift in external stressors, women may find themselves struggling with issues they had previously managed, pointing toward the profound physical and neurochemical upheaval of perimenopause.

Perimenopause Causes Anxiety, Depression, Brain Fog, and Identity Confusion

Perimenopause is also marked by significant mental health and cognitive effects that can unsettle women's sense of self. Increasing anxiety, depression, and emotional volatility are common. Women may find themselves snapping at loved ones or losing patience more easily. Haver recounts her own experience of yelling at her children, considering divorce, or even rethinking her career—reflecting the identity confusion and emotional overwhelm many women report.

This stage is also characterized by pronounced brain fog. The neuroendocrine system is in upheaval due to fluctuating hormones, which affect critical neurotransmitters—serotonin, [restricted term], [restricted term]—that regulate mood, cognition, and emotional resilience. Haver explains that parts of th ...

Perimenopausal Women and Pubescent Children Create a "Perfect Storm" of Hormonal Changes

Becky Kennedy describes the unique challenge facing many women who experience perimenopause while parenting children in puberty. She notes it can feel like "two nervous systems colliding" and brings a sense of chaos to the household due to simultaneous hormonal changes. Kennedy calls it "some cruel joke" that so many women are dealing with their own hormonal transitions at the same time as their children’s. Mary Claire Haver concurs, likening it to "having triplets," saying the "whole house is hormonal" and calling it a "perfect storm." The convergence of teenagers testing boundaries and parents navigating perimenopausal changes amplifies the difficulty of parenting during this phase.

Parenting Challenges During Hormonal Transitions

Both Kennedy and Haver agree that these hormonal transitions can make parenting particularly challenging. With everyone's emotions heightened and boundaries constantly tested, the household dynamic becomes more challenging to manage.

Perimenopausal Women: Career Transitions and Caring For Aging Parents

Many women in perimenopause face significant career transitions and, in addition to raising teenagers, also care for aging parents. Mary Claire Haver describes women as being "on the struggle bus," acknowledging that their resilience is put to the test by the combined pressures of work, family, and hormonal shifts. She shares that her clinic aims to offer resources and support, to help women "give you b ...

Perimenopause Was Long Misunderstood and Overlooked, With Limited Education and Research

For decades, perimenopause was neither well-understood nor openly discussed, leaving generations of women unprepared and unsupported during this transition. Mary Claire Haver recalls that her mother only vaguely mentioned menopause and never explained her experience. Even in medical school, Haver describes menopause as receiving just brief attention, limited to six one-hour lectures, without clinical training or robust focus on care for post-reproductive women. The subject of perimenopause barely surfaced, defined only as a "gentle decline of ovarian function," with no detailed exploration of hormonal changes. At best, education consisted of noting that periods become irregular, sometimes accompanied by a few hot flashes before menopause.

This superficial instruction created a profound knowledge gap—even among healthcare providers. Haver and Becky Kennedy observe that women's symptoms have often been dismissed by doctors, who attribute hot flashes, sleep disruption, or brain fog to stress or aging, rather than considering hormonal causes. Haver points out that women were socialized to internalize these struggles as personal failings or "all in her head," failing to connect symptoms back to perimenopause. The medical system has not historically focused on post-reproductive care or respected women's health narratives, often only acknowledging menopause if symptoms became "severely life disrupting."

Broader systemic issues reinforced this pattern. The 2002 release of the Women's Health Initiative study triggered widespread fear about hormone therapy. Practitioners began telling women that hormone therapy should be used only as a last resort and for the shortest time possible, further narrowing options and discouraging treatment. Haver notes that, even today, the misconception that hormone therapy is dangerous remains difficult to dispel due to the lack of nuanced education and research dissemination.

Women Advocating For Perimenopause Awareness and Treatment

Women Rewrite the Narrative Around This Life Transition By Sharing Experiences, Seeking Expert Healthcare, and Demanding Research and Resources

A cultural shift is underway as women take active roles in rewriting the narrative of perimenopause. Haver and Kennedy highlight how, in the past, women coped in isolation, often believing their symptoms were imaginary or shameful. Increasingly, women are sharing their experiences, comparing notes, and naming what is happening to their bodies. This collective storytelling has prompted both women and some clinicians to seek education beyond traditional medical training and demand better care.

Social media and the proliferation of books on perimenopause have played vital roles in breaking the silence. Haver's work is emblematic of this shift—after discussing perimenopause publicly, she received messages from thousands of women, many of whom described ongoing periods and a variety of debilitating symptoms. The pattern was unmistakable, leading her to translate scientific findings into accessible information and advocate for awareness.

Kennedy and Haver emphasize the importance of self-advocacy. Women are now encouraged to seek out specialized, menopause society-certified clinicians who have pursued additional training outside standard residency programs. Haver’s clinic maintains a resource of patient testimonials about effective providers, organized by city and state, helping women find knowledgeable care. They stress asking friends for referrals, leaning on community, and not hesitating to switch doctors if necessary—even if it means risking uncomfortable conversations or perceived loyalty breaches ...