Five years ago, I started noticing changes in my body.
Nothing dramatic. No hot flashes. No waking up drenched in sweat. No hormonal rage that made me want to throw something at my husband.
Just little things that, over time, started adding up.
I had been working out consistently for more than a decade. I knew my body. I knew what it was capable of. But suddenly, workouts that used to feel manageable were getting harder. My muscles ached more. My strength wasn't what it used to be. My energy wasn't quite the same.
And what did I tell myself?
Well, you're in your 40s now. This is probably just what happens.
So I adjusted.
I stopped boxing because I figured it was becoming too hard on my upper body. I backed away from heavy lifting. I incorporated more yoga and bodyweight exercises. I focused on simply moving instead of pushing myself the way I once had.
I thought I was doing the right thing.
What I didn't realize was that I might be experiencing perimenopause.
And I certainly didn't realize how much I didn't know about it.
I Thought Perimenopause Looked a Certain Way
When I thought about menopause, I pictured hot flashes, night sweats, mood swings, and periods eventually stopping.
That's what I'd heard about. That's what I'd seen portrayed. That's what I thought I was supposed to look for.
Nobody had explained that perimenopause could begin years before menopause itself. Or that hormonal changes might show up in ways I wouldn't immediately recognize.
Changes in sleep. Brain fog. Joint discomfort. Shifts in mood. Changes in menstrual cycles. Different patterns of weight distribution. Feeling like your body isn't responding the way it used to.
Not every woman experiences all of these things. Some barely notice the transition. Others experience symptoms that significantly affect their daily lives.
And here's something else I wish I'd understood: not every change we experience in midlife is necessarily caused by hormones.
Fatigue, weakness, and changes in how we feel can have multiple causes, including anemia, thyroid conditions, sleep problems, medications, and other health issues.
That's exactly why asking questions matters.
For me, the changes were gradual enough that I kept finding ways to explain them away.
Until my menstrual cycle changed.
That was the moment I started wondering whether something more was happening.
Then Came the Confusion
I scheduled an appointment with my gynecologist.
When I explained what was happening with my cycle, birth control was suggested as an option to help regulate it.
Now, I want to be clear. Hormonal birth control can be an appropriate and effective treatment for certain perimenopausal symptoms. I'm not suggesting otherwise.
But I had never taken birth control, and I wasn't ready to start without understanding what was happening in my body.
I wanted to know why my cycle was changing.
I wanted to understand whether the changes I'd been experiencing with my energy and strength might be connected.
And I wanted to know what other options existed.
I wasn't looking for someone to hand me a magic pill.
I was looking for answers.
Eventually, I explored functional medicine support and had additional bloodwork done. That testing identified concerns worth discussing, including hormone levels and declining iron levels. I already knew I was anemic, but seeing that my iron-related concerns were getting worse gave me another important piece of the puzzle.
What I appreciated about this approach was the willingness to look at my symptoms, health history, and test results together.
There was a conversation about different possibilities. There were options to consider. There was a plan to make changes gradually and monitor how I responded.
For the first time in a while, I felt like I was participating in figuring out what was happening instead of simply accepting it.
But here's where things get tricky.
My gynecologist had one perspective. Functional medicine offered another. And the internet had approximately 47 million opinions.
Who was I supposed to believe?
Hormones Are Complicated. So Is the Information.
One of the biggest things I've learned is that perimenopause isn't always something you can identify with one blood test.
Hormone levels fluctuate throughout the menstrual cycle, and those fluctuations can become even more unpredictable during perimenopause.
That means a hormone panel might provide useful information in certain circumstances, but it doesn't necessarily tell the entire story. For many women over 45, healthcare professionals identify perimenopause primarily through symptoms, menstrual history, and clinical evaluation rather than routine hormone testing.
And while changes in hormones can contribute to certain symptoms, a low result on a lab report doesn't automatically prove what's causing fatigue, muscle weakness, or changes in body composition.
My anemia, for example, was something that needed attention in its own right.
I wish I'd known all of this earlier.
Because when you're feeling unlike yourself, it's easy to become desperate for an explanation.
And when someone finally offers one, it's tempting to believe you've found the answer.
But good healthcare isn't necessarily about finding one number that's out of range or one hormone to blame.
It's about looking at the bigger picture, considering other possible causes, and working with qualified professionals to understand which options make sense for you.
The Options I Wish I'd Known Existed
Here's what I really want women to understand.
You have options.
Not every option is right for every woman. Some treatments have decades of research behind them. Others are newer, less studied, or still being evaluated.
But you deserve to know what's available so you can have an informed conversation about your health.
Hormone Therapy
Menopausal hormone therapy can be an effective treatment for certain menopause-related symptoms, particularly hot flashes, night sweats, and some sleep disturbances associated with those symptoms.
There are different formulations and ways to take it, including pills, patches, gels, and vaginal treatments. The appropriate choice depends on your symptoms, medical history, whether you have a uterus, and other individual considerations.
Hormonal contraception can also be useful for some women during perimenopause, especially when menstrual bleeding, cycle control, or pregnancy prevention is a concern.
These treatments aren't interchangeable, and they aren't appropriate for everyone.
Testosterone is another area where I discovered there is a lot of discussion and sometimes conflicting advice. Current evidence supports carefully prescribed testosterone therapy for a specific sexual health condition in certain postmenopausal women. It does not establish testosterone as a general treatment for fatigue, muscle weakness, or weight gain.
That's why understanding the purpose, benefits, risks, and evidence behind any recommended treatment matters.
Nonhormonal Treatments
Hormones aren't the only option.
There are prescription nonhormonal medications that can help with certain menopause symptoms, particularly hot flashes. Some women may benefit from treatments that address sleep difficulties, mood concerns, or other specific symptoms.
And if testing identifies something else, like iron-deficiency anemia or a thyroid condition, treating that condition may be an important part of feeling better.
Sometimes the answer isn't one treatment.
Sometimes it's understanding that several things may be happening at once.
Movement, Nutrition, and Lifestyle
This is an area where I've been making adjustments myself.
I'm walking consistently. I'm hiking, practicing yoga, incorporating bodyweight exercises, and working my way back into lifting weights.
I'm learning that what worked for my body ten years ago might not be exactly what works today.
But that doesn't mean I have to stop challenging myself.
Strength training, regular physical activity, adequate nutrition, and quality sleep can all play meaningful roles in supporting health as we age.
For women in midlife, maintaining muscle strength and bone health becomes especially important.
And I wish I'd known sooner that adapting my workouts didn't have to mean abandoning my goals.
Supplements and Emerging Treatments
This is where I think women need to be especially thoughtful.
There are supplements marketed for hormone balance, menopause support, energy, and healthy aging. You'll also hear about newer wellness treatments, including NAD+ therapies and peptides.
Some may sound promising. But promising isn't the same as proven.
The evidence supporting many of these products for perimenopause is limited, and some carry risks or interact with medications.
Natural doesn't automatically mean safe. New doesn't automatically mean better.
If you're considering these options, ask what research supports them, whether the product is regulated or approved for the proposed use, what the potential side effects are, and how your clinician will evaluate whether they're helping.
You don't have to dismiss every emerging approach.
But you also don't have to become someone's experiment because you're desperate to feel better.
You Don't Have to Figure This Out Alone
Something else I didn't know five years ago?
There are healthcare professionals who focus specifically on helping women navigate this stage of life.
Gynecologists, primary care clinicians, menopause specialists, and other appropriately trained healthcare professionals can help evaluate symptoms and discuss treatment options.
Registered dietitians, physical therapists, qualified fitness professionals, and coaches may also provide support with nutrition, movement, habits, and navigating life changes. Their roles are different from medical diagnosis and prescribing, but that support can still be valuable.
And you are allowed to seek a second opinion.
You are allowed to ask why a treatment is being recommended.
You are allowed to ask what other options exist.
You are allowed to say, "I understand this may be common at my age, but it's affecting my quality of life, and I'd like to understand what we can do about it."
You don't need to walk into an appointment knowing all the answers.
You just need to know that your questions are worth asking.
I'm Still Figuring It Out
Here's the thing. I haven't figured out the magic formula.
I'm 46. I'm still carrying five pounds I'd love to lose. I'm still working to rebuild the strength and endurance I once had.
Some days I feel great. Other days, I'm still trying to figure out what the hell my body is doing.
But I'm no longer willing to accept "it's normal at your age" as the final answer.
I see women 10, 15, even 20 years older than me lifting heavy weights, running marathons, and doing incredible things with their bodies.
I'm not saying we should all be running marathons at 60.
Hell, I don't want to run one now.
What I'm saying is that getting older doesn't automatically mean giving up on feeling strong, energetic, and capable.
Sometimes there are underlying issues worth investigating. Sometimes there are treatments that can help. Sometimes it's about changing how we move, eat, rest, or recover.
And sometimes it's a combination of things.
I'm still learning what works for me.
But now I'm asking better questions, exploring my options, and finding professionals who can help me understand what's happening.
Because I don't need to look or feel 25 again.
I just want to feel like me.
Getting Older Is Inevitable. Feeling Powerless Isn't.
I wasn't worried about the weight gain.
I was worried about losing myself again.
And I think that's what so many women struggle to explain.
It's not always about the number on the scale or the wrinkles appearing around our eyes.
Sometimes it's about looking in the mirror and not quite recognizing the person looking back.
It's about feeling like something has changed and not knowing why.
It's about wondering whether this is just how life is going to feel from now on.
We're all going to get older. That's life.
But getting older doesn't mean we have to quietly accept every change without asking questions.
I can't tell you which treatment is right for you. Hell, I'm still learning what works for me.
But I can tell you this:
You have options.
There are professionals who have dedicated their careers to helping women navigate this transition. There is research, there are treatments, and there are conversations worth having.
And if sharing my experience helps one woman recognize something she hadn't considered, ask a question she didn't know she could ask, or find someone who can help her feel more like herself, then this conversation is worth having.
Because every woman who lives long enough will experience menopause, but no two women will experience the transition in exactly the same way.
You deserve to understand what's happening to your body. And you deserve to know what your options are.
And if you'd like to have more honest conversations about what we're navigating in midlife, come join us in
Beyond the Bullshit, my Facebook community for women who are ready to talk about the things we don't talk about nearly enough.
No pretending. No judgment. Just real women having real conversations.
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Note: I'm sharing my personal experience and general educational information, not medical advice. Symptoms and treatment decisions should be discussed with a qualified healthcare professional.
