What’s Actually Happening Hormonally During Perimenopause?

Understanding the hormonal shifts of your 30s and 40s with clarity, compassion, and cycle literacy

Hormonal Shifts in Perimenopause: The Basics

If your period is getting weirder, your moods are suddenly more chaotic, or your tolerance for everything is just lower - you might be in perimenopause.

Perimenopause is the natural, transitional phase leading up to menopause - often beginning in your late 30s to early 40s, especially if you’re sensitive to hormonal fluctuations.

Despite what many people are told, perimenopause isn’t just a slow fade into menopause. It’s messy, dynamic, and often very emotional. It deserves more than just a shrug and a “welcome to the club.”

Estrogen, Progesterone, and Nervous System Overload

Perimenopause is defined by fluctuating levels of estrogen and a gradual decline in progesterone. But the real kicker? These shifts aren’t linear.

Here’s what’s typically going on:

  • Estrogen levels spike and crash erratically, leading to mood swings, heavy or painful periods, sore breasts, and brain fog

  • Progesterone production declines as ovulation becomes more sporadic, contributing to anxiety, sleep trouble, and PMS-like symptoms

  • Shorter luteal phases or anovulatory cycles become more common, meaning less hormonal stability overall

  • Histamine sensitivity, inflammation, and nervous system shifts may also play a role

This hormonal turbulence can last anywhere from 2 to 10 years before periods fully stop (menopause).

Common Perimenopause Symptoms You Might Not Know Are Related

  • Cycles getting shorter, longer, or just unpredictable

  • Sleep changes, especially trouble staying asleep

  • Mood swings, rage, or anxiety spikes

  • Worsening PMS or PMDD symptoms

  • Joint pain, hot flashes, fatigue, or palpitations

  • New food sensitivities or gut shifts

  • Brain fog or trouble finding words

  • Vaginal dryness, low libido, or painful sex

Many people are told these symptoms are “normal” or unrelated. But they are very real - and they’re hormonally driven.

How Naturopathic Support Can Help

Perimenopause support is not one-size-fits-all. In my practice, I focus on practical, trauma-aware, and non-performative care that helps your body adapt with more ease.

Some of the most evidence-informed (and real-life effective) tools I use include:

  • Cycle tracking to notice patterns and flag hormone shifts

  • Sleep and nervous system support (think stress cycle completion and magnesium)

  • Gentle nutrition focused on blood sugar regulation and anti-inflammatory meals

  • Botanical allies like chaste tree (Vitex), ashwagandha, or black cohosh when appropriate

  • Supplements like B vitamins, magnesium, or omega-3s for mood and cognitive support

  • Thyroid and iron testing, especially when fatigue is intense

  • Compassionate mood and identity support - because this is a tender, expansive identity shift, not just a biological one

Let’s Work Together Through This Phase

You’re Not Broken. You’re Changing.

Perimenopause can feel like everything is changing - your cycle, your energy, your sense of self. You're not broken. You're in a transition that deserves support.

🧡 If you want care that feels kind, curious, and collaborative, book a free call here. Let’s figure out how to support you through this phase with clarity and compassion.

Dr. Jennah Miller, ND is a Naturopathic Doctor who provides holistic hormonal care for all bodies - offered virtually in Ontario & Nova Scotia

Jennah Miller