You’re Not Losing Your Mind. It Might Be Perimenopause.
Something is shifting. Your sleep is off. Your mood swings in directions it never used to. You’ve been doing everything the same — same diet, same routine — and your body is responding differently. You feel like yourself, but not quite. And when you bring it up with a clinician, you might hear: you’re too young, it’s stress, your labs are normal.
This HERtalks session was built for exactly that moment.
Four clinicians — a women’s health nurse practitioner, an OB-GYN and menopause specialist, a registered dietitian, and a licensed clinical social worker — sat down to talk about perimenopause the way it rarely gets discussed: honestly, practically, and without dismissing what women are actually experiencing.
First, What Perimenopause Actually Is
Perimenopause is the transition before menopause — the years when your hormones, primarily estrogen and progesterone, begin fluctuating in ways they never have before. Its literal translation is “the time around menopause.” It typically begins in the 40s, but can start in the mid-30s, and the average duration is four to eight years.
It is not a buzzword. Jackie Piasta, WHNP, who opened the session, addressed that directly: she has had patients told by their own clinicians that perimenopause is “just a buzzword.” It isn’t. It is a universal, hormonal transition — and one that medicine has been slow to take seriously.
A few myths the panel cleared up immediately:
“If you’re still getting your period, you’re not in perimenopause.” Not true. Early perimenopause often happens with regular cycles. It’s late perimenopause when periods start pulling significantly apart — typically around age 47.
“You’re too young.” Women in their late 30s are increasingly recognizing symptoms, and many are right to. Mid-30s onset is real, especially for women who experience early or surgical menopause.
“If you’re not having hot flashes, it’s not perimenopause.” Hot flashes are one symptom among many. Their absence doesn’t mean the transition isn’t happening.
“Blood tests can diagnose it.” Hormone levels fluctuate day to day, sometimes hour to hour, during perimenopause. Labs are not reliable for diagnosis. This is a clinical conversation, not a number on a lab report.
What It Actually Feels Like
The panel spent real time on this, because the symptom list is longer than most women are told. Yes, hot flashes. But also:
Sleep disruption — often one of the earliest signs. Mood changes, irritability, and anxiety that feel out of proportion and out of character. Brain fog. That particular feeling that Lauren Tetenbaum, LCSW, described as “I don’t recognize myself” — which, as it happens, was formally named in a 2024 paper in the Menopause Journal: NFLM, Not Feeling Like Myself.
Weight and metabolism shifts, even when nothing about your diet or exercise has changed. Changes in hair, skin, and nails. Changes in sexual health and vaginal tissue. Heart palpitations. And beneath all of it, the health implications that don’t always get discussed: shifts in cholesterol patterns, bone density starting to decrease, and subtle changes in how the body processes blood sugar.
The panel’s message on all of this: knowing it is happening, and naming it, changes things. You can’t address what you haven’t been told to expect.
Treatment — There Are More Options Than You Think
Dr. Adrienne Mandelberger, OB-GYN and founder of Balanced Medical, organized treatment into a four-prong framework that covers everything from hormonal options to lifestyle interventions — and the way she laid it out made it clear that most women are only being offered one or two of the available tools, if that.
What’s worth knowing going in: perimenopause is a fundamentally different clinical situation than menopause, and the treatment approach is different too. Something that works beautifully for a postmenopausal woman may not produce the same results for someone whose hormones are still in flux — and understanding why changes what you ask for and what you accept.
The full session walks through each option in the framework, what it’s actually targeting, who it tends to work best for, and what the honest limitations are — including the ones clinicians don’t always volunteer.
The Nutrition Piece — More Nuanced Than the Headlines Suggest
Anita Mirchandani, RD, covers the nutrition side of perimenopause in a way that will likely reframe a few things you thought you already knew — including some of the advice that’s loudest on social media right now.
The conversation touches on why what worked in your 30s stops working, what most women are inadvertently doing that makes the transition harder, and where to focus first if you want to see a real difference. There’s also a lively panel debate on protein — how much, what kind, and whether the number you keep hearing is actually right for you — that’s worth staying for.
The Mental Health Piece — Which Doesn’t Get Enough Attention
Lauren Tetenbaum wrote the book on this — literally. Her book Millennial Menopause came directly from her realization that she, as a psychotherapist specializing in women’s reproductive health, had received no training on menopause whatsoever.
Up to 70% of perimenopausal women experience significant mood symptoms. Depression rates are two to four times higher during perimenopause than at other phases of life. Suicide rates in midlife women are elevated. And the session named something that doesn’t get said often enough: women are sometimes hospitalized for psychiatric conditions during midlife, and no one mentions perimenopause.
The mental health effects of this transition are real, they are hormonally mediated, and they are treatable. Tetenbaum’s message to women: you don’t have to meet the clinical threshold for a diagnosis to deserve support. Not feeling like yourself is enough of a reason to ask for help.
And if your clinician dismisses you? Find another one, or find resources. The Menopause Society’s provider directory is a starting point. So is this platform.
Access the Full Recording
The full session — all four presentations and the live Q&A, including a lively discussion on protein recommendations and a detailed conversation on treatment options — is available to HERmedicine members.
Frequently Asked Questions
What is perimenopause?
Perimenopause is the hormonal transition before menopause — the years when estrogen and progesterone levels begin fluctuating irregularly. It typically starts in the early-to-mid 40s but can begin in the mid-30s, and the average duration is four to eight years. It is a clinical diagnosis based on symptoms and cycle changes, not blood tests.
Can you be in perimenopause if you're still having regular periods?
Yes. Early perimenopause commonly occurs while cycles are still relatively regular, varying by no more than seven days. It's late perimenopause when periods begin pulling more than 60 days apart — typically around age 47. Regular menstrual cycles do not rule out perimenopause.
What are the symptoms of perimenopause besides hot flashes?
Perimenopause symptoms include sleep disruption, mood changes, irritability, anxiety, brain fog, weight and metabolism shifts, changes in hair and skin, vaginal changes, and heart palpitations. Many women also experience what a 2024 Menopause Journal paper formally named NFLM — Not Feeling Like Myself — a catch-all for symptoms that are real but hard to name.
How is perimenopause diagnosed?
Perimenopause is a clinical diagnosis based on symptoms, age, and menstrual cycle patterns. Blood tests for hormone levels are not reliable during this transition — levels fluctuate too unpredictably from day to day, sometimes hour to hour. The conversation to have is with a clinician, not a lab report.
At what age does perimenopause start?
Perimenopause typically begins in the early-to-mid 40s, but onset in the mid-to-late 30s is real and increasingly recognized. Women who experience early menopause — before age 40 — will begin the perimenopausal transition even earlier. Age alone is not a reliable indicator; symptoms and cycle changes matter more.
About the Speakers
Jaclyn (Jackie) Piasta, RN, MSN, RNFA, WHNP-BC, MSCP
Jaclyn (Jackie) Piasta, RN, MSN, RNFA, WHNP-BC, MSCP, is a board-certified Women’s Health Nurse Practitioner and certified menopause practitioner through the North American Menopause Society. With over 20 years of experience in women’s health, she specializes in perimenopause, menopause, and sexual health. Jackie is known for her empathetic, evidence-based approach and her ability to make complex hormonal changes understandable and manageable for the women she works with.
Adrienne Mandelberger, MD, FACOG, MSCP
Adrienne Mandelberger, MD, FACOG, MSCP, is a board-certified internist and women’s health specialist and founder of Balanced Medical in New York. She combines evidence-based internal medicine with lifestyle and functional approaches, with a particular focus on midlife and menopause care. Dr. Mandelberger advocates for personalized, hormone-literate medicine that treats the whole person across every stage of life.
Anita Mirchandani, MS, RD
Anita Mirchandani, MS, RD, is a registered dietitian and certified fitness professional with dual master’s degrees in clinical nutrition and exercise physiology from NYU. As founder of FitNut, she brings a holistic, science-backed approach to women’s nutrition and movement, with a particular focus on hormonal health, metabolic support, and sustainable lifestyle strategies.
Lauren Tetenbaum, LCSW, JD, PMH-C
Lauren Tetenbaum, LCSW, JD, PMH-C, is a licensed clinical social worker, women’s rights advocate, and writer specializing in counseling women through identity shifts related to motherhood, career, and reproductive health. Drawing on her background as both a lawyer and a psychotherapist, she is a frequent contributor to media and professional organizations on women’s mental health. She is the author of Millennial Menopause: Preparing for Perimenopause, Menopause, and Life’s Next Period (2025).
Dr. Lisa Larkin, MD, FACP, MSCP, IF — Moderator
Dr. Lisa Larkin, MD, FACP, MSCP, IF, moderated the discussion. As founder of HERmedicine and Ms.Medicine, Dr. Larkin is a national leader in personalized, evidence-based women’s preventive health and hormonal care.
