The Perimenopause Talk You Should Have Had Years Ago

We got the talk in 5th grade. We had books for puberty and pregnancy. But nobody sat us down for this one. In this episode Shari gives you the perimenopause conversation you should have had years ago, naming the symptoms nobody connected for you, explaining what your hormones are actually doing, and giving you four specific things to bring to your next appointment.

Listen to this episode

Key Takeaways

• Perimenopause can begin as early as the late 30s and last more than a decade. It is far more than hot flashes.
• Estrogen, progesterone, testosterone, and serotonin all shift during this transition, and together they affect sleep, mood, memory, metabolism, joints, skin, and identity.
• Normal lab results do not mean nothing is wrong. Hormone levels fluctuate and one blood test on one day does not tell the whole story.
• Hormone therapy is not for everyone, but every woman deserves an educated and compassionate conversation about it.
• Lifestyle habits matter, including the way you sleep, nourish yourself, move, and respond to stress. These are things you have real influence over.
• You do not have to figure this out alone. Supportive environments exist to help you make one small shift at a time.

Resources

• 🎯 Take the free Midlife Spark Type Quiz: https://www.sharibiery.com/quiz
• 📗 Read It's Your Turn: https://www.sharibiery.com/its-your-turn-book
• 🌐 Website: https://www.sharibiery.com
• 📖 Join Me on Substack: https://sharibiery.substack.com/p/start-here
• 🔍 Find a Certified Menopause Practitioner: https://www.menopause.org
• 💪 Join Nourish You Live: A guided 4-week coaching experience to help midlife women nourish, move, and rest in a way that actually fits real life: https://www.sharibiery.com/nourish-you-live

Transcript

The Talk Nobody Gave Us

[00:00:03] Shari Biery: Do you remember the talk? Fifth grade, fluorescent lights. The boys went to one room, and we went to another. Someone's mom came in, or maybe it was the school nurse, or a teacher. Mine was Mrs. Carter, I think. There was a video, there was a pamphlet, there were diagrams nobody wanted to look at directly. And if you were a reader, maybe you found your way to Are You There, God? It's Me, Margaret. Remember that book? Or, later, maybe What to Expect When You're Expecting, which at least told you what was coming most of the time, chapter by chapter, month by month.

But then we hit midlife, perimenopause and menopause, and nobody gave us that book. Our mothers really didn't talk about it. Our grandmothers certainly didn't. There was a phrase, "the change." That was it. Said quietly, if at all, like it was something to just get through, not something to understand. And so most of us arrived here completely unprepared.

Something is finally changing, though. The good news is that it's starting to shift. The market is flooded with books about perimenopause and menopause right now, and it's about time. Women are writing about their own experiences. Researchers and doctors are finally centering around women's health. And the conversation that should have been happening for decades is getting louder.

Curious doctors are trying to catch up. There are practitioners out there who are really interested in this space, who have done the additional training on women's health, who will sit with you and actually look at the whole picture. And the ones who say, "I don't do this, that's not really my area," that's okay, as long as they're not dismissing you. You're allowed to know that, and you're allowed to keep looking and find the person who can help you through this time when it comes to your medical care.

But here's the problem. For most of us, that shift came too late. We'd already spent years wondering what was wrong with us, going to appointments and leaving with more questions than answers, trying harder, adjusting everything, and still feeling off in ways we couldn't name. So today, let's talk about this, the talk we should have had years ago. And from a perspective that if we're comfortable talking about it, we're going to be comfortable talking about it with our friends without laughing and joking about it, but also with our daughters, too, so they know and they're prepared.

What Is Perimenopause, Actually?

[00:03:18] Shari Biery: So, what is perimenopause, actually? And before I jump into that, everything I share on this show comes from my perspective as a National Board Health and Wellness Coach. It is for informational purposes only, and it's not intended for medical or mental health advice, so please always consult a qualified healthcare practitioner or a mental health professional with any questions about your health.

So, perimenopause is the transition period before menopause, and it can begin as early as your late 30s, though for most women, it starts in the early to mid-40s, and it can last anywhere from a few years to more than a decade. Menopause itself is defined as one full year without a menstrual period. Everything leading up to that point is perimenopause.

This is also known as the zone of chaos, because estrogen, progesterone, and testosterone levels begin to really fluctuate. And these hormones don't just affect your reproductive system, they affect your brain, your sleep, your mood, your metabolism, your cardiovascular system, your joints, your skin. You won't feel it in just one place. And maybe no one's connected that for you until now.

Meet Your Hormones

[00:05:09] Shari Biery: So let's talk about the hormones and what they do, because these words get thrown around a lot, but it helps to actually know what they do. I'm going to give a very basic explanation, there's much more information out there on this, but let's start with estrogen.

This is one we've all heard of, and it plays a role in your menstrual cycle, yes, but it helps you regulate your sleep, your mood, your memory, your cardiovascular health, your bone density, and the elasticity of your skin and joints. Estrogen is anti-inflammatory, so when we lose it, we lose that response. When estrogen fluctuates, you feel it in all these places, not just one.

Let's talk about progesterone, which works alongside estrogen and has a really important relationship with sleep and anxiety. It has a natural calming effect on your nervous system. So when progesterone drops, which happens earlier in the menopause transition than most women realize, sleep gets lighter, and anxiety can quietly creep in.

Then testosterone, which is not just a male hormone. We think of these hormones as just men or women, but they're not, men and women have all of them. Testosterone matters because it contributes to energy, motivation, libido, and muscle strength. And when it declines, women often describe feeling flat, less driven, or more physically fatigued than you used to feel.

Something to understand, these three are not operating separately. They're in constant conversation with one another, and when one shifts, the others respond. Because they touch so many systems in the body, the symptoms can feel completely unrelated when they're actually all coming from the same place.

One more I want to mention, because it will make sense when it comes up: serotonin. Serotonin is often called the feel-good chemical. It plays a major role in mood, emotional stability, and sleep. Most women don't know that estrogen helps regulate serotonin production. So when estrogen is fluctuating, serotonin can too. And this is why mood shifts happen, irritability, a new or worsening sense of anxiety during perimenopause, that you may be told is "just in your head." It's not. It's a direct hormonal pathway underneath all of these things going on.

Signs Nobody Named for You

[00:08:27] Shari Biery: So let's talk about some of the signs maybe nobody named for you, because it's more than hot flashes.

Sleep is one of them. One of the most common early signs is disrupted sleep. And it's not the kind where you can't fall asleep, it's where you wake up at 3 AM and can't get back to sleep. Or when you sleep a full night and you still feel exhausted. Women often chalk this up to stress or busy minds. Sometimes it is, but often it's hormonal.

Mood and anxiety: increased anxiety, irritability, mood shifts that feel really out of proportion to what's actually happening. I remember a friend telling me, "My husband's chewing drives me crazy." We can all chuckle about that, but women tell me they feel like they're overreacting and they can't stop it. They feel like they're losing their patience in ways that aren't like them. Estrogen has a direct relationship with serotonin, and when it fluctuates, so does your mood.

Another one is brain fog: forgetting words mid-sentence, walking into a room and forgetting why, feeling like your thinking is slower than it used to be. I describe this as feeling really heavy to make decisions or focus. This is one of the most distressing symptoms, too, because we often worry something is seriously wrong. A lot of times we start thinking, could this be dementia or Alzheimer's? You may go down that path if you have a family history, and that's something to discuss with your practitioner, but looking at the hormones running the show could be a cause. For most of us, it's hormonal, and it tends to improve after this whole chaotic time.

Weight changes is another area. Weight gain, particularly around the midsection, even when nothing in your eating or exercise habits has changed. Estrogen affects how your body stores fat, so when it declines, the body tends to shift storage around the belly. Many of us might start thinking this is a failure on our part, willpower, or "I should be able to do this better." It's biology. It's a physiological change that's happening. We need to be gentle with ourselves here.

Temperature regulation, we often connect this with hot flashes, but also night sweats, or suddenly feeling cold, or a general sense that your body is running on a really unpredictable thermostat. These vary enormously from woman to woman, some barely notice them, others are waking up soaked every night.

Physical changes: joint aches, especially in the morning, where you can't get out of bed because you hurt so bad. I hear this often, and it's related to the work my husband does as a physician in osteopathic medicine, musculoskeletal issues, frozen shoulder, chronic hip pain, these are all related. Changes in skin texture and dryness, heart palpitations that feel alarming but are often benign, hair thinning or changes in hair texture, urinary changes like more urgency or frequency, pain during sex. These are all on the list, and they're rarely talked about. We need to bring these to the light.

And one more thing I want to mention, because this is an area I talk about a lot: emotional and identity shifts. A growing sense of restlessness. You question whether the life you've built is still the one you want. Feeling like you're changing in ways you can't fully articulate. These aren't just "midlife crisis," our hormones influence how we relate to ourselves and our lives. This transition is not just physical. It's emotional, and it's often tied to our identities, too.

Considering Hormone Therapy

[00:13:39] Shari Biery: So, what do we do with all this? I want to name something that's often in the media spotlight right now, especially, hormone therapy, because it will likely come up in your conversation.

These are individual health considerations that should be a decision between you and your practitioner, someone who actually knows your full picture, or a practitioner educated in this area. Hormone therapy is not for everyone. It depends on your risk and benefits, so this is an individual health consideration. You deserve an educated and compassionate conversation around it, not a dismissal, not a one-size-fits-all conversation. It's really a real conversation.

Four Ways to Prepare for Your Appointment

[00:14:40] Shari Biery: So I want to give you some tips here. There are 4 ways you can go prepared to your appointment. And I just want to remind you, if you haven't had a doctor's appointment lately and you're having some of these symptoms, book that appointment. Book the time. If you're not sure who the provider is, I'll share a resource shortly.

First, write down your symptoms before you go in. Be specific. Not just "I'm tired," but something like: I wake up between 2 and 4, three times a week, and I cannot get back to sleep, and this has been happening for six months. It's really hard to wave off when someone is being specific.

Second, ask this question directly, because it will save you a lot of time and a lot of heartache: Do you feel comfortable talking about hormones and hormone therapy? That one question tells you a lot, whether the provider sitting in front of you is the right provider for this conversation.

Third, if the answer is no, or you feel dismissed, that is information. Curious doctors are out there. They are training themselves, learning, staying up on the most recent education and research around menopause, perimenopause, and women's health in general. One resource I can offer you today is the Menopause Society. If you go to menopause.org, they have a tool specifically designed to help you find a certified menopause practitioner in your area. That's a real resource, and I'll put the link in the show notes. This is probably one of the most common things when I'm having conversations with women, finding the right practitioner. I know in my own case, it took me two people to find the right person. Some people have said five, some seven, some nine. This is getting better, but it's still one of those things we have to do research on to find the right provider.

And number four, I want you to know that normal lab results do not mean nothing is wrong. Hormone levels really fluctuate during perimenopause. It's a very big zone of chaos, so one blood test on one specific day does not tell you the whole picture. Certainly, if your practitioner wants to get a baseline, there's that. But being dismissed after normal labs doesn't mean the next day they're not in a different direction. So you're allowed to say, "I hear that my labs look normal, and I still want to understand why I feel this way."

Lifestyle Habits Matter More Than You Think

[00:18:44] Shari Biery: So, remember, we didn't get the book on this. Now there are many books out there, but we can have this conversation starting right now. I want to wrap up in a final couple of thoughts here. Lifestyle habits matter more than you think, and here's what I know from working with women in this season.

The cycle that keeps most midlife women stuck isn't from a lack of trying. It's trying things that weren't built for where you are right now. You're starting over every Monday, or you're feeling bloated and achy and wondering what you're doing wrong, looking for the next best thing because nothing has stuck. This is the wellness industry gap I've mentioned before, we're trying products, we're trying different things. What I really want to anchor here for you is lifestyle. Habits matter more than we give them credit for. You have control over this.

What a Health Coach Actually Does

[00:19:52] Shari Biery: As a health coach, I wanted to explain, because not everybody knows what a health coach is, I find that people often ask, can you tell me what the difference is here? I'm trained as a health coach and a life coach together. My role is not to prescribe or diagnose. It's here to help you connect the dots between what is going on in your body, what your body is telling you, and the daily habits, the rhythms, and the choices that can actually support it. There's a big gap between the doctor's office and home, and navigating that on your own can be very difficult. That's where a health coach, whether it's me or someone else, can help you.

The Beliefs Running the Show

[00:20:34] Shari Biery: And one of the things I specifically pull into my programs is talking about beliefs. Because beliefs are the things we carry around, and they're running on autopilot underneath all of this. They're the beliefs you carry around about your body, about food, your relationship with food, about rest, about whether you've even deserved to slow down. Beliefs like "my body is broken," or "I have no willpower," or "I'll take care of myself when things slow down." The quiet one underneath all of it, a lot of times, is "it's too late," or "I don't know that I can feel any different than this."

I want to shine a light on this, because you can have all the information in the world and still stay stuck if the belief underneath it all is saying nothing is going to work. That's also where support matters. Having someone in your corner who can help you recognize when you're getting stuck, and help you move through it rather than giving up and starting over, that changes everything. Many women come to me and say, "This should be so simple, why can't I do it?" Well, change is hard. And a lot of times it's these beliefs that we're running that slow us down or have us stuck.

Where to Go From Here

[00:22:15] Shari Biery: This is exactly why I built the two specific coaching programs I run. One is called Nourish You, and the other is called Reclaim You. Nourish You is coming up, and I want to mention this because we're going to run a cohort in September. It's a four-week supported reset for midlife women, where we work on these basic habits and the beliefs that come together. We don't go on diets, it's not a rigid protocol, we find what works for you around food, movement, rest, because you have to have some nervous system regulation. And no other program out there will do that. It's a real, supported experience where you have a coach and a community in your corner while you do it. Women often come in feeling very disconnected and exhausted, but they leave with steadier energy, more self-trust, and habits that finally stick because they had the support to make them stick.

And for women who want to go even deeper, Reclaim You is my 12-week signature program, where that work continues. September, Nourish You is open, the link is in the show notes. If this is something you're interested in, or you have questions, reach out to me. I also offer a 15-minute curiosity call, or clarity call, where we can get on and just talk if you feel like maybe this is what you're looking for, but you're not sure. It's very brief, and it's a no-pressure call.

If this episode helped you see your own experiences differently, there are a few other steps you can take. The Midlife Spark Type Quiz is a good next step. You can find out whether you are a giver, a reclaimer, or a seeker. And the thing I love about this, it helps you understand where you are right now, and what your body and your life need right now. Those links are in the show notes.

Keep Taking Your Turn

[00:24:48] Shari Biery: I just want to say thank you for spending the time with me today. If something in this episode really hits your heart, share it with a woman in your life right now who may need to hear it as well. This period of time, perimenopause and menopause, can feel like a very lonely time, and so I want you to know you're not alone. So, until next time, keep taking your turn.

Sources

1. The Menopause Society. Find a Menopause Practitioner directory tool. https://menopause.org

This content is for informational purposes only and is not intended as medical or mental health advice. Always consult a qualified healthcare provider or mental health professional with any questions about your health.

AI Disclosure: I'm a mom, wife, veteran military spouse, healthcare worker, and National Board Certified Health and Wellness Coach. My writing connects back to my book, It's Your Turn, and my own lived experience. I use AI to help draft and edit, but every idea, story, and word comes from me.