About ten years before menopause, your egg quality declines and your hormones begin to shift—estrogen diminishes a little, and progesterone plummets. “Everyone thinks perimenopause is due to low estrogen, but it’s low progesterone very early on,” says Stanton. “It’s not until the end that you get to the low estrogen.”


Brain fog. Researchers suspect lower estrogen may be partly to blame for the trouble some perimenopausal women report with memory and decision-making, but the stress of busy daily lives makes it worse, Pick says. Chronic stress can lead to adrenal fatigue, a collection of symptoms remarkably similar to perimenopause: insomnia, headaches, fatigue, anxiety, inability to concentrate, and depression. Research also suggests chronically elevated cortisol levels may decrease memory performance.

Weight gain. Yep, stress can make you fat. Cortisol releases sugar into the bloodstream to provide fuel during stressful times, and insulin mops up the excess. With too much sugar to process, the body becomes insulin resistant, and converts the excess to belly fat, or visceral fat, which is linked to greater risk for heart disease and other serious health problems. “Visceral fat is harder to lose,” Lommen says. And for many people, turning to refined-carb “comfort foods” when stressed worsens the cycle.

Sleep problems and hot flashes. Perimenopausal women may have trouble falling or staying asleep, possibly due to low progesterone, high cortisol demands, or a disturbance in melatonin, the hormone that helps regulate sleep-wake cycles. Erratic estrogen levels cause hot flashes, says Pick.


Eat right, sleep, and meditate. This will keep cortisol and insulin levels stable, and your weight down. Choose low-glycemic foods like lean proteins and complex carbs, which break down more slowly in the body. Sleep seven hours a night to stabilize cortisol levels and balance appetite hormones leptin and ghrelin. A new study published in Menopause found that women who participated in a mindfulness-based stress-reduction program, which included meditating and mindful stretching, had fewer, less-intense hot flashes, better sleep quality, and less anxiety and perceived stress.

Consider bio-identical hormones. They’re the exact same structure as the hormones you make,” unlike the hormones used in the now-infamous Women’s Health Initiative study, Stanton says. (See “Is Hormone Replacement Safe?,” TKwhere.) Nevertheless, the decision to use bio-identicals remains controversial. “They haven’t been studied to the same degree that synthetic hormones have,” Johnson says. “But I see women having fewer problems adjusting to being on them, and fewer side effects than with synthetic hormones.” Women who have a personal or family history of breast cancer, blood clots, stroke, or heart disease should discuss risks with their physicians. Finally, if you know for certain your progesterone levels are low, a natural progesterone cream also may improve symptoms.