Perimenopause Explained: What’s Happening to Your Hormones?

Perimenopause can feel confusing because hormone changes do not always happen in a smooth, predictable way. Many women are told their labs are “normal,” but they still feel like their body is changing. In this video, I explain what perimenopause actually is, how it is different from menopause and post-menopause, why estrogen and progesterone can fluctuate, and why symptoms can feel so random. We’ll also talk about common perimenopause symptoms like irregular periods, heavier bleeding, hot flashes, night sweats, poor sleep, mood changes, anxiety, brain fog, low libido, vaginal dryness, urinary changes, fatigue, and weight gain around the middle. Most importantly, we’ll cover what can be normal during perimenopause and what should not be ignored — especially abnormal bleeding or any bleeding after menopause. This video is for education only and is not personal medical advice. If you are having significant symptoms, abnormal bleeding, bleeding after menopause, or concerns about hormones, please work with a qualified healthcare professional who can evaluate your specific situation. Topics covered: What perimenopause is Perimenopause vs menopause vs post-menopause Why hormones fluctuate during perimenopause Common symptoms of perimenopause Why normal labs do not always rule out perimenopause What bleeding patterns should be evaluated What is normal vs concerning Works Cited: American College of Obstetricians and Gynecologists. “Abnormal Uterine Bleeding.” ACOG. https://www.acog.org/womens-health/fa... American College of Obstetricians and Gynecologists. “Hormone Therapy for Menopause.” ACOG. https://www.acog.org/womens-health/fa... American College of Obstetricians and Gynecologists. “Perimenopausal Bleeding and Bleeding After Menopause.” ACOG. https://www.acog.org/womens-health/fa... American College of Obstetricians and Gynecologists. “The Menopause Years.” ACOG. https://www.acog.org/womens-health/fa... Bromberger, Joyce T., and Howard M. Kravitz. “Mood and Menopause: Findings from the Study of Women’s Health Across the Nation (SWAN) over 10 Years.” Obstetrics and Gynecology Clinics of North America, vol. 38, no. 3, 2011, pp. 609–625. https://pmc.ncbi.nlm.nih.gov/articles... Burger, Henry G., et al. “A Review of Hormonal Changes during the Menopausal Transition: Focus on Findings from the Melbourne Women’s Midlife Health Project.” Human Reproduction Update, vol. 13, no. 6, 2007, pp. 559–565. https://pubmed.ncbi.nlm.nih.gov/17630... Delamater, Lara, and Nanette Santoro. “Management of the Perimenopause.” Clinical Obstetrics and Gynecology, vol. 61, no. 3, 2018, pp. 419–432. https://pmc.ncbi.nlm.nih.gov/articles... El Khoudary, Samar R., et al. “The Menopause Transition and Women’s Health at Midlife: A Progress Report from the Study of Women’s Health Across the Nation (SWAN).” Menopause, vol. 26, no. 10, 2019, pp. 1213–1227. https://pmc.ncbi.nlm.nih.gov/articles... Harlow, Siobán D., et al. “Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unfinished Agenda of Staging Reproductive Aging.” Menopause, vol. 19, no. 4, 2012, pp. 387–395. https://pmc.ncbi.nlm.nih.gov/articles... Hall, Janet E. “Endocrinology of the Menopause.” Endocrinology and Metabolism Clinics of North America, vol. 44, no. 3, 2015, pp. 485–496. https://pmc.ncbi.nlm.nih.gov/articles... Santoro, Nanette. “Perimenopause: From Research to Practice.” Journal of Women’s Health, vol. 25, no. 4, 2016, pp. 332–339. https://pmc.ncbi.nlm.nih.gov/articles... Santoro, Nanette, et al. “The Menopause Transition: Signs, Symptoms, and Management Options.” The Journal of Clinical Endocrinology & Metabolism, vol. 106, no. 1, 2021, pp. 1–15. https://pubmed.ncbi.nlm.nih.gov/33095... Santoro, Nanette, and Chhanda D. Chatterjee. “Menopausal Symptoms and Their Management.” Endocrinology and Metabolism Clinics of North America, vol. 44, no. 3, 2015, pp. 497–515. https://pubmed.ncbi.nlm.nih.gov/26316... Su, H. Irene, et al. “Hormone Changes Associated with the Menopausal Transition.” Minerva Ginecologica, vol. 61, no. 6, 2009, pp. 483–489. https://pmc.ncbi.nlm.nih.gov/articles... The North American Menopause Society. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society.” Menopause, vol. 29, no. 7, 2022, pp. 767–794. https://pubmed.ncbi.nlm.nih.gov/35797...