Do you ever feel like the woman you used to be has simply left the building? Hot flashes, fatigue, isolation, and a profound loss of self… If this sounds familiar, you may be entering perimenopause.
The Perimenopause Diaries:
What’s Happening to Me!? (and What Can I Do About It?)
3:00am
Woke in a full-body sweat, convinced the house was on fire. It was not on fire. It was just me.
5:58am
After catastrophizing about every word I’ve ever said to anyone since 1987, finally fell back asleep—two minutes before the alarm.
11:00am
My husband called, confirming he would pick up the kids at school. I hmm’d. He asked, “Are you okay?” Of course I’m not ok! I wanted to scream. I said, “I’m fine.”
2:30pm
Stood in Shoppers Drug Mart with two toothpaste tubes for a full four minutes trying to remember what I was doing there.
6:45pm
Five hot flashes in the last hour and half. Might hit a new personal record.
8:00pm
I’m exhausted. I’m angry. I’m lonely—who am I now? When is this going to stop…?
Do you ever feel like the woman you used to be has simply left the building? You’re experiencing disrupted sleep, cognitive fog, isolation, fatigue, hot flashes, and a profound loss of self-recognition—all in one day! If this sounds familiar, it may be perimenopause. And you are not broken.
What Is Perimenopause?
Perimenopause is the transitional phase that precedes menopause, marked by fluctuating levels of estrogen and progesterone that gradually decline over time. Because estrogen and progesterone influence nearly every system in the body—your brain, cardiovascular system, bones, gut, skin—their disruption produces a remarkably wide range of symptoms. While it typically begins in a woman’s early to mid-forties, it can start as early as the mid-thirties and last anywhere from four to ten years.*
* It is worth noting that the experience of perimenopause is not universal. Research suggests that symptoms vary meaningfully across cultures and ethnicities. As well, perimenopause and menopause aren’t strictly experienced by women; it can affect transgender men who did not undergo the removal of their ovaries or uterus. Throughout this article, the term women is used to refer specifically to those who are biologically female at birth, while acknowledging and affirming that this transition is a shared experience that extends across gender identities and deserves inclusive, compassionate care for all who go through it.
The most recognized symptoms in Western societies are hot flashes and night sweats. But perimenopause also commonly causes sleep disturbances, mood swings, anxiety, brain fog, joint pain, irregular periods, low libido, weight changes, and even something as unexpected as itchy ears. Many women also describe something harder to name, a feeling that they are no longer quite themselves.
Perimenopause is not a mental health crisis. It is not burnout (though it can look similar). It is a neurological and hormonal event, and it will happen to roughly half the population, largely in silence.
It can feel overwhelming and, in my experience, the proper help is not always easy to find. Which is why I’d like to share a few small steps I’ve seen work, that you may find helpful to improve your quality of life while navigating this transition.
Finding the Right Medical Support
This is one of the most frustrating aspects of perimenopause. Unfortunately, a common experience for women seeking help in the medical system is having their concerns dismissed or not taken seriously. As a consequence, we’ve spent years being told our symptoms are stress, depression, or simply aging. Despite the growing infrastructure to increase awareness and education about perimenopause and menopause within the medical community, it’s still unlikely to find a doctor with training in these matters. Getting the right support often requires persistence.
Start by talking to your doctor and being specific about your symptoms; bring a list if you need to and ask about treatment options. If your doctor dismisses your concerns or is unfamiliar with current menopause guidelines, ask for a referral to a menopause-informed specialist. In Canada, the Menopause Society of Canada and the Society of Obstetricians and Gynaecologists of Canada maintain resources to help women find knowledgeable practitioners.
You deserve a clinician who understands what you are going through. Advocating for that is not being difficult—it is being a good patient.
Sleep
Sleep is foundational. It directly shapes our energy levels, cognitive capacity, and emotional resilience. Unfortunately, sleep disturbances are among the most common symptoms women face during perimenopause. One of the first hormones to decline is progesterone, which has a natural sedative effect on the brain. That’s why sleep disruption tends to arrive early and quietly, before many women even realize what is happening. Once hot flashes start as well, getting a good night’s sleep can feel like an impossibility!
Thankfully, a consistent sleep routine can significantly reduce the impact of hot flashes and night sweats, while small, intentional changes to your daily habits can make a meaningful difference and work as signals to your nervous system that needs recalibrating. Some of these changes may include:
- reducing alcohol and caffeine,
- limiting screen use in the evening,
- keeping consistent bedtimes and wake times,
- dimming the lights an hour before bed.
Practices that foster relaxation—whether meditation or breathwork—can also help quiet the ruminative and anxious thought patterns that so often take over in the small hours of the night. Sleep will affect every other step you try, so the sooner you address it, the better.
Nutrition
Weight management is often the first nutrition concern women raise during perimenopause. But what we eat during this transition matters well beyond the bathroom scale. Getting less concerned about calories or diet trends and focusing more on what the body really needs helps ease the symptoms interfering with one’s wellbeing.
What we put on our plate today has a direct impact on how our brain functions, and on our cognitive health in the years ahead. Without the right nutritional support, we risk accelerating cognitive decline, struggling with brain fog, and increasing our vulnerability to conditions like dementia later in life—risks that are already heightened during menopause as estrogen, which helps protect the brain, begins to fall.
Another important aspect to consider is that muscle mass begins to decline from around age forty and protein intake becomes especially important to maintain muscles. Healthy muscles preserve our mobility, which is paramount to keep our physical and mental health.
Equally relevant is to consider that phytoestrogens—found in foods like soy, flaxseed and legumes—may offer modest symptom relief for some women and help to stabilize mood, energy, and weight.
Introducing some of the following changes in your eating habits can go a long way:
- staying well hydrated,
- maintaining a good balance of macronutrients (fats, protein, and carbohydrates) and micronutrients (vitamins and minerals),
- eating anti-inflammatory foods, rich antioxidants, and healthy fats (fatty fish, leafy greens, berries, and nuts),
- reducing highly processed foods, refined sugar, and alcohol.
Remember, this is not about restriction or perfection! It is about giving your brain and body what they need during a transition that asks a great deal of both.
Movement
Among specialists in menopause, the consensus on exercise is remarkably consistent—it is non-negotiable! Movement is not presented as optional, or something to consider once other things are in order. And as Dr. Jen Gunter puts it plainly in The Menopause Manifesto, “If exercise were a drug, it would be the one thing every clinician would prescribe to everybody.”
The type of exercise matters, and different modalities serve different needs during perimenopause.
Resistance Training
This is the most consistently recommended type of movement during perimenopause. As muscle mass naturally begins to decline from around age forty, strength work becomes one of the most effective tools for preserving it. Talk to your doctor or a certified fitness professional about what is appropriate for your current fitness level.
Example Exercises:
- Push-ups
- Weightlifting
- Bodyweight exercises
Cardiovascular Exercise
This supports heart health and mood regulation and may help reduce the frequency of hot flashes. Even moderate aerobic movement done consistently makes a meaningful difference.
Example Exercises:
- Brisk walking
- Cycling
- Swimming
- Dancing
Weight-Bearing Movement
Bone health becomes increasingly relevant during the perimenopause transition, so weight-bearing movement deserves specific mention. These kinds of exercise all place load through the skeleton in ways that support your bone health by signalling to your body that your bones need to stay strong. Without that signal, and with estrogen declining, bone can quietly weaken over time—raising the risk of osteoporosis and fractures that can significantly affect your quality of life in later years.
Example Exercises:
- Walking
- Hiking
- Dancing
- Stair climbing
Yoga and Mind-Body Practices
These exercises address what the other modalities do not always reach: your nervous system. For stress regulation, sleep quality, and the anxiety that so often accompanies perimenopause, practices that combine breath, movement, and stillness offer something measurable and meaningful—and fit naturally alongside psychological support.
Consistency
The most important principle of movement is simple: consistency matters more than intensity. The perfect workout done occasionally is far less valuable than a modest, sustainable habit done regularly. Do not wait for the right moment, the right gear, or the right level of energy—start now. Whatever you can do today counts, and a twenty-minute walk is a perfectly legitimate place to start.
Managing Anxiety and Emotional Volatility
You may look at the steps above and feel genuinely motivated. And then 4:00pm arrives, you have not slept properly in three weeks, your heart is racing for no clear reason, and the idea of doing anything at all feels impossible. This is not a lack of willpower—this is your nervous system under chemical siege! The good news is understanding what’s going on will help you manage it.
Why Anxiety Feels So Different Now
When estrogen and progesterone levels drop during perimenopause, serotonin levels also fall, contributing to increased irritability, nervousness, and anxiety. Higher levels of cortisol, the stress hormone that increases with age, compound that effect.
Progesterone plays a particularly important role. Once in the brain, it calms the nervous system by activating the same receptors targeted by many anti-anxiety medications. When progesterone declines, that natural calming mechanism weakens—leading to more anxious thoughts, greater stress sensitivity, and disrupted sleep.
This is the biology behind the 3:00am spiral; the catastrophizing and feeling that you are not yourself. You are not overreacting: your brain is literally operating with fewer tools than it used to have.
What Actually Helps
The nervous system is responsive. It can be recalibrated—and psychological support plays a central role in that process, alongside the self-care practices that make daily life more manageable.
Therapy approaches with a strong evidence base for anxiety and emotional regulation may be helpful during perimenopause, including:
- Emotion Focused Therapy (EFT) helps clients differentiate between secondary reactions (reactions to feelings) and primary reactions (reactions to events) and works with the emotion system directly to help individuals come into awareness of their deeper feelings and the needs they signal. EFT has an extensive research base including research aimed at understanding the underlying mechanisms of change in shifting anxiety and depression.
- Cognitive Behavioural Therapy (CBT) helps identify and interrupt the thought patterns that fuel anxiety—the catastrophizing, the rumination, the middle-of-the-night spirals. It is one of the most extensively researched psychological interventions for perimenopausal mood symptoms, with evidence supporting its effectiveness for both anxiety and sleep disturbance.
- Dialectical Behaviour Therapy (DBT) was originally developed for emotional dysregulation and remains one of the most effective tools for managing intense, rapidly shifting emotions. During perimenopause, when mood volatility can feel disproportionate and hard to predict, DBT offers concrete skills in four areas—mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness—that translate directly to the daily challenges of this transition.
- Internal Family Systems (IFS) offers a different entry point—one that is particularly relevant when perimenopause triggers a deeper questioning of identity. Rather than managing symptoms, IFS works with the different parts of yourself that may feel overwhelmed, lost, or in conflict. For women asking who am I now, this approach can be genuinely transformative.
Alongside therapeutic support, self-directed practices can help regulate your nervous system day to day:
- Journaling slows anxious thinking down, creates distance from the content of worried thoughts, and activates the prefrontal cortex—the part of your brain responsible for perspective. Five minutes of unstructured writing before bed can interrupt the loop that hijacks sleep.
- Meditation – breath-focused, body scan, or loving-kindness—has growing evidence for reducing cortisol and improving sleep. It does not require stillness or thirty minutes on a cushion. Two minutes consistently matters more than twenty minutes occasionally.
- Emotional freedom technique or tapping offers a physical, embodied interruption to an acute stress response—something that can be used in the moment, when the spiral is already underway.
Your nervous system responds to safety, repetition, and consistency. There is no single right method—the one that works is the one you will actually do. But if anxiety, mood shifts, or the loss of your sense of self are significantly affecting your quality of life, that is exactly what therapy is for.
You Do Not Have to Figure This Out Alone
If you are feeling overwhelmed after reading this, that is completely understandable. I’ve given you a lot to try—in the middle of an already full life!
You do not need to address everything at once. In the coming weeks, I will go deeper into each of these areas, one topic at a time.
Perimenopause is a transition that asks for accompaniment—someone to journey with you who can hold both the biology and the emotional weight of feeling like a stranger in your own life. If you would like to explore whether working together makes sense, I offer a free fifteen-minute conversation to find your first step. You are not alone.
