Chapter 4 - Perimenopause Is Not Menopause...(Yet)

Your GP says your blood tests are normal, but your body is telling a different story. If you’re exhausted before you’ve even started the day, bleeding heavily, waking at 3 am, or feeling anxious and scattered for no obvious reason, this conversation names what often goes unnamed: perimenopause can begin in your 30s and early 40s, even while you’re still cycling. We’re here to separate fact from the common myths that keep women stuck, dismissed, and quietly suffering.

We unpack the practical definition that matters: perimenopause means you’ve had a period within the last year, while menopause begins only after one year and one day without bleeding. From there we dig into the hormone paradox that trips people up. For many women, perimenopause isn’t simply “low oestrogen” it’s wildly fluctuating oestrogen alongside a steady drop in progesterone, especially when ovulation becomes unreliable. That pattern can help explain night sweats, brain fog, mood swings, sleep disruption, migraines, heart palpitations, and heavy bleeding, and why the right support can look different to menopause care.

We also walk through the phases of the menopause transition, share the grandmother hypothesis as a powerful reframe of menopause as an evolutionary advantage, and tell a cautionary story about what happens when clinicians don’t order the right investigations. We talk progesterone’s calming link to GABA, why ferritin matters when heavy bleeding is draining iron stores, and how an integrated approach can connect hormones, gut health, and nervous system balance into one clear plan. If this resonates, subscribe, share the episode with a friend, and leave a review so more women can find answers sooner.

Transcript

Kate’s Perimenopause Symptoms Dismissed

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Chapter four Perimenopause is not menopause yet. A smooth sea never made a skilled sailor. Kate was only thirty-nine, yet every morning she woke already drained of energy. Her body felt swollen and heavy, and her face puffy in a way she described as a puffer fish. Month after month she endured heavy and disruptive bleeds that made even ordinary routines feel impossible. When she turned to her GP for help, his response was simply your blood tests look normal, and considering your age, it might be that you're depressed, anxious, or perhaps just stressed out. And this misdiagnosis is more common than you think. Kate knew her body and felt that something wasn't right. But, like so many women, her symptoms were brushed aside because of her young age. Instead of answers or a diagnosis, she was left feeling confused, frustrated, and hopeless that she would ever find a solution, while questioning, Am I broken? Am I doing something wrong? In my clinic I often hear stories similar to Kate's, in which women are told, You're too young to be in perimenopause, if this term is mentioned at all. Then they are reassured that their symptoms will make more sense once they reach menopause. But, as Professor Geraldine Pryor's research at the Center for Menstrual Cycle and Ovulation shows, women as early as 35 can be in perimenopause, even while they're still experiencing bleeding. As I've stated earlier, perimenopause is not menopause. It is its own distinct phase in a woman's life, and one that requires a different treatment protocol. When the two are blurred together, women are left at risk of what I believe to be inadequate care. I opened this book with a bold promise. I want perimenopause to be a time of empowerment, not struggle. A time when a woman steps fully into her power and vibrancy, and empowerment begins with knowledge. Knowing that perimenopause is not menopause yet. Knowing that these are two separate life phases that a woman's body will naturally move through, and that each requires its own protocol. Too often this truth is never shared because most doctors were never trained to recognize it. And so, some women are left not properly supported, dismissed, or misdiagnosed when they could be thriving. When doctors don't know what they don't know.

Why Doctors Miss Perimenopause

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The medical education crisis in women's health is evident on both sides of the Atlantic. In the United States, a comprehensive needs assessment revealed that only 7% of obstetrics and gynecology residents felt adequately prepared to manage menopause, with most programs providing minimal formal education on this critical health transition. The situation in the United Kingdom mirrors this inadequacy. A 2022 peer-reviewed study found that 77.5% of practicing GPs expressed that menopause training in medical school and GP training needs improvement, with many reporting they received no menopause education at all during their training. These statistics simply make no sense to me. A woman's reproductive system is one of the most intricately complex systems in the body. It is interconnected with her brain, her adrenals, her thyroid, her gut, her nervous system, every part of her physiology. To dedicate only a few hours of medical training means most doctors are not equipped to recognize what's actually happening in a woman's body during the critical stage of perimenopause. It's not that GPs and doctors don't care, they just don't know what they don't know. That gap leaves far too many women without the answers and the support they deserve. This lack of training often results in women being told by their GP that they are too young to be experiencing perimenopausal symptoms. Without the proper depth of understanding, doctors can inadvertently leave women feeling dismissed during what is a very natural transition state. It's important to clarify that this isn't intentional on the part of the doctors. Rather, it reflects the gaps in medical education. However, there's no reason women should feel confused or unsupported during this very natural biochemical transition. What they deserve is acknowledgement and validation of what they're feeling. When a woman says, I just don't feel quite right, I'm exhausted, moody, I feel scattered, she should be met with reassurance that proper guidance does exist. There are alternative ways to navigate perimenopause to feel vibrant during this time. My dream is for every practitioner's toolbox to revolve around one woman, rather than exist in separate silos, so she can draw from the best of Western and Eastern medicine, along with the wisdom of naturopaths, functional doctors, and holistic practitioners. When these paths work together, their strengths are no longer competing but combined in service of the person at the center of her own care. For now, my mission is to democratize this information and place it in the hands of every woman. This way, if a woman should fall through the cracks of the orthodox medical model, she's able to track her symptoms, ask the right questions, and request the right tests in order to dig deeper into what might be happening in her body. For a woman who is more sensitive or has a more complex set of issues, this knowledge can protect her from inadequate care that could lead to more serious consequences. At this point, you may have noticed that what I'm sharing in these pages doesn't always align with the dominant narrative in the medical field. You're correct. It is in fact my intention to gently disrupt, to challenge and to expand the current way of thinking, because what we are doing now simply doesn't work for every woman. Every woman deserves to know that there are alternative paths to healing beyond the toolbox she's been presented with by her GP. I want you to know there are bigger toolboxes with more options, even for those with the most sensitive bodies and complex issues.

Perimenopause Versus Menopause Explained

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Perimenopause is not menopause yet. Perimenopause comes before menopause, and it can last for years, even when your menstrual cycles appear regular and normal in length. You're not alone if you're asking yourself, but how do I not know this? Only recently have doctors and practitioners even begun to talk about the distinction between perimenopause and menopause. The two are often still lumped together under the single diagnosis of menopause, leaving many women unaware of the differences. The distinction between the two is simple. Perimenopausal women have menstruated within the last year. A woman graduates to menopause only when she has gone one year and one day without a period. But while the definition may be simple, perimenopause is anything but she is complex, volatile, and highly unpredictable. She, perimenopause, is also paradoxical, with both loss and renewal, and both unsettling and transformative. Yet within lies the possibility of profound healing and new beginnings. The Paradoxes of Perimenopause. Professor Pryor's work has been groundbreaking in our understanding and treatment of the hormonal changes during perimenopause, particularly the role progesterone plays. Her work and willingness to rethink traditional approaches to this critical life stage have been hugely influential in my own work. Professor Pryor identifies what she calls the six paradoxes of perimenopause. For our purposes here, I want to touch on the first four. I believe that understanding these four paradoxes is key to not only surviving this often chaotic time, but also reclaiming your peace and vitality. Paradox one Perimenopause comes before menopause and is different from menopause. This is so critical for every woman to know that it is worth saying again. Perimenopause is not menopause yet. But eventually every lucky woman will graduate to the peace of menopause. Paradox number two. Rather they soar and fall, putting you on a wild roller coaster ride. Menopause is defined by a lower estrogen state, even though it's often taught that in both perimenopause and menopause your estrogen levels are low, and it is the reason you're experiencing night sweats, the foggy brain, and the hot flushes. This is where so many people get it wrong. Research clearly demonstrates that perimenopause is characterized by high, fluctuating estrogen levels fundamentally different from menopause's low estrogen state. The truth about estrogen is that if you're still menstruating, even if your cycle is irregular, you may still have enough estrogen. The difference is that during perimenopause, estrogen levels swing widely, taking your body on what can feel like a chaotic ride. Research demonstrates that perimenopausal estrogen levels can reach peaks significantly higher than reproductive years, creating dramatic fluctuations rather than simple deficiency. What is not talked about enough, however, is your progesterone. In perimenopause, you're actually progesterone deficient. Progesterone is the first to quietly leave the scene, leaving estrogen up to her tricks, and to throw what I call her tantrums. Without proper progesterone levels to modulate estrogen, keeping her in check, she can become a bit unruly. That's why chapter six is devoted entirely to progesterone, which I like to call the goddess. The hormonal patterns across the female lifespan, see figure three in the resource section, clearly demonstrate the paradox of perimenopause. In your perimenopausal years, your progesterone levels steadily decline, while your estrogen levels spike, peak, and then fall. It's these dramatic swings in estrogen, not an overall deficiency that drive many of the classic symptoms of this stage, including night sweats, mood swings, and foggy brain. The perimanopause paradox high estrogen, low progesterone. Every woman's body has a reproductive lifespan. During your fertile years, both estrogen and progesterone maintain steady, predictable patterns. But in perimenopause everything changes. Estrogen surges to dramatic peaks, while progesterone steadily declines, often dropping to near zero levels when you don't ovulate. This is the paradox of perimenopause. You're not estrogen deficient, you're progesterone deficient in the context of erratically high estrogen. Finally, in menopause, both hormones settle into consistently low levels, marking a completely different hormonal state that requires completely different treatment. Understanding this pattern is crucial because it explains why your symptoms feel so chaotic and unpredictable during perimenopause, and why the loss of progesterone, not estrogen, is driving most of what you're experiencing. When you see this pattern, you understand why perimenopause is not minimenopause, and why you need progesterone support, not necessarily estrogen replacement yet. More simply said, in perimenopause your estrogen levels can, in some instances, double the peak levels you experienced during your younger years. In contrast, as you graduate into the calm of menopause, your estrogen levels fall as you stop ovulating and stop bleeding. But, in the perimenopause storm, it is the progesterone deficiency in combination with highs and lows of estrogen that can trigger symptoms like excessive bleeding, night sweats, mysterious weight gain, heart palpitations, migraines, mood swings, and difficulty sleeping. Some women may experience none of these and that is normal as well. Perimenopause looks different for every woman, shaped by her unique biochemistry and lifestyle. As estrogen levels gradually decrease, things begin to settle. Eventually, you graduate to menopause and a period-free life, a milestone that is worth honoring, and yes, even celebrating. Before we move on to the next paradox, I want to pause for a moment to share my greatest hope for you, because there is hope. My wish is that the information in this book will help you navigate perimenopause gracefully, and that not one more woman will be told she has exhausted all her options in seeking solutions for her health challenges. Not one more woman has to be told by her practitioner or doctor that your blood levels look normal, there's nothing wrong with you. When deep down she knows something is not normal. What is often overlooked is that falling within normal range does not mean there aren't underlying issues to uncover. In my clinic, I don't want a woman's body to fall within normal range. I want her operating at optimal levels. As we'll explore in the next chapter, these deeper conditions often go ignored without proper foundational blood tests to first identify and then address the actual root causes of her symptoms. For now, as we continue with the last two paradoxes, remember that the chaos you may feel in your body today is temporary and you don't have to simply suffer through it. I created the hierarchy of healing to guide women through this wild ride called perimenopause. Part two of the book will provide the tools and strategies to help you navigate your way to the other side, so you can successfully graduate to the calm of menopause. The sunrise awaits.

Four Phases Of Perimenopause

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Paradox 3. Perimenopause is not because you're old. In fact, at this point, we as women often still have half our lives ahead of us. In her book, The Hormone Repair Manual, Dr. Lara Bryden N. D. argues that menopause has existed for as long as humans have walked the earth. It is not an accident, as some would have you believe, that women experience menopause simply because we're now living too long. In fact, menopause may actually be one of the driving forces behind the evolution of longer human lifespans. The timing of menopause is determined by your genetics. If you reach menopause on the younger side, in your mid-40s, it doesn't mean you're aging more quickly than your friends. It is simply due to your unique genetic makeup. If your transition comes later, closer to your mid-50s, that is how your body is genetically designed. All of this is to say that in both cases perimenopause and menopause happen alongside aging, but are not caused by aging. It is a matter of your genes. Remember, perimenopause can last for years and I want you to understand the full journey. Understanding the full journey. The stages of perimenopause explained. As mentioned, early perimenopause often starts in your late thirties or early forties, sometimes even earlier. This phase can last anywhere from two to five years before you move into the more obvious later stages. Perimenopause isn't one phase, it is a journey through several distinct stages, each with its own hormonal patterns and symptoms. Understanding where you are on this journey can help you make sense of what's happening and what to expect. It's important to note that these time frames are averages and individual experiences can vary significantly. Not all women experience every symptom in each phase. Perimenopause actually consists of four phases and is sometimes referred to as the menopause transition. Early perimenopause two to five years. Your estrogen is actually higher than normal and fluctuating wildly, while progesterone starts to decline. Your cycles might be regular but shorter. About twenty five percent of women experience heavy bleeding, some have breast tenderness and struggle with sleep. This is often when premenstrual night sweats start and migraines worsen. Early menopause transition can last three years. Estrogen continues its erratic, unpredictable peaks. Progesterone drops further with more menstrual cycles where you don't ovulate, and ovulatory cycles, which explains why progesterone drops so dramatically. Your cycle length becomes more variable, night sweats become more consistent, and you might find yourself waking up in the middle of the night regularly. Mood changes intensify and weight gain can happen even without changes in your lifestyle or diet. Late menopause transition can last three years. Estrogen is still fluctuating with unpredictable low lows and high highs, but progesterone is often completely absent. You start skipping periods, sometimes going more than sixty days between flows. Hot flushes and night sweats increase, sleep disruption affects many women, and mood swings are common symptoms. Insulin resistance often develops during this phase. Late perimenopause one to three years. Estrogen finally begins to decline, but is still fluctuating. Your progesterone production is minimal. These are the final years leading up to your last period. Breast tenderness starts resolving, heavy bleeding decreases, but hot flushes and night sweats may increase. Sleep disturbances continue, though premenstrual symptoms begin to diminish. Each phase certainly brings its own challenges but also the possibility for healing and thriving. Lara Bryden describes perimenopause as a second puberty, a time of profound change. And just as with those early teenage years, there are ways to ease the transition. Your symptoms can be treated, mitigated, and often resolved so that you can experience vibrancy. Through each phase of perimenopause there is always hope and alternative paths available to help you reclaim your vitality and embrace the season of life. Paradox 4. Progesterone's decline drives perimenopause symptoms, not estrogen deficiency. While the dominant narrative focuses almost exclusively on estrogen, progesterone plays the starring role in perimenopause. During your fertile years, progesterone's power becomes evident after ovulation. Once you've ovulated, progesterone rises sharply and becomes the dominant hormone of the luteal phase, reaching concentrations many times higher than estradiol when they are compared in the same units, acting as estrogen's natural counterbalance. Progesterone is often called the calming hormone because it supports sleep, reduces anxiety, protects against breast tenderness, and helps regulate menstrual flow. When progesterone levels are adequate, estrogen's effects remain balanced and manageable. In perimenopause, however, ovulation becomes less reliable, and with it, progesterone production declines dramatically. Even when you still have regular periods, many cycles become anovulatory, meaning no ovulation occurs, so no progesterone is produced while estrogen is still present. This is why progesterone deficiency, not oestrogen lack, so often sits at the heart of the mood swings, sleep problems, anxiety, and heavy bleeding that characterize perimenopause for many women. Progesterone is so often overlooked as a key player in perimenopause. I like to think of her as the calm, cool, collected one, while estrogen is the bratty little sister who throws tantrums. When progesterone levels fall, estrogen is left unmodulated, which often triggers the very unpleasant symptoms you might be experiencing. If you're listening right now, chances are you're searching for answers and solutions to exactly how you feel. My hope is that you understand these four paradoxes and how perimenopause truly differs from menopause. You will feel empowered to ask your doctor the right questions and request the proper testing to reveal what might be happening in your body at a deeper level. And to give you a sense of just how critical this stage is and why it is not an evolutionary accident.

The Grandmother Hypothesis And Meaning

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I want to share with you the grandmother hypothesis. The grandmother hypothesis. Although perimenopause is not menopause yet, both phases are essential life stages in a woman's life. In her book The Slow Moon Climbs: The Science, History and Meaning of Menopause, Susan Matton argues that menopause has been a key component in human flourishing, supported by anthropological research demonstrating the evolutionary advantages of this post-reproductive life stage.

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Dr.

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Lara Bryden's research, which I first encountered in her book, The Hormone Repair Manual, beautifully illuminated something I had long sensed from my own understanding of woman's health. Menopause is not a biological flaw, but an evolutionary advantage. While my African heritage had already made me familiar with anthropologist Kristen Hawkes's groundbreaking work in Tanzania, it was Lara Bryden who brought this research powerfully to the forefront of my clinical understanding, showing how it aligns perfectly with what I see in practice. Following this evolutionary perspective, Susan Matten suggests in the Slow Moon Climbs that menopause enhances human survival by creating a fundamental shift in a woman's role in society. A postmenopausal woman transitions from a reproductive role to a nurturing one, becoming essential to the survival and success of her grandchildren through her wisdom, care and resource sharing. Anthropologist Kristen Hawkes first introduced the grandmother hypothesis in the early 1990s through her research with the Hadza people of northern Tanzania, one of the last remaining hunter-gatherer tribes. The Hadza have no word for menopause, and their women experience very few symptoms, perhaps because they remain largely untouched by the modern world. Among the Hadza, these post-reproductive women play a crucial role in providing resources for mothers as they tend to their babies. While mothers focus on child rearing responsibilities like breastfeeding and caring for children, the grandmothers forage for food and bring it back to be shared. As we'll discuss in the repair phase of the hierarchy of healing, these postmenopausal women are able to share their wisdom, resources, and energy. They have also become metabolically flexible, meaning they can burn both fat and glucose as fuel. This metabolic flexibility means they require fewer calories, so when food is scarce, they can fast, providing more resources for the fertile mothers and their children. Because of this adaptability, Hadza grandmothers remain lean, strong, and energetic enough to forage and share resources with the next generations. In essence, these grandmothers provide more food than they consume. Research has shown that when there is a ratio of three adults to one child and especially when grandmothers are present, the children's survival rates increase. The grandmother's care for the mothers and the youngest generation also allows the fertile women to have more children, which directly supports Matten's idea that elder women play a central role in human flourishing. Similar to the work of Susan Matten, Lara Bryden, and Kristen Hawkes, I want to reframe menopause so that it is not seen as a time of struggle or a medical malady, or to simply be endured, or treated only with hormones and antidepressants. Instead, I see it as a time when women step into their power, realizing that they have the capacity to be incredibly influential and productive. Although perimenopause is different and distinct from menopause, neither should be seen as a biological anomaly or flaw. Each carries its own evolutionary advantages, designed to improve human survival. Science aside, you can see the grandmother hypothesis in everyday life. Picture a family out to dinner with several young children. The mother, overwhelmed, will simply hand her baby to the grandmother with complete trust, freeing herself to tend to the needs of the other children. You might notice the grandmother get up to refill drinks, or she might instinctively begin feeding the younger children. In her unique role, she lightens the burden for the mother and makes life just a bit easier for everyone at the table. Yet there are physicians who will tell you, in the past, we as women were dead at forty-seven, and so it is cruel to make us live without hormones we once relied on in our reproductive years. I believe the opposite to be true. Women are naturally meant to transition into a lower hormonal state, and this shift is not a flaw but a key evolutionary advantage. Perimenopause and menopause are natural occurrences in your biochemistry and your body. A cautionary tale.

Mary Ann’s Case And Root Causes

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Before we move on, I want to share a real life example of what can happen when perimenopause and its hormonal imbalances are ignored, which reveal the very reason why it's critical to understand the difference between perimenopause and menopause. You may remember Mary Ann from chapter three. While we initially explored her gut health journey, her story runs much deeper. At just thirty-seven, Mary Ann could have been the poster child for inadequate care because her doctors dismissed the possibility of hormonal imbalance, telling her she was too young. Since the proper testing was never ordered, she endured more than six years of unnecessary suffering, impacting not only herself but also the love of her life and her immediate family. Marianne When Mary Ann came to see me, she was suffering from extreme anxiety, terrible gastrointestinal issues, and severe endometriosis that had already led to three surgeries. Tragically, during her last surgery, one of her ovaries was accidentally removed. The loss of her ovary had real hormonal consequences. While the remaining ovary typically compensates to some degree, Marianne's ovarian reserve was significantly reduced, and her cycles became increasingly irregular. What her doctors failed to recognize was that her symptoms weren't just about having one ovary. They were about the variability this created in her hormonal cycles. Here's what's really happening. Ovulation doesn't alternate predictably between ovaries. For some cycles, Mary Anne would ovulate normally and produce adequate progesterone. These were her in inverted commas good months. For other cycles, she may not ovulate at all, or her lutil phase would be inadequate. These were her nightmare months. From days one to fourteen of her cycle, Mary Anne could manage. But from days fourteen to twenty eight when her body should have been producing progesterone, the difference between an ovulatory and an anovulatory cycle was the difference between Mary Ann functioning and falling apart. The progesterone GABA connection. Progesterone is our calm, cool, and collected hormone. When it crosses the blood brain barrier, it converts into allopreganolone, which literally calms us down by boosting GABA GAMA aminobuteric acid, our primary inhibitory neurotransmitter. GABA is like a chemical messenger that slows your brain, blocking certain signals in your central nervous system. Without adequate GABA activity, your mind races and your anxiety takes over. In months when Marianne's progesterone was low or absent, she lost this neurological brake system entirely. The iron deficiency connection. Compounding this was her heavy menstrual bleeding, which created severe iron deficiency. Month after month of blood loss depleted Marianne's iron stores. Iron deficiency has well documented psychiatric manifestations agitation, sleep disruption, hypervigilance and emotional instability. In Chinese medicine we understand this as blood deficiency, literally not having enough material substance for your spirit to rest. You feel ungrounded, startle easily, and are unable to settle. Western research confirms this. Iron deficiency impairs dopamine and serotonin synthesis, disrupts emotional regulation and creates what researchers describe as emotional dysregulation associated with iron deficiency. The perfect storm. When you combine what Marianne faced endometriosis, unpredictable ovulatory patterns, with reduced ovarian reserve from the loss of an ovary, pre-existing hormone imbalances, and the constant drain of her blood deficiency, it is no wonder that her nervous system was stuck in high alert. A state of hyper excitability, which is what we call an excitory dominant state. Her body was missing the hormonal and nutritional building blocks it needed to maintain nervous system balance. Marianne couldn't breathe. She couldn't leave the house because her anxiety was so high. The medical system failure. What makes Marianne's case so troubling is that proper hormone testing could have revealed this pattern early. Had her doctors ordered comprehensive hormone panels, particularly progesterone levels timed to her cycle, they would have seen the irregular ovulation pattern. Had they tested her iron status thoroughly, serum ferritin, not just hemoglobin, they would have caught the deficiency. Instead, at just 37, they dismissed her as too young for hormonal problems. When Marianne came to see me, we ordered the correct tests. Once her doctors saw these results, they recognized their oversight and immediately scheduled her for a bone density scan. With reduced ovarian function and low progesterone, her bone health was at risk. Loss of bone density can lead to osteoporosis. We'll talk more about progesterone's role in protecting our bones in chapter six. The solution no one offered When Mary Ann came to see me, we finally saw her symptoms for what they were not separate problems, but one interconnected picture. Endometriosis is an estrogen driven condition, with lesions producing their own estrogen locally. Yet no one had offered her progesterone support for her anovulatory cycles, despite evidence that progesterone can oppose high estrogen and suppress the inflammatory pathways driving her pain. We addressed her gut health. When your gut lining is damaged, bacteria that should stay safely inside your digestive system can escape through the weakened barrier and travel to other parts of your body, potentially contributing to endometriosis lesions. We also supported her immune system and provided progesterone in her deficient cycles. Within weeks, Marianne started sleeping, her anxiety began to lift. Her years of chronic pain began to fall away. This wasn't a miracle, it was simply treating the root causes instead of dismissing her symptoms as separate, unrelated problems.

Testing, Treatment, And Reclaiming Vitality

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Why this matters? Marianne is the woman I have written this book for. She is the woman who fell through the cracks of the orthodox medical model. At just thirty-seven, her doctors dismissed her symptoms, thinking she was too young, so they didn't consider ordering the correct testing to uncover what was really going on. Testing that could have guided them to rebalance her hormone levels. That oversight was inadequate care, and it's something I don't want another woman to endure. Had Marianne been given appropriate support early in her treatment, progesterone supplementation in her deficient cycles, iron repletion and proper monitoring, many of the chronic issues she still faces could have been avoided. Marianne's experience is precisely what I don't want for you. My wish is that you are armed with the right information and a clear understanding of the differences between perimenopause and menopause, and in their treatments. With this knowledge, I know it's possible to prevent the risk of inadequate care that cost Marianne so dearly. Proactive care and an educated practitioner are what perimenopausal women need. That begins with having the right information. The start of your healing journey is to return to the basics, your foundational health and your basic female biochemistry. From there you begin to reclaim your vitality.