September is "Perimenopause Awareness Month" — a moment to bring a spotlight, clarity, care, and conversation to a life stage far too many women navigate alone.

My goal? To bring clarity, care, and conversation so you feel informed, prepared, and supported.

Here's what I wish every woman could know.

Perimenopause at a glance

It can start earlier than you think. While many enter perimenopause in their 40s, changes can begin in the mid-30s and continue until menopause (average age is 51).
Symptoms vary widely. Hot flashes, night sweats, sleep shifts, mood changes, libido changes—your mix and intensity are uniquely yours, and they are real.
There’s no one-size-fits-all journey. Duration and severity differ from woman to woman; personalized support matters.
Hormones fluctuate significantly. Estrogen and progesterone swings drive irregular cycles and many symptoms you feel.
It often shows up emotionally. Mood swings, anxiety, brain fog, memory lapses, and difficulty concentrating are all valid parts of this transition.

What’s Really Happening During Perimenopause

Perimenopause is a transition, not a decline. Ovarian hormones begin to fluctuate and gradually decline, affecting multiple body systems—not just reproduction.

Common Myths, Debunked

“Everyone has hot flashes.” Not true. Many do, but not all and intensity ranges widely.

“You need a single lab test to know you’re in perimenopause.” There's no reliable one-and-done test; hormone levels can swing dramatically day-to-day. Diagnosis is based on your unique pattern presentation and is supported by various foundational biomarkers that look at multiple body systems.

“Perimenopause only starts in your 40s.” For many, it begins in the late 30s—or even earlier.

“If you still have periods, you can’t treat symptoms.” Management is individualized; appropriate therapies (hormonal or non-hormonal) can be considered based on phase, needs, and risk profile.

“It’s a quick transition for everyone.” Average duration is 3–4 years, but it can last up to 12.

The Most-Asked About Symptoms I See in Practice

Hot flashes, night sweats, low libido
Stubborn weight changes (especially midsection)
Brain fog, word-finding issues, “lost my edge” feeling
Anxiety, irritability, low mood, early-morning waking
Irregular cycles, heavier or lighter bleeds, vaginal dryness
Joint stiffness, new aches, hair shedding or thinning

Remember: your presentation is valid even if it doesn't look like your friend's

What Actually Helps (Foundations First)

These non-negotiables create the strongest base for symptom relief and long-term health:

1. Blood-sugar balance: Build meals around protein, fiber, plants, and healthy fats.

2. Progressive Strength Training: 3–4 sessions/week to support bone, muscle, and metabolism as estrogen declines.

3. Sleep hygiene: Consistent wind-down, cool/dark room, morning light exposure; limit alcohol to a minimum.

4. Stress regulation: Select a daily practice you'll actually do (breathwork, meditation, nature walks, acupuncture, tapping).

5. Targeted support: Consider evidence-based options (nutritional strategies, non-hormonal aids, or—when appropriate—hormone therapy.)

When to Check In With Your Doctor

Bleeding that is very heavy, prolonged, or occurs more often than every 21 days
New or severe migraines, chest pain, or neurologic symptoms
Persistent low mood, anxiety, or sleep problems that impair daily life
You’re unsure whether a symptom is “perimenopause” or something else

A perimenopause-informed exam helps differentiate normal transition from issues that need further evaluation.

Why Perimenopause Awareness Month Matters

Perimenopause awareness reduces stigma and speeds access to care and is intended to educate earlier, so fewer women are caught off-guard and receive the support they need when they need it most.

My Approach: Personalized + Data-Informed

Every woman's journey is different. In my practice, I tailor support with a whole-body lens—hormone health, gut/liver function, adrenal balance, and metabolism—so you have a clear, individualized plan for symptom relief and long-term vitality.

If you're considering HRT now or later, we'll map a readiness strategy that optimizes the foundations first and aligns with your personal risk/benefit profile.

Your Next Step

Don’t navigate this chapter alone. Book a Hormone Strategy Session so we can create a plan that helps you move through this transition feeling calm, clear, and powerful.

Be well,
Dr. Talina Hermann