By Margot Rutigliano

Perimenopause can feel confusing and messy — like, what is happening right now?
All of a sudden, what I could always count on — that monthly cycle with the cramps, the mood swings, the appetite changes, and the general uncomfortableness — isn’t so predictable anymore.

Now I’m feeling warm (okay, hot), more tired than usual, a little achy, and my brain doesn’t seem to be firing the same way it used to. My body’s temperature regulation? Off. My energy? Fluctuating. My patience? Also… fluctuating.

Oh hey there — it’s you, perimenopause. Nice to meet you… or not.

Anyone else been down this road?

Luckily, we’ve got an amazing post from Dr. Stefania Tiveron to help us rethink what perimenopause really is — and how to find a bit more stability in the chaos.

By Dr. Stefania Tiveron

Rethinking Perimenopause: Finding Stability in the Chaos

For so many women, the years leading up to menopause can feel like losing yourself. You get stuck in your own head. You start to wonder: What’s wrong with me?

Here’s what I want you to know right from the start: your symptoms are real. The brain fog. The anxiety. The emotional reactivity. That overwhelming sense of, “I just can’t cope with my day-to-day responsibilities anymore.”

And it doesn’t just stay internal. It spills into your work, your relationships, and perhaps most deeply, your sense of self.

The truth is, it’s not just stress. It’s not simply a workload issue. And it’s not burnout in the traditional sense. What you’re experiencing is biology. Once we understand that—once we see the patterns underneath—we can begin to take back a sense of control.

Perimenopause 101

So, how do we know if it’s perimenopause?

First, timing. Perimenopause often starts earlier than most people expect—sometimes in the mid-30s, occasionally even earlier. It’s the two to ten years leading up to menopause.

Here’s something that may surprise you: unlike menopause, perimenopause is defined by symptoms, not by lab results.

And those symptoms can be profoundly volatile and chaotic—like being strapped into a rollercoaster you didn’t sign up for. Weight gain, changes in your menstrual cycle, breast tenderness, night sweats, hot flashes, mood swings, disrupted sleep, even migraines and allergies—all of these can show up during this time.

As Professor Jerilynn Prior, a Canadian endocrinologist, reminds us: “Women need to know that the turbulent time of perimenopause ends in a kinder and calmer phase of life called menopause.”

The big takeaway here is this: it’s not all in your head. These shifts are real. They’re being driven by hormonal fluctuations—especially estrogen spiking and crashing quickly and unpredictably.

I hear from my patients all the time, “I don’t even recognize myself anymore.” That loss of self isn’t imagined—it’s the ripple effect of your brain and body working overtime to adapt to instability.

Supportive tools can help—herbs and adaptogens to calm the nervous system, mind-body therapies like EMDR or breath work, or talk therapy to provide perspective. But here’s where these tools and approaches miss the mark: they’re overlooking how fluctuating estrogen is rewiring the body’s ability to cope.

Reframing Perimenopause: It’s About Instability

The old model of perimenopause said it begins in your late 40s, and the problem was either too much or too little estrogen. But here’s what we now understand: the real issue isn’t simply high or low. It’s instability. It’s the constant up-and-down swings.

Think of it this way. Instead of moving steadily, like on a gentle escalator, estrogen levels are fluctuating unpredictably. And here’s the thing: your brain and body don’t thrive on chaos—they thrive on rhythm. That’s why even “normal” estrogen levels can still feel overwhelming if they’re changing too quickly.

If your internal physiology is swinging from one extreme to another, it’s no wonder you feel like you’re unraveling.

Without stabilization, those fluctuations show up in daily life:

Mood & stress: women in perimenopause have a 2–4x greater chance of experiencing mental-emotional challenges like anxiety, irritability, or depression, even if they’ve never struggled before.
Energy & focus: brain fog, forgetfulness, and a reduced capacity to juggle as much as you used to.
Body symptoms: blood sugar crashes, weight gain, worsened allergies, inflammation, and sleep disruption.

Here’s something I see often in practice. A patient comes to me and says, “I know how to eat healthy. I know I need to walk more. I want to do these things.” I know they intend to follow through...

But then brain fog makes them forget, emotional overwhelm leads to shut-down, or guilt and shame creep in, which keeps them from rebooking appointments.

This is why the tools you’ve relied on in the past—willpower, diet changes, even therapy—sometimes don’t stick. Not because you’re incapable, or lack the willpower. But because the foundation isn’t stable enough to support integration and transformation.

The empowering part? Once estrogen is stabilized, everything else starts to work better. The practices you know are good for you finally have a solid ground to stand on.

Creating Stability: Foundations First

So, what can we actually do to create more stability? How do we buffer the highs and lows? The answer lies in building a strong foundation, because hormones don’t work in isolation — they interact with many systems in the body.

It’s not just about taking progesterone for sleep, or testosterone for bone and muscle health. It’s also about insulin and blood sugar, the immune system and inflammation, mitochondrial energy, gut health, and liver detoxification.

In other words, it’s never this or that. It’s this and that.

Now, bioidentical hormone therapy—or MHT (menopause hormone therapy)—can be incredibly helpful. Some people benefit from hormonal support like estradiol patches (I won’t go deep into prescriptions today, but I want you all to know that options exist). But hormones aren’t magic on their own. If the foundation isn’t strong, it’s like layering therapy on top of chaos. The foundation—that stability piece, has to come first.

From my experience, there are three essential pillars to supporting this transition: Insulin, Immune System, and Hormones.

1. Blood Sugar & Insulin

Insulin resistance becomes more significant during perimenopause and menopause — and it’s a major driver of symptoms like hot flashes, night sweats, and genitourinary symptoms. In fact, women are three times more likely to develop diabetes and metabolic dysfunction during this phase.

The interplay between insulin, cortisol, and estrogen also explains common changes in body composition during perimenopause: increased intra-abdominal and truncal fat, with decreased subcutaneous fat. These changes can affect not only how your clothes fit, but how your body feels, your energy, and even your hormone balance.

The takeaway? Stabilizing blood sugar through balanced meals rich in protein and fibre, regular eating patterns, and consistent movement isn’t just about weight — it’s about giving your hormones a steady foundation to work from.

2. Inflammation & Immune Function

Perimenopause is, biologically speaking, a transitional state of chaos. Hormonal fluctuations cause an increase in pro-inflammatory markers, heightened immune responses, and reduced ability to clear infections efficiently.

It’s also the most common period for the onset of autoimmune conditions.

On top of this, the dramatic drop and fluctuation in estrogen levels make perimenopause a histamine-dominated state, contributing to symptoms such as brain fog, anxiety, migraines, and allergies.

That means immune system balance — through stress, inflammation, and gut support — is a key pillar of perimenopause care.

3. Hormones & Nervous System Health

Estrogen is a powerhouse hormone. It doesn’t just regulate the menstrual cycle — it influences brain chemistry, mood, sleep, energy production, and even the gut microbiome.

Fluctuating estrogen affects serotonin and norepinephrine, which explains why anxiety, depression, and emotional reactivity are common. Estrogen receptors are also present in brain areas associated with memory and cognition — so when levels drop or spike, brain fog and concentration difficulties often follow.

Beyond mood, estrogen plays a vital role in mitochondrial health — your body’s energy producers. When estrogen fluctuates and mitochondrial function is compromised, oxidative stress increases. That means less energy, more fatigue, and more inflammation.

The Inner Work Must Come First

Supporting hormonal balance is therefore not just about replacing estrogen — it’s about creating a stable system where hormones can work effectively.

Once those systems are steadier, then hormone therapy—if it’s right for you—can have its full impact. At that point, it’s not one or the other, but one layered on top of the other. That’s when people often begin to feel like themselves again.

So remember: hormonal therapy can be an amazing tool. But it’s not about replacing the inner work your body needs—it’s about amplifying it once the foundation is strong.

Worth & Empowerment

Perimenopause is a transition—and transitions are powerful.

The very symptoms that make you feel like you’re losing yourself are also signals from your body, asking for support, rhythm, and care.

When you stabilize your hormones, you create a foundation strong enough to support transformation. From that place, your nervous system and hormone axis can finally integrate all the hard work you’re doing around blood sugar, inflammation, therapy, and lifestyle.

When you understand your biology, you quiet the self-doubt. And when you feel stable again, you can step more fully into your worth.

So if you’ve been second-guessing yourself, or feeling like you’re unraveling—it’s not you. It’s your hormones. And there is so much we can do to support you through this chapter so you can live fully, confidently, and with joy.

Finding Your Foundation in the Perimenopause Transition

By Margot Rutigliano

If you’re in the middle of perimenopause and everything feels a little off — you’re not alone. The good news? You don’t need to overhaul your entire life to start feeling more balanced. Before you dive into supplements, hormone therapy, or complicated protocols as the first line of defense, it might be helpful to start with the foundations. These may seem “basic,” but they are powerful levers for helping your body regain stability and resilience through this transition.

1. Hydration:
Aim to stay consistently hydrated throughout the day. Even mild dehydration can amplify fatigue, headaches, and brain fog — all things we don’t need more of right now.

2. Protein:
Support your muscles, hormones, and metabolism by including protein at every meal. Think lean meats, fish, eggs, tofu, or Greek yogurt — about 25–30g per meal is a great goal.

3. Movement:
Move daily, but don’t overdo it. A mix of strength training, walking, stretching, and low-impact cardio can do wonders for energy and mood regulation.

4. Mindset Work:
Your body is changing — and that’s okay. Learning to meet yourself with compassion and curiosity instead of frustration makes all the difference.

5. Stress Management:
Chronic stress can worsen hormonal symptoms. Find daily practices that help you decompress — journaling, deep breathing, meditation, or time outdoors.

6. Sleep:
Prioritize 7–8 hours of restful sleep. If sleep feels elusive, look at caffeine intake, nighttime screen use, or alcohol — all can quietly sabotage rest.

7. Sunlight:
A few minutes of natural light in the morning helps reset your circadian rhythm, supports mood, and can improve energy throughout the day.

These foundational pieces don’t necessarily take the place of medical intervention but they sure can help to build that stable place to build from. That being said, digging deeper can provide answers that certain other actions and protocols can’t.

If symptoms still feel unmanageable — think significant sleep disruption, anxiety, hot flashes, mood swings, or anything that has you worried and uncomfortable — that’s your cue to explore more testing, nutrient deficiencies, and to work with a practitioner who understands women’s health through midlife.

→ Book a Complimentary Discovery Call with Dr. Stefania

Perimenopause doesn’t have to feel chaotic. With awareness, a few daily habits, and the right support, you can navigate this phase with more ease, energy, and confidence.