I am a nurse and I work with all women, save one. Bless him. Because besides calling his name every time we can’t find something, run out of something, or need something fixed, a good portion of us are “women of a certain age.” AKA, as my mother’s generation called it, “going through the change of life.” The medical community is now calling it perimenopause.

Cue every pun you can imagine.

Once your device gets wind that you’ve had a single hot flash, your social media thread will hot flash from the latest Taylor/Travis sighting and wild pet fiascos to women sporting two pairs of readers and a neck fan looking for their sex drive in the lost and found. You’ll also see said women’s husbands weighing in on the matter (tread carefully my dudes) and health influencers ranging from know-nothings to OBGYNs posting the gamut. Some of it is humorous, some of it is informative, and some of it is straight up B.S.

Influencer Just Being Melani has recently had her popularity skyrocket after starting the We Do Not Care Club, which chronicles her (apparently very validating) journey through perimenopause. Oprah, Halle Berry, Drew Barrymore, and other celebrities have made their own stories public, sometimes promoting a product in the process. The overarching theme–going through “the change” sucks and it has been ignored, minimized, undertreated, and riddled with misinformation for too long. My own experience confirms that theme.

Dr Amy B Killen, a doctor who specializes in perimenopause treatment and who is posting some good quality content, recently critiqued a post from a chiropractor (man) who said that if you have taken care of yourself, your hormone levels should stay stable and you shouldn’t need supplementation. Dr Killen (woman) proceeded to correct him.

Now don’t take my parentheses wrong. I am not a man hater. I am as guilty as any of the women at my job of calling for The Man when I can’t figure out why a piece of equipment isn’t working or I can’t find a needed supply. I appreciate the good things men have done throughout history (I repeat, the good things) and the good things they continue to do that I can’t or don’t want to do. But when it comes to perimenopause, I’m finding that the women are a teeny tiny bit more invested. Go figure.

Before I started experiencing symptoms, I actually had the same belief as that chiropractor. I have taken really good care of myself. I’ve eaten healthy, I’ve exercised, I’ve meditated, I’ve done Neurofeedback, I take vitamins, I eat my greens. I felt good. I was healthy and rarely visited the doctor. I had energy to spare. Perimenopause? Not gonna happen.

Until it did.

It started with heart palpitations. I went to a cardiologist, had the full work up. They said my heart looked perfect and they didn’t know why I was having palpitations (even though the tech and I watched them hiccup along intermittently on the EKG). They sent me on my way, told me not to worry about the random, unpredictable trilling flutter (PVCs) in my chest. It’s fine. Not one mention of perimenopause or that heart palpitations can be one of the symptoms. See you never.

Next came frozen shoulder. Out of the blue, no recollection of an injury or strain, I suddenly could barely move my left shoulder and was having fairly intense pain, whether I moved it or not. Not long after that, my hips started aching so much that the pain would wake me up in the night.

I’ve only had one hot flash, but I’m finally not freezing all the time. I’m one of those people who has spent their life replying, “warm heart” after someone shakes my hand, shivers, and says, “cold hands!” So maybe just not being cold is my “hot flash?”

My periods started getting irregular—at first closer together and just recently, unpredictably farther apart. I also started to notice that I didn’t have the unbounded energy I used to have.

Then came the last straw—sleeplessness. Tossing, turning, night waking, can’t get comfortable, can’t fall back to sleep. And there seemed to be a fire alarm in my head that went off at 3 am. It was getting worse and worse to the point that I thought I was going to lose it. I hadn’t made the perimenopause connection yet and spent a year trying to troubleshoot—Was it what I ate for dinner? Did I exercise too late? Was it because I had started keeping my cellphone next to my bed to use for my alarm? I got grounding sheets, black out curtains, we got a new bed. I tried every supplement that the Internet claimed would help with sleep. The only thing that touched it was large doses of melatonin, which is not recommended. But I was desperate.

I was talking about all these symptoms to my girlfriends and coworkers. “Ya,” one of them said. “When I turned 50, things just started falling apart.” I was researching causes for the individual symptoms, feeling like The Tin Man from The Wizard of Oz–slowly freezing up one body part at a time. I suspect either my evil twin has hijacked my body or someone devious has a Melanie voodoo doll. I’m grateful to report that my sex drive hung in there, but I think being a newlywed helped. I’ve definitely heard from many of my friends that decreased sex drive is an issue. Between myself and all my coworkers and friends, we had all the symptoms check marked. Yet not one person made the connection or mentioned, “maybe it’s perimenopause”. Fortunately, the timing coincided with Halle Berry and Mel Robbins opening up about their own symptoms and experiences. I didn’t have exactly the same symptoms as they did, but the interviews included lists of the wide range of symptoms women can feel and it finally clicked. Excited to have a direction, I made an appointment with my primary care provider (man). I chronicled all my symptoms. I told him that I thought these symptoms were perimenopause. He ran my labs. When they resulted a couple weeks later, he made a note in my electronic chart.

“No signs of menopause.”

I’m sorry, what? I mean like—WTF???

I had just turned 50. What do you mean “no signs of menopause”? Like, do you think because my labs are what you would call “normal,” maybe it isn’t happening to me even though it happens to every. Single. Woman my age??? Again, I am not a man hater, but sometimes they do test.

I moved on. What proceeded was over a year of playing the part of guinea pig. I didn’t know one woman who was on hormone replacement therapy (HRT). I had heard that perimenopause tends to be similar to what it was like for your mother. *Regardless of your lifestyle.* Suddenly, I remembered that when I was in my 20s, my mother was an insomniac. So I talked to her. She had taken HRT for a while and it had really helped her, but that was right when the Women’s Health Initiative Study put an abrupt halt to HRT (now practitioners are sounding the alarm–that was a highly flawed study that has since been mostly dismissed for several reasons). My mother was among the women who quit cold turkey and suffered through the remainder of her change, taking sleeping pills to survive the insomnia.

I called Loma Linda University Health (a leading hospital system in the US) to see if they had an OBGYN on my Loma Linda insurance that specializes in perimenopause. They said there was one. And she was not accepting new patients.

I’m sorry, what? I mean like—WTF??

I have always done things naturally when possible. So I made an appointment with a naturopathic doctor and tried a cream with some improvements to joint pain, but no improvement with sleep. It was an expensive side quest, not covered by my insurance and it didn’t have the impact I was hoping for.

Fortunately, the perimenopause/HRT information explosion was starting and I stumbled on the Mel Robbins podcasts. Not coincidentally, these OBGYNs are all “women of a certain age” who say they received almost no formal education in medical school about perimenopause/menopause and spent their early careers not knowing how to help women. But once they started going through it themselves, they started questioning the status quo. It's too little, too late for women from previous generations, but it’s better than continuing with the same tired narrative that we just have to suffer through it.

The conversations continued at work. The girls started trying this, that, and the other. Some were open. Others were too scared to try anything. One of the girls tried the pellet (two words–throbbing vagina–and not in a good way!), one was put on birth control (messed with her period), several started HRT (with varying results), all had trouble finding practitioners with knowledge and every practitioner had different recommendations. Finally, word trickled around that one of the OBGYNs we work with (a woman of a certain age) was starting to prescribe HRT. I decided to give it a go.

I have definitely not arrived. But I have learned a lot and I’m doing better. Here’s the gist of what I’ve learned along the way and what is working for me–

WHAT in the hormonal hell is happening, WHO does it happen to, WHEN does it start, and for the love of God, WHY??? Some of your hormones decline as you age. These include estrogen, progesterone, melatonin, testosterone, and growth hormone. What age your hormones start to decline varies from woman to woman, but it can start as early as your 30’s. It is considered common to start noticing changes between 45-55 years. You feel the change because there are hormone receptors all around your body including every joint, organ, your skin, bladder, hair, and all over your brain. Normally your body stocks these receptors with hormones and they literally help hold your body together. But when there are not enough hormones to go around, receptors are left wanting, vacant. And your body literally starts to break down. These hormonal changes can cause a variety of symptoms including joint pain and frozen shoulder, sleep disturbances, mood and brain changes, hot flashes, decreased sex drive, painful sex, skin and hair changes, heart palpitations, and more. The latest information is showing that all this can eventually lead to decreased bone density, heart disease, and dementia.
WHERE can I find help? If your practitioner says, despite your fairly obvious list of symptoms, that your labs are normal and therefore you don’t need any interventions yet, you can take two routes. You can politely thank them and move on or you can try to educate them on the latest information. I’ve done both. I am still seeing my primary care practitioner, but I am telling him what I’m doing to get the support I need. Good news, he has been open and it seems their practice is getting more on board with the latest info. There are also online clinics that specialize in HRT. Midi and Winona are two that I have looked into and been impressed by (and no, I’m not being paid to say that).
WHAT to do? Healthy lifestyle is still a piece of this puzzle. It’s more important than ever to eat healthy, exercise, and get quality sleep. But. These are supportive measures. Hormone Replacement Therapy (HRT) is what will help get you feeling like yourself again. “But it’s not natural,” you say? Okay, look. We are living wayyyy longer than what has been evolutionarily “natural”. I agree that modern medicine, in many cases, is acting as a Band-Aid for the effects of our modern, unhealthy lifestyles. Much of what ails people today can be prevented with healthy living, but this is not one of those things. Every woman will go through it, though each woman’s experience will be different. And it’s not just about treating the annoying symptoms. It’s also about preventing bone loss, heart disease, and dementia later in life. So far, what is working for me is HRT (estradiol patch, progesterone pill), DHEA, magnesium glycinate, tryptophan and L-theanine. I’m not going to list dosages because that is out of my scope of practice. Also, I’m still fine-tuning my dosages and the dose that works for me might not be right for you. By all means, post in the comments if something is working for you! Also consider that your hormones are changing so what works today might not work in six months. You may need a higher dose as your hormones further decrease. I am interested in trying a little testosterone supplementation, but I’m still working with my doctor on this so I can’t advise from personal experience yet. One of my coworkers has reported feeling much better with a little bit of testosterone along with the estrogen and progesterone. I take everything in the evening before bed except for the estradiol patch, which I change twice per week. I’m happy to report that my joint pain is gone (still not as flexible as I used to be though), I’m sleeping better, the heart palpitations are mostly gone, and I feel like my energy has improved. Overall, I’m feeling more like myself.

You are unique

Your symptoms may be similar to other women you know or they may be completely different. Every woman is unique and the important thing is to not let your healthcare provider minimize your symptoms. Also, what works for your friend, coworker, sister, someone on social media, might not work for you. Progesterone has worked wonders for my coworker’s sleep. Me? Nada. Doesn’t do anything. It can be frustrating to find the right balance, but keep trying. The good news is there’s lots of updated information coming out right now and we have more help available than our mother‘s had.

What I think would be great is if we added perimenopausal symptoms to the intake forms at doctors offices. Why wait until we are desperate to start hormone replacement therapy? I think doctors need to implement a proactive effort and offer hormone replacement therapy more routinely as opposed to only offering it to women who are begging for help. Perhaps we should also have our hormones tested starting when we are young and healthy so that we know what is normal for us as individuals. Then maybe we could use that as a map for what dosages will help each of us, instead of just trying to treat everyone the same. I wonder if maybe we all have different natural ratios of estrogen, progesterone, and testosterone? If we knew before perimenopause what was normal for us, maybe we could have a better idea of what ratios to aim for in perimenopause. Just an idea.

Doesn’t HRT cause cancer? This fear has been engrained so deeply into the consciousness of women these last 20 years since the Women’s Health Initiative study. But word is getting out that the study was deeply flawed, and we need to move onto more updated information. A knowledgeable doctor will take a look at your family health history. My OBGYN requires an annual mammogram. Do your own research. Look for reputable sources of information. Here are those informative Mel Robbins podcasts that I found helpful—

I love listening to Just Being Melani list all the things she has stopped caring about. Laughter is medicine, ladies! And I think there is value in caring a little less about some of the things women tend to get neurotic about. Let’s embrace the next stage of life by leaning into being more authentic and spending a little more time taking care of ourselves. I believe in a combination of aging gracefully and finding ways to feel my best. Also, keep in mind that this all leads to the eventual cessation of menstruation. In plain terms, you’ll stop bleeding for a week out of every month! I don’t hear anyone complaining about that!

The kids are older and while I miss them like crazy, I’m really enjoying having more time to do the things I want to do (find the love of my life, write, travel, garden, did an Ironman!). It’s the next chapter in this beautiful messy journey called life and it’s an opportunity to take stock, make some healthy changes, and begin again.

If there is one thing the last several years have taught me, it’s that life is about second chances. Every day, every moment, every interaction, every breath is an opportunity to begin again.

💕Melanie

References

Aging Changes in Hormone Production. Medline Plus. National Library of Medicine. 2024.

Menopause. Icahn School of Medicine at Mount Sinai. 2025.

Perman, Saranne, MD. Disputing the Original Women's Health Initiative (WHI) Research Findings. Winona. April 25, 2025.

Sneaky Symptoms of Perimenopause. UCLA Health. 2025.

Perimenopause—What, When, Where, How, Why???

You are unique

If there is one thing the last several years have taught me, it’s that life is about second chances. Every day, every moment, every interaction, every breath is an opportunity to begin again.

💕Melanie

References

So You’re Having a Baby! Do’s and Don’ts from a Newborn Nurse

Begin Again