What’s Going On? A Real Talk Introduction to Perimenopause & Menopause
Welcome to our Perimenopause & Menopause Series—a space where we break down the hormonal roller coaster so many women are riding, with clarity, confidence, and support.
I’m Amanda Fisher, pelvic floor physical therapist, certified perimenopause/menopause coach, and a mom in my late 30s who’s right here in this season with you.
Whether you're just starting to notice changes or are deep in the shift, this blog is for you.
Let’s Start With the Basics: What Is Perimenopause?
Here’s the truth: perimenopause often starts way earlier than we think—sometimes as early as your mid-30s. This transition phase can last anywhere from 4 to 15 years. Yes, years.
Menopause, on the other hand, is officially defined as the point when you've gone 12 full months without a period and your FSH level is 30 mIU/mL or higher.
But this transition isn’t just about your period stopping or dealing with hot flashes. It’s a full-body experience—one that affects your mood, your energy, your pelvic health, and your entire nervous system.
Common Symptoms of Perimenopause & Menopause
So what exactly might you feel as hormones begin to fluctuate and decline?
Pelvic Health-Related:
Bladder leakage
Constipation
Pelvic organ prolapse
Pain with intercourse
Hormonal & Whole-Body Changes:
Hot flashes + night sweats (vasomotor symptoms)
Vaginal dryness, low libido, and reduced orgasm
Anxiety, mood swings, and irritability
Insomnia or waking from 2–4am
Brain fog + daytime fatigue
Thinning hair, joint pain, high cholesterol
Higher risk of osteoporosis, heart disease, and muscle loss (sarcopenia)
You’re not making this up. These changes are real, and they’re connected to what’s going on with your estrogen, progesterone, and testosterone.
So, What’s Actually Happening in Your Body?
Think of it this way: your ovaries are starting to retire. We’re going through puberty… but in reverse.
Perimenopause is the transition phase. Cycles become irregular and hormone levels fluctuate wildly.
Menopause is when your periods stop completely.
Postmenopause is everything that happens after.
Estrogen doesn’t just gradually dip—it swings. Meanwhile, calming progesterone begins declining in your 30s. And testosterone, which helps drive libido, motivation, and mental focus, drops too—especially after surgical menopause.
Is It Genetic?
Yes—genetics do play a role. Ask your mom, aunts, or older sisters when they went through menopause. I did this recently and was amazed to see how similar the timeline was for the women in my family.
But genetics aren’t everything.
Other factors that affect symptom severity and timing include:
Smoking
Ovarian surgery or hysterectomy (even if ovaries are left intact)
Chronic stress and poor sleep
Inflammation and blood sugar instability
Life Is Stressful. That Matters.
Many women hit perimenopause during peak stress years—juggling parenting (including postpartum recovery), careers, aging parents, finances, and relationships. The nervous system is often already maxed out… then hormones shift and everything feels harder.
You are not imagining this.
And you are not alone.
A Mindset Shift: You Don’t Have to Suffer
Perimenopause and menopause symptoms are common—but suffering through them isn’t your only option.
This season is your invitation to learn what your body needs, reconnect with yourself, and feel strong, calm, and vibrantagain.
We’ll be diving into:
How to support your nervous system
The power of sleep, nutrition, and stress management
Understanding HRT (Hormone Replacement Therapy)—and whether it’s right for you
How to protect your muscles, bones, and libido
The role of pelvic floor therapy in this stage of life
Tools like breathwork, mobility, HRV tracking, and community connection
What You Can Do Next
Here’s your “homework” to kick off your journey:
✅ Tune in – Start noticing your cycle patterns (if you still have them) and track symptoms.
✅ Ask questions – Talk to family members, your healthcare provider, and trusted resources about your options.
✅ Reframe your symptoms – View them as signals, not setbacks. Your body is speaking. Are you listening?
You deserve more than just surviving this season—you deserve to thrive. Through your 30s, 40s, 50s, and beyond.
I'm so glad you're here.
Stay tuned for our next post in the series, where we’ll dive into how nutrition and exercise can support your hormones, energy, and mood.
Until then,
Amanda Fisher, PT, DPT
Pelvic Floor Physical Therapist & Menopause Coach