Menopause is defined as going 12 consecutive months without a menstrual period. Technically, menopause is one day in your life—after those 12 months, you’re officially postmenopausal, though the terms are often used interchangeably. This is a natural event associated with the reduced functioning of the ovaries, which leads to lower levels of ovarian hormones. The average age of menopause in the United States is 51 or 52 but some women experience this change earlier or later in life. Perimenopause, sometimes called “the menopause transition” most typically starts in the late thirties or early forties, but again, some women will start to experience changes in their cycles sooner. A 2025 study published in Nature showed that approximately 90% of women may seek medical care for symptoms during perimenopause, including hot flashes, mood swings, and fatigue. ​Other common symptoms are brain fog, changes in menstrual cycle length as well as duration and heaviness of periods. The average age of menopause in the United States is 52. Until fairly recently, perimenopause and menopause were not addressed much in media—or in medical school. In 2020, nearly half of women worldwide were unaware of perimenopause and were surprised when it began. ​In 2022, more than 90% of women reported never being taught about menopause in school, and over 60% did not feel informed about it. ​Research published in 2025 showed only 6.8% of medical residents felt prepared to manage menopausal symptoms, with 20.3% receiving no training on menopause during residency. ​ However, more women are taking a proactive approach by looking into what they can to improve their menopause transition experience. Here’s what healthcare providers recommend to help you make a perimenopause game plan, so to speak. MORE FOR YOU Trump Issues Huge Fed Challenge—Sparking Stock Market Plunge As Gold And Bitcoin Price Soar New Gmail Warning — Do Not Open This Email From Google WWE WrestleMania 41 Results, Winners And Grades On Night 2 Establish a baseline Starting the conversation early before your symptoms make you feel less than functional —or even before you have symptoms—can help preserve your quality of life. Knowing where you’re starting can help you spot shifts before they become overwhelming. Dr. Tracy Verrico, Board-Certified OB-GYN and hormonal health expert, previously told ForbesWomen, “Starting these discussions in their late 30s or early 40s — while cycles are still regular — allows us to identify imbalances early and support sleep, mood, and metabolic health before symptoms spiral.” She recommends establishing a baseline via the following tests: Progesterone Follicle-Stimulating Hormone (FSH) Thyroid Panel (TSH, Free T3, Free T4, and Thyroid Antibodies) Fasting Glucose Hemoglobin A1c These tests give insight into ovarian function, thyroid function, hormone levels and overall metabolic health. Some other health metrics you can track to help you spot changes are: Waist Circumference Physical activity levels and daily steps Sleep patterns Menstrual cycle Eating a well-balanced diet rich in protein, fiber, and antioxidant-rich food is recommended for ... More optimizing wellbeing in perimenopause. Optimize your nutrition Abby Chan, MS, RDN is a Registered Dietitian and Co-Owner of Evolve Flagstaff, a collaborative health and performance center in Flagstaff, Arizona. “During perimenopause,” she says, “hormone levels, especially estrogen and progesterone, begin to fluctuate and eventually decline. These fluctuations contribute to a range of symptoms, including hot flashes, blood sugar instability, breast tenderness, increased cholesterol levels, digestive changes, and shifts in bone metabolism.” Dietary fiber plays a crucial role in supporting health during this transition, says Chan. “It helps regulate blood sugar, digestion, manages cholesterol levels, and binds to excess estrogen in the gut to aid in its elimination. These functions can help reduce symptoms of perimenopause and menopausal symptoms, while also supporting heart and metabolic health.” Good sources of fiber include fruits, vegetables, whole grains, legumes, nuts, and seeds. “Protein is another essential nutrient to prioritize during and after menopause, “Chan adds, “estrogen helps maintain both muscle and bone mass, so as estrogen declines, it becomes more difficult to preserve these tissues, increasing the risk of injuries, falls, and osteoporosis.“ She explains, “Getting enough protein is essential for maintaining muscle mass, supporting recovery, and promoting strength, balance, and mobility. It also plays a key role in satiety, managing blood sugar levels, and mood.” While the Recommended Dietary Allowance (RDA) for adults is 0.8 grams of protein per kilogram of body weight, says Chan, “this amount is considered the minimum to prevent deficiency, not necessarily optimal for active individuals or those experiencing age-related muscle loss. Women in midlife and beyond may benefit from higher intakes, around 1.2 to 1.6 grams per kilogram per day, or approximately 20 to 30 grams per meal, especially when paired with regular resistance training.” Resistance training is recommended for supporting muscle mass and bone health as women enter ... More perimenopause Make sure your fitness routine serves you As our bodies evolve, fine-tuning our fitness routine can help us thrive. Dr. Jessica Shepherd is the Head of Medical Affairs at functional fitness brand Pvolve. She shares that as we age, we start to lose muscle mass, leading to metabolic dysfunction and bone density is also negatively impacted. This is due largely to changes in hormone levels but can also be related to lifestyle changes like decreased physical activity due to responsibilities of work and parenthood many women juggle at this stage of life. She encourages incorporating functional movement to help build strength, balance, and flexibility and also support healthy bones. “I say to all my patients that we're training for a marathon, not a sprint.” She also emphasizes the importance of consistency over intensity. “Consistency can show up in different ways. Some days maybe you do a really hard workout and some days not. Having some type of regular movement routine gets them the outcome that they're looking for.” So if you’ve been in a pattern of doing hard-core spin workouts or running as your primary exercise, you don’t have to stop doing what you love, but balance out the more intense cardio activity with things like strength training, stretching ,and walking. Or if exercise hasn’t been part of your life, this is a great time to start building a sustainable routine to support your long term health goals. She adds that finding a supportive community, something that really drew her to working with Pvolve, can make exercise feel like an enjoyable part of your life. “I do think that women hold ourselves to such a high standard and are very critical of ourselves. Sometimes we do need communities that [encourage us to] bring more self-love to ourselves.” Meditation and mindfulness may help manage stress, a key part of supporting cellular health. Think about your cellular health The health and resilience of our body’s cells is not a thing many women think about, shares, Dr. Aimee, Fertility Doctor aka “The Egg Whisperer” and Tru Niagen partner, but it’s important for long-term overall health and longevity. “Women should care about their cellular health because it’s the foundation for how we feel, function, and age,” she says. “Every cell in our body plays a role in energy production, hormone balance, cognitive clarity and immune response—all things that become increasingly important as we age. When our cells are healthy, we’re more resilient, more energized and better equipped to manage the physical and emotional changes that come with different life stages, especially perimenopause and beyond.” Some of the ways we can naturally support cellular health, says Dr. Aimee, are “prioritizing sleep, eating antioxidant-rich foods, managing stress and staying active all play a role.” She also encourages thoughtful use of supplements. One example getting a lot of media attention right now is nicotinamide adenine dinucleotide (NAD+), which first became popular via videos of celebrities doing IV infusions. “NAD+,” Dr. Aimee explains, “is a vital molecule that declines with age and is essential for cellular energy and repair.” As levels of this coenzyme decline with age, says Dr. Aimee, “it can further impact cellular function and resilience. This is particularly relevant for women navigating perimenopause, where supporting NAD+ levels through supplementation can be beneficial.” However, instead of taking an NAD supplement, as many celebrities have posted themselves doing, Dr. Aimee adds, use a supplement with nicotinamide riboside (NR), “which helps replenish NAD+.” She explains, “Nicotinamide riboside (NR) is not only the most efficient way to boost NAD+ levels, but is the most well studied, safe and efficient NAD+ booster on the market. Taking NAD+ directly isn’t very effective because the molecule is so large it’s hard for your body to absorb. However, NR is easily taken up by your cells and naturally converted into NAD+. This means NR can more efficiently support your body’s NAD+ levels, helping to promote energy, cellular repair and overall vitality. It’s a smarter, more effective approach to supporting healthy aging and feeling your best, longer.” Beyond NR supplements, Dr. Aimee says, women can support reproductive health by maintaining a healthy diet, managing stress and considering a prenatal supplement.” Because individual needs can vary, always talk to your doctor before starting a new supplement. Nutrition can be a powerful tool for supporting brain function and mental health in perimenopause. Don’t overlook mental health One aspect of health often overlooked when discussing preparing for perimenopause is mental health. Dr. Uma Naidoo known as “America’s Nutritional Psychiatrist" is a Harvard trained psychiatrist, professional chef and nutritional biologist, as well as an instructor at MasterClass and author of Calm your Mind with Food and the national & international bestseller This is Your Brain on Food. “During perimenopause women may experience mood shifts, irritability, rage, and emotional outbursts,” she says, “which are linked to the unpredictable fluctuations in estrogen and progesterone.” “Estrogen plays a protective role in brain health by modulating inflammation,” Dr. Naidoo explains. “During menopause when estrogen declines, its loss can lead to increased brain(neuro) inflammation. The gut-brain axis is also influenced by estrogen and less estrogen can cause leaky gut and systemic inflammation, which impact mood and cognition.” Some of the most common mental health symptoms women experience in perimenopause, Dr. Naidoo adds, may also include mood swings, anxiety, panic attacks, brain fog, irritability, rage, and sensory sensitivity. “Sleep disturbances from night sweats and hot flashes are also quite common. These symptoms often arise without warning and feel destabilizing due to erratic hormone levels.” Hormone-related changes in levels of neurotransmitters are a main factor, she explains. “Declining estrogen during perimenopause affects serotonin levels which then impacts emotional regulation. Irritability, rage, and emotional outbursts are common symptoms due to estrogen’s impact on neurotransmitters like serotonin. Mood swings are common due to fluctuating estrogen levels affecting serotonin and dopamine. Anxiety can increase because lower progesterone reduces GABA activity, which normally calms the brain.” This can be a time when new-onset depression may set in. Those with a history of mood disorders are especially susceptible, she adds. Dr. Naidoo recommends being intentional about incorporating a few specific nutrients that have been shown to help improve mental health. “Adding anti-inflammatory foods to your diet helps reduce symptoms of depression, anxiety, and brain fog. Omega-3 fatty acids from fatty fish like salmon or sardines can also improve mood, reduce inflammation, and help restore brain cell integrity. Some of my favorite vegetables to add in are cruciferous vegetables (cauliflower, Brussel sprouts and broccoli ) and seed cycling may help balance estrogen metabolism,” she adds. Another food she recommends are flax seeds, which are rich in lignans, “a type of phytoestrogen that helps balance estrogen metabolism. They also offer short chain omega-3 fatty acids, fiber, and antioxidants to support hormone regulation and gut health.” She also suggests pumpkin seeds. “They’re packed with zinc, protein, and healthy fats. These nutrients are known to support estrogen balance, immune function, and overall hormone health.” Beyond food, consulting with a mental health care provider can be immensely helpful to come up with an individualized treatment plan. Get support Perimenopause is a major life transition, but it doesn’t have to feel like trying to solve a mystery—or like something you “just have to push through.” Every woman’s experience with the menopause transition is unique, and remember that you are the expert on your body. Being proactive by getting the support system you need in place to not just survive but thrive during this transition can make all the difference. Start where you are, be open to evolving and remember: you don’t have to do this alone. Follow me on Twitter or LinkedIn. 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