Perimenopause Isn’t a Problem to Fix—It’s a Phase to Support
We only just start to feel like we understand our bodies… and then things begin to shift again.
For many women, perimenopause doesn’t arrive all at once. It’s more of a slow awareness over time. A few subtle changes here and there—until one day it becomes clear that something is different.
I’ve felt this myself over the past few years.
For me, it’s shown up as changes in body composition—more weight around the midsection, more inflammation. There are clear hormonal waves now, where only part of the month feels like “myself.” Energy dips more noticeably before and during my cycle. And this past winter, the weight gain was more than I expected. Enough to pause and really take a closer look.
This isn’t surprising. I knew this phase was coming. But knowing and experiencing it are two very different things.
And what I see in my own body is exactly what I see in many of my patients.
This Isn’t Just Hormones
Hormones are shifting in perimenopause—that part is true.
But what often gets missed is that this isn’t just about hormones.
One of the biggest underlying shifts I see—both personally and clinically—is increasing insulin resistance.
Even in women who:
- Eat well
- Don’t consume much sugar
- Have “normal” standard lab results
This is where a tool like the QUICKI score can be helpful. It looks at the relationship between glucose and insulin in a way that can reveal patterns not obvious on standard labs.
In my case, my glucose, insulin, and A1c look normal. But my QUICKI score—and the changes in my body—tell a different story.
There are also other factors at play. Some women, myself included, may have androgen patterns that aren’t always easy to track on standard labs, but can still influence metabolism and insulin sensitivity. Diet matters too—even healthy fats, in higher quantities, may not always work well in the setting of insulin resistance.
All of this is happening alongside shifting and declining hormone levels, which further impacts how the body handles blood sugar, energy, and fat storage.
What I See in Practice
In clinic, the patterns are consistent.
Women in their late 30s, 40s, and early 50s often come in saying:
- “I don’t feel like myself anymore”
- Sleep is more disrupted
- Energy is less predictable
- Mood feels different
- Libido is lower or absent
- Weight is harder to lose—despite doing “all the right things”
There are also changes in the menstrual cycle itself:
- Shorter cycles
- Irregular timing
- Skipped ovulation
- More noticeable hormonal fluctuations throughout the month
And one important clinical reality:
Hormone testing in this phase can be tricky.
Because levels are fluctuating so much, a single snapshot doesn’t always tell the full story. This is often why women are told their labs are “normal,” even when they don’t feel well.
Why This Feels So Frustrating
For many women, this phase feels confusing—not because they aren’t trying, but because what used to work… doesn’t work the same way anymore.
I also see a common pattern:
Years of calorie restriction, dieting, or pushing through fatigue.
Over time, this can make the body less metabolically flexible—and more resistant to change.
So when perimenopause begins, the margin for error gets smaller.
We all want this to be easy.
But for most women in this phase, it’s not.
Common Mistakes I See
A few patterns tend to make things harder:
- Undereating or chronic calorie restriction
- Over-exercising
- Pushing through fatigue instead of responding to it
- Assuming everything is fine because basic labs are “normal”
These approaches often come from a place of effort and sometimes desperation—but they can backfire in this phase.
What It Actually Looks Like to Support This Phase
If perimenopause isn’t a problem to fix, then what does support look like?
In my practice, it means shifting the focus toward:
- Metabolic health, especially insulin sensitivity
- Nourishment, rather than restriction
- Balanced movement, not overtraining
- Supporting stress physiology, instead of pushing through
This is not a one-size-fits-all process.
It’s highly personalized—based on symptoms, patterns, lab markers, and how someone is actually feeling in their body.
A Natural and Integrative Approach
There is a lot we can do to support this phase naturally:
- Nutrition
- Lifestyle shifts
- Targeted supplementation
And at the same time, there is also room for an integrative approach.
In many cases, that’s the sweet spot.
This isn’t about choosing one path or another—it’s about finding what works best for each individual.
A Different Way to Look at Perimenopause
If you’re in this phase and things feel off, you’re not imagining it.
Your body is changing.
Your physiology is shifting.
And there are real reasons behind what you’re experiencing.
Your body isn’t broken.
It’s adapting—and it needs a different kind of support now than it did 10 or 15 years ago.
There is a way to navigate this phase with more clarity, more stability, and more support.
You don’t have to just push through it.
About the Author
I’m Dr. Sarah Giardenelli, a naturopathic doctor and acupuncturist at Collective Health Center. My work focuses on helping patients better understand what’s driving their symptoms—from metabolism and hormone balance to inflammation and nutrient status—so we can take a more personalized, root-cause approach to care.
If you’re navigating changes in your energy, hormones, or overall health and are looking for a more individualized plan, you’re welcome to learn more about working together or schedule a discovery call.
