Menopause doesn’t arrive overnight or follow a tidy script. The changes often begin years earlier, as energy dips, brain fog creeps in, sleep gets choppy, joints ache, and weight redistributes from hips to the belly. We invited OB-GYN Dr. Kael Murphy Pettis to break down what’s actually happening in perimenopause and share a practical roadmap that helps women feel better, stronger, and clearer without getting lost in internet noise.

We unpack the under-recognized signs that signal shifting hormones and the simple labs that often get skipped—iron, B12, vitamin D, and thyroid—that can mimic menopause symptoms. Dr. Murphy-Pettis explains why perimenopause is uniquely tricky: estrogen spikes and crashes make one-size-fits-all hormone replacement a poor fit. She contrasts older, oral hormone regimens with today’s transdermal estrogen plus micronized progesterone, clarifying who tends to benefit and why the risk profile looks different now. For those who prefer to avoid hormones—or can’t use them—we highlight evidence-backed supports like L-theanine for sleep and anxiety, creatine’s emerging role in brain health, and the importance of hitting around 30 grams of fiber a day.

We also go beyond cardio to the unsung hero of midlife health: strength training. From bone density and muscle preservation to metabolic resilience and the surprising power of grip strength, heavy lifting is a cornerstone for thriving through menopause. We discuss vaginal estrogen for dryness with minimal systemic absorption, caution against untested DIY uses, and spotlight a new nonhormonal option—a neurokinin-3 receptor antagonist—that cools hot flashes at the source and opens doors for breast cancer survivors and others avoiding estrogen.

If you’ve felt dismissed or unsure where to start, this conversation offers a clear plan: get the right tests, set realistic lifestyle goals, and collaborate with a clinician who listens. Subscribe, share this with a friend who needs it, and leave a review telling us the one question about menopause you still want answered.