It's a life stage that affects the body, and the identity. Here are one woman's confounding perimenopause symptoms, and how she got sorted out.

“Here’s How I Knew I Was in Perimenopause”: How a Healthcare Professional Self-Advocated and Finally Found Treatment

Perimenopause is the transitional time before menopause when women still have their menstrual cycle, yet ovarian function begins to decline, causing fluctuating reproductive hormones. While it can start in a woman’s thirties, as a study published in Contemporary OB/GYN Journal suggests, it typically begins in their mid-forties, says the Cleveland Clinic.
Menopause eventually occurs for all menstruating women, but about 75% to 80% of women in the U.S. experience perimenopause symptoms ranging from easy breezy to life-altering, notes StatPearls. Unfortunately, women’s symptoms can be misunderstood or dismissed, which can be especially trying as perimenopause can last months to several years.
“Maybe the period becomes lighter or heavier, or comes more often or less often,” says Julie Taylor, MD, MPH, is a functional medicine physician, menopause specialist, and author of The Hormone Manual: A Straightforward Guide for Every Woman At Every Stage of Life. Other symptoms of perimenopause can include difficulty sleeping, mood changes, anxiety, depression, decreased libido, weight gain, and foggy thinking. A few uncommon symptoms might be joint pain, tinnitus, and headaches.
Dr. Taylor adds: “Almost anything that is a new symptom during this time of life could be related to perimenopause.”
Ahead, Toby Amidor, MS, RD, CDN, a registered dietitian from New York and the author of Health Shots, shares her frustrating journey as she first started noticing unusual hormone-related changes at the age of 48. Even with her career as a clinical healthcare professional, she felt ill-prepared to handle her exasperating symptoms.
Read about her quest to get answers and the proper treatment for her perimenopause symptoms.
How I Knew I Was in Perimenopause
By Toby Amidor, as told to Jackie Newgent, RDN, CDN
The beginning of my perimenopause journey
I had been on the birth control pill for at least 10 years, and my gynecologist never advised me to stop the regimen. At 48 years old, I asked whether I should have my hormone levels checked. My gynecologist had never spoken with me about perimenopausal symptoms and told me checking in on my bloodwork wasn’t necessary until after I’d turn 50. This gave me the impression that I wouldn’t even hit perimenopause until then.
How my symptoms were impacting my daily life
But I knew something was off. I was very fatigued, didn’t sleep well, and couldn’t live without my daily naps. I play competitive USTA tennis on numerous teams and captain three teams. My joints were hurting for about a year, and I would hobble off the tennis courts. I had such brain fog that it was tough for me to concentrate.
And I was hungry all the time and kept gaining weight. I used my training as a dietitian to cut back on the appropriate number of calories, but nothing was moving on the scale and my clothing size kept going up. It was extremely frustrating. I also work from home and have a busy schedule, so I try to prepare easy options. And even as a nutrition expert, sometimes grabbing a cookie is the quickest fix!
My aha moment
I was still on birth control at 50 and had been complaining for years to my therapist that I wasn’t sleeping well. When I told her that I was going off birth control, she told me to check with my gynecologist about how far into perimenopause I was.
What?! But…perimenopause doesn’t start until age 50, right?
Little did I know, I was already well in the throes.
Getting my perimenopause diagnosis and treatment
In January 2025, I was miserable, and my symptoms had been escalating for several years. I just kept gaining weight. If I cut back on calories—even a little—the result would be feeling even hungrier for a few days after. So, in mid-January, I tried finding a gynecologist who specialized in perimenopause. I made the first appointment possible five months later in mid-May. But I knew I needed help sooner.
I booked a concierge gynecologist, Dr. Sadaf Lodi, within a week. She took an extensive history to ensure I didn’t have any contraindicated medical conditions, ordered initial hormone bloodwork, and took me off birth control pills immediately.
After two weeks off the pill, my bloodwork showed my estrogen was extremely low. Dr. Lodi recommended an estrogen patch, estradiol vaginal cream, and progesterone.

The results after just a few days on these interventions were unbelievable—and now, five months later, I feel revitalized.
We added testosterone to my regimen and increased my estrogen patch to find the level that works best for me. (After six weeks on testosterone, she drew bloodwork again; I’m currently awaiting hearing about those results on my next visit.)
Now, I’m thinking clearly. I have better temperature and hunger regulation (though I still like sweets but have better control now). I get more sleep and have less fatigue (and take much shorter naps—I love my naps!). My joints are healthy, my throat is less dry, and my libido is back. Weight loss is still not easy, but I also workout almost daily with Pilates, competitive tennis, or hiking, and have a trainer for stretching/weight training once a week. I’m fitter than I was previously.
My current treatment approach
Medical hormone therapy (MHT) is my treatment right now. This includes an estrogen patch (0.075 mg), estradiol vaginal cream (two times per week), testosterone cream (the size of a pea nightly behind the knee), and progesterone (200 milligrams). Plus, my gynecologist stressed the importance of weight-bearing exercise since I’m on medical hormone therapy. I have been reborn! I couldn’t walk very far with my dogs, and now I can walk for hours (with good sneakers)!
What I wish I knew sooner
I wish my previous gynecologist had started talking to me about perimenopause symptoms in my late thirties or forties, as some women start the journey sooner than others. Why isn’t there an assessment for all women visiting their gynecologist to determine how they’re doing? I’m so confused about the lack of education on perimenopause, how real it is, and how so many dismiss it as “it’s all in your head.”
My advice for others
Once I saw a women’s health physician who specialized in perimenopause, I knew I was in good hands. Dr. Lodi was able to provide me with the latest research and scientifically sound treatments—she was speaking my dietitian lingo. I also started feeling much better, immediately.
I’ve already told my friends who are feeling possible perimenopause symptoms to see a licensed, credentialed women’s health doctor who specializes in it. While it may be difficult to get an initial appointment with such a gynecologist or to find someone in a small town knowledgeable about the latest treatments, ideally start seeing one in your mid-thirties or early forties to hopefully catch symptoms before they begin.
While everyone’s treatment protocol will be different (and medical hormone therapy is contraindicated for some people), if you can start estrogen early, it may help prevent weight gain later. I wish I had known about this five years ago!
What to do if you suspect you’re experiencing perimenopause
If you think you’re experiencing perimenopause symptoms, especially if they’re affecting your quality of life, do this:
- Pay attention to your body. Don’t ignore symptoms. Track or journal them, along with your menstrual cycle, including dates and times.
- Seek treatment from a specialist. “If you think you have a hormonal imbalance, find a specialist who is trained in perimenopause and knows how to test, monitor, and adjust treatment as needed,” says Dr. Taylor. It’s a long-term approach. Hormones are complicated, requiring specific attention.
- Ask and ask again. If you have any questions about symptoms you’re experiencing, ask your perimenopause healthcare provider. Get another opinion if you’re not receiving adequate guidance.
- Don’t fear perimenopause. While recommending a whole-body approach, Dr. Taylor advises, “This can be an incredible time of life, and if done well, you can thrive and feel better than ever.”
For daily wellness updates, subscribe to The Healthy by Reader’s Digest newsletter and follow The Healthy on Facebook and Instagram. Keep reading:
- “Here’s How I Knew I Had Low Estrogen”: A Patient’s Story of Sudden Menopausal Symptoms
- When Does Menopause Start—and When Will It Start for You?
- The 11 Most Frustrating Problems You Didn’t Know Are Signs of Menopause
- Managing Menopause with This May Be Linked with Higher Alzheimer’s Risk, Says New Report