--- title: "Not Feeling Like Yourself in Midlife? It Could Be Perimenopause" entity: "blog" canonical_url: "https://www.onnalomd.com/blog/not-feeling-like-yourself-in-midlife-it-could-be-perimenopause" markdown_url: "https://www.onnalomd.com/llms/blog/not-feeling-like-yourself-in-midlife-it-could-be-perimenopause" lastmod: "2026-04-29T02:27:00.000Z" --- If you’ve been feeling tired, foggy, irritable, anxious, achy, or simply “not like yourself,” it may not be just stress. In this episode of Reclaim Vitality, I sit down with [Dr. Amy Hawkins ,](https://drhawkinsnd.com/) a licensed naturopathic doctor and North American Menopause Society-certified practitioner, to talk about one of the most misunderstood seasons in women’s health: perimenopause, menopause, and postmenopause. Many women think menopause begins when symptoms start. But technically, menopause is just one day: the day you have gone 12 full months without a period. The years leading up to that day are called perimenopause, and this is often when women begin noticing changes in energy, mood, brain function, sleep, metabolism, sexual health, and overall vitality. ## What Is Perimenopause? Perimenopause is the transition leading up to menopause. It can begin much earlier than many women expect, sometimes up to 10 years before the final menstrual period. Since the average age of menopause is around 51 to 52, some women may begin noticing perimenopause symptoms in their early 40s. For women who go through menopause earlier, symptoms may even begin in the mid-to-late 30s. This can be especially confusing because many women are in one of the busiest seasons of life. They may be raising children, growing a career, caring for aging parents, running a business, or managing a full household. So when symptoms begin, they are often blamed on stress. ## Why Perimenopause Can Feel Like a “Zone of Chaos” One of the most important takeaways from our conversation is that perimenopause is not always a slow, steady decline in hormones. Instead, hormones can fluctuate. Some days estrogen may feel higher. Other days it may feel lower. This unpredictability is why symptoms can feel different from woman to woman, and even different from month to month in the same woman. That is why perimenopause can feel confusing, inconsistent, and hard to explain. ## Common Perimenopause Symptoms Women Often Miss Many women expect hot flashes to be the first sign of menopause, but that is not always the case. Early symptoms may include: - Brain fog - Fatigue - Irritability - Anxiety - Mood swings - Sleep disruption - Feeling less mentally sharp - Trouble keeping up at work - Feeling less resilient under stress - Not feeling like yourself Many women describe it as: - “I can’t keep up like I used to.” - “I don’t have the energy I used to have.” - “I’m losing my temper more easily.” - “I can’t track everything the way I used to.” - “I just don’t feel like myself.” That phrase, “I don’t feel like myself,” is one of the most important signals we discussed. It may reflect changes in mood, cognition, energy, pain, libido, and overall emotional regulation. ## Hot Flashes, Night Sweats, and Sleep Changes Hot flashes and night sweats are classic menopause-related symptoms, but they may come later for some women. A hot flash may feel like sudden warmth, overheating, or wondering if someone turned up the heat in the room. Night sweats may show up as waking in the middle of the night feeling sweaty or overheated. These symptoms may also be triggered by stress, anxiety, pressure, or feeling rushed. ## When Labs Look “Normal” But You Still Feel Off One of the most frustrating experiences women report is going to the doctor, sharing their symptoms, and being told, “Your labs look fine.” But normal labs do not always mean everything is fine. In midlife, symptoms can come from multiple overlapping systems, including hormones, stress, thyroid function, blood sugar, metabolism, sleep, and inflammation. This is why working with a menopause-informed practitioner can be so helpful. The goal is not just to label everything as perimenopause, but to look at the full picture and ask: What else could be going on? ## Unexpected Symptoms: Joint Pain and Palpitations Some symptoms surprise women because they are not always talked about as part of perimenopause. Joint pain, body aches, frozen shoulder, and unprovoked pain can show up during this transition. A woman may not have had an injury, but suddenly her shoulder, hands, or joints feel achy. Heart palpitations can also be very unsettling. For many women, feeling their heart race or flutter is scary, especially when paired with anxiety or stress. These symptoms should always be taken seriously and evaluated appropriately, but they can also be part of the broader hormonal transition for some women. ## Sexual Health, Vaginal Health, and Urinary Symptoms Perimenopause and postmenopause can also affect vaginal, vulvar, sexual, and urinary health. Dr. Hawkins shared that the official term for this symptom picture is genitourinary syndrome of menopause. Symptoms may include: - Vaginal dryness - Pain with intercourse - Low libido - Recurrent urinary tract infections - Changes in vaginal moisture - More yeast infections or bacterial vaginosis - Changes in mucus or odor These symptoms are common, treatable, and not something women need to simply power through. ## Bone Health and Menopause Bone health is another major topic that often gets addressed too late. Many women do not think about bone loss until they get a DEXA scan at age 65 and find out they have osteopenia or osteoporosis. But bone loss can begin earlier, especially as estrogen declines. Women experience both hormone-related bone loss and age-related bone loss. The most rapid decline in bone mineral density often happens in the first five years after menopause. This is why awareness matters. Even if you cannot feel bone loss happening, it is still important to understand your risk, especially if you have a family history of osteopenia or osteoporosis. ## You Don’t Have to Wait Until Life Feels Derailed You do not need to wait until life feels completely derailed before asking for support. If you feel off, tired, foggy, anxious, irritable, achy, or unlike yourself, your symptoms are real. They deserve attention. Perimenopause may be part of the picture, but it may not be the whole picture. Midlife is also a time when blood sugar changes, insulin resistance, thyroid issues, metabolic changes, and other health concerns may become more noticeable. The next step is to have the conversation, get the right workup, and work with a practitioner who understands this stage of life. Watch the Full Episode Here In our next episode, we’ll talk more about hormone testing, treatment options, and the fears many women still carry around hormone replacement therapy. Subscribe to our [Youtube channel](https://www.youtube.com/onnalomd)to get notified when it comes out. If this episode helps you better understand what is happening in your body, share it with a friend who needs to hear it. If you’ve been feeling tired, foggy, irritable, anxious, achy, or simply “not like yourself,” it may not be just stress. In this episode of Reclaim Vitality, I sit down with [Dr. Amy Hawkins ,](https://drhawkinsnd.com/) a licensed naturopathic doctor and North American Menopause Society-certified practitioner, to talk about one of the most misunderstood seasons in women’s health: perimenopause, menopause, and postmenopause. Many women think menopause begins when symptoms start. But technically, menopause is just one day: the day you have gone 12 full months without a period. The years leading up to that day are called perimenopause, and this is often when women begin noticing changes in energy, mood, brain function, sleep, metabolism, sexual health, and overall vitality. ## What Is Perimenopause? Perimenopause is the transition leading up to menopause. It can begin much earlier than many women expect, sometimes up to 10 years before the final menstrual period. Since the average age of menopause is around 51 to 52, some women may begin noticing perimenopause symptoms in their early 40s. For women who go through menopause earlier, symptoms may even begin in the mid-to-late 30s. This can be especially confusing because many women are in one of the busiest seasons of life. They may be raising children, growing a career, caring for aging parents, running a business, or managing a full household. So when symptoms begin, they are often blamed on stress. ## Why Perimenopause Can Feel Like a “Zone of Chaos” One of the most important takeaways from our conversation is that perimenopause is not always a slow, steady decline in hormones. Instead, hormones can fluctuate. Some days estrogen may feel higher. Other days it may feel lower. This unpredictability is why symptoms can feel different from woman to woman, and even different from month to month in the same woman. That is why perimenopause can feel confusing, inconsistent, and hard to explain. ## Common Perimenopause Symptoms Women Often Miss Many women expect hot flashes to be the first sign of menopause, but that is not always the case. Early symptoms may include: - Brain fog - Fatigue - Irritability - Anxiety - Mood swings - Sleep disruption - Feeling less mentally sharp - Trouble keeping up at work - Feeling less resilient under stress - Not feeling like yourself Many women describe it as: - “I can’t keep up like I used to.” - “I don’t have the energy I used to have.” - “I’m losing my temper more easily.” - “I can’t track everything the way I used to.” - “I just don’t feel like myself.” That phrase, “I don’t feel like myself,” is one of the most important signals we discussed. It may reflect changes in mood, cognition, energy, pain, libido, and overall emotional regulation. ## Hot Flashes, Night Sweats, and Sleep Changes Hot flashes and night sweats are classic menopause-related symptoms, but they may come later for some women. A hot flash may feel like sudden warmth, overheating, or wondering if someone turned up the heat in the room. Night sweats may show up as waking in the middle of the night feeling sweaty or overheated. These symptoms may also be triggered by stress, anxiety, pressure, or feeling rushed. ## When Labs Look “Normal” But You Still Feel Off One of the most frustrating experiences women report is going to the doctor, sharing their symptoms, and being told, “Your labs look fine.” But normal labs do not always mean everything is fine. In midlife, symptoms can come from multiple overlapping systems, including hormones, stress, thyroid function, blood sugar, metabolism, sleep, and inflammation. This is why working with a menopause-informed practitioner can be so helpful. The goal is not just to label everything as perimenopause, but to look at the full picture and ask: What else could be going on? ## Unexpected Symptoms: Joint Pain and Palpitations Some symptoms surprise women because they are not always talked about as part of perimenopause. Joint pain, body aches, frozen shoulder, and unprovoked pain can show up during this transition. A woman may not have had an injury, but suddenly her shoulder, hands, or joints feel achy. Heart palpitations can also be very unsettling. For many women, feeling their heart race or flutter is scary, especially when paired with anxiety or stress. These symptoms should always be taken seriously and evaluated appropriately, but they can also be part of the broader hormonal transition for some women. ## Sexual Health, Vaginal Health, and Urinary Symptoms Perimenopause and postmenopause can also affect vaginal, vulvar, sexual, and urinary health. Dr. Hawkins shared that the official term for this symptom picture is genitourinary syndrome of menopause. Symptoms may include: - Vaginal dryness - Pain with intercourse - Low libido - Recurrent urinary tract infections - Changes in vaginal moisture - More yeast infections or bacterial vaginosis - Changes in mucus or odor These symptoms are common, treatable, and not something women need to simply power through. ## Bone Health and Menopause Bone health is another major topic that often gets addressed too late. Many women do not think about bone loss until they get a DEXA scan at age 65 and find out they have osteopenia or osteoporosis. But bone loss can begin earlier, especially as estrogen declines. Women experience both hormone-related bone loss and age-related bone loss. The most rapid decline in bone mineral density often happens in the first five years after menopause. This is why awareness matters. Even if you cannot feel bone loss happening, it is still important to understand your risk, especially if you have a family history of osteopenia or osteoporosis. ## You Don’t Have to Wait Until Life Feels Derailed You do not need to wait until life feels completely derailed before asking for support. If you feel off, tired, foggy, anxious, irritable, achy, or unlike yourself, your symptoms are real. They deserve attention. Perimenopause may be part of the picture, but it may not be the whole picture. Midlife is also a time when blood sugar changes, insulin resistance, thyroid issues, metabolic changes, and other health concerns may become more noticeable. The next step is to have the conversation, get the right workup, and work with a practitioner who understands this stage of life. Watch the Full Episode Here In our next episode, we’ll talk more about hormone testing, treatment options, and the fears many women still carry around hormone replacement therapy. Subscribe to our [Youtube channel](https://www.youtube.com/onnalomd)to get notified when it comes out. If this episode helps you better understand what is happening in your body, share it with a friend who needs to hear it. ## Your health won’t wait—why should you? Let’s get to the root of what’s getting you stuck. Schedule Your Discovery Call Today Get actionable tips delivered to your inbox so you can start using right away to feel more energ ized and improve your overall health. Get It Here References: 1. “Not Feeling Like Myself” in Perimenopause—What Does It Mean? Observations From the Women Living Better Survey. Coslov N, Richardson MK, Woods NF. Menopause. 2024;31(5):390–398. doi:10.1097/GME.0000000000002339. PMID: 38531011. PMCID: PMC11465791. Disclaimer: This information is for educational purposes only and is not intended as medical advice. Consult a qualified healthcare professional before making any health-related decisions. Individual results may vary.