Perimenopause is finally getting the attention it deserves. Women are talking more openly about changing hormones, doctors are paying more attention, and women who spent years wondering what in the world was happening to their bodies are finally getting some answers. All of that is good.

BUT…I think the pendulum may be swinging a little too far in the other direction. It now seems like almost anything that happens to a woman in her 40s or 50s is being blamed on hormones…and Menopause Hormone Therapy (MHT) is the gold-standard answer. 

Fatigue, brain fog, middle-of-the-night wake-ups, weight gain, anxiety…the list goes on.

Could changing hormones be contributing to those things? Absolutely. But just because a symptom appears in midlife and can be caused by changing hormones doesn’t mean hormones are the only thing contributing to it.

Sometimes, your changing hormones may actually be exposing something that was already there.

Think About Your Body Like a Boat on the Ocean

Now, before you come at me with “MHT saved my life and sanity,” I get it! MHT can be a very helpful tool for many women, but it’s ONE potential tool in a much bigger toolbox. 

Here’s where I want to broaden the conversation, and where I want every woman to focus regardless of whether MHT is part of her plan.

Picture yourself as a boat with plenty of water underneath you. There are big rocks below the surface, but the water is high enough that you can move right over them. You don’t even know they’re there.

Then the tide starts going out. Suddenly, you start hitting those rocks you used to glide right over. The rocks didn’t just appear. The tide exposed what’s been there all along.

This is a helpful way to look at what’s happening during perimenopause. 

Estrogen and progesterone (the tide) don’t just affect our menstrual cycles. They affect our brain, our heart, our muscles, our tissues, our entire body. So when those hormones begin fluctuating in perimenopause – and the tide goes out – the environment our bodies have been accustomed to operating in changes too.

The receding tide may be exposing imbalances (rocks) that were already there. Blood sugar that hasn’t been particularly well regulated may become more noticeable. Years of getting by on inadequate sleep may start catching up with you. Nutrient deficiencies, undernourishment, inflammation or digestive dysfunction may become harder for your body to work around.

In other words, the tide is changing. But that doesn’t mean every rock we’re suddenly hitting was created by the tide.

A “Perimenopause Symptom” Doesn’t Necessarily Tell Us the Cause

This is where the conversation gets tricky. Many of the symptoms we associate with perimenopause aren’t specific to perimenopause.

Brain fog is a good example. Changing hormones can absolutely affect cognition, but so can inadequate sleep, blood sugar swings, nutrient deficiencies, undernourishment and inflammation. Digestive dysfunction can also affect our ability to break down and absorb the nutrients our brains and bodies need.

The same overlap exists with body composition and metabolism. Hormone changes can have an impact, but blood sugar regulation, nourishment, sleep, movement, digestion and inflammation still matter when we’re talking about weight…and these also influence our body composition and metabolism. 

Everything in your body is connected.

This is why, whenever I hear someone mention a new symptom in midlife, my immediate thought is not “It’s your hormones.”

Hormones are just one piece of the bigger picture of YOU.

When I started experiencing my own perimenopause symptoms, including hot flashes, brain fog and cyclical anxiety, I chose to first address the rocks through nutrition and lifestyle changes. The vast majority of my symptoms resolved (as well as many others that I wasn’t focusing on!). That doesn’t mean changing hormones weren’t part of what I was experiencing. It showed me firsthand, though, how much influence the other pieces of the picture can have on how we experience perimenopause.

Don’t Just Watch the Tide. Look at the Rocks.

We can’t completely control the hormonal changes that happen during perimenopause, but we can influence many of the conditions in which those changes are taking place.

We can look at whether we’re adequately nourishing ourselves and getting the nutrients our bodies need. And we can work on blood sugar regulation, prioritize quality sleep, support healthy digestion and consider what may be contributing to unnecessary inflammation. None of those things will stop perimenopause from happening, but improving them can change how our bodies experience it.

And the benefit goes far beyond any one symptom.

If we improve blood sugar balance because we’re struggling with brain fog, we’re not only helping our brains. Better blood sugar regulation can influence your sleep, cravings, energy and metabolic health in ways that reach far beyond brain fog.

And the same principle applies to the other rocks. When you improve a foundational process, the benefits aren’t confined to the symptom that first got your attention.

THIS is why I don’t love the symptom-by-symptom approach to health. It can leave us looking for one solution for brain fog, another for weight gain, something different for poor sleep, and yet another thing for anxiety…when several of those symptoms may be influenced by the same underlying issues.

When we address the rocks we improve the environment in which our whole body is functioning. We’re not just trying to make one symptom disappear. We’re helping multiple systems do their jobs better.

Ask a Bigger Question

I don’t want us to go backward and start dismissing the role hormones play in women’s health. The increased awareness around perimenopause is long overdue, and understanding what’s happening hormonally can help make sense of changes that might otherwise feel confusing or frightening.

I just don’t want hormones to become another answer that stops us from looking deeper.

When you feel new symptoms appearing in midlife, instead of automatically thinking, “This is my hormones,” I encourage you to try widening the question: “My hormones are likely fluctuating. And what else might be part of the picture?”

That “what else” may simply mean getting curious about how you’re sleeping, whether you’re adequately nourishing yourself, how well your blood sugar is regulated, how your digestion is functioning or what may be contributing to inflammation.

Because changing hormones are only one part of what’s influencing how your body functions during perimenopause. And while you can’t prevent that tide from changing, you can pay attention to the rocks it may be exposing.

When we do that, we have an opportunity to do much more than chase perimenopause symptoms. We can support our whole body in functioning better, now and for the years ahead.