Essential Guide to Understanding Perimenopause After Babble's Balance Events
- Brooke Amidei
- May 5
- 12 min read
Erika and I have just spent the past five months deep in perimenopause. Not only being in the thick of it ourselves (which we are) but we have also hosted two perimenopause events, which immediately surrounded us with incredible industry experts with various backgrounds. We've also read books, listened to podcasts and had endless conversations about this important topic. We have been interviewed for magazines and newscasts about our findings and asked by countless friends what we have learned on this women's health journey.
Do we have all the answers? No. But we sure have a lot more information than we did five months ago. So, in true Babble fashion, we are going to share our biggest takeaways worth your time.
A Quick Note: We are not doctors or healthcare professionals. The following information is quintessential Babble - we were interested, then passionate, did the research and now we're babbling about it. Woman-to-woman. Friend-to-friend. That's it. You need to have these conversations with your doctor before making any significant changes to your healthcare.
Babble's Perimenopause Cheat Sheet
Here are some of the main things we have learned about perimenopause and how we would describe to our girlfriends:
Every woman goes through perimenopause. But just as every body is different, so are each person's specific journey, symptoms and severity.
Perimenopause lasts on average 7-10 years and is the stage directly before menopause.
Menopause is just ONE DAY - the day when you have officially been period free for 12 months.
The 7-10 years before that day is perimenopause and the years after that point, you are post-menopausal.
The average age of the start of perimenopause is mid-40's (around age 46).
However, it can begin as early as your mid-30's.
The average age of menopause is 51.
You do not need a specific doctor's diagnosis for perimenopause, just like you didn't need a doctor's diagnosis when you went through puberty.
5 Most Common Perimenopause Symptoms (from Dr. Mary Claire Haver's book The New Perimenopause:
Hot Flashes
Weight gain and redistribution
Anxiety, depression and panic attacks
Sleep disturbances
Fatigue
Other Common Symptoms:
Sexual Dysfunction and vaginal changes
Gastrointestinal problems (bloating, digestion issues)
Brain fog, migraines, dizziness, memory problems
Joint pain, muscle aches, or osteoporosis
Increased cholesterol
The average LDL increase during perimenopause is 18.6% - by doing nothing but going through the transition to menopause. HDL will also decrease.
Heart palpitations or irregular heartbeat
Skin, hair and nail changes
Dry, itchy eyes
Burning mouth sensation
Taste changes
Urinary dysfunction
Allergies
Body odor changes
Frozen shoulder
Itchy ears
Our Suggestions For Every Woman
Get to know your body:
This sounds cheesy but start by really getting tuning into your body. Even if you don't write it down, make mental notes of how you are feeling. Have you noticed any changes? Are there any symptoms (even weird ones like itchy ears) that could have something to do with hormonal changes?
Find a provider who specializes in hormone health:
Take the time and invest in a great doctor who specializes in hormone health. This is a big one, and I know it might be the most daunting. It's confusing. It can be expensive because they often don't take insurance (though you may be surprised that some hormone prescriptions are quite affordable, even out of pocket). BUT this will be the number one game-changer for you and your overall health and longevity going forward.
I can already hear your excuses for dragging your feet on this, but it's time to put YOU first. Just like that old saying, "You can't pour from an empty cup." If you aren't feeling well, if your moods are all over the place, the brain fog is getting in the way of your daily life...it's impacting you and those around you in a big way. Take care of yourself. You are your biggest advocate.
Wondering where to start? Check out Wake Her Up to find local providers and perimenopause resources.
Because of our local Balance events, we have a few recommendations for our Utah and Idaho ladies:
WholistRx Idaho, Utah, Washington
High West Medical Utah
Quantum Idaho
HRMN Health Idaho
If there isn't a provider where you live:
It probably seems overwhelming right now, but you will be amazed how many providers you can find where you live. I'm in small, little Boise, Idaho and have now found a several providers I would trust and be thrilled to see! It is true - there aren't as many hormone specialty clinics as there really should be (women got screwed with bad research and bad reporting on a hugely important topic). But there are more than you likely realize and SO many offer zoom appointments.
About That OBGYN:
Maybe you have a unicorn of an OBGYN who is well-educated and well-versed in hormone replacement therapy. But...probably not. Unfortunately most OBGYN's have only been required to have one hour of menopause training during their medical education journey. It's insane and it's not nearly enough. It isn't your doctor's fault - this is just the maddening way our system has been for the last several decades. They don't know what they don't know. Not only that, but the average doctor's appointment time with your OBGYN is 10-15 minutes. Per year! That is not nearly enough time to cover all that your complicated body needs during this complicated time. This makes finding a healthcare provider who specializes in hormone therapy (and other perimenopause treatments) so important.
It's expensive.
It is. But maybe not as expensive as you think. Also, I will say with these costs usually comes better access to your provider. Included in my annual membership with my functional medicine doctor, I get access to significantly longer appointments (many of which are on zoom which is incredibly convenient), direct messaging, longer appointment times and more appointments. A specialist with more time can get into the heart of the matter better.
Buckle up...there will likely be some specific labs requested by your provider to get to the root of your specific issues, taking a deeper dive into your health. Also, you know it will be a lot more expensive in the long run if you aren't proactively treating yourself and instead are reactively approaching your health. If you can make it work in any way, shape or form...invest in your health.
Don't wait:
This goes back to being reactive instead of proactive. Unfortunately the American healthcare system is based on reactive care, rather than proactive. You can take this approach, and I get it- if it's not broke, don't fix it! However, you may regret it. As we've mentioned earlier, the symptom list is long and many can be mistaken as caused by something else. Symptoms can sneak up quickly too, sometimes feeling like they appeared over night! So it would be fabulous to already have a provider you trust.
It can also be a game-changer to get some baseline lab work done so you know where you are before you're fully on this perimenopause rollercoaster. This could help you avoid unnecessary suffering down the road.
There are A LOT of things that change in your body with your hormones shifting. A great provider can help you work through what is happening. Don't wait until you feel awful.
What questions should you ask:
Girl, we got you. WholistRx has a great free resource of exactly what questions you can and should ask your provider. Check it out here!
Feeling confused? (What even is HRT?)
It is confusing. There is A LOT of information and products out there. And even more "snake oil salesmen" trying to take your money (if you were at our Utah event, you heard the experts tell us this will be a $30 billion industry in just three short years!).
Personally I'm loving the HRT (Hormone Replacement Therapy) that I am using (testosterone and estrogen creams and the progesterone pill), but it is all I know. Other women love the patch or pellets. These are things you will have to talk to your provider about and research the pros and cons. I promise this world is not that scary once your dip your toe in and start talking to a licensed professional.
Time To Do Your Own Research (With Our Help, Of Course)
We have personally read and listened to a lot of material on perimenopause. Don't reinvent the wheel - take advantage of our hard work. Check out our top recommendations below to get your started. We have given these very recos to our girlfriends. We've also created a list of additional resources here - personal recommendations from Erika and I.
If You Do Just One Thing...
If you read just one book:
This will become your new bible. My copy is highlighted, dog-eared and bleeding with notes. It also comes along with me to every doctor's appointment - whether with my OBGYN, primary care provider, therapist...it's with me, opened and being discussed.
If you listen to just one podcast:
(Oct. 27, 2025) includes guests Dr. Mary Claire, Dr. Vonda Wright, Dr. Natalie Crawford, Dr. Stacy Sims. This is a doozy- it is 2 hours 37 minutes, BUT listen to it while you're doing dishes, folding laundry, putting your make up on and you will have digested all of this great information without missing a beat in no time.
If you watch just one show:
Balance: A Perimenopause Journey obviously.
This docuseries produced by Alyssa Milano and Jeannie Mai brings together a powerhouse of experts, but does it through storytelling by following the journey of two jain monks who are seemingly doing everything right- prioritizing sleep, eating healthy, meditating and avoiding stress, etc. on their journey to figure out what is happening in their bodies during perimenopause. This does not feel like you are reading a medical journal, but you will finish this docuseries absolutely with a clearer understanding of your body, the history of hormone treatment, solutions to your symptoms and path toward your longevity.
While we have hosted two large-scale events centered on this specific docuseries, we know many women who have watched this from the comfort of their own home and who have organized small watch groups. One friend is gathering weekly on Wednesday nights to watch one episode per week for a month. What a great idea for a scheduled girls night with purpose!
You can see it now on AppleTV+ and Amazon Prime.
If you follow jut one Instagram account:
Dr. Rachel Rubin: @drrachelrubin
She was our collective favorite of the Balance docuseries and I have sense loved listening to her on the Mel Robbins podcast and following her on Instagram. She's brilliant, passionate and relatable.
Things That Shocked Us The Most
The Importance of Vaginal Estrogen
Urinary Tract Infections (UTI) can be very common in midlife women. However, as we age, these infections can become extremely dangerous, especially when it progresses to a kidney infection that can then lead to a blood infection and sepsis. Basically, UTI's can kill grandma! Vaginal estrogen can prevent more than half of UTIs (50-75%) making it one of the most effective preventative strategies (again preventative vs. reactive).
Other benefits of vaginal estrogen include:
Improved vaginal dryness
Sexual benefits (increase blood flow, help with arousal, reduces pain with sex)
Reversed vaginal atrophy (fancy word for improving tissue health and resilience)
Improved urinary symptoms (reduces urgency and frequency, can decrease mild incontinence - I literally don't pee my pants when I jump anymore)
Prevents other vaginal infections in addition to urinary tract infections
AND it has low systemic absorption (minimal estrogen enters the bloodstream so it does not carry the same risks as oral therapy!)
As Dr. Heather Hammerstedt had us all say out loud at our events, "EVERY VAGINA DESERVES ESTROGEN!" This was a major takeaway for me and brought me immediate symptom relief! (It's also not expensive at all.).
✨Bonus: Dr. Rachel Rubin talks about this specifically with Mel Robbins during this episode.
Osteoporosis Prevention Starts NOW (or 10 years ago!)
Talk about taking a deep dive! Erika and I have learned so much about our personal bone health during the last few months. We both have different risk factors contributing to our concern about our bone health and when we learned about the rate at which your bone health declines before and during perimenopause, we had to investigate further. You can read about our personal bone health journeys in detail here, but let me highlight a few main takeaways below:
We reach peak bone density/bone health around our late 20's early 30's.
From then, we lose about 1% of our bone density each year.
That loss increases significantly during perimenopause - we can lose up to 20% of our done mass due to the hormonal changes that happen during the perimenopause years.
This rate of loss slows once you reach the postmenopausal stage, but the damage is done by then.
Fun stat: Women over 50, your risk of an osteoporotic fracture is between 40-51% (that's half of women).
Estrogen is a key regulator of the skeletal system.
Progesterone works with estrogen in bone formation.
This applies to all women - even the active ones who eat healthy and take Vitamin D supplements. Your bones can still be significantly impacted...because of those hormones.
Pelvic physical therapy can be awesome for a lot of women!
Take this to heart: "Just because it's common, doesn't mean it's normal." Just because you and most of your mom friends pee your pants when you're on a trampoline, doesn't mean that it's normal.
Pelvic PT is a lot more than doing your kegels. It can treat all sorts of issues you might be dealing with - you know, the ones that you're chalking up to, "This is just the stuff women just have to deal with." Reality check: It's not normal, and you can get great help. At both our Boise and Salt Lake events, women have specifically said their lives were changed by meeting a pelvic PT.
Here's the two who joined us at our events:
Lifting heavy weights is one of the best things we can do
This comes up time and time again. I know we've all heard it, but it's time to actually do it. We need to put down the cute (usually pink) dumbbells and pick up something heavy. Seriously heavy. Scary heavy. You can do it! And you must if you really want to challenge and change your muscles.
If you were at our Utah event, you heard Ali with Pure Fitness talk about this. Lifting heavy means that your goal with a particular movement should be about 6 reps. If you're lifting heavy, you should be able to get to 6 reps but 7 just isn't going to happen. THAT is lifting heavy. No more five-pound dumbbells at 30+ reps. Stop it.
It goes without saying that you first need to ensure you have proper form so you don't injure yourself. Find a great trainer who can help you figure out the heavy weights that will challenge your muscles.
A few things to clarify:
"I don't want to get bulky." Well, you won't get all big and bulky and not be able to put your arms down. No. It just won't happen (unless you specifically train for body building, but that's a whole other thing). In fact! You'll likely find just the OPPOSITE: You'll get smaller, fitter, toner the more muscle you put on.
Muscle mass impacts your metabolism. More muscles = higher metabolism.
Muscle mass directly impacts your bone health. Bones and muscles work together in the body - the more muscle you have, the lower your bone loss and lower your risk of bone injury.
You'll look GOOD! You want to look younger? Get stronger!
That testosterone prescription your provider wrote for you can also help you with your muscle building (nice little side effect) - and, again, no you will not "get huge" on it.
We know testosterone impacts muscles. Did you know estrogen plays a big role too?
Taking a creatine supplement can help with your muscles too. Check out why creatine is SO important for women here.
Hormone Quick Reference Cheat Sheet
Erika put together the following list just so she could keep herself sane through the transition of perimenopause. Hormones fluctuate BIG TIME during perimenopause, so it's good to keep track of what is doing what and when. Our hormones are all interconnected. Every cell in our body has hormone receptors, which is why the list of perimenopause symptoms seems to include everything. Erika wanted something she could refer to, quickly, on those days when her body was acting up. Things like, "Ok, my sleep is crap this week...which hormone could be at fault?" Check it out what each hormone is primarily responsible for:
Estrogen:
Memory, cognition, mood
Executive function
Metabolism
Fat storage and insulin resistance
Inflammation
Cholesterol Levels
Estrogen therapy has been shown to lower LDL by as much as 12%
Skeletal system regulation (bone loss)
Sleep
Menstrual cycle regulation
Transdermal Estradiol can mitigate cognitive decline
Progesterone:
Antidepressant, anti-anxiety, sedative (helps with sleep)
Helps with mood disorders
Bone formation
Menstrual cycle imbalance (heavy periods)
Breast tenderness
Testosterone:
Libido
Muscle growth and maintenance (which impacts bone health)
Brain fog
Self-confidence, self image, motivation and emotional connectiveness
Energy levels
Note: Most providers recommend bioidentical hormones, but talk to you doctor about what is best for you.
Erika keeps the above list handy. It goes with her to doctor's appointments so they can discuss her hormone therapy in detail and make adjustments as needed based on her current symptoms.
➡️Print this list by clicking here. Keep it handy.
What If You're Postmenopausal...Now What?
You went through this already. You had your last period. You're now officially past all of this and likely missed out on a lot of this valuable information (mostly because it's only become available in the past few years). Now what?
Check out this amazing guide from WholistRx: Menopause & Postmenopause: What It Actually Is and Why Care Still Matters
There are a lot of resources out there - this is just the tip of the iceberg. And the research is pouring in. Gen-X is IN perimenopause and we are not okay with the status quo our mothers endured. We're demanding change. And it's happening. Slower than we want...but the conversation has not only started, it's gaining speed.
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