If you were born female, there’s likely a lot about your body that no one ever really taught you.
When I was nearing puberty, my mom handed me a set of life-cycle books and then promptly ran out of the room. I studied the anatomical drawings and brought them to school to show my friends in the hallway so we could giggle. Younger generations now swap books for Snapchat and TikTok. The medium has changed, but the silence surrounding our bodies hasn’t.
When my own daughters got their first periods, I had grand plans: pull them out of school, take them shopping, go out to lunch and celebrate. I wanted it to feel like a joyful rite of passage. But of course, they had other ideas. One quietly told the nanny instead of me. She didn’t want “a big deal.” The other happened to be at a sleepover, and by the time she told me, her friends had already cheered, supported her, and told her what to do.
But when I reached menopause at 48, no one cheered. No one brought over soup or told me what to expect. I don’t remember anyone in my life even mentioning menopause, not my mother, not my friends, not my colleagues. And yes, I’m a board-certified OB-GYN.
The Silence Has a History
For centuries, anything involving female reproductive function has been clouded in secrecy and shame. In the 19th century, menstruating women were believed to spoil food, kill crops, or scare away lightning. In some places, those superstitions still linger. (In 2024, I visited a temple in Bali that still prohibits menstruating women from entering.)
That cultural shame has consequences. Research shows that a lack of understanding about the menstrual cycle contributes to negative body image and low self-esteem. And I believe the same holds true later in life. When you don’t understand what’s happening during the menopause transition, you’re more likely to feel anxious, confused, and ashamed.
That’s why it’s time to break the silence. Understanding what’s happening inside your body is the first step to reclaiming agency.
Welcome to the Zone of Chaos
Perimenopause is the transition from a hormonally stable reproductive cycle to one marked by wild fluctuation. It is not linear, not gentle, and rarely discussed. I call this phase the Zone of Chaos, and if you’re in it, you know exactly why.
It’s the phase where women start to feel “off”—sometimes years before their periods change. Brain fog, mood shifts, sleep disruption, anxiety, weight gain. And yet, when they seek answers, they’re often told: “Your periods are still regular. It can’t be perimenopause.”
Except—it can. And it is.
First, a Quick Refresher on Your Egg Supply
When you're born, your ovaries contain 1 to 2 million immature eggs. By puberty, that number drops to about 300,000. Each month, your body recruits up to 1,000 eggs to start the process of ovulation—but only one egg typically makes it to release. The others undergo a natural process of degeneration, and over time, this depletes both the quantity and quality of your egg reserve.
From puberty through your late 30s, your cycle follows a fairly reliable rhythm:
Menses (Days 1–5): Estrogen and progesterone are at their lowest. The uterine lining sheds.
Follicular Phase (Days 6–14): Rising estrogen stimulates follicle growth and thickens the uterine lining.
Ovulation (Around Day 14): A surge in luteinizing hormone (LH) triggers release of a mature egg.
Luteal Phase (Days 15–28): Progesterone supports the uterine lining. If no pregnancy occurs, hormones drop and the cycle resets.
This rhythmic dance of estrogen, progesterone, LH, and FSH is what keeps your reproductive system humming along—until it doesn’t.
What Breaks First: The Brain
Here’s what most medical training misses: perimenopause begins in the brain.
Your hypothalamus and pituitary gland start sensing changes in ovarian responsiveness. As your egg supply ages and becomes less responsive, the brain compensates by pumping out more LH and FSH to try to stimulate ovulation.
When that stimulation doesn’t work as reliably, ovulation becomes delayed or skipped. The hormonal feedback loop falters. The result is a cascade of irregular, often extreme hormonal shifts, particularly in estrogen and progesterone.
These fluctuations don’t just affect your period. They affect your brain, your metabolism, your sleep, your mood, your cognition and your quality of life.
The Brain Fog Is Biochemical
Studies show that estrogen is critical for glucose metabolism in the brain. When estrogen drops, the brain has to scramble to find alternative fuel sources. Progesterone normally interacts with GABA, a calming neurotransmitter—so when progesterone declines, your stress response becomes more sensitive. And estrogen also plays a role in regulating serotonin and dopamine, which support mood, focus, and emotional regulation.
So if you’ve noticed you’re more irritable, anxious, unfocused, or emotionally flat—and your doctor tells you it’s “just stress”, you’re not crazy. You’re in perimenopause.
What the Ovaries Are Doing
Meanwhile, the ovaries are still trying to do their job. They’re recruiting follicles each cycle, but with fewer viable eggs, the process is slower and less predictable. Sometimes ovulation happens. Sometimes it doesn’t.
When ovulation doesn’t occur, progesterone production is disrupted. Cycles can become shorter, longer, heavier, or irregular altogether. Even if estrogen is still being produced, it may no longer follow its familiar rise and fall. Instead, it surges and crashes unpredictably, creating symptoms that range from hot flashes to migraines to irritability.
Eventually, ovulation stops. But before that, you may spend years in a state of hormonal turbulence.
This Isn’t Just About Periods
Estrogen receptors exist throughout the entire body. So as estrogen production becomes erratic and eventually declines, multiple systems begin to feel the impact:
Heart: Blood vessels stiffen. Cardiovascular risk increases.
Bones: Bone breakdown accelerates. Bone building slows down.
Brain: Inflammation increases. Cognition is affected.
Muscles: Muscle mass and strength decline.
Liver and fat metabolism: Insulin sensitivity changes.
Skin and connective tissue: Elasticity and collagen decrease.
This is why perimenopause is not a minor transition. It is a whole-body shift with long-term implications for your health.
Why This Moment Matters
Perimenopause is a critical window for intervention. It’s when we can take steps to support long-term health outcomes, from preventing osteoporosis and heart disease to preserving brain function and quality of life.
But that requires knowing what’s happening. And for that, you need accurate information, not outdated advice.
If you feel different, even if your cycle looks “normal,” trust yourself. You may very well be in the early stages of perimenopause. You deserve care, answers, and options—not dismissal.
You are not broken.
You are not alone.
And you are not imagining this.
You are in the Zone of Chaos. And now—you know why.
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