What is perimenopause?

Perimenopause is a transitional phase that occurs in a woman’s reproductive years, typically starting a few years before menopause. It typically begins sometime in a woman’s mid-40s or early 50s. While many women experience these symptoms to some degree during this period of their lives, the exact timing and degree of changes will differ from person to person.

During perimenopause, hormones like estrogen and progesterone start to fluctuate more widely, causing drastic changes in mood, energy levels, and overall health. Additionally, changes in sleep patterns and weight gain can occur as women’s bodies adjust to this new physiological state. 

Perimenopause can last for several years before leading to complete cessation of menstrual periods and officially reaching menopause.

What is the difference between perimenopause and menopause?

Perimenopause and menopause are two major milestones in a woman’s life, but they differ greatly in terms of their physiology and symptoms. Unlike menopause, perimenopause usually occurs over the course of several years. Menopause is defined by the absence of menstrual periods for an entire year, and it marks the end of a woman’s reproductive cycle. Compared to perimenopause, menopause is a much more abrupt change focused mainly on hormonal fluctuations. Ultimately, both perimenopause and menopause signify important developmental milestones for any woman, but they each have very different physiological implications and impact women in different ways.

Stages of perimenopause

Often referred to as the “menopausal transition,” perimenopause can last for several years, or even decades for some women, and is characterized by fluctuating hormone levels. During perimenopause menstrual cycles can become heavier or lighter, they can become more frequent or less frequent, or any combination of these. And this is all normal.

What are the symptoms during perimenopause?

There is an increase in estrogen and decrease in progesterone production as well as fluctuations in other reproductive hormones like follicle stimulating hormone (FSH) and luteinizing hormone (LH). 

These hormonal changes can lead to symptoms that can begin to appear as the body transitions from a reproductive to a non-reproductive state. Some of the most common symptoms include hot flashes, weight gain, depression, difficulty sleeping, and mood swings. Additionally, changes in bodily functions such as menstruation and libido can occur during this stage as well. 

While these symptoms can be unpleasant, they can be managed.

How can I balance my hormones during perimenopause?

To help manage the symptoms of perimenopause, Tier1 Health & Wellness does the following with our patients.

  • Optimize progesterone, which enhances everything that’s good about estrogen while minimizing its negative effects (breast tenderness, bloating, pelvic cramps, migraines/headaches)
  • Optimize testosterone, which will help to restore sexual function/libido
  • Optimize thyroid if needed, which it usually is

Micronized Progesterone Replacement Therapy

Progesterone is a calming, mood stabilizing hormone that no woman should be without. It offers protection against breast cancer, and has been shown to be as effective in treating breast cancer as Tamoxifen, one of the preferred drugs prescribed to treat breast cancer or prevent recurrence of breast cancer. Progesterone is the drug of choice to treat PMS as it enhances all of estradiol’s positive effects and minimizes estradiol’s negative effects such as: breast tenderness, irritability, cramping, heavy menstrual periods, and migraine headaches.

Testosterone Replacement Therapy

Testosterone is a hormone that is responsible for sex drive and energy levels. When levels decline during perimenopause, it can cause decreased libido and fatigue. Testosterone replacement therapy can help alleviate these symptoms by replacing the testosterone that is no longer being produced. We generally recommend women use bioidentical testosterone cream because it is easy to adjust, easy to apply, and has positive cardiovascular effects and does not carry some of the adverse effects that other delivery methods may cause.

Thyroid Optimization Therapy

Optimized thyroid hormone can increase your energy levels, improve metabolism and make it easier to lose weight, reduce hair loss, improve your skin and nail health, give you better bowel movements, decrease anxiety and depression, give you better temperature regulation, regulate the menstrual cycle, and lower cholesterol levels.

How to Enroll in Our Telemedicine Program


Schedule a Consultation

Complete the form on this page and one of our team will call you back to help you get started on your optimization journey.


Physical & Lab Work

Get a physical exam from a healthcare provider near you and we will order the necessary bloodwork


Telemedicine Appointment

We’ll schedule your first telemedicine appointment.



We’ll enroll you in our program. Military, law enforcement, and firefighters get discounted rates. We also have convenient payment plans.


Custom HRT Plan

Based on your lab work and symptoms, we’ll create a custom BHRT plan that will be monitored and adjustments made monthly until your symptoms are resolved.


Follow up

You’ll have unlimited access to our HIPPA compliant patient portal and phone appointments at no additional charge. Any time you want to talk to us, we’re here for you.

Your Life Without Optimized Hormones

  • Weight gain, especially in midsection
  • Loss of lean muscle mass
  • Degenerative disease (diabetes, cancer, heart disease, osteoporosis)
  • Compromised immune system
  • Thinning of the skin.
  • Depression and stress
  • Cognitive decline/forgetfulness
  • Insulin resistance
  • Loss of sex drive
  • Fatigue
  • Sleep disorders
  • Muscle aches and pains
  • Bone loss
  • Heat/cold intolerance
  • Indecision
  • Erectile dysfunction
  • Thinning hair
  • Irritability
  • Hot flashes
  • Heart palpitations
  • Vaginal dryness


I’ve recommended hundreds of people to Tier1 Health & Wellness. If you’re a man or woman who’s looking to get your hormones optimized… I give them my highest endorsement

Jay Campbell

Best-selling author of the Testosterone
Optimization Therapy Bible


Schedule Your Free Consultation

Ready to get started? Just want to talk to a real person? Enter your details in the form and someone from our team will call you back within 24 hours.