Perimenopause may seem like a stage you just have to “get through,” but the reality is much deeper—and more critical. This transitional time, typically beginning in a woman’s 40s, marks the start of hormonal shifts that influence virtually every organ in the body, from the bones and heart to the brain and gut. Understanding these changes can help you take charge of your health now and set the stage for a stronger, more vibrant future.Let’s shine a spotlight on how perimenopause impacts women’s health and share science-backed strategies to help you thrive in this next chapter.
Protecting Your Bones for the Long Haul
Estrogen plays a crucial role in maintaining strong bones. As levels dip during perimenopause, bone loss can accelerate, increasing your risk of osteoporosis and fractures. This bone thinning often begins about two years before your last period and can continue for several years after.
Smart Strategy:
Incorporate weight-bearing and resistance exercises at least three times a week
Eat calcium-rich foods (aim for 1200 mg/day) and get enough vitamin D (800 IU/day)
Avoid smoking and excess alcohol
Talk to your doctor about whether hormone therapy may be right for you—it’s shown to reduce bone loss and fracture risk
Maintaining Strength and Muscle
Hormonal shifts, including declines in estrogen, testosterone, and progesterone, are linked to sarcopenia—a gradual loss of muscle mass and strength that makes you feel weaker and less energetic.
Smart Strategy:
Prioritize strength training
Ensure adequate protein intake (about 1 gram/Protein per kilogram of ideal body weight)
Consider hormone therapy if appropriate—it may help preserve muscle in some women
Your Heart After 40
Estrogen’s protective effects on heart health decline during perimenopause. As levels fall, cholesterol may rise, blood pressure can creep up, and fat may shift to your abdomen—all of which increase the risk of cardiovascular disease.
Smart Strategy:
Exercise at least 150 minutes per week with moderate-intensity cardio
Stop smoking, manage stress, and get regular screenings for blood pressure, cholesterol, and glucose
Note: Hormone therapy is not recommended solely for heart disease prevention after menopause
Mood, Memory, and Mental Wellness
Brain fog, mood swings, anxiety, and depression are common during perimenopause, thanks to fluctuating estrogen levels. Some women also notice changes in memory and focus.
Smart Strategy:
Cognitive behavioral therapy (CBT), exercise, and good sleep hygiene can help
Hormone therapy or antidepressants (SSRI/SNRI) may be beneficial
Prioritize social engagement and mental stimulation—what’s good for the brain is good for the soul
Safeguarding Brain Health for the Future
Estrogen affects brain regions tied to memory and cognition. While most women won’t develop dementia, some are at increased risk, especially those with early menopause or a strong family history of Alzheimer’s.
Hormone therapy may offer some protection when started around the time of perimenopause, but it’s not a treatment for cognitive decline
Gut Health Gets Hormonal, Too
Estrogen influences the makeup and health of your gut microbiome. As levels decline, your gut barrier may become weakened, leading to increased inflammation and metabolic issues.
Smart Strategy:
Eat a diet rich in fiber from fruits, vegetables, whole grains, and legumes
Consider probiotics or prebiotics
Stay active and explore hormone therapy if needed—some women see benefits in gut function
Metabolism in Midlife
Estrogen helps regulate how your body uses and stores energy. Without it, you may notice weight gain, especially around the middle, along with blood sugar fluctuations.
Smart Strategy:
While hormone therapy isn’t a weight-loss tool, starting it in perimenopause may support better insulin sensitivity and help reduce abdominal fat
Combine this with regular exercise and healthy eating habits for the best results
When Sleep Starts to Suffer
Hot flashes, night sweats, and hormonal imbalances can seriously disrupt sleep. Over time, this can affect your energy, mood, and overall quality of life.
CBT for insomnia is highly effective and doesn’t involve medication
Stick to a regular bedtime, avoid screens at night, and manage stress through relaxation or mindfulness
Caring for Vaginal and Urinary Health
Lower estrogen levels can cause vaginal dryness, irritation, and painful sex, as well as more frequent urinary tract infections. Testosterone decline may worsen these issues.
Sexual desire, arousal, and satisfaction can take a hit during perimenopause and menopause. Hormonal changes impact everything from blood flow to sensation, and emotional factors also play a role.
Open communication with your partner is key to rebuilding intimacy and connection
Final Thoughts
Perimenopause isn’t just about hot flashes or skipped periods—it’s a whole-body transformation that calls for a proactive approach to health. By understanding what’s happening and making thoughtful lifestyle choices, you can navigate this transition with strength, clarity, and confidence.Your next chapter can be one of empowerment, starting now.Dr. David Samadiis the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of two books, Prostate Cancer, Now What? A Practical Guide to Diagnosis, Treatment, and Recovery and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.
