Top Perimenopause Myths Debunked
By: Dr. Jackie Piasta, DNP, WHNP-BC, MSCP
Top Perimenopause Myths Debunked
Perimenopause—the years of hormonal transition leading up to menopause—is one of the least talked about yet most impactful phases of a woman’s life. On average, this stage lasts 4–10 years, but myths and outdated advice often leave women confused or dismissed. Let’s tackle the biggest misconceptions and set the record straight with the science and clinical insight you deserve.
Myth #1: “If you’re still getting your period, you’re not in perimenopause.”
Truth: You can absolutely still be in perimenopause even if you’re menstruating regularly. Perimenopause is defined not by the absence of periods, but by hormonal fluctuations—especially in estrogen and progesterone—that affect your cycles, mood, sleep, cognition, and more.
What actually happens: Early in perimenopause, ovulation becomes less consistent. Progesterone levels decline first, while estrogen may spike unpredictably high or dip suddenly. This imbalance can lead to heavy periods, irregular bleeding, breast tenderness, or worsening PMS.
Clinical takeaway: Just because you still bleed doesn’t mean your hormones are stable. Tracking cycles and symptoms often gives more reliable information than waiting for menstruation to stop altogether.
Myth #2: “You’re too young for perimenopause.”
Truth: Perimenopause often begins in the early 40s, but can start in the mid-to-late 30s. Genetics, lifestyle, medical history, and even race/ethnicity all influence timing.
Examples: Women who smoke, undergo cancer treatments, or have autoimmune conditions may transition earlier. Studies show Black women, on average, enter perimenopause sooner and experience more severe vasomotor symptoms than white women. Conversely, those with higher body mass indexes tend to go through the transition later.
Why this matters: Dismissing women in their 30s or 40s with symptoms like brain fog, anxiety, or cycle changes delays care. These years are also when long-term risks like bone loss and cardiovascular changes may first appear.
Clinical takeaway: If you’re experiencing changes, you’re not “too young”—you may be right on time.
Myth #3: “You’re not in perimenopause if you aren’t having hot flashes.”
Truth: Hot flashes and night sweats are classic, but not universal. Perimenopause symptoms are highly variable and often extend well beyond temperature regulation.
Other early symptoms: Sleep disruption, irritability or anxiety, low mood, cognitive changes (“brain fog”), migraines, weight redistribution, hair and skin changes, or worsening PMS.
Why this happens: Fluctuating estrogen and falling progesterone affect neurotransmitters like serotonin, GABA, and dopamine—explaining why mood, sleep, and cognition often shift first, even without vasomotor symptoms.
Clinical takeaway: Perimenopause is a whole-body transition, not just about hot flashes.
Myth #4: “You just have to tough it out.”
Truth: Perimenopause is a transition that deserves evidence-based treatment. Suffering through symptoms isn’t necessary, and untreated symptoms can carry long-term consequences.
Quality of life: Poor sleep, anxiety, and brain fog affect relationships, work performance, and daily wellbeing.
Health outcomes: Untreated estrogen deficiency accelerates bone density loss, cardiovascular changes, and metabolic shifts that may increase future risk for osteoporosis, heart disease, and diabetes.
Options: Hormone therapy, non-hormonal medications (SSRIs, SNRIs, gabapentin, etc.), lifestyle interventions, nutrition, and integrative approaches can all help.
Clinical takeaway: Support is available. “Toughing it out” is outdated advice that fails women.
Myth #5: “Blood tests are the best way to diagnose perimenopause.”
Truth: Hormone levels fluctuate widely in perimenopause—sometimes day to day or hour to hour. A single blood test can be misleading.
Why labs fall short: An estradiol level may appear “normal” on paper even if symptoms are significant. FSH (follicle-stimulating hormone) levels spike and drop unpredictably in perimenopause, making them unreliable markers.
Best diagnostic tool: A detailed symptom history and menstrual pattern review remains the gold standard. Bloodwork can help rule out thyroid disease, anemia, or other conditions that mimic perimenopause but is not the primary diagnostic test.
Clinical takeaway: Your experience matters more than a single lab number.
Myth #6: “Hormones are dangerous and should be avoided.”
Truth: This myth stems from outdated interpretations of the Women’s Health Initiative (WHI) study in the early 2000s. Modern research paints a very different picture.
Updated evidence: For women younger than 60 or within 10 years of menopause, the benefits of menopausal hormone therapy (MHT) often outweigh the risks. These include improved quality of life, reduced vasomotor symptoms, bone protection, and possible cardiovascular and cognitive benefits when started early.
Safety nuance: Route and timing matter. Transdermal estrogen carries less risk of clotting than oral formulations, and adding micronized progesterone (not synthetic progestins) may further improve safety.
Clinical takeaway: Hormone therapy is not one-size-fits-all. For the right candidate, it’s not only safe—it can be life-changing.
Myth #7: “Perimenopause only affects your periods.”
Truth: Perimenopause is a whole-body transition that goes well beyond menstruation.
Cardiovascular: Estrogen supports healthy blood vessels and nitric oxide production. Its decline contributes to increased risk of hypertension and heart disease.
Bone health: Estrogen protects against bone resorption. Loss accelerates bone density decline and raises osteoporosis risk.
Brain health: Hormones affect memory, concentration, and mood. Research is exploring estrogen’s role in long-term cognitive health and dementia risk.
Metabolic shifts: Weight often redistributes to the abdomen, increasing risk of insulin resistance.
Clinical takeaway: Perimenopause is a pivotal window for prevention and proactive health planning, not just cycle management.
The Bottom Line
Perimenopause is not just about “getting older.” It’s a profound hormonal transition with whole-body effects. By cutting through myths, women can better advocate for themselves, seek timely care, and protect their long-term health.
If your symptoms are disrupting daily life—or if you simply want to be proactive, you have options! Together, we can create a plan that not only eases symptoms but also supports your bone, brain, heart, and overall wellbeing for decades to come.
