The 14 Biggest Myths About Perimenopause
By Dr. Kelly Casperson, MD
Peri means "around". So perimenopause means the time around menopause (which is the day after one year of no natural periods - in America, the average age is 51). Amazingly, the definition of menopause is wholly made up - nothing magical happens exactly one year after no periods. BUT/AND perimenopause is also NOT magical - it is very real.
Perimenopause is the period of fluctuations that occur as the ovaries approach the end of their functional lifespan. And it isn't just a slow decline; you can have periods of high estrogen as the ovary tries hard to release eggs. High estrogen. Low estrogen. High estrogen, low estrogen. And low progesterone. And your testosterone has been going down since your 20’s. Reverse puberty? A roller coaster? Yes, yes and yes. Understanding perimenopause as a dynamic, hormonal roller coaster—rather than a simple fade to black—is the first step in empowering women to navigate it with clarity, confidence, and the support they deserve.
Understanding perimenopause is crucial, as it empowers you to take control of your health and well-being. It's not just about knowing the facts but also about taking responsibility for your health and seeking informed medical advice. Because suffering isn't a rite of passage, and you deserve better than outdated advice.
Let's get something straight: perimenopause is real. It's messy, it's disruptive, and for far too many women, it's completely misunderstood—even by their doctors.
Every week, I hear the same questions:
"Is this perimenopause?"
"My doctor said I'm too young for hormones—is that true?"
"Why didn't anyone tell me it could feel like this?"
The root of the confusion? Myths. Outdated, unscientific, persistent myths that keep women in the dark about their health.
Let's debunk these myths—one by one, empowering you with the knowledge you need to take control of your health and bring a sense of relief. Knowing the truth about perimenopause can help you manage it more effectively and feel reassured that what you're experiencing is normal.
1. "Perimenopause starts in your 50s."
Truth: It often starts in your late 30s to early 40s. Hormonal changes begin years before menopause. If you're suddenly moodier, sleeping worse, and losing your mind every time someone chews too loudly, it's not "just stress." It might be perimenopause. Other common symptoms include irregular periods, hot flashes, night sweats, vaginal dryness, and changes in sexual desire. Oh, and weight gain, lipid panel increases, and rising blood sugar, even though you aren't doing anything different - all consequences of your body losing its anti-inflammatory ovarian-producing hormones. Perimenopause is real and often happens WAY before you are thinking about menopause.
2. "You can't use hormones until your periods are done."
Truth: That's outdated advice. Hormone therapy can be a game changer in perimenopause. You don't need to wait until menopause to feel better. You need a provider who understands what's happening, and if they say this myth, it is a good bet that they don't understand. Other treatments, such as lifestyle changes, dietary supplements, and non-hormonal medications, can also help manage symptoms and improve your quality of life, but as the LITERAL REASON you are having symptoms is decreasing hormones, replacing the hormones is often the most helpful.
3. "Birth control is the best (or only) option."
Truth: The pill can help some symptoms, but it's not hormone replacement and not always ideal for midlife. There are better options—especially if you're looking to support your brain, bones, metabolism, and long-term health. That said, if you need to protect yourself from sperm, you need a sperm protection plan, which may include birth control. Hormone replacement doesn't prevent pregnancy. 1/3rd of pregnancies over age 40 are unplanned. We still have to stay vigilant! One thing that birth control is excellent at (besides preventing pregnancy) is helping with heavy periods. It is not "wrong" to be offered oral birth control or an IUD during perimenopause, but it isn't always the best medication for some of the symptoms of fluctuating hormones.
4 "If your periods are regular, it's not perimenopause."
Truth: You can still be in perimenopause with clockwork cycles. Often, hormone fluctuations happen before bleeding does. Symptoms like night sweats, mood changes, or anxiety may show up years before your period misbehaves.
5 "Hot flashes are the first sign."
Truth: For many, they're not even in the top five. You're more likely to notice rage, sleep problems, low libido, weight gain, or anxiety first. If you're waiting for a hot flash to prove you're in perimenopause, you might miss the whole transition.
Photo by Matthew Staples on Unsplash
6 "It's natural, so just tough it out."
Truth: Childbirth is natural, too, but we don't tell women to "just deal with it" without options. Natural doesn't mean painless or optimal. You deserve support and solutions, not martyrdom.
7 "You're too young for hormone therapy."
Truth: The ideal window for starting hormone therapy may actually be before menopause, in your 40s and early 50s: symptoms, not age, guide treatment—quality of life matters.
8 "Blood tests will tell you if you're in perimenopause."
Truth: Hormone levels fluctuate wildly—sometimes hourly. A normal lab result doesn't necessarily mean you're not experiencing symptoms. Diagnosis is clinical, based on what you're feeling, not just a number on a chart. That said, a rising FSH (follicle stimulating hormone) is a sign that menopause may be within a few years - but did you really need a blood test to know that?
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9 "Perimenopause only affects your uterus."
Truth: It affects your brain, bones, muscles, metabolism, mood, and more. This is a full-body transition, not just a reproductive one.
10 "Sex drive disappears, and there's nothing you can do."
Truth: Libido often dips in perimenopause, but gone today doesn’t have to mean gone tomorrow. Desire is complex—and treatable. Hormones, communication, nervous system regulation, and mindset all play a role.
11 "You'll know when it's over."
Understanding the truth about perimenopause can be a huge relief—it means you're not broken, you're not alone, and what you're going through is both normal and manageable. One-third of women don’t have periods, so the idea of waiting for some mythical “one-year mark without natural periods” to declare menopause is irrelevant for many. And honestly, it doesn’t really matter. Your treatment options, your symptoms, and your needs don’t hinge on crossing that arbitrary line—they remain the same one day before or one day after.
The bottom line? Menopause isn't a single day on the calendar—it's a transition, and you deserve support through every step of it.
12 "Bone loss starts after menopause."
Fact: Bone density can begin to decline during the perimenopause period. This is your window to protect your skeletal future with strength training, lifestyle, and the right hormones. Oh, and ditto for muscle mass.
13 "It's not real—it's just in your head."
Truth: This is gaslighting, plain and simple. Perimenopause is a real, neurohormonal shift with measurable physiological effects. If someone minimizes your experience, get a second opinion. And yes, check for thyroid disorders and other things that can show up with similar symptoms, but as perimenopause happens to 100% of women, as we say in medicine, “common things are common” - it is very likely it could be perimenopause.
14 "Doctors are trained to handle this."
Truth: Most medical schools spend less than 4 hours on menopause—and even less on perimenopause. Many clinicians are not up to date. If you feel dismissed or unsupported, you're not crazy (obviously) - your doctor may not be adequately trained in this area of health. And remember: just because something is naturally occurring in nature doesn't mean somebody should tolerate it. Death during childbirth is natural. Enough said.
Bottom Line:
Healthcare providers play a crucial role in managing perimenopause. They can help you understand your symptoms, provide appropriate treatments, and offer support and guidance. By working with a knowledgeable and supportive healthcare team, you can navigate perimenopause more effectively and improve your quality of life.
Ready to learn more and get the support you need? Don't hesitate to seek further information and support, as it can help you navigate perimenopause more effectively at kellycaspersonmd.com.
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Dr. Kelly Casperson, MD
Urologist | Author | Podcaster | Sex Educator
Host of You Are Not Broken