You’re exercising more than ever, and you’ve cut out most of the sugar, mindless snacking, and alcohol. Maybe you’ve even cut gluten or dairy, gone keto, or tried fasting. But your clothes don’t fit, you’re gassy and bloated, the cravings are relentless, your mood is unpredictable, sleep is elusive or your sheets are soaked through, your skin is a mess, and your brain seems to be on permanent vacation. If any of this sounds familiar, you’re not alone — myself and my clients are navigating this phase right along with you.
Battling weight, energy levels, and emotions in perimenopause can really get you down. But it doesn’t mean you’re failing, lazy, broken, or lacking willpower. Your hormones are just shifting — and they touch every single system in your body. .
I promise you can get back to vitality and feeling at home inside your body again with some diet and lifestyle changes. But before we talk about the “how” in parts 2 and 3 of this series, let’s talk about “what” and “why”. Understanding what’s going on hormonally can bring huge relief. Once you see the “why,” you can stop blaming and start focusing — on working with your body instead of against it.
What Is Perimenopause?
The roughly 5 to 10 years we spend transitioning into menopause. Once you officially hit menopause (1 year after your last period), your ovaries have stopped making estrogen and progesterone. But before they bottom out, they fluctuate unpredictably.
Personally, it’s the unpredictability that really drives me bananas. Dealing with once-a-month energy and mood dips, bloating, or a pimple is no biggie because you know it’s coming. There’s even a sense of comfort in the rhythm as you’re reminded to be more gentle with yourself and get more rest. But without those patterns, the brain fog, fatigue, and emotional fragility can make you feel like you’re losing your mind.
And the night sweats and weight gain just make it all feel worse. So let’s meet the key players.
Progesterone: Your Calming Hormone
Progesterone is often the first hormone to decline in perimenopause. It’s your natural calmer, the hormone that helps you feel grounded and sleep deeply. When it’s low, you may feel:
- Anxious or restless
- More irritable
- Wired at night, tired in the morning
- Like PMS has taken up permanent residence
How this can effect your weight: Chronic insufficient or poor quality sleep and chronic stress (which go hand in hand), both lead to chronically elevated cortisol levels which promote fat storage.
Adding oral micronized progesterone at bedtime has been a game changer for my mood and sleep. We will talk more about cortisol, sleep, and supplements in part 3.
Testosterone: Your Vitality Hormone
Testosterone isn’t just a male hormone. Women need it, too — for energy, muscle, metabolism, and mood. It naturally declines with age and ovarian changes, and low levels may make weight management and vitality harder.
- Supports muscle mass & strength
“Even at low levels, testosterone plays a key role in preserving lean body mass and physical function in women.”(Fogle RH et al., Menopause, 2007)
- Boosts metabolism and energy
“Low testosterone is associated with reduced metabolic rate, increased fat mass, and lower vitality.” (Davis SR et al., Menopause, 2015)
- Supports motivation, focus, and sexual desire
“Low levels are linked to fatigue, low mood, and reduced quality of life.”
(Wierman ME et al., J Clin Endocrinol Metab, 2014)
- Cardiometabolic effects
“Low testosterone in women correlates with higher visceral fat, insulin resistance, and unfavorable lipid profiles.” (Zhao D et al., J Am Heart Assoc, 2018)
Estrogen: The Stabilizer Hormone
Estrogen has worked alongside other key hormones and neurotransmitters to help keep your mood, metabolism, and energy more steady for decades. As it starts to fluctuate and decline, you might notice:
- Hot flashes and night sweats
- Weight gain, especially around your belly
- Brain fog or forgetfulness
- More fragile moods
Estrogen is a key piece of weight gain mystery because it’s one of the hormones that drives where you store fat. It helps control ghrelin and leptin which are hormones that tell us when we are hungry or full and signal fat storage.
This isn’t weakness folks — it’s biology. Estrogen is closely tied to serotonin and dopamine, which is why mood can feel so unpredictable, motivation elusive, and cravings relentless as estrogen drops.
✨Estrogen is also intricately woven together with many other hormones which impact metabolism.
Insulin: The Blood Sugar Regulator
Insulin helps shuttle glucose from your bloodstream into your cells for energy. And like many of the hormonal pathways — insulin and estrogen signaling pathways interplay. As estrogen declines, insulin sensitivity decreases. This is a problem because insulin sensitivity is critical for blood sugar regulation, a healthy metabolism, and the ability to manage weight. So as you become more resistant to insulin:
- Carbs hit harder (causing bigger spikes and crashes)
- You feel hungrier, sooner
- Fat storage increases
To make matters worse, that fat storage isn’t just any fat — it’s visceral fat (the dangerous belly fat around your organs). This fat can further decrease insulin sensitivity and increase inflammation in a vicious downward spiral cycle which is one reason why you can be eating “the same as always” and still gain weight in midlife. But that’s not all!
Cortisol: The Survival Hormone
Cortisol is one of the hormones our adrenals produce often referred to as a “stress hormone”. It’s actually an important survival hormone that helps orchestrate the body’s response to stress, regulate metabolism & blood sugar, and control sleep patterns. In modern life though, it often runs too high for too long.
And just like insulin, cortisol and estrogen are linked. As estrogen levels decrease, cortisol often increases which only serves to amplify the symptoms related to progesterone and estrogen decline.
The prolonged elevation in cortisol common in perimenopause and/or long periods of stress promotes fat storage. But not only that, in perimenopause we can become more sensitive to stress with foggy brains, memory lapses, intense cravings, mood disturbances, emotional dysregulation, increased inflammation, and poor sleep.
Signs include:
- Belly fat that won’t budge
- Sugar cravings
- Sleep disruption
- Feeling constantly “on edge”
And let’s be honest — for many of us, cortisol was already problematic having lived decades with over-scheduled calendars, porous boundaries, not nearly enough sleep, no meaningful work/life balance, and shoving garbage in our bodies as we wasted away years sedentary behind a desk relentlessly shaming ourselves and trying to morph into society’s definition of perfect.
The point is—cortisol is a survival hormone doing a job by desperately trying to hold on to existing fat and store even more. And those cortisol cravings? They just make its job even easier.
Thyroid: The Silent Player
The hormonal changes that start in perimenopause can also impact the function of your immune system and thyroid gland. As estrogen decreases, TSH(thyroid stimulating hormone) can increase, leading to hypothyroidism. Free thyroid hormones in the bloodstream (T4 & T3) can also be impacted. Additionally, perimenopause and hypothyroidism have many overlapping symptoms (fatigue, weight gain, difficulty sleeping, mood swings, hair loss, etc) which means misdiagnosis and delayed treatment are more common.
l recommend getting a FULL thyroid panel along with your hormone panel (including TSH, T3, T4, and antibodies) These are not expensive cashpay tests — if you run into any roadblocks getting this ordered, I can help. You want that thyroid optimized in order to help manage weight.
Growth Hormone: Wrapping it up with a bow
Growth hormone has already been declining for quite some time, but now that’s amplified by a drop in estrogen and testosterone and muscle wastes at an even faster rate, slowing the rate at which the body uses calories. Factor in the chronic elevations in cortisol, reduction in insulin sensitivity, deteriorating sleep quality, and increased sensitivity to stress, and you get the perfect hormonal storm.
No wonder midlife feels destabilizing — every major hormone system is in transition. Very suddenly, you find yourself living in a body and brain you don’t recognize.
But there’s good news: you are not powerless. While you can’t stop hormonal shifts, you can absolutely influence how your body responds. Food, movement, and lifestyle choices become powerful levers to bring your system back into balance.
✨ In Part 2, we’ll dive into the nutrition and strength strategies that make the biggest difference — the tools that help you feel steady, energized, and resilient again.
✨ In Part 3, we’ll tackle stress, sleep, and supplements — the final pieces to help you feel fully supported and resilient in perimenopause.
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