Understanding Perimenopause: Symptoms and Management
Anna Harrelson • June 1, 2024
Red head meditating



Welcome to Wondercreek Health!

If you have found yourself here, then like myself a few years ago and almost all of my other patients, you need validation, explanation & treatment of some whacky and frustrating things happening in your body these days!

Navigating the choppy waters of perimenopause can feel a lot like trying to solve a puzzle without all the pieces. It’s a journey that’s both uniquely personal and frustratingly elusive. Today, I want to share not just the facts, but also the feelings and strategies from someone who’s right there in the trenches with you.

The What and Why of Perimenopause

Perimenopause marks the transition toward menopause, the point when your ovaries gradually begin to make less estrogen. It typically starts in your 40s but can kick off in your 30s or even earlier. Symptoms vary widely in both type and severity, ranging from irregular periods to more surprising signs like heart palpitations and, of course, the infamous hot flashes.

Symptoms to Watch For

Here are a few common perimenopause symptoms that many of us may wave off as just stress or aging:

  • Irregular Periods: This might be the first sign you notice. The length of time between periods may be longer or shorter, your flow may vary (IT CAN GET RIDICULOUS!), and you might even skip some periods.
  • Hot Flashes and Night Sweats: These are the calling cards of the menopause transition. Sudden waves of heat can disrupt your day and your sleep. It can be subtle or dramatic, but there is a link between these heat waves and cardiovascular disease. They are not something to just SUFFER THROUGH!
  • Sleep Problems: You might find it harder to fall asleep, or you might wake up long before your alarm and struggle to drift off again. This can really set the stage for all of the other symptoms to be amplified.
  • Mood Changes: Fluctuations in hormones can lead to increased irritability or feelings of sadness. You may realize that you just don't feel love or joy the same and that you aren't laughing much or enjoying the things that you once did.

Managing Symptoms

While there’s no one-size-fits-all solution, here are just a few of the many strategies that have helped me and might help you too:

  • Lifestyle Adjustments: Diet and exercise really are our best friends. Focus on heart-healthy foods and regular physical activity to help manage weight and stress.
  • Hormone Therapy: This can be a game-changer for many women. It’s not right for everyone, but it’s worth discussing with a healthcare provider who takes your concerns seriously. This is a place where I am happy to work with you to find out if you (most women are) a candidate for hormone therapy.
  • Mindfulness and Meditation: Both can be incredibly effective for managing stress and mood swings. I also love journaling. These practices help me stay centered and combat the mental fog that often comes with hormonal upheaval.

Seeking Support

You’re not alone in this. Connect with healthcare providers who listen—really listen—to what you’re experiencing. It’s crucial to feel supported and understood by your medical team.

I’m living this right now, right alongside you, and I believe in a proactive approach to perimenopause, one that embraces comprehensive care, empathy, and an abundance of caution. We're in this together, and I’m here to share every insight, setback, and victory along the way.

Let’s keep this conversation going. Have you started experiencing changes? How are you managing them? Share your story in the comments below—I’d love to hear from you. If you are looking for a partner to help you along this journey, I am thrilled to be on your team!

Warmly (like , all night where is the fan warmly,

Dr. Anna



WonderCreek Health Blog

By Anna Harrelson April 11, 2025
You’re not crazy. You’re not lazy. And no, you’re not just "getting older." If you’re dragging through your days, feeling foggy, heavy, or worn out—but your labs are "normal"—you’re not alone. One of the most overlooked causes I find in my practice is suboptimal ferritin levels. Let’s break it down—with science, a little wit, and a whole lot of hope. Your Body: A High-Performance Machine Imagine your body like a beautifully engineered, high-performance car. Hormones are your spark plugs. Micronutrients are your engine oil. Proteins are your gears and pulleys. Without the right balance of all these building blocks, the engine sputters. It doesn’t matter how good the outside looks—if you're low on fuel or missing key fluids, you’re not getting out of the driveway. And iron —stored as ferritin—is a huge part of that fuel system. What Is Ferritin, and Why Should You Care? Ferritin is your body's iron storage protein. It’s like your gas tank. Not your current speed, not your miles per gallon—your actual reserve of fuel. Iron is essential for carrying oxygen to every cell in your body. It's crucial for energy production (ATP) in your mitochondria. It supports your thyroid, neurotransmitter function, hair growth, immune system, and even mood. If you’re low on ferritin, you might still show " normal " hemoglobin or hematocrit—so traditional screening won’t catch it until you’re running on fumes. Symptoms of suboptimal ferritin can include: Fatigue and poor exercise tolerance Brain fog or poor concentration Mood swings or low mood Headaches Hair shedding Shortness of breath with minimal exertion Restless legs or poor sleep Sound familiar? But My Labs Say I'm Normal... Here's the kicker: most lab ranges are designed to flag anemia — not optimal function. You could have a ferritin of 12 and be told " everything looks fine " — but feel absolutely awful. For most women, especially those who are still menstruating or recently stopped, ferritin levels under 40–60 ng/mL can cause symptoms . Many functional and integrative medicine specialists aim for 70–100+ ng/mL to support optimal energy, cognition, and hair health. Low-normal is not optimal. When your engine light is blinking, topping off the tank halfway doesn’t cut it. Why You Might Be Low Menstruation: Every period can deplete iron stores, especially if cycles were heavy. Pregnancy and postpartum: Even years later, many women never rebuild their iron stores. Gut health issues: Poor absorption due to low stomach acid, celiac disease, or IBS. Dietary patterns: Plant-based diets can be low in easily absorbed heme iron. Chronic inflammation: Inflammatory signals can "hide" your iron from circulation. Food First, But Realistic Yes, food matters. Red meat, poultry, seafood, lentils, spinach, and pumpkin seeds all contribute iron. But rebuilding storage? That’s a bigger lift. Think of dietary iron like filling up your gas tank 10–15% at a time. Helpful, but slow if you're starting on empty. Sometimes you need a boost. That’s where targeted supplementation can help—whether it’s gentle oral iron (like iron bisglycinate) or occasional intravenous iron if needed. And by the way, ever wonder why "senior" vitamins have no iron? Because postmenopausal women typically don’t lose blood monthly. We don’t want too much iron. But we also can’t function with too little. Balance is everything. Final Thoughts If you’re feeling run down, foggy, achy, or unlike yourself—it’s not "all in your head." Your body is whispering (or screaming) for better support. And sometimes the missing piece isn’t fancy. It’s basic, foundational, and fixable. Ferritin matters. Iron matters. You matter. At Wondercreek Health, I believe in digging deeper, connecting the dots, and helping you rebuild the strong, steady foundation your body deserves. Because you weren’t designed to run on empty. Iron-Rich Foods to Boost Your Levels Beef, lamb, liver (heme iron is best absorbed) Dark poultry (chicken thighs, turkey) Shellfish (clams, oysters, mussels) Lentils and chickpeas Spinach and swiss chard Pumpkin seeds and cashews Fortified cereals and oatmeal Tofu and tempeh Tip: Pair iron-rich foods with vitamin C (like bell peppers, oranges, or strawberries) to boost absorption! Ferritin Target Chart Ferritin Level What It Means <15 ng/mL Severe deficiency 15–40 ng/mL Low stores (symptoms likely) 40–60 ng/mL Borderline (may still have symptoms) 70–100+ ng/mL Optimal for energy, cognition, hair health Individual needs vary—always interpret ferritin in the context of your full health picture! When to Suspect Low Iron Feeling tired despite good sleep Exercise feels harder than it used to Brain fog or poor memory Unexplained hair thinning Pale skin or brittle nails Frequent headaches Restless legs or poor sleep Shortness of breath climbing stairs If you’re nodding along to several of these, it’s worth a closer look at your ferritin levels.
By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
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