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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 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.
By Anna Harrelson March 30, 2025
Let’s be honest: midlife can feel like your body is changing the rules without warning. You’re doing what used to work, but the results aren’t the same. The scale doesn’t budge, your sleep is disrupted, your energy is inconsistent, and your moods might feel like a rollercoaster you didn’t sign up for. And while hormone therapy, supplements, and nutrition are powerful tools for navigating perimenopause and menopause, movement—especially strength training and nervous system-aware exercise—is one of the most underutilized forms of medicine. As a lifestyle medicine physician and menopause specialist, I talk about this daily with my patients. Movement isn’t just about burning calories. It’s about retraining your stress response, building metabolic resilience, preserving muscle, and improving insulin sensitivity. Why Movement and Muscle Matter in Midlife During perimenopause and menopause, we experience natural declines and fluctuations in estrogen, progesterone, and testosterone. These shifts impact far more than reproduction—they affect how we regulate blood sugar, manage stress, build muscle, sleep, and recover from daily life. In this stage of life: Muscle mass declines more rapidly if not actively maintained Insulin sensitivity drops, raising the risk for metabolic syndrome and weight gain Cortisol levels rise and become harder to regulate, especially in women with high stress or trauma histories Nervous system resilience weakens, making it harder to bounce back from emotional or physical stressors Movement is the antidote to all of this. What the Research Shows Muscle is a metabolic organ. It stores glucose, improves insulin sensitivity, regulates inflammation, and even contributes to hormone production and detoxification. Building and maintaining muscle in midlife is one of the most powerful ways to protect against: Type 2 diabetes and insulin resistance Cognitive decline Cardiovascular disease Falls, fractures, and osteoporosis And beyond the physical? Movement is critical for regulating the autonomic nervous system, which influences: Your ability to sleep Your mood and anxiety levels Your response to daily stressors Your digestive and immune function Not Just Any Movement This isn’t about hitting the gym for 90 minutes or going hard every day. It’s about intentional movement that supports your biology. Here’s what I recommend: 1. Prioritize strength training. 2–3 times per week of bodyweight, resistance bands, dumbbells, or machines Focus on form, tempo, and functional movement—not just reps or weight 2. Include low-impact, nervous-system regulating movement. Walking, mobility flows, Pilates, yoga, or tai chi Think of this as your recovery and resilience training 3. Move throughout the day. Break up sedentary time with stretching, light movement, or standing tasks Movement snacks matter for metabolic health 4. Don’t overtrain. Too much high-intensity exercise can increase cortisol, disrupt sleep, and worsen hormonal symptoms Listen to your body and focus on consistency over intensity It’s Not About Looking Fit. It’s About Feeling Well. This phase of life isn’t just about managing symptoms—it’s about building your future resilience. Every time you lift something heavy, take a walk, or stretch with intention, you are: Supporting your insulin and glucose balance Reinforcing your bone, brain, and cardiovascular health Regulating your nervous system Building muscle that keeps you independent and active for decades to come Movement is medicine, & muscle is your midlife superpower. Final Thoughts If you feel like your metabolism has shifted, your sleep is off, or your body feels unfamiliar—you’re not alone. But you’re not broken. You’re evolving. And your body is still responsive to thoughtful support. Start small. Lift something. Go for a walk. Move in a way that honors your nervous system, builds strength, and reminds you that this phase of life is not a decline—it’s a recalibration.
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