6 truths about perimenopause an OB/GYN wants you to know

Perimenopause isn’t just “menopause lite” — it’s a complex hormonal journey that can come with unexpected twists. But it’s also a time of insight, growth and the opportunity to care for your body in new ways.

Farah Benarba Castro, DO, an OB/GYN with Atlantic Health, is pulling back the curtain on this transformative phase of life with six truths that you may find surprising — and empowering.

1. Perimenopause starts earlier than you think.

Many women are surprised to learn that perimenopause can begin as early as their late 30s, not just in their 40s. This hormonal shift doesn’t happen overnight — it unfolds gradually over several years. One of the earliest signs? Periods that become more irregular, accompanied by physical and mental changes that can feel puzzling until you understand what’s happening. Despite the irregularity, fluctuating hormones and inconsistent ovulation, you can still get pregnant during this time. The chances, however, decrease with age and the risks like miscarriage, gestational diabetes, preeclampsia and chromosomal abnormalities increase.

2. Your symptoms are more than just hot flashes.

Hot flashes and night sweats are common, but perimenopause can show up in other unexpected ways: itchy ears, burning mouth, shifting weight around the middle, achy joints or changes in skin and hair. You might feel like your teenage skin has returned with breakouts — or notice thinning hair or new hair growth in unwanted places. Sleep disturbances, brain fog and forgetfulness are also common. Knowing that these symptoms are part of a larger pattern can be reassuring and help you seek the right support.

3. Hormones become a rollercoaster.

During perimenopause, estrogen and progesterone can spike and dip unpredictably, affecting mood, metabolism and mental clarity. One day you might feel like yourself, and the next, you’re overwhelmed for no obvious reason. It’s not just in your head — it’s your hormones fluctuating dramatically. Understanding this and knowing that there are steps you can take to help relieve symptoms and improve your quality of life can help you ride the waves with more patience and less self-judgment.

4. Your sex life can change — but help is available.

As estrogen declines, vaginal dryness can lead to discomfort or pain during intimacy. Libido may shift, too. Vaginal dryness is one symptom that doesn’t improve on its own — it often needs treatment, according to Dr. Benarba Castro. The good news? Specialized lubricants, moisturizers and vaginal estrogen can make a significant difference, restoring comfort and confidence.

5. Lifestyle matters more than ever.

Your habits can play a powerful role in managing symptoms. Alcohol, caffeine and sugar can intensify hot flashes and mood swings. Stress has a bigger impact now, making relaxation techniques like yoga, meditation or even daily walks important. Exercise — especially strength training — helps preserve muscle mass, support metabolism and boost mood during this transition.

6. You have more options than ever before.

You don’t have to “tough it out.” Today, women have access to a growing toolbox of options to help ease perimenopause symptoms:

Hormonal support like low-dose birth control pills and hormone replacement therapy (HRT)
Non-hormonal medications for hot flashes and mood symptoms
Vaginal estrogen for comfort
Diet and lifestyle changes to help ease symptoms naturally
Targeted supplements to support hormonal balance

“Women don’t have to suffer,” emphasizes Dr. Benarba Castro. “Understanding perimenopause is about improving quality of life — not just enduring a biological process. I’ve seen firsthand how validating a woman’s experience can be the first step toward relief and renewed vitality.”

As awareness and research grow, so does the support available to help you navigate perimenopause with clarity, strength and grace.

Find an OB/GYN

Published: June 09, 2026

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