Perimenopause often begins years before menopause, commonly in the late 30s or 40s. It is marked by fluctuating hormones rather than a steady decline, which is why experiences vary so widely. Changes in menstrual cycles, sleep, mood, anxiety, energy, focus, and how the body responds to stress are often early signals.

Standard hormone blood tests may appear “normal” during perimenopause because hormone levels can rise and fall dramatically from day to day. For this reason, lab results alone are rarely diagnostic.

That said, some people begin to notice shifts in broader blood markers during this transition, such as changes in cholesterol, blood sugar regulation, inflammation markers, or emerging nutrient deficiencies. These changes do not confirm perimenopause on their own, but they can reflect the body’s changing hormonal landscape and offer helpful context when symptoms are present.

Perimenopause is best understood through patterns over time, including how you feel, how your cycles change, and how your body responds, rather than through a single test result.

In addition, regulatory complexity, lack of provider education, and inconsistent insurance coverage can create barriers, leaving many people to advocate strongly for care that should be routine.

You have the right to ask why a treatment is being declined, what evidence is guiding that decision, and whether a referral to a menopause-informed provider is available. Advocacy is not confrontation. It is a necessary part of navigating a system that has not prioritized this stage of life.

It is common for coverage to require prior authorization, which can delay care but does not necessarily mean treatment is unavailable.

Synthetic hormones are also made in a lab, but their chemical structure differs from the body’s natural hormones and may interact with receptors differently.

Neither option is universally better. Many FDA-approved hormone therapies use bioidentical hormones, and synthetic hormones may be appropriate in certain cases. What matters most is how the hormone works in your body, how it is dosed, and whether care is guided by a knowledgeable provider.

Some herbs have been studied for their potential to support hormonal balance and ease symptoms such as hot flashes, mood changes, sleep disruption, and stress. Responses vary, and herbs work best when chosen thoughtfully and used with guidance.

Commonly referenced herbs include black cohosh for hot flashes, night sweats, and sleep support, and ashwagandha for stress regulation, anxiety, and fatigue. Rhodiola has been studied for stress resilience and energy, while maca may support mood, libido, and overall well-being. Chasteberry (Vitex) is sometimes used to support cycle-related symptoms during early perimenopause.

Herbs are not risk-free and may interact with medications or be inappropriate for certain health conditions. They are best viewed as supportive tools rather than replacements for medical care. Consulting a knowledgeable provider can help determine what is appropriate for your body and stage of transition.