8. Decoding Perimenopause Stages: Midlife Hormones 101

You're eating well, moving your body, trying to sleep — and yet the weight is creeping up, your moods are unpredictable, and your brain feels like it's running on dial-up. Sound familiar? This isn't a willpower problem. It's a hormone problem, and there's a big difference.

Dr. Mary walks you through the three stages of perimenopause — from the earliest signs (hello, ramped-up PMS and mysterious weight gain) to the chaotic middle years of skipped cycles and 3am wake-ups, all the way to the "almost there" phase just before menopause. You'll learn why progesterone, testosterone, DHEA, and even your thyroid all play a role in how you feel — and why the advice you've been given probably wasn't designed with your midlife body in mind.

By the end of this episode, you'll have a clearer map of where you are, what's driving your symptoms, and what to watch for as things continue to shift. This transition is real, it's significant, and it is absolutely navigable — when you know what you're actually dealing with.

In This Episode:

• The three stages of perimenopause — from early signs like ramped-up PMS and mysterious weight gain, through the chaotic middle years, to the phase just before menopause
• Why progesterone, testosterone, DHEA, and thyroid all shift during this transition — and how each affects how you feel
• How to identify which stage you're in and what to watch for as your hormones continue to change

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Disclaimer: The content shared on this channel is for educational and informational purposes only and does not constitute medical advice. Nothing here is intended to replace the guidance of your physician, licensed healthcare provider, or any information accompanying a product you've been prescribed or recommended. Do not rely on this content to diagnose or treat a health condition, or to make decisions about medication or other therapies.

Transcript

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So many frustrated women tell me I'm eating the way I always have, moving my body, trying to sleep, doing all the things and it's not working. They want to know why. Why they've gained weight, why they're not sleeping, why they're suddenly wanting to throttle their poor partner for making chewing noises next to them at the dinner table. Well, we're gonna talk about why today, and I wanna ground this whole conversation in the idea that what we used to do doesn't work anymore because our operating systems have updated, so to speak, and we need to relearn how to use them, how to navigate these bodies of ours, probably for the first time since we were teenagers, or maybe for some since pregnancy. So, in this episode, I'm gonna walk you through what changes in midlife and what you can expect as you move through the stages of perimenopause. And in a following episode, we'll then talk about hormone replacement options, best practices, worst practices, a lot of hotly contested ideas in there. I'm excited about it. Probably gonna blow your mind a little bit. It's not what you're gonna hear at your doctor's office. But don't worry, I will always bring it back to the science, as we'll do today. So, everybody, welcome to the Better Beyond 40 Formula podcast, where smart, driven women over 40 and those who support them can ditch the confusion and cut the midlife wellness nonsense. I'm Dr. Mary Pine's award-winning PhD biomedical scientist of 25 years with a decade in women's health and longevity consulting. I specialize in transforming the lives and the health of women from their late 30s to their early 60s by delivering clarity and practical real-life solutions with honesty, compassion, and a little humor. In this podcast, I'm gonna share my top tips and tricks from within my one-on-one coaching program to help you redefine what's possible for yourself and feel unmistakably better beyond 40. So, today we're gonna focus on the different stages of perimenopause, how to recognize what stage you're in, and what to expect down the road. So you can view this as the metamorphosis it really is. So you're prepared. As I talk about in episode two, this is not something to fear or hate on. So the conventional playbook of health advice, let's start there. Ooh, goody, like all that crap. Calories in, calories out, eat more, move less for weight loss, or you've worked work on your sleep hygiene for sleep, or maybe for mental health, just manage your stress, do some breathing, that kind of a stuff. Well, sure, but for women in midlife, often this just isn't enough. It doesn't work anymore. And sometimes doubling down on those kinds of tactics can make things worse. Part of the problem is that most of the research behind these kinds of conventional wisdom, so to speak, has been done in men or at best in younger women in their early reproductive years. So college, university students. What works for a 25-year-old woman with steady hormones does not hold up when you're 45 and everything changes. So when things change, when our hormones start to shift, and changes happen in our metabolism and pretty much every other system in our body, we really come to realize that our hormones are the boss. They're our master regulators. So a lot of the lifestyle adjustments I encourage women to make work because they bring us back into alignment with not only one, how our female bodies actually evolve to work over tens of thousands of years. This is different than men, but two, how our hormones, metabolism, brains, immune system, organs, our whole physiology changes in middle life. We need to realign with that, with that system upgrade I just spoke to. Perimenopause is often likened to puberty in reverse. And by the time we reach menopause, a lot has changed in our bodies and our minds. And so obviously, we need new habits to support these bodies we're living in when we get there. So stepping back and asking, where am I living out of alignment with how my body works now is a huge opportunity. And with so many clients, the biggest shifts come not from things like cutting out wine or bread or cheese or chocolate forever. Screw that noise. Life is too short. Rather, it comes from changing a lot of the sneaky, sort of normalized cultural habits we have that quietly sabotage our hormones and metabolism. So by understanding how your hormones respond to your lifestyle, what they want for you, and how to keep them happy, you can move through midlife making better decisions for your energy, your mood, weight, your brain, your relationships, all of it. And being able to anticipate the hormonal shifts in your 40s, 50s, and 60s is incredibly helpful. When you know what's happening, you can navigate symptoms more calmly and advocate for what you need with your care providers and everyone around you. And that's one of our goals today. Okay. So before we get granular, I'm gonna breeze through some basics. Okay, first we'll talk about the three big hormonal events in a woman's life. And to start us off, I want you to please appreciate how incredibly major this midlife transition is. Way too many people, including many doctors, downplayed. So the three hormonal events in a woman's life are puberty, perimenopause, and menopause. And since puberty, the start of your fertile years, when you first start your period, your sex hormones have been rising and falling in a relatively predictable pattern every single month, for most women anyway. Then, a couple decades later, a new hormonal shift kicks in as we near the end of our fertile years. And this transition is called perimenopause. It's usually six to ten years, and you can think about like the on-ramp to menopause. Now, the average age of menopause in North America and most of Europe is about 51 years old. Some women will effectively breeze through this transition. They'll barely notice that much is changing, which is amazing. And if that's you, congratulations, you special flower you. However, most of the rest of us, we fall somewhere between I just don't feel like myself, and good sweet baby Jesus, what the stam hell is going on, and when can I get off this ride somewhere in there? So this is happening because throughout perimenopause, certain hormones are fluctuating wildly, causing an array of symptoms that look different woman to woman. And it's not just that the hormones changing is causing the hem, it's that your brain hates this up and down roller coaster sudden swings in the hormones. So we get this one-to-punch of like the stress that that causes on the nervous system and the stress that that causes in our bodies as a direct result of the hormones themselves. It's whoo ha ha. It's a thing. And a recent study actually found that there's more than a hundred symptoms associated with perimenopause and menopause. And the top 10, including fatigue, lack of energy, brain fog, sleep issues, memory loss, forgetfulness, anxiety, joint pain, lack of concentration, lack of focus, hot flashes, and low libido. Those are the top 10. There's like over 90 more. One thing I want to draw attention to though, and this links to my prior comment about the stress on the nervous system. I want you to notice how many of those are psychological or cognitive, the brain fog, the memory flaws, the forgetful loss, the anxiety, lack of focus, moodiness in general. So a lot of doctors misdiagnose this as stress-related, maybe it's depression or an anxiety disorder. And therefore, we take the wrong path. Maybe meds we don't need, or useless advice like try going to bed earlier, try breathing. It's like, okay. It's not quite that simple. And then on top of that, we layer on what women are doing in their 40s and 50s. So, like parenting, working, we're usually mid-career if we're into that, managing aging parents, managing young children, oftentimes, running households, often managing a husband or partner, and generally holding it down with a hair tie and a half-charged phone. And it's easy to think you're simply not coping well, or even that you're losing it when you're doing all this stuff and your hormones are just like woo, wacky. And when your doctor has nothing to say about your symptoms, that can be scary and isolating. So let's step back for a second, give this whole thing a timeline and talk about the stages so it is less scary and isolating. And you can start to make sense of what it all means and where you may be going from here. So here's how I break down perimenopause in stages. So clinically, please know that only two stages are officially recognized. But myself and some other experts in this space find it more useful to think of three stages. So we're gonna walk through stage one, which is early perimenopause, stage two, which is what I like to call the messy middle, and stage three is late perimenopause, the kind of almost their phase. And their being a postmenopause. Now, please note everybody's experience is different, so none of this is like a rigid playbook. Think about it as like a map that was drawn by a little kid. It's it's approximate and it's gonna change every time, you know, for every woman. So let's dive in and talk about these faces. Before we do. Just a quick moment of honesty. I don't run ads, so if you're getting value here, please hit the follow button and share the show with your friends. This helps you not only never miss an episode, but you can change the life of someone you care about too. Thank you. Okay, so stage one, early perimenopause. Some of the earliest changes women notice in early perimenopause relate to the menstrual cycle. So changes in the length, heaviness, the intensity of the whole thing. Here are some common patterns. Cycles shorten at first. For example, from 28 days to 24 or 25 days, or from 30 days to 26 days. Some women, though, will notice longer cycles. It can be either or. Clinically, this phase is defined by cycle changes of up to seven days, shorter or longer than your previous normal. Oftentimes, this comes with the period changing, so it will often become lighter and shorter. For example, as for myself, I was seven days, went down to four or five, very typical. Though a smaller group of women will get heavier or longer bleeds. Symptom-wise, most women start noticing intense PMS, like way more intense, in the last seven to ten days before their period, that luteal phase, which I liken to fall before our winter phase, or the that can look more like moodiness that's way worse than before, more cramping, more fatigue, bloating, brain fog, anxiety, and more trouble sleeping. The sleep piece is really very common. And the sleep disruption patterns usually the waking around three or four in the morning for an extended period of time, or maybe waking and not even being able to go back to sleep. That said, some women still feel pretty normal through most of the month, but then they fall apart right before their period, just like a couple days, while others will feel off all month. It's just like everything is different all the time, but things then get dramatically worse in that pre-period window. So why? What's going on here? Why is all this happening? Early phase symptoms are often driven by good old progesterone, which we love so much, and our bodies miss it. It starts to fluctuate up, down, all over the place on its way towards generally lower levels. So it's on its on a decline on very slowly for many of us, and it fluctuates up and down as it gets lower. Progesterone, we love it because it's calming, anti-anxiety, it supports sleep, and it helps us from feeling bloated, crampy, and ragey in that PMS window. Pokey. Oh, and it's just as important as estrogen. But estrogen, for some reason, is the one that gets all the press, which is very weird. So let me give you an example of an early perimenopause client I've worked with. Oh, we'll call her. Sarah. Sarah's 41, she has two kids, runs a small business. Type A like really has her shit in a pile. Up until about a year ago, her cycle was like clockwork. 28 days, pretty predictable mood-wise, but lately her period has been showing up every 24 or 25 days. Her bleed is shorter and lighter than it used to be. What's really throwing her though is the week before her period. She feels like a different person, she says to me, for like seven days. She says she's more anxious, her patience is gone, she's snapping at her partner and kids, her sleep has gone to hell. She's so bloated she doesn't wear one wear her jeans anymore. But she works for her business, she can't remember things. Like she just keeps dropping words in the middle of presentations. Very common all of this for early perimenopause. And on paper, you know, everything else in her life looks pretty normal, quote unquote, for a busy 40-something with work, kids, Asian parents, all that, but her brain and body feel anything but normal. So classic early perimenopause. Cycle's still mostly regular, but progesterone is starting to fluctuate and drops, which turns up the volume on the PMS, the mood swings, the bloating sweep issues, the brain fog, even though she hasn't really changed anything. Oh, and then there's weight gain. She has also put on all of a sudden 15 pounds out of nowhere. And this is the kind of thing that often starts an early parry and tends to worsen later, sometimes for different hormonal reasons than the early peri reasons. This is the kind of weight that doesn't respond to eat less and exercise more because the main issue isn't about food or calories or workouts or any of that stuff. It's about hormones and metabolism that are running the show. The pattern of where you gain weight on your body, which I like to call your hormone signature in your body, gives us clues about what's going on. So more in the hips, thighs, and butt, like a pear shape, can hint at estrogen dominance. All over gain can suggest thyroid imbalance, and more fat in the belly and the back, like as in an apple or a spare tire shape, often points towards cortisol and insulin issues. Sometimes a combination of two or even all three of those things. Many women are dealing with. All three. And this sucks because they're often trying all of the things with all of the diets and workouts, and none of them are doing anything. And yet, all the advice is like, here's another diet, this one's gonna work. Try keto, try lifting heavier weights, all of this stuff. Like, we need to do some other things too. Otherwise, you get nowhere and you just exhaust yourself. Okay, so let's move on from progesterone and talk about the other two VIP hormones that I'm watching in early perimenopause, and those are testosterone and DHEA. These so-called androgens, which comes from the Greek word meaning man-producing, or that which produces a man or male. Like, oh my god, how many hundreds of years ago did we make this word and we still uh have assigned these hormones as man-only hormones? Like, no! We know that these are crucial for women too, and yet our medical paradigm still generally does not recognize this. It's insane. Like when I'm talking hormone replacement therapy done well, I mean all of the hormones, and especially do not forget testosterone and DHEA, but like if you talk to anyone in retro medicine, it's like all it means is estrogen and progesterone. For most women, testosterone and DHEA start to decline in the late 20s and early 30s. Actually, when we're still really young, it's a little bit shocking. And what these hormones do is so much. They support energy, motivation, drive, muscle mass, and bone strength, hip function, and of course, sexual function. That's kind of how people now think about testosterone for women. It's all about libido. Well, yes, it is about libido, but it's about so much more. And when I hear a woman say, I really feel blah, like I'm not motivated anymore. I used to work out like a beast, and I'm just like, fuck it. Or meal prep or you know, whatever it is, they can't be bothered. Or they'll say, I work out, but I can't build muscle, like I'm lifting heavy and I'm not seeing any changes. I'm then thinking, I'm thinking about testosterone, thinking about DHEA, and I'm also thinking about thyroid. So let's double-click on DHEA for a second. DHEA is a hormone that a lot of people have never heard of, but it is very important. And it can be, it's kind of called like a pro-hormone. It's at the top of the cascade and it can be converted to estrogen and testosterone, but it also has its own direct benefits, effects on brain function, energy, and just general resilience. It's incredibly powerful in cancer protection, for example. In my own case, uh, DHTA was the last hormone I added to my personal hormone replacement therapy protocol, and it was the one that finally clinched my brain fog. Like those moments of walking into a room I would have, and I couldn't remember why, or like losing words, mid-sentence, or just going totally blank in the middle of a thought. Not awesome. DHEA offer ooh gave me a definite lift in my both my brain function and my clarity, but also my energy. So good. So please don't ignore DHEA. So next I wanna mention thyroid. I just sort of mentioned it just briefly in passing when I was talking about motivation and energy and kind of just feeling blah, having good brain function. We need to talk about thyroid in midlife because it's an often neglected player, and reduced thyroid function actually becomes super common with age, with chronic stress. That includes like physical stress on the body, cellular stress like inflammation, but also a sense like felt stress, like psychological stress. Over time, the body dials up and down thyroid function in response to tr to stress to like slow you down. And so a part of like a burnout picture, for example, like maybe a super intense athlete or somebody like myself who just could not put all the things down was go, go, go, go for so many years will impact their thyroid function over time. And clinically, in my practice, I see a lot of women with suboptimal thyroid function by the time they're in their mid to late 40s. This often shows up as deep fatigue. Like tired even after a full night's sleep, or like needing a nap in the afternoon. Brain fog, weight gain because your thyroid controls your metabolism. Feeling cold is a regular feature, like just body temperature. Often goes with dry skin, but not always constipation, but not always bit of brittle hair, nails, not always. And sometimes changes in blood pressure, heart rate, or even can cause cycle irregularity when we're talking about more intense thyroid issues. And I went into quite a bit of detail on why clinicians often miss what we call subclinical hypothyroidism. So that's a mildly low thyroid function in episode four, where I talk about decoding your hormones and labs. But suffice to say, please don't ignore your thyroid. And actually, TSH is not enough. You need T3 and T4, and standard reference ranges. You do not want to be anywhere near the outsides of those things. Those are whack. And I always want to see those numbers if I work with you, because I'm gonna actually want you in a much higher bracket for T4 and T3, and especially T3, which is your active thyroid hormone. Zooming out in early perimenopause, I like to see labs for at least progesterone, testosterone, DHA, thyroid, and estrogen, plus the metabolic hormones like insulin and ideally cortisol as well. Morning cortisol. Side note on this it makes me a bit mental when providers refuse to test hormones across the board in perimetopause because they fluctuate so much. Like, yes, estrogen and progesterone fluctuate a lot. And yes, symptoms matter a lot. We can go based on symptoms. However, lots of things aren't fluctuating a ton. Slash, it is still useful to test them. Things like the androgens, so-called testosterone, DATA, I want to see your thyroid, insulin, cortisol, these are hugely important. Vitamin D, other vitamins that support hormone function as well. So testing is important. And if someone's like, we don't test hormones in perimenopause, like I'd say, sure, let them get away with saying that for estrogen and progesterone, but not the others. We still want the rest. Even with estrogen in early perimenopause, testing can be helpful because in early period estrogen is still often running fairly strong. But some women, and this is important to know, some of them will have very high estrogen while some are already running low, and this is consistent month to month. High, high, high, high, or low, low, low, low. Sometimes we'll see this in body shape. Where are they storing fat? And we'll see this in symptoms sometimes. However, there is a lot of overlap between symptoms and hormone imbalances, and so sometimes it's actually quite helpful to know which hormones are imbalanced so that you can parse out where the symptoms are coming from. If your estradiol, for example, is at 200, that's very different than if it's at 900. And sometimes you cannot tell which is which based on symptoms alone, because there's a lot going on that's not related to estrogen. Okay, so let's move on to the middle stage. Stage two, the messy middle. So after a few years at an early perimenopause, typically, many women would enter what I would call stage two. And clinically, this is where we start to see a more apparent cycle of regularity, more anovulatory or without ovulation cycles. This affects progesterone a lot more strongly. This often looks like a skipped period here and there, which prompts the classic, like, oh my god, am I pregnant? Whew, that can be terrifying. So just know that that can happen. This also can look like cycles that start getting longer overall, but also more variable. Some longer, some shorter, some surprising you out of nowhere. It can look like some cycles without ovulation, which lead to much lighter periods. Then maybe after a longer cycle, you might get a much heavier, longer bleed. Overall, things are just less predictable. Some women blow through this middle phase relatively quickly and barely notice it, and others live in the messy middle for a long time, for years, maybe. It's very individual. So, in this case, what's happening under the hood? As the number of follicles in your ovaries declines, ovulation becomes less common and hormone levels fluctuate more dramatically. Some women often notice that their symptoms will ramp up in this phase. Like things get worse regarding mood, sleep, they'll start to get hot flashes and night sweats. Brain fog gets worse, they're more anxious, uh, and the body changes has become maybe more intense. They feel less stable overall because things are actually less stable. Here's an example of what the messy middle can look like in real life. Let's call our next lady Dana. Dana's 46, and for most of her 30s and early 40s, her periods were regular. Over the last 18 months, she's had a 24-day cycle and then a 35-day, and then she skipped a month entirely and was convinced she was pregnant. Pregnancy tests. Yay. Showed no. The following month, her period came back with a vengeance, heavy and crampy and longer than usual. Around the same time, she started to wake up at 3 a.m. She was wired but exhausted. She's having random hot flashes in meetings and like more regularly, just forgetting in the middle of what she was doing, why she was doing it. And her doctor ran basic labs and told her she was fine. Probably just stressed and suggested meditation and cutting back on coffee. Ah. This is that sort of stage two territory where ovulation is hit or miss. Hormones swing more traumatically, and symptoms can feel chaotic and unpredictable. Nothing is wrong with Dana in a broken sense, of course. Her body is transitioning, but without context, it feels like chaos instead of a normal, annoying phase. If this sounds familiar, the pregnancy scares, the unpredictable cycles, the 3 AMs, you're probably hanging out in that middle perimenopause zone. The third stage is late perimenopause, the sort of almost their phase. This is what conventional medicine will label as stage two. This is when skip cycles become a lot more regular. Clinically, this phase is defined as going 60 days without a period. Quite different from phase one, and that's why I like to define three phases rather than two. Population is much more rare at this point. So your period might disappear for a few months, and then it'll pop back in, uninvited to the party. You might go, you know, two months off, one month on, five months off, then you get two periods in a month, like whoa, it's a wild ride. And this phase usually lasts one to three years, but again, everybody's different. Just here's some stats for you. About one in ten women stop menstruating more abruptly with way less prolonged irregularity. So the sphere is really short. But on average, about six to ten of the final cycles before menopause are longer and an ovulatory, so no ovulation. Six out of ten, and in the last one to two years before menopause, it's common for cycles to stretch past five weeks. So an anovulatory cycle, again, is a really light cycle. You don't ovulate, you're not producing much testosterone, barely a little bleed, and then not much longer cycles are common. On average, the last six out of the final ten cycles before a woman hits menopause, six out of ten of the last ones are longer and an ovulatory, meaning no ovulation, meaning very little progesterone, meaning they're very light generally. And in the last one to two years before menopause, it's common for cycles to stretch past five weeks long. Throughout bleat perimenopause, symptoms often feel worse as you spend longer in stretches with lower levels of estradiol and progesterone than you were used to earlier in life. Unless you're on hormone replacement, obviously. Yay! Hormone replacement. But if not, it can it can be janky. So let me paint a picture of the almost layer phase in real life terms. Client called her Monica, she's 51. And over the last two years, she's gone three months without a period. Then she had what? And then it was five months with laughing, and then two periods and six weeks, and she keeps thinking, like, okay, I'm there, like I'm almost done. And and then like her uterus is like, no, word of surprise. Didn't have that one on the calendar, did you? Yeah. And with Monica, her hot flashes and nice words got really intense. During the long gaps without a period, her mood felt flatter. She's about felt a lot more meh. It's partly because estrogen is a mood booster in general, unless it's too high. And she noticed her weight shifting quite a bit more to her midsection, even though she had changed nothing about her habits. So we when we looked at her labs, a marker that I'm gonna speak to in a second called FSH was consistently higher and in the menopausal range, while her estradiol was really low, her progesterone was really low, which fits with what her cycle was doing. She is in late perimenopause, very close to menopause, but not quite past that 12 months without a period mark yet, which is the official marker for menopause. So if you might relate more to monica's long stretches without a period, then a random surprise, you're probably in late perimenopause almost there phase. So here's how your labs can help when you're unclear about where you are cycle-wise. So obviously, like symptoms are one thing, but when your cycle isn't regular, maybe you've been irregular your whole life, or you're on an IUD that stops your bleeds, you're like, I'll no idea where I am. I get this question a lot. In that case, one of the most useful markers for where you are on this spectrum is a marker I just mentioned called FSH, and that means follicle stimulating hormone. FSH is the signal that comes from your brain and tells your ovaries, like, hey, make more estrogen. And as the ovaries wind down from early perimenopause all the way to menopause, FSH slowly rises because the brain is essentially shouting louder and louder, make more estrogen, and the ovaries can't respond, and so it just keeps dialing up the volume, but there's no response. So as FSH starts to rise, this is how we know where you are. And it starts to rise on average about six years before your final period happens. So if you were to measure it on day three recycle once a year, starting in like your mid-30s or early 40s, you would see likely a trend. For example, you would start at maybe three or four, then you'd go up to five, ten, then you'd go up to twelve, and then twenty, and then thirty-five over several years. And once you're above about 35 to 40 consistently, together with low esterdial and 12 months a little period, if you get a period, you're considered to be post-menopausal. Now, this isn't a perfect test that predicts when you'll hit menopause. Timing is very individual and it is not a linear change, but you can tell from roughly where your FSH is if you don't have a period regularly or you don't have one at all, like where roughly you are. Factors that affect the onset of menopause. There are several actually. So that would be genetics, it would also be your ovarian health. Whether you've had pregnancies, pregnancy tends to delay menopause, partly because that surge of hormones is so longevity promoting, like estrogen and progesterone being so high for a while. Lifestyle factors like smoking actually accelerate menopause, overall stress, toxin exposure, nutrition, sleep, all of the things that affect cellular level health all have an impact. But on average, as I mentioned, menopause happens around 51 for women in North America and most of Europe. So if you want help interpreting your labs or knowing what you should look for or where your levels should be, you could grab my free lab values for midlife women, download from episode four's show notes. I include FSH and some reference ranges on there. Handy dandy. So with menopause, this is the final stage past the three stages of menopause, which it is technically defined as the moment that it's been 12 months since your last menstrual period. From that day on, you are considered post-menopausal. So menopause is really a moment of time. I plan to have a big party when I hit my menopausal moment. I'm stoned for it. So once menopause is reached, many women feel like things sort of level out. Some of the hardest symptoms from perimenopause may ease or disappear, which can be a huge relief. Other women find that certain symptoms improve, well, some new challenges can show up. Things like more dryness, joint pain, inflammation, changes in body composition, maybe sleep issues persist or get worse, mood, sometimes depression because low estrogen, that kind of stuff. And these are exactly the kinds of issues that can, and in my opinion, should be supported with a well-designed bioidentical hormone replacement therapy, which is the topic of one of my next episodes. So please do tune into that. It'll be really good. Okay, I hope this episode has helped you decode what's happening in your beautiful body through the second half of life and maybe given you more of a sense of where you might be on the perimenopause roadmap. Alright, my fan, thank you so much for listening. And thanks to my wonderful producer, Kayle Gosen. If this episode helped you feel more seen or supported, and maybe you want to go deeper, if you're a midlife woman who is ready for more clarity, support, and a roadmap that can truly help you feel better beyond 40, check out my website, drmarypines.com, and explore my Better Beyond 40 formula program. Join my newsletter for weekly guidance and my free community group on school. That's SKO L dot com. It's also called the Better Beyond 40 formula. I offer lots of tips and tricks to keep you informed of the latest. You can also follow me on Instagram at Dr. MaryPines, DR Mary Pines for Day to Day Inspo. You are not alone on this journey. My friend, we're in it together, and you deserve to feel incredible all along the way. I will talk to you soon.