By Dr. David Pollack

For many women, the perimenopausal journey can be fraught with challenges. While menopause typically occurs around ages 49 to 50, the perimenopausal phase often begins earlier—sometimes as early as the early forties—and can extend into the mid-fifties. This transitional period is frequently marked by changes that are disheartening and uncomfortable. But it doesn’t have to be that way. The perimenopausal and menopausal transition should be a natural, manageable process.

I know some may hesitate to hear this from a man, but in my 18 years of practice, I’ve helped hundreds—if not thousands—of women navigate this phase successfully. It is possible to experience perimenopause with ease.

What’s Really Happening?

Perimenopause and menopause mark the body’s natural transition from fertility to the next stage of life. This change is most evident in hormone levels, which shift from a dynamic state to a more stable, lower balance. However, this transition can often create hormonal imbalances and fluctuations, leading to symptoms such as hot flashes, night sweats, weight gain, and mood changes.

In my experience, these symptoms often indicate an inappropriate hormone imbalance. They’re not an inevitable part of menopause—they’re a sign that the body’s systems need support. With the right approach, perimenopause can become a smooth and even empowering transition.

Understanding Hormonal Shifts

Hot flashes and night sweats, for example, are usually signs of estrogen levels dropping too low. Conventional medicine often addresses this with hormone replacement therapy (HRT). While HRT can be effective, a functional medicine perspective seeks to help the body balance its hormones naturally, without relying on synthetic compounds.

One common reason for low estrogen is adrenal gland fatigue. The adrenal glands produce many essential hormones, including precursors for estrogen and testosterone. They also produce cortisol, the stress hormone, which helps regulate inflammation, blood sugar, and mood. However, when chronic stress overwhelms the adrenal glands, they prioritize cortisol production over other hormones, a phenomenon known as “cortisol or pregnenolone steal.” This leaves fewer resources for estrogen production, resulting in the imbalances that cause many perimenopausal symptoms.

The Role of Stress

Stress plays a significant role in these imbalances. For many women in their forties, stress levels have been elevated for years, leading to biological effects that are often mistakenly dismissed as psychological. Chronic stress forces the adrenal glands to work overtime, resulting in fluctuating hormone levels that vary from day to day, or even hour to hour.

Stress isn’t just emotional—it includes physical stress from injuries, poor posture, or chronic pain, as well as chemical stress from inflammation, digestion issues, or toxin exposure. All these factors combine to influence our overall health, not just during perimenopause but throughout our lives.

A Holistic Approach to Perimenopause

One of the largest groups of patients in my practice is women in their forties who want to avoid or reverse a difficult perimenopause. Many are amazed by how manageable their transition becomes. They’re sleeping soundly, no longer experiencing night sweats, feeling calmer and happier, and regaining control over their weight and cravings.

How do we achieve this? By taking a holistic approach. Rather than focusing exclusively on the reproductive system, we investigate the whole body. This includes improving digestion, addressing physical pain, managing stress, and optimizing sleep and energy. By restoring the body’s innate ability to balance its hormones, we create a smoother, healthier transition through perimenopause and beyond.

Perimenopause doesn’t have to be a struggle. With the right guidance and care, it can be a time of renewal, balance and empowerment.

Pollack Wellness is located at 66 Commack Rd., #204, in Commack, NY. For more information, call 631-861-HEAL (4325) or visit PollackWellness.com.