There might come a time when the woman you love is somewhere between her late 30s and early 50s, and she suddenly seems like a different person. Or, more importantly, she might tell you she doesn’t feel like herself.

Please don't make the mistake of assuming your relationship is falling apart.

She may be going through perimenopause.

I've been through it. As a woman, a wife, and a nurse, I can tell you this: your understanding and compassion for what is happening inside her brain and body can be the difference between becoming frustrated with each other and becoming a stronger team.

Perimenopause can affect sleep, mood, memory, body temperature, energy, body composition, menstrual cycles, comfort during intimacy, and the way a woman experiences stress [1,2]. The symptoms can be mild for some women and profoundly difficult for others.

So, partners, consider this your field guide.

You are not her doctor. You don't need to "fix" her. But you do need to understand what’s happening in order to empathize with what she's going through.

First, What Exactly Is Perimenopause?

Let's clear up one of the biggest misconceptions: Perimenopause and menopause are not the same thing.

Menopause is technically one point in time: it is recognized after a woman has gone 12 consecutive months without a menstrual period that cannot be explained by another physiological or pathological cause. 

Perimenopause, often called the menopausal transition, includes all of the years leading up to the final menstrual period, starting when menstrual cycles and reproductive hormones begin changing [3].

Natural menopause occurs at an average age of 51 years, after an average 4 years of perimenopause [3]. A caveat here is that there is considerable variation in these ages and times, and perimenopausal symptoms can extend beyond the final menstrual period. 

Here's the simple biology:

A woman's ovaries produce hormones including estrogen and progesterone. As she moves toward menopause, ovarian function changes. Ovulation becomes less predictable, menstrual cycles become increasingly variable, and estrogen and progesterone patterns change [3,4].

Imagine the thermostat in your house. What if the program it ran on was the same for your entire adult life? Then, one day somebody starts changing it, randomly, when you aren’t looking.

It might take you a little while to notice, but once you recognize you have lost control over the way you feel in your home, it becomes all you can think about.

That's a little like what hormonal changes can feel like during perimenopause.

And this is why symptoms may seem unpredictable. She can feel terrific one week and terrible the next. Her menstrual cycles may become shorter, longer, heavier, lighter, or increasingly irregular. Later in the transition, she may skip periods for weeks or months at a time [3].

And those hormonal changes don't just affect her reproductive system.

Estrogen receptors are found throughout the body and in multiple regions of the brain involved in functions such as cognition, mood, and stress regulation [5]. That’s why the menopause transition is associated with vasomotor symptoms such as hot flashes and night sweats, sleep disruption, mood symptoms, cognitive complaints, and changes in sexual and genitourinary health [1,2,6].

In other words, this is not just about her period stopping. Her reproductive hormones and multiple interacting body systems are changing during this stage of life.

Her entire system is adapting.

"Why Is She So Irritable?"

If your partner has been awake since 3 a.m. in an anxiety spiral, threw the covers off because she was suddenly drenched in sweat, then cocooned herself in the covers because she was freezing, couldn't fall asleep again, and then had to get up and get ready for work…

She's probably not going to greet you that morning with sunshine and rainbows.

Sleep problems become more common during the menopausal transition, especially difficulty staying asleep, and vasomotor symptoms such as hot flashes and night sweats can contribute significantly to nighttime awakenings [7,8].

Persistent sleep disruption can also affect daytime functioning, mood, concentration, and quality of life [8].

Hormonal changes may play a role in mood as well. Research suggests that fluctuations in estradiol during the menopausal transition may contribute to depressive symptoms in susceptible women [9]. 

The transition itself appears to be a period of increased vulnerability: a recent systematic review and meta-analysis found a higher risk of depressive symptoms and depressive disorders during perimenopause compared with premenopause [10]. Women with a previous history of depression are among those who warrant particular attention during this stage of life [1].

This doesn't mean every emotion she experiences is "just hormones."

Please don't ever say that. It feels dismissive, even if hormones are contributing to what’s happening. Her experience is real and hormones don't make her concerns any less distressing.

The better response is:

"It seems like you're not feeling your best today. How can I help?"

That's partnership.

Perimenopause Brain Fog

This one can be scary for women.

You walk into a room and forget why you're there. You can't find the word you've used a thousand times. You're telling a story and suddenly the name you need disappears.

"What is wrong with me?"

Research suggests that roughly 40% to 60% of women report cognitive symptoms during the menopause transition [11]. Women frequently describe forgetfulness, difficulty concentrating, distractibility, and trouble retrieving words or names [11,12].

The reassuring part is that for most women, performance remains within normal cognitive limits. Menopause-related brain fog is not the same thing as dementia [12].

In fact, subjective brain fog and objective cognitive test performance do not always track closely with one another [13]. Sleep, mood, stress, vasomotor symptoms, and other health factors can all influence how cognitively sharp a woman feels [11,12].

That doesn't mean significant cognitive changes should simply be ignored. New, progressive, or functionally impairing cognitive symptoms deserve medical attention because menopause isn't the only possible explanation. Sleep disorders, depression, anxiety, thyroid disease, medication effects, and other medical conditions can also affect cognition [11].

So don't tease her about it. Empathize. Help her protect her brain.

At our house, brain health is whole-person health. That means we prioritize sleep, exercise, eating nutrient-dense whole foods, managing stress, staying socially connected, and continuing to learn.

Daniel and I have spent years teaching that daily habits can either support or undermine brain health. This is an incredible opportunity to practice healthy habits together.

Her Body May Feel Foreign to Her

This part requires extra compassion.

A woman may have spent decades learning to get comfortable in her body, only to reach midlife and suddenly feel as though someone changed the operating system.

Her waistline and body composition may change even if the number on the scale doesn't change dramatically.

Weight gain across midlife is influenced substantially by aging and other factors, but the menopause transition itself is associated with an acceleration in fat gain and loss of lean mass, independent of chronological aging [14].

In other words, she may genuinely notice that her body is changing even if her lifestyle hasn’t changed dramatically.

Musculoskeletal discomfort is also common during the menopausal transition, with research showing an increased prevalence of muscle and joint pain compared with premenopausal women [15].

Then there are the symptoms many couples don't talk about.

As estrogen levels decline, tissues of the reproductive organs and lower urinary tract can change. This constellation of symptoms is known as genitourinary syndrome of menopause, or GSM. Symptoms can include vaginal dryness, burning or irritation, urinary symptoms, and discomfort during intimacy [16].

Libido may change as well, although desire is much more complicated than hormone levels alone. Physical health, mood, stress, medications, sleep, relationship quality, pain, body image, and other factors can all affect sexual function and desire.

Partners, hear me on this:

Avoiding intimacy due to pain is not rejection.

And don't assume reduced desire means she isn't attracted to you.

Talk openly and honestly about it, even when that’s hard to do.

Ask what feels good now rather than assuming what worked ten years ago still works today. Remember that there are so many ways to build intimacy without intercourse.

Encourage her to talk with her healthcare provider if she’s struggling to navigate these changes. GSM is treatable and there are numerous evidence-based options that can help make intimacy more comfortable again [16,17].

What You Can Actually Do

This is where you become incredibly important as a teammate.

1. Believe her.

If she tells you she is exhausted, anxious, hot, uncomfortable, overwhelmed, or not feeling like herself, believe her. She is the only one living inside her body.

2. Protect her sleep.

Sleep can become incredibly fragile during this stage. Sleep disruption and insomnia become more common during the menopausal transition, and vasomotor symptoms can contribute to nighttime awakenings [7,8].

Keep the bedroom cool. Practice good sleep hygiene. Share nighttime responsibilities. Don't bring up difficult or stressful topics at bedtime.

And if you snore loudly, gasp during sleep, or have other signs of sleep apnea, don't ignore it. Sleep-disordered breathing can disrupt a partner's sleep too.

3. Don't weaponize hormones.

Never dismiss legitimate anger with, "Is this you or menopause?" If you wouldn't have said it when she was 25, don't say it now.

4. Carry more of the load.

Midlife can be a pressure cooker. Women may simultaneously be managing demanding careers, housework, children, aging parents, relationships, and changing bodies.

Don't wait for her to hand you a list. Look around. Find something that needs doing and do it. She will notice.

5. Make healthy choices with her.

Don't sit beside her eating junk food while she’s struggling with changes in her body. Make dinner together. Fill her water bottle. Take a walk together. Strength train together. 

Exercise is an important strategy for preserving physical health and body composition during and after the menopause transition. Resistance exercise is particularly valuable for maintaining muscle mass, strength, bone health, and physical function as women age [18].

6. Stay affectionate without making every touch a request for more.

Hug her. Hold her hand. Rub her shoulders. Tell her she's beautiful. Make physical connection feel safe rather than transactional.

7. Encourage good medical care.

If symptoms are affecting her quality of life, encourage her to find a clinician who understands the menopausal transition.

Treatment may include lifestyle interventions, evidence-based nonhormonal therapies, and menopausal hormone therapy depending on her symptoms and medical history [16,17].

And please don't assume you are now a hormone expert because you read this article.

Support her in becoming informed. She is the expert on her experience, working in partnership with a knowledgeable healthcare professional.

Don't Lose Sight of the Woman You Love

Perimenopause is a transition; it is not her identity.

She is still the woman who built a family or a life with you. The woman who has navigated setbacks, celebrated victories, cared for other people, and probably carried more than you've ever realized.

Her body is changing.

That doesn't mean she's disappearing.

In fact, this season can become an extraordinary opportunity for a couple to get closer.

Ask better questions.

"What has been hardest for you?"

"What do you wish I understood better?"

"What would make you feel supported?"

And then, this is the important part: listen. Listen without defending yourself or immediately trying to solve the problem.

Sometimes the most healing words in a relationship are simply:

"I'm with you. I’m not going anywhere. We'll figure this out together."

When someone you love is struggling, it’s better to join their team than to become the referee.

Perimenopause is no different.

Partners, you cannot regulate her hormones for her, but you can make sure she doesn't go through this transition feeling alone.

• Learn what's happening.
• Take her symptoms seriously.
• Protect her health.
• Keep laughing with her.
• Keep reminding her that she's desirable, capable, and loved.

...And when she sticks her head inside the freezer because she's having another hot flash?Don't ask questions, just move the frozen peas out of her way.

References

1. Williams, M., & Maki, P. M. (2025). A review of cognitive, sleep, and mood changes in the menopausal transition: beyond vasomotor symptoms. Obstetrics & Gynecology, 146(3), 350-359.
2. Maki, P. M., & Jaff, N. G. (2022). Brain fog in menopause: A health-care professional's guide for decision-making and counseling on cognition. Climacteric, 25(6), 570–578. 
3. Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., & de Villiers, T. J. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism, 97(4), 1159–1168. 
4. Hale, G. E., Zhao, X., Hughes, C. L., Burger, H. G., Robertson, D. M., & Fraser, I. S. (2007). Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop staging system. The Journal of Clinical Endocrinology & Metabolism, 92(8), 3060–3067. 
5. Österlund, M. K., & Hurd, Y. L. (2001). Estrogen receptors in the human forebrain and the relation to neuropsychiatric disorders. Progress in Neurobiology, 64(3), 251–267. 
6. Avis, N. E., Crawford, S. L., & Green, R. (2018). Vasomotor symptoms across the menopause transition: Differences among women. Obstetrics and Gynecology Clinics of North America, 45(4), 629–640. 
7. Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: Prevalence, impact, and management challenges. Nature and Science of Sleep, 10, 73–95. 
8. de Zambotti, M., Colrain, I. M., Javitz, H. S., & Baker, F. C. (2023). Optimizing sleep across the menopausal transition. Climacteric, 26(3), 198–205. 
9. Gordon, J. L., Rubinow, D. R., Eisenlohr-Moul, T. A., Leserman, J., & Girdler, S. S. (2016). Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition. Menopause, 23(3), 257–266. 
10. Badawy, Y., Spector, A., Li, Z., & Desai, R. (2024). The risk of depression in the menopausal stages: A systematic review and meta-analysis. Journal of Affective Disorders, 357, 126–133. 
11. Maki, P. M., & Jaff, N. G. (2022). Brain fog in menopause: A health-care professional's guide for decision-making and counseling on cognition. Climacteric, 25(6), 570–578. 
12. Maki, P. M., & Jaff, N. G. (2024). Menopause and brain fog: How to counsel and treat midlife women. Menopause, 31(7), 647–649. 
13. Furey, R. T., Thomas, E. H., Kulkarni, J., & Gurvich, C. (2025). Subjective versus objective cognition during menopause: a systematic review and meta-analysis. Journal of the International Neuropsychological Society, 1-19. 
14. Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865. 
15. Lu, C.-B., Liu, P.-F., Zhou, Y.-S., Meng, F.-C., Qiao, T.-Y., Yang, X.-J., Li, X.-Y., Xue, Q., Xu, H., Liu, Y., Han, Y., & Zhang, Y. (2020). Musculoskeletal pain during the menopausal transition: A systematic review and meta-analysis. Neural Plasticity, 2020, 8842110. 
16. The North American Menopause Society. (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause, 27(9), 976–992. 
17. The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. 
18. González-Gálvez, N., Moreno-Torres, J. M., & Vaquero-Cristóbal, R. (2024). Resistance training effects on healthy postmenopausal women: A systematic review with meta-analysis. Climacteric, 27(3), 296–304. 

Disclaimer: This article is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult your healthcare provider before beginning any new treatment or therapy, especially if you have a medical condition, are pregnant, or have recently undergone surgery. Never delay or disregard professional medical advice because of something you have read in this article.