Perimenopause vs. Menopause: What You Need to Know

Navigating hormonal changes as you age can feel confusing, overwhelming, and even isolating. You may ask yourself, “Is this perimenopause or menopause?” or “Why am I suddenly experiencing mood swings, night sweats, or irregular periods?”

As a licensed naturopathic doctor in Encinitas, Dr. Wafaa Matti, NMD, specializes in women’s hormonal health. Through compassionate, evidence-based care, she helps women decode their symptoms, restore hormonal harmony, and transition through midlife with clarity, confidence, and vitality.

Whether you’re just starting to notice changes in your cycle or are well into post-menopause, this page will help you understand what your body is telling you—and how Dr. Matti can support you naturally and holistically.

What Is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, when a woman’s body begins to shift hormonally, but periods have not yet stopped. It's often misunderstood, misdiagnosed, or mistaken for stress, burnout, or even mental health issues—yet it’s a completely natural stage of life.

When Does Perimenopause Start?

Perimenopause typically begins in a woman’s late 30s to early 40s, but can start earlier depending on genetics, lifestyle, and overall health. This phase can last 4 to 10 years, gradually leading up to menopause (which is marked by 12 consecutive months without a menstrual period).

What’s Happening Hormonally?

During perimenopause, the ovaries begin to slow down hormone production, but not in a predictable way. The most common hormonal pattern includes:

• Estrogen spikes and crashes – leading to hot flashes, breast tenderness, and anxiety
• Progesterone declines – due to less frequent ovulation, often causing estrogen dominance
• Fluctuating testosterone and cortisol – which can affect libido, mood, and energy

Early Signs of Perimenopause

Many women don’t realize they’ve entered perimenopause because symptoms may be subtle or inconsistent. Common early warning signs include:

• Irregular periods or heavier/lighter flow
• Breast tenderness
• New or increased PMS symptoms
• Fatigue that isn’t resolved by rest
• Sleep disturbances
• Irritability, anxiety, or mood swings
• Brain fog and difficulty concentrating
• Changes in libido

What Is Menopause?

Menopause is a natural biological milestone in a woman’s life, officially marked by 12 consecutive months without a menstrual period. It signifies the end of fertility and the completion of the reproductive years. While it’s a normal part of aging, the hormonal shifts that accompany menopause can significantly affect a woman’s physical and emotional well-being.

When Does Menopause Happen?

The average age of menopause is 51, though it can occur anytime between the late 40s and early 50s. Menopause before the age of 40 is considered premature menopause, and before age 45 is early menopause.

What Happens to Hormones During Menopause?

Once menopause sets in, ovarian function significantly declines. This leads to a sharp and sustained drop in estrogen and progesterone—the hormones responsible for regulating the menstrual cycle, mood, metabolism, and more.

This hormonal decline is sometimes described as a “flatline,” meaning hormone levels no longer fluctuate like in perimenopause; they remain consistently low.

What This Means for the Body

Low hormone levels affect many systems in the body, increasing the risk of:

• Hot flashes and night sweats
• Vaginal dryness and discomfort during sex
• Bone loss (osteopenia/osteoporosis)
• Slowed metabolism and weight gain
• Cognitive changes like brain fog or memory lapses
• Mood changes, anxiety, or depression
• Skin thinning and hair loss

Because these symptoms are driven by depleted hormones—not fluctuating ones—it requires a different approach than perimenopause. This is where natural hormone replacement therapy or functional support may help, under the guidance of a trained provider like Dr. Wafaa Matti.

Key Differences Between Perimenopause and Menopause

Hormonal Patterns: Fluctuating vs. Depleted

• Perimenopause is marked by wild hormonal fluctuations—especially in estrogen and progesterone. Some days you may feel fine; other days may bring anxiety, insomnia, or brain fog.
• Menopause, on the other hand, is a state of hormonal depletion, where estrogen and progesterone remain consistently low. The erratic ups and downs stop, but symptoms related to low hormone levels may intensify or become more persistent.

Symptom Overlap and Unique Features

Both phases may involve:

• Hot flashes
• Sleep disturbances
• Mood swings
• Fatigue
• Low libido

However, perimenopause often presents with PMS-like symptoms, heavier periods, and emotional reactivity, while menopause may bring more physical symptoms like vaginal dryness, joint pain, and bone loss.

Menstrual Cycle Changes

• Perimenopause: Cycles may become shorter, longer, heavier, or skipped altogether.
• Menopause: No menstrual periods for 12 consecutive months.

This is the defining marker—if you’re still menstruating, you are not yet in menopause, even if symptoms have already begun.

Emotional and Cognitive Differences

• Perimenopause may bring irritability, anxiety, or mood volatility due to hormonal swings.
• Menopause often presents more subtle, persistent changes like low motivation, emotional flatness, or memory lapses due to sustained low estrogen.

Health Risks at Each Stage

• Perimenopause may increase the risk of hormone-related cancers in those with unopposed estrogen or irregular cycles.
• Menopause increases the risk of osteoporosis, heart disease, cognitive decline, and metabolic changes due to long-term estrogen deficiency.

How Dr. Wafaa Matti Supports You Through the Transition

Functional Testing to Pinpoint Hormone Levels

Unlike conventional testing that only scratches the surface, Dr. Matti uses advanced functional diagnostics to get a clear picture of your hormonal ecosystem. This may include:

• DUTCH test – a gold-standard dried urine test for comprehensive hormone mapping
• Bloodwork – for estradiol, progesterone, testosterone, TSH, and cortisol
• Thyroid panels – to evaluate T3, T4, reverse T3, and thyroid antibodies
• Adrenal stress index and cortisol rhythm

Natural Hormone Replacement Therapy (BHRT)

For many women, bioidentical hormone replacement therapy (BHRT) is a safe and effective way to relieve the intense symptoms of hormonal decline. Dr. Wafaa Matti offers customized, low-dose BHRT options designed to mimic your body’s own natural hormones, reducing the risk of side effects often associated with synthetic versions.

Treatment options may include:

• Estrogen Therapy – Often administered via transdermal creams, gels, or patches to reduce hot flashes, vaginal dryness, and night sweats.
• Progesterone Therapy – Especially important for women with a uterus to protect against estrogen dominance; may be given as oral capsules or topical creams to support mood, sleep, and cycle regulation.
• Testosterone Support – For libido, energy, and cognitive sharpness; provided as creams or sublingual troches if indicated.
• Thyroid Hormone Optimization – For women with hypothyroidism or subclinical thyroid imbalances, using natural desiccated thyroid or compounded T3/T4 blends.

Botanical and Nutritional Support

Not every woman needs—or wants—hormone replacement. Dr. Matti offers evidence-based alternatives that restore balance by supporting your body’s natural hormone production and detox pathways. These may include:

• Adaptogenic herbs (e.g., ashwagandha, rhodiola)
• Estrogen-modulating herbs (e.g., chasteberry, black cohosh, red clover)
• Nutrients like magnesium, B6, omega-3s, and vitamin E
• Gut and liver support to enhance hormone metabolism
• Personalized nutrition to stabilize blood sugar and reduce inflammation

Adrenal and Thyroid Care

Your adrenal and thyroid glands are the unsung heroes of hormonal balance—especially during perimenopause and menopause. When these systems are stressed or underactive, symptoms like fatigue, anxiety, brain fog, and weight gain can intensify.

Dr. Matti evaluates your cortisol rhythm, thyroid hormones, and nutrient cofactors (like selenium, zinc, and iodine) to support:

• Adrenal fatigue recovery with adaptogens and B vitamins
• Thyroid optimization using nutrition, botanicals, or gentle thyroid support
• Better resilience to stress and improved metabolism

Lifestyle and Emotional Resilience Coaching

Hormonal shifts don’t just affect the body—they can deeply impact mental and emotional well-being. That’s why Dr. Matti integrates trauma-informed, holistic coaching into every care plan. She provides tools and support for:

• Stress management and nervous system regulation
• Sleep hygiene and circadian alignment
• Mind-body practices like yoga, breathwork, and guided relaxation
• Emotional processing and life-stage support for the midlife transition

Navigate Hormonal Change with Clarity and Confidence

If you're navigating new symptoms, emotional ups and downs, or sudden body changes and wondering whether it's perimenopause or menopause—you're not alone. These transitions are natural, but they don’t have to be disruptive or confusing.

At her Encinitas clinic, Dr. Wafaa Matti, NMD, offers a clear, compassionate path forward. With expertise in naturopathic and functional medicine, she provides holistic, personalized care to help you decode your symptoms, support your body, and regain a sense of control.

Whether you need hormone testing, gentle botanical therapies, lifestyle guidance, or bioidentical hormone support, Dr. Matti’s approach is designed to help you feel like yourself again—balanced, vibrant, and at peace.

Reclaim Balance with Compassionate, Natural Support

📍 Clinic Location:
324 Encinitas Blvd, Encinitas, CA 92024
Inside the Stengler Center for Integrative Medicine

📞 Schedule a Consultation: 760-274-2377
💻 Email: dr.wafaamatti.nd@gmail.com
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