If you've spent any time on social media in the past year, you've seen the wave: women in their 40s describing the same cluster of symptoms — losing words mid-sentence, missing deadlines for the first time in their lives, drowning in browser tabs and unfinished tasks — and asking the same question: Is this ADHD, or is this perimenopause? As a menopause-trained physician, here's how I think about it, drawing on traditional medicine, lifestyle medicine, and functional medicine.

Yesterday, a patient in her early forties sat across from me describing something she had never experienced before: her heart would suddenly race for no apparent reason, jolting her awake at 2 a.m. She could not fall back asleep. She felt foggy at work. She wondered if something was seriously wrong. Nothing was wrong with her heart. What she was experiencing were some of the earliest signals of perimenopause. The purpose of this blog is to walk you through the major body systems affected by perimenopause and to show you what to expect at each phase. My hope is that by understanding these changes, you will feel empowered rather than frightened, and that you will recognize the signals your body is sending you as it moves through this natural, but sometimes disorienting, transition.

In our last blog, we discussed how the erratic estrogen fluctuations of perimenopause disrupt the production of serotonin and dopamine — two neurotransmitters essential for mood, motivation, sleep, and emotional well-being. The good news is that in addition to hormone therapy, there are evidence-based nutritional supplements that can support your body’s ability to produce these critical brain chemicals.

For many women in their 40s, the "midlife shift" begins with a specific brand of exhaustion—the kind that coffee can't fix and a full night's sleep barely touches. Usually, the first suspect is perimenopause. And while declining estrogen is often to blame, there is a "Great Mimicker" lurking in the background for millions of women: Hashimoto's Thyroiditis.

A groundbreaking 2025 randomized controlled trial, recently published in the Journal of the American Nutrition Association, looked specifically at the effects of creatine on brain metabolism, mood, reaction time, and lipid health in midlife women. The results were remarkable: even low doses of creatine hydrochloride led to measurable improvements in brain energy, focus, and emotional balance—with no identified adverse effects.

Testosterone isn’t just a “male hormone.” It’s an essential part of every woman’s hormonal orchestra—powerfully influencing libido, mood, cognition, and energy. As a Menopause Society Certified Physician, I often see women who have optimized their estrogen and progesterone therapy yet still feel their spark is missing. That missing piece? Often testosterone.

During perimenopause, many women experience fluctuating estrogen and progesterone levels that can have profound effects—not only on physical health, but on the brain and mood. For neurodivergent women, including those with ADHD or autism spectrum conditions, these changes may be especially destabilizing.

Cortisol is the hidden hormone that often gets overlooked in perimenopause, yet it has the power to disrupt sleep, mood, cognition, and metabolism—while also offering opportunities for holistic, personalized wellness strategies. This comprehensive blog explores the science, symptom patterns, and action plans for navigating cortisol challenges during perimenopause, featuring visuals and practical protocols.

If you’ve found yourself dragging through your day, wondering why you’re exhausted even after a full night’s sleep, or if you’ve noticed brain fog, sudden weight gain, or hot flashes that feel like your body is on fire, you’re not alone. With the right tools — evidence-based hormone therapy, functional medicine support, and lifestyle strategies — you can feel like yourself again.

During menopause, declining estrogen impacts neurotransmitter production, mitochondrial function, and the nervous system. B vitamins, especially B12, are critical for mood regulation, nervous system health, and adrenal support. Vitamin B12 exists in several forms, but methylcobalamin is the active, methylated form that your body can use immediately. Unlike the synthetic form, cyanocobalamin, methylcobalamin does not require conversion in the body, making it especially important for individuals with genetic variations (such as MTHFR mutations) or age-related declines in nutrient absorption.

NAC is a promising supplement for perimenopausal women seeking to optimize health, resilience, and longevity. By supporting antioxidant defenses, immune function, hormonal balance, and detoxification, NAC addresses many of the root causes of perimenopausal symptoms and chronic disease risk.

While testosterone is commonly associated with men, it plays a vital role in women’s health as well. For perimenopausal and menopausal women experiencing symptoms such as low libido, fatigue, or brain fog, testosterone replacement therapy (TRT) can be a transformative option. By addressing issues like low libido, fatigue, and cognitive decline, TRT has the potential to restore vitality during this transitional phase of life.

Sleep disturbances are a common and frustrating challenge for women in perimenopause, often caused by hormonal fluctuations, especially declining progesterone levels. This blog explores why sleep is essential for mood, memory, and long-term health, and how changes in progesterone—and its calming metabolite, allopregnanolone—disrupt the body’s ability to rest.

Are you experiencing chronic fatigue during perimenopause and wondering if there's more to it than just hormonal changes? Our latest blog explains the critical role of cortisol and thyroid testing in uncovering hidden imbalances that could be affecting your energy levels. Learn how comprehensive assessments like the DUTCH Cortisol Awakening Response test and detailed thyroid studies can help you reclaim your vitality. Discover targeted strategies to manage fatigue and improve your overall well-being.

Dr. Bonza will guide you through the crucial role your gut microbiome and estrobolome play in your health during perimenopause. You'll learn about the complex world of microorganisms that reside in your digestive tract and their profound impact on everything from your hormone balance to mood, weight, and overall well-being. Discover how these tiny bacteria can have a big impact on managing symptoms like hot flashes, mood swings, and weight gain. We'll delve into practical tips for nurturing your gut microbiome through diet, lifestyle changes, and targeted supplements to help you feel more balanced and vibrant during perimenopause.

Discover the secrets to beating brain fog during perimenopause and menopause in our latest blog post. We delve into a multi-faceted approach that combines lifestyle changes, functional medicine, and traditional medical treatments to tackle this frustrating symptom. Learn how diet, exercise, and strategic supplementation can enhance brain health, and see how targeted hormone therapies and individualized treatment plans can restore your mental clarity. This comprehensive guide not only explains the underlying causes of brain fog but also offers practical solutions to help you regain your cognitive sharpness during menopause. Don't miss out on reclaiming your brain power—read on to find out how!

Unlock the secret to a clearer mind during perimenopause and menopause. Our latest article delves into the causes of brain fog—a common cognitive issue affecting many women during this transition. Learn about the crucial role hormones play in brain health and discover actionable strategies to alleviate brain fog. From hormone therapy and supplements like Ginkgo biloba and omega-3 fatty acids to lifestyle modifications including diet, exercise, and stress management, we provide a comprehensive guide to help you regain clarity and focus. Dive into our research-backed insights and tips to navigate menopause with confidence and cognitive ease.

Brain fog is one of the symptoms that many perimenopause and menopause women experience during their journey; even I had that symptom when I was on my perimenopause journey. But there are natural supplements that help can help you experience relief and alleviate brain fog. Read the blog post for more information!

We’re big on natural, effective ways to help women overcome perimenopausal and menopausal symptoms. In this blog post, we specifically discuss hot flashes, headaches, and migraines, which are common symptoms for women going through perimenopause or menopause. We share some of the most popular natural remedies to help reduce these symptoms in this post. Check it out!

Your mental and emotional health can be affected greatly during perimenopause or menopause. Let’s learn about the gut-brain connection and how it can affect your mood and your mental space in this informative blog post.