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Flourishing Through is a research based platform for education, support, and community for perimenopause Perimenopause deserves better. Too many women spend years confused by symptoms their doctors don't connect to the menopausal transition. Flourishing Through was built to change that — with research-based content, symptom tracking, and a community that understands what you're going through. Why Flourishing Through? Most health content about perimenopause is either too vague to be useful or too clinical to be accessible. Flourishing Through was built in the gap. We translate the latest perimenopause research into clear, honest guidance — written with physician input, transparent about what the evidence does and doesn't yet tell us, and designed for women who want real answers, not oversimplified reassurances. Because you deserve information you can actually trust. Everything you need to navigate perimenopause with confidence 🔬 Research You Can Trust Evidence-based articles covering the full range of perimenopause changes — written with physician input and fully cited, so you know exactly where the information comes from. 📊 Track Your Symptoms Log your symptoms over time and start seeing patterns — so you can have more informed, productive conversations with your care team. 🤝 You're Not Alone Access a community of women navigating the same transition, plus ongoing content that grows with you as new research emerges. Free Content Become a Member Start learning today - go deeper as a member Free Access Introductory perimenopause articles Overview of stages and symptoms Access to selected research summaries Member Access Full research library - all topics fully cited In-depth action based guides rooted in reserach Symptom Tracking New content added regularly Community Become a Member Not ready to join yet? Stay in the loop. Perimenopause can start earlier than most women expect - and the more you know, the better prepared you'll be. Sign up for our newsletter and get our free Perimenopause Starter Guide delivered to your inbox. What's inside: The most common early signs of perimenopause What to track before your next doctor's appointment How to talk to your care team about the menopausal transition Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

GSM (Genitourinary Syndrome of Menopause) affects nearly 50% of women. Declining estrogen thins vaginal tissue, disrupts the vaginal microbiome, and causes dryness, pain during intercourse, and urinary issues. Unlike many perimenopause symptoms, GSM is likely to worsen over time without treatment. Treatment options exist — seeking care is important. GSM | Genitourinary Syndrome of Menopause aka Vulval, vaginal, and urinary changes More than 30% of women in perimenopause experience symptoms related to GSM and the number increases to more than 50% of women in post menopause ( Azman & Hussain, 2022 ). Give me some actionable research TLDR. Shifting estrogen levels impact both the tissue and the microbiomes of the vulva, vagina, urethra and bladder, which can lead to vaginal dryness, itching, pain during intercourse, and urinary issues which can all have a significant impact on quality of life. You're not alone, over 30% of perimenopausal women and over 50% of postmenopausal women experience symptoms related to these systems (Azman & Hussain, 2022 ), and concerning changes require treatment or intervention to alleviate pain or discomfort as they are likely to persist or worsen as women move into post menopause. Summary. The vulva, vagina, urethra, and bladder all have estrogen and androgen receptors. As these hormone levels fluctuate in perimenopause, the tissues that depend on these hormones undergo a structural change. Symptoms associated with these changes include vaginal dryness, itching, pain during intercourse, and urinary issues. Urinary issues may include urgency, increased frequency, painful urination, and recurrent UTIs (American Urological Association ). As estrogen levels decline, the vaginal walls often thin and lubrication often declines which can both lead to an increased likelihood of painful sex (Gandhi et al., 2016 ). Lactobacillus are the predominant microbiota in the biome of the vagina before the overall decline in estrogen which begins in perimenopause. Once estrogen declines the pH increases (shifts from acidic to alkaline) and the number of lactobacillus decreases, disrupting the bacterial population balance . When the balance of the microbiome is out of balance, there is an increased opportunity for pathogenic organisms to take over potentially leading to an increased susceptibility to infections. (Laniewksi & Herbst-Kralovetz, 2022 ) Not all incontinence is the same, and understanding the distinction between the two most common types — stress incontinence and urge incontinence — can help you have a more productive conversation with your care team. Stress incontinence occurs when physical pressure on the bladder — from coughing, sneezing, laughing, or exercise — overwhelms the urethral sphincter's ability to stay closed. It is primarily a structural issue, rooted in weakened pelvic floor muscles or urethral support, and is strongly associated with pregnancy, childbirth, and the connective tissue changes that accompany declining estrogen during perimenopause. Urge incontinence, by contrast, is driven by an overactive or unstable detrusor muscle — the bladder wall itself — which contracts involuntarily and sends a sudden, intense urge to urinate that can be difficult to defer. Leakage with urge incontinence tends to occur on the way to the bathroom rather than during physical exertion. Many people in the perimenopause transition experience mixed incontinence, a combination of both types, which underscores why a personalized evaluation matters: the underlying mechanisms — and therefore the most effective interventions — differ between them (Wasserman & Rubin, 2023) . Women who suffer from urinary changes including symptoms in their urinary tract are 7x more likely to experience painful intercourse and are 4x more likely to have issues becoming sexually aroused. The two systems are linked, and treating urinary issues can have significant impacts on sexual health and quality of life. (Wasserman & Rubin, 2023 ) These physical symptoms and a woman's psychological well-being are closely linked. In the SWAN cohort, vaginal dryness, depressive symptoms, and anxiety each independently lowered sexual function scores across perimenopause, with effects beginning roughly 20 months before menopause (Avis et al., 2017 ) Treatment plans that address both the physical and psychological side of these changes are likely to be more effective than addressing either alone. Naming . All of the changes related to these systems (Reproductive & Urinary) were grouped together in 2014, to be called Genitourinary Syndrome of Menopause (GSM ); Genitourinary refers to both the reproductive & urinary systems. This replaces prior terminology of atrophic vaginitis or vulvovaginal atrophy, which did not fully represent the scope of symptoms or organs affected, and indicated the conditions as a disease state, rather than a spectrum of symptoms related to normal hormone changes through the life cycle. What next? Because the symptoms are linked to consistently lower levels of estradiol, this is a set of symptoms that can worsen as women move into later postmenopausal years. Unlike many symptoms of the perimenopause transition, they are unlikely to get better with time. Changes to these systems can also feel particularly uncomfortable given how closely they're tied not just to physical comfort but also to your sexual health and sense of wellbeing. There are actions which can be taken to alleviate symptoms and Flourish Through this phase of life. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Declining estrogen affects skin elasticity, hair texture and density, and nail strength in over 70% of women. Understanding these changes can be a meaningful investment in your physical health, confidence, and wellbeing Hair, Skin, and Nails More than 70% of women notice changes in their skin ( Le-Pillouer-Prost, 2020 ) and many notice changes in their hair, and/or nails as they go through perimenopause. Give me some actionable research TLDR. Declining estrogen levels can impact the appearance and health of a woman’s skin, hair, and nails. Skin . Estrogen loss through menopause has a significant impact on skin elasticity and thickness, with collagen and dermal thickness measurably declining in post menopausal years (Brincat et al, 2005 ). The first sign of change will likely be dry skin. Over time dry skin may contribute to additional lines and wrinkles. The decrease in estradiol causes changes in skin hydration, elasticity and oil production (Zouboulis et al, 2022 ). Hot flashes can cause worsening of rosacea due to repetitive vasodilation of the capillaries on the face (Roster et al, 2025) . There may be worsening of melasma symptoms in menopause transition, which is darkening of skin which is known to be hormone sensitive. Menopausal women may have more melasma at non-facial sites (Roster et al, 2025 ). Hair . Hormone shifts in perimenopause and into menopause can ultimately lead to thinning and changes in hair texture (Williams et al., 2020 ). The extent varies by individual and may also be linked to genetic and lifestyle factors (Williams et al., 2020, Kamp et al., 2022) . Typically changes are seen in texture, thickness of hair caliber and density of scalp hair follicles. Conditions such as frontal fibrosing alopecia and female pattern baldness typically will be diagnosed during and after menopause transition. Temporary hair thinning called telogen effluvium can also be seen in menopause transition (Kamp et al., 2022 ). Nails . Nails are made of keratin, the same structural protein found in hair and skin (NIH Informed Health, 2024 ). Estrogen receptors are expressed in keratinocytes throughout skin appendages, and estrogen helps regulate keratin production (Ohnemus et al., 2006 ). Declining estrogen during perimenopause is one of several factors associated with thinner, more brittle nails. Roughly 20% of the general population is estimated to have brittle nails and women over 50 are more even more likely to have them (Chessa et al, 2019 ) You're not alone. Changes in composition of skin are noted in more than 70% of women (Le-Pillouer-Prost, 2020), women in menopause are particularly likely to have brittle nails (Chessa et al, 2019). Most research we found focuses on the impact of declining estrogen and collagen. Given the permanent decline of estrogen as women move into post menopause, the changes here often last decades. The health of our hair, nails, and skin is often linked with our overall physical appearance and sense of self esteem. Taking time to understand and address changes here can be incredibly valuable for physical health, mental health, and the health of our social lives. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Hormone fluctuations during perimenopause affect serotonin which can impact your mood and sense of wellbeing. Mood Many women report changes in their mood while going through perimenopause, and there is an increased risk of depression during this phase particularly for those with a history of depression ( Bromberger et al., 2011 ) Give me some actionable research TLDR. As hormone levels shift through perimenopause, they may impact your mood and sense of wellbeing. Hormones . Changes in hormone levels can lead to feelings similar to those experienced in PMS. Specific symptoms include irritability, anxiety, tension (Bromberger et al., 2013 ) as well as cognitive symptoms like difficulty concentrating (Greendale et al., 2020 ). Its not just you. An analysis of a longitudinal SWAN analysis found that women in perimenopause were more likely to be anxious or irritable than those who were premenopausal (Bromberger et al., 2013). These changes are driven by fluctuations in hormones ahead of menopause. Many of the hormones which are fluctuating as we move through perimenopause (Estrogen, Progesterone, and FSH) have an impact on production of and reception of serotonin (Bethea et al., 2002 ). Serotonin helps your body with cognitive function, happiness, temperature, sleep, sex drive, and hunger. (Berger et al., 2009 ) As we progress through perimenopause, hormone shifts may no longer be linked with menstrual cycles. Higher FSH variability and estradiol fluctuations have been linked to negative mood shifts independent of other symptoms (Freeman et al, 2006 ). Many women report experiencing changes in mood while going through perimenopause and women are more than twice as likely to report feelings of depression during perimenopause (Bromberger et al., 2011 ) Through perimenopause, progesterone levels can also become erratic before eventually declining. Fluctuations in progesterone have different impacts on different women. Some women report an increase in anxiety similar to Premenstrual Dysphoric Disorder (PMDD) as progesterone levels fluctuate (Backstrom et al, 2013 ). Window of Vulnerability Hypothesis . Soares & Zitek (2008) , advanced this framework, describing women in perimenopausal state as being more sensitive to the neurobiological effects of hormonal changes. This hypothesis has been supported by subsequent research (Maki et al., 2019) . There is a link between prior history of depression or bipolar disorder and relapse during perimenopause. (Musial, et al, 2021 ) Sleep & Mood Relationship . There is a strong relationship between sleep quality and overall sense of wellbeing. When sleep quality is poor, research has shown risks of developing symptoms of depression double (Baglioni et al, 2011 ) If you're struggling with sleep quality, you're not alone. Check out our page on the relationship between perimenopause and sleep . You're not alone. After decades of being able to predict and manage when PMS is coming, not knowing when these swings are coming and how long they'll last can be A LOT. It's more than just the PMS, perimenopause is a long period of transition with lots of other changes happening. Some might be welcome, some neutral, and others might be frustrating. Many women report an increase in anxiety and an increase in depression during this transition. You have got this. Working through this phase of life may take some new techniques, framing, habits, and support systems. Tools and techniques exist to help us flourish through this phase. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

During perimenopause, fluctuating estrogen levels can disrupt brain function, leading to "brain fog" — difficulty with memory, word retrieval, and concentration — reported by an estimated 44–62% of women. Estrogen receptors in key brain regions are affected, and symptoms can be compounded by sleep disruption, hot flashes, anxiety, and fatigue. The good news: these changes are not linked to dementia, and many women see cognitive improvements after entering menopause. Cognition aka "brain fog" More than 45% of women are estimated to report changes in cognition while going through perimenopaus e (Sullivan et al, 2001) Give me some actionable research TLDR. Hormones fluctuating in perimenopause can have an impact on cognition. Summary. Cognitive changes are among the most commonly reported with more than 45% of women estimated to report changes in cognition while going through perimenopause (Sullivan et al, 2001 ). Women often describe brain fog which is a term that captures difficulty with word retrieval, concentration and memory. Research has demonstrated a link between cognitive difficulties and anxiety (Huang et al, 2021 ), depressed mood (Greendale et al, 2010 ), fatigue (Huang et al, 2021 ), sleep problems (Bojar et al, 2020 ), and vasomotor symptoms (Hayashi et al, 2022 ). The Study of Women's Health Across the Nation (SWAN), one of the largest studies of midlife women in the US, has documented these changes as well (Karlamangla et al, 2017 ). These experiences are real and vary widely across individuals. Hormones. Estradiol - the dominant form of estrogen during reproductive years - is a potent neuroactive hormone. The brain contains estrogen receptors in regions critical to cognition, including the hippocampus (central to memory encoding), the prefrontal cortex (executive function, attention, and decision-making), and the basal forebrain (cognition) (Hara et al., 2015 , Ramli et al, 2023 ) During perimenopause, estradiol levels often fluctuate unpredictably before ultimately reaching a lower baseline. Estrogen influences dopamine signaling in dopamine pathways involved in attention, working memory, and executive function. Cognitive symptoms during perimenopause can resemble those of ADHD, reflecting this disruption. Additional research is needed to understand the relationship between estrogen and cortical dopamine and various genetic phenotypes for estrogen sensitivity in order to continue to advance women's health (Jacobs & Esposito, 2011 ) Estrogen also supports the system responsible for arousal and attention (locus coeruleus-norepinephrine system), which may help explain some of the shifts in ability to focus. Brain Energy: Estrogen regulates cerebral glucose metabolism. During perimenopause, this support diminishes and the brain shifts to ketone-based fuel (Brinton et al, 2015 ). While clinical evidence is still emerging, it may be worth considering how diet might impact fuel for our brains. Direct vs. Indirect Effects The SWAN analysis showed the objective cognitive changes during the menopause transition weren't fully explained by co-occurring symptoms. However, the indirect effects of these symptoms are also significant: Sleep disruption is strongly linked with cognitive difficulties Anxiety and depression are linked with declines in cognitive abilities. Dementia Risk . Many women fear cognitive decline during perimenopause is a precursor to dementia. The good news is the cognitive decline in perimenopause is currently not linked to dementia and many women see improvements in cognition after entering into menopause (Greendale et al, 2009 ) Women with genetic risk factors or vascular comorbidities (like hypertension or diabetes) may have an elevated risk of dementia and should approach this with their health care team for support accordingly (Livingston et al., 2024 ). You're not alone. If you're noticing shifts here, you're not alone, and the good news is these changes don't typically last throughout menopause. Millions of women around the world are on this journey and there are steps you can take to Flourish Through this journey onto the best years of your life. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Listing of changes associated with perimenopause.  This list is a starting point and we're constantly adding new changes.  Changes Associated with Perimenopause Physical Changes Vasomotor Symptoms aka Hot Flashes & Night Sweats Sudden intense heat in face, neck, and chest which may come with perspiration, quickened heart rate, anxiety, and may be followed by a period of feeling chilled. Night sweats are hot flashes that happen at night. Along with shifts in period frequency, this is one of the signature hallmarks of perimenopause. Hot flashes and night sweats often peak in post menopause. These are believed to be caused by the decreases in estrogen and increases in FSH which are hallmarks of perimenopause and menopause. However, since experiences vary widely it is believed there are other factors also impacting the prevalence of hot flashes & night sweats. Average hot flashes per day range from 4 to 20. (Avis et al, 2018 ) Actions, Prevalence, & Duration Physical Changes Changes in Menstrual Cycle Menstruation might be more or less frequent or there may be significant changes in flow. All of these could be signs of perimenopause. Actions, Prevalence, & Duration Physical Changes Changes in Sleep. Continuity & Duration Trouble falling asleep or waking after falling asleep. Sex hormones play a role in sleep regulation so the fluctuations of these hormones during perimenopause may introduce new challenges with sleep. (Coborn et. al, 2022 and Pengo, et. al, 2018 ) While there is a link between night sweats and decreased ability to sleep through the night, night sweats are estimated to account for less than 30% of the sleep disturbances in perimenopausal women. (Coborn et. al, 2022 and Summer, 2024 ) Restless Legs Syndrome (RLS) and Obstructive Sleep Apnea (OSA) are two conditions found in roughly 50% of women with trouble sleeping during perimenopause. (Summer, 2024 ) Anxiety and frustration with a lack of trust in one's own ability to sleep can create a viscous cycle of sleep disturbances. (Summer, 2024 ) There is evidence to suggest these disruptions continue through post menopause (Pengo, et. al, 2018 ). Actions, Prevalence, & Duration Physical Changes Changes in body composition Proportions of fat and lean mass shifting as women head into menopause. So while the scale might read the same, there might be more fat and less muscle. At the start of perimenopause, fat gain rates double and lean mass declines. These changes stabilize within 2 years of experiencing menopause. (Greendale et al, 2019 ) Estrogen and FSH are both linked to changes in fat mass, and both of these hormones fluctuate significantly as women prepare for and move through menopause. (Fenton, A., 2021 ) These changes highlight reductions in metabolism, changes in liver function, insulin resistance, and lower satiation rates which can lead to increased weight gain and low grade inflammation. These changes and the risk factors associated with them can be alleviated through lifestyle. Nutrients including Vitamin D, Calcium, Vitamin C, B Vitamins and protein are all thought to play a large role in alleviating some of the risk factors mentioned above. (Erdelyi, et al, 2019 ) The links between the gut microbiome, Estrogen, and FSH aren't well understood. Some preliminary research in animals has shown the gut microbiome may impact estrogen metabolism. (Fenton, A., 2021 ) Actions, Prevalence, & Duration Physical Changes Changes in composition of hair, nails, or skin Skin . As estrogen levels decline, skin loses thickness, collogen, and elasticity. (Thorton, MJ, 2013 ) Skin may also take longer to heal from wounds. (Thorton, MJ, 2013 ) There may also be more dark spots and irregularities in pigmentation. (Bravo et al, 2024 ) Hair. Decreases in estrogen may lead to thinning hair and or the increase of hair growth on the face. (Zouboulis et al., 2022 ) Nails . May become brittle or have increased ridges. (Zouboulis et al., 2022 ) Actions, Prevalence, & Duration Physical Changes Genitourinary Syndrome of Menopause (GSM) aka Vulval, vaginal, and urinary changes All of these changes were grouped together in 2014 to be called Genitourinary Syndrome of Menopause. The name here can be confusing since it's called of Menopause. It's called of menopause because if left untreated, the symptoms will persist or worsen. So unlike hot flashes, these don't typically go away on their own once hormone levels even out. If someone is going to experience symptoms here, they often begin in perimenopause and continue until they're treated. These changes are driven by decreases in estrogen levels. Decreases in estrogen levels can change structures, pH, and microbiomes of these systems. Some more specific examples of what these changes can entail include: vaginal dryness, irritation, burning, pain during sex, pelvic pain, UTIs, increased urinary frequency, and urinary incontinence. These changes can significantly impact quality of life and are treatable. (Carlson & Nyugen, 2024 , and Park et al., 2023) Lactobacilius are the predominant microbiota in the biome of the vagina before the overall decline in estrogen which begins in perimenopause. Once estrogen declines so do the number of lactobacillus throwing the balance of the biome out of whack, which is when women sometimes experience physical changes and discomfort. (Mercier et al, 2023 ) Women who suffer from urinary changes including symptoms in their urinary tract are 7x more likely to experience painful intercourse and are 4x more likely to have issues becoming sexually aroused. The two systems are linked, and treating urinary issues can have significant impacts on sexual health and quality of life. (Wasserman & Rubin, 2023 ) Since the name changed recently (2014), here are some other names these changes have gone by: vulvovaginal atrophy Actions, Prevalence, & Duration Mental Changes Changes in Cognition Typically reported and researched as changes in verbal skills, attention, processing speed, and short term memory. Actions, Prevalence, & Duration Mental Changes Changes in Mood Changes in hormone levels can lead to feelings similar to those experienced in PMS. Specific symptoms include irritability, depression, anxiety, low energy, and difficulty concentrating. (Mallory, AB, 2022 ) These changes are driven by fluctuations in hormones ahead of menopause. They may no longer be linked with menstrual cycles. There is a link between prior history of depression or bipolar disorder and relapse during perimenopause. (Musial, et al, 2021 ) Many of the hormones which fluctuate significantly during perimenopause (Estrogen, Progesterone, and FS) have an impact on production of and reception of serotonin. Serotonin helps your body with cognitive function, happiness, temperature, sleep, sex drive, and hunger. (Cleveland Clinic, 2025 ) Actions, Prevalence, & Duration Social Changes Changes in feelings of connectedness Coming soon.. Actions, Prevalence, & Duration Social Changes Changes in Sex Drive Declining levels of estrogen impact arousal and can also impact vaginal dryness, vaginal tissue density, and urinary issues. Changes driven by hormonal shifts during this time may also be impacting sex drive. So, resolving other changes, may help with changes in sex drive. Lack of sleep, depression, and anxiety have been linked to a decrease in sex drive (Woods et al, 2010 ) Actions, Prevalence, & Duration Social Changes Changes in Confidence Experiencing any of the changes described above can be unsettling. They may also be keeping you from engaging in activities you used to enjoy or engaging with friends in the same way you did before. (Menopause Center 2025 ) Many women report feeling more confident once they're post menopause. Actions, Prevalence, & Duration Physical Symptoms At Flourishing Through, we're constantly looking to improve and we're looking for a few members to help shape the future of our platform. If you're interested, learn more here .

The Research Library is a growing, searchable collection of evidence-based articles covering the physical, mental, and general changes of perimenopause — including cognition, mood, libido, sleep, GSM, menstrual cycles, hot flashes, hair and skin, periodontal disease, UTIs, IUDs, oral birth control, waistline changes, and tracking. New articles are added regularly. Search the Library Research Understanding what evidence actually says—and why it matters—is the first step toward navigating this transition with clarity, confidence, and agency. General Read Cognition Hormones fluctuating in perimenopause can have an impact on cognition. Mind October 24, 2025 Read Tracking Perimenopause unfolds over years and impacts most systems in your body in ways that can feel disconnected. Tracking your observations enriches your self awareness and builds confidence for conversations with healthcare providers. This can have a huge impact. General April 8, 2026 Read Hair, Skin, and Nails Declining estrogen levels can impact the appearance and health of a woman’s skin, hair, and nails. Body October 12, 2025 Read Changes in Sleep Perimenopause can impact a woman’s sleep with women in perimenopause waking 1.5x on average per night. There are actions which can help alleviate these sleep disturbances. Body January 1, 2026 Read Hot Flashes & Night Sweats Changes in hormones can impact the body's temperature comfort zone. Body December 1, 2025 Read Oral Birth Control Oral birth control can impact symptoms and changes experienced during perimenopause and menopause transition. Read through to get a deeper understanding of the research. If you're considering a change here, leverage your knowledge to have a more informed conversation and better planning with your care team. Body March 9, 2026 Read Periodontal Disease Changes in hormones impact the dental health. With the right care team and plan disease progression can be managed. Due to lack of menopause certifications for dentists, building a care team in this area may take some extra time and consideration. Body March 2, 2026 Read UTIs Changes in hormones impact the urinary tract & how it functions. It may be time for a new routine to prevent UTIs. Body March 1, 2026 Read Libido If you’ve noticed your interest in sex shifting — feeling less present, harder to access, or just different than it used to be — you’re not alone, and you’re not broken. Changes in libido are among the most common symptoms of perimenopause, affecting 40–55% of women during the transition . They’re also among the least discussed, which means many women spend years wondering if something is wrong with them before they learn that what they’re experiencing has a name, a physiological explanation, and real options. This article is here to give you that foundation. Body & Mind April 14, 2026 Read Mood Hormone fluctuations during perimenopause affect serotonin which can impact your mood and sense of wellbeing. Mind October 23, 2025 Read GSM Shifting estrogen levels impact both the tissue and the microbiomes of the vulva, vagina, urethra and bladder, which can lead to vaginal dryness, itching, pain during intercourse, and urinary issues which can all have a significant impact on quality of life. Nearly 50% of women experience one or some symptoms related to these systems, and concerning changes require treatment or intervention to alleviate pain or discomfort as they are likely to persist or worsen as women move into post menopause. Body October 20, 2025 Read Increasing Waistline During perimenopause, hormonal shifts change how women’s bodies store and metabolize fat and muscle. If you’re concerned about an increase in your waistline, making changes can potentially have long term health impacts. Body January 3, 2026 Read Changes in Menstrual Cycles Changes in period or menstrual cycles are commonly associated with perimenopause. What to expect varies based on the stage of perimenopause you're in. Body December 1, 2025 Read Why does Menopause Happen? Theory as to why women go through menopause General October 8, 2025 Read IUDs There are two types of IUDs. Hormonal and Copper. Each type of IUD has it's own impacts both positive and negative on perimenopause. Understand the research and if you're looking to make a change, leverage your knowledge for a richer dialogue and better planning with your provider. Body March 9, 2026 Read Changes Associated with Perimenopause Listing of changes associated with perimenopause. This list is a starting point and we're constantly adding new changes. General October 1, 2025 Read

Declining estrogen during perimenopause disrupts the urinary microbiome, making UTIs more common. UTIs aka. Urinary Tract Infections 10 % of women have had a UTI in the last 12 months Give me some actionable research TLDR. Changes in hormones impact the urinary tract & how it functions. It may be time for a new routine to prevent UTIs. Women who are in perimenopause and post menopause are diagnosed with more urinary tract infections (UTIs). The primary cause of increased bladder infections is thought to be caused by decreases in the estradiol level causing changes in the microbiome (the bacterial population that lives on the skin) of the bladder and urogenital region. The decreased estrogen environment reduces prevalence of healthy lactobacilli species and allows more disease-causing bacteria to grow more easily. (Sovran,et al, 2016 ) Recurrent urinary tract infections are part of the genitourinary syncrome of menopause, which affects almost half of women during menopause transition. Other symptoms of genitourinary syndrome can be pain with intercourse, urinary frequency without infection, worsening urinary incontinence, vaginal pain and dryness. It is important to make sure that symptoms experienced are actually due to a bacterial infection and not a manifestation of the genitourinary syndrome of menopause. What is a UTI? UTIs (Urinary tract infections) are caused by bacterial infection of the urinary system, in which bacteria from the skin travels up into the bladder through the urethra, causing frequent and painful urination, occasional bloody or cloudy urine, lower abdominal pain, and sometimes sensation of incomplete emptying. There are many bacteria that can cause infection, and most often infections will respond well to antibiotic therapy. Your doctor likely will do a urine dipstick and may or may not run a urine culture. Symptoms should respond within 5 days of treatment, and further testing or change in antibiotic therapy is needed if you’re not feeling better. Untreated, bladder infections can occasionally travel higher into the body, affecting the kidneys (a condition called pyelonephritis), causing flank pain, vomiting and fever. Any symptoms of this severity need to be evaluated and treated promptly. Ok... so how frequent is frequent...? 2 or more UTIs in 6 months or 3 or more UTIs in 12 months. Recurrent UTIs are most often reinfection rather than relapse of a prior infection. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

The content on Flourishing Through website and associated app Through & Through - including articles, tools, and community discussions - are for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Using the platform does not create a doctor-patient relationship, and Flourishing Through LLC is not a healthcare provider. Medical Disclaimer Last Updated: 12.09.2025 The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Not a Substitute for Professional Medical Care The content available through Flourishing Through, including articles, resources, tracking tools, and community discussions, should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition, symptoms, or health concerns. No Doctor-Patient Relationship Use of this website and app does not create a doctor-patient relationship between you and Flourishing Through LLC, its owners, or contributors. We are not healthcare providers and do not provide medical services. Individual Health Varies Perimenopause and menopause affect each person differently. Information shared through our platform represents general educational content and may not apply to your specific situation. Your healthcare provider is the best source for personalized medical guidance based on your individual health history and needs. Emergency Situations If you are experiencing a medical emergency, call 911 or your local emergency number immediately. Do not rely on information from this platform for emergency medical situations. Do Not Disregard or Delay Medical Advice Never disregard professional medical advice or delay seeking it because of something you have read on Flourishing Through. If you think you may have a medical condition or concern, contact your healthcare provider promptly. User-Generated Content Community discussions and user-shared experiences on our platform represent personal perspectives and should not be considered medical advice. Other users are not healthcare professionals unless explicitly identified as such, and even then, they are not providing medical care through this platform. Accuracy and Updates While we strive to provide accurate, evidence-based information, medical knowledge evolves continuously. We make reasonable efforts to keep content current but cannot guarantee that all information is complete, accurate, or up-to-date at all times. Consult Before Making Health Decisions Before making any decisions regarding your health, medications, supplements, or treatment approaches based on information from this platform, consult with your qualified healthcare provider.

There are two types of IUDs. Hormonal and Copper. Each type of IUD has it's own impacts both positive and negative on perimenopause. Understand the research and if you're looking to make a change, leverage your knowledge for a richer dialogue and better planning with your provider. IUDs aka. Intrauterine Devices 15% of women using contraception are estimated to be using IUDs as their contraception method of choice impacting a significant portion of the population in perimenopause Give me some actionable research TLDR. There are two types of IUDs. Hormonal IUDs can have an impact on perimenopause. Copper IUDs have limited or no impact on symptoms and changes associated with perimenopause. Why are we talking about this? It is estimated that more than 15% of the women using contraception in the US are using IUDs, making this a meaningful topic for many women entering into perimenopause. Understanding how these contraception methods function and their potential impacts on perimenopause and menopause can inform how women approach these milestones. Types of IUDs. There are two primary categories of interuterine devices (IUDs): Hormonal and non-hormonal (copper). In the United States, five FDA-approved brands are currently available (Lanzola & Ketvertis, 2023 ). How do IUDs work? Hormonal IUDs , which all use a synthetic progestin called levonogestrel (LNG), work locally within the uterus. The progestin thickens cervical mucus, keeps the lining of the endometrium thin, and in higher dose devices may partially suppress ovulation. This form of contraception acts predominantly within the uterine cavity, systemic absorption is less than that of oral progestin (Pinkerton et al, 2022 ), which is a meaningful distinction in perimenopause symptom management. Copper IUDs operate differently from the hormonal IUDs. The copper ions from this type of IUD create a spermicidal environment without any hormonal action. Potential Impact of IUD on Perimenopause Symptoms & Changes Hormonal IUDs Help to prevent heavy bleeding which is sometimes associated with perimenopause. With Hormonal IUDs, the endometrium is where the impact of IUDs and perimenopause overlap is the heaviest. As estrogen levels fluctuate, the uterine lining can thicken unpredictably and contribute to heavy menstrual bleeding. LNG IUDs contract this by promoting a thin inactive lining as a result these IUDs have been used off-label to has the progestin component of Hormone Replacement Therapy, which helps manage heavy menstrual bleeding and risk of endometrial cancer (Clark & Westberg, 2021 ). Masking menstrual irregularities as these IUDs often consistently decrease period frequency and duration. These IUDs are also often associated with a decrease in period frequency or an increase in menstrual cycles. These IUDs can obscure menstrual irregularity associated with perimenopause as well as the onset of menopause. Up to 40% of Mirena users experience amenorrhea within 3 years of insertion (Bayer HealthCare Pharmaceuticals, 2024 ). Clinical guidance suggests many women can continue hormonal IUDs until approximately age 55, at which point most women have likely gone through menopause. Mixed Research on mood changes . Research on whether IUDs impact symptoms of depression is mixed ((Elsayed et al, 2022 ), and most studies focus generally on women of reproductive age. Additional research or reviews are needed here specifically on the intersection of IUDs and mood changes in women experiencing perimenopause. Little or no impact on symptoms across other systems. Given that these devices and the progestin they release act predominantly in the uterine cavity, they don't address the symptoms of perimenopause across the rest of the body like vasomotor symptoms (hot flashes), GSM symptoms, and cognitive changes. (Pinkerton et al, 2022 ) Copper IUDS Little or no impact on symptoms and changes associated with perimenopause. There are often reports of heavier bleeding and cramping in the first few months after insertion, this form of contraception doesn't alter the frequency of a woman's menstrual cycle so any shifts in period frequency which are often a first sign of perimenopause won't be masked. Bone Mineral Density (BMD) . Neither type of IUD on its own has a material impact on bone mineral density for women who are near menopause. Since the IUDs act locally, it makes sense that an impact across other body systems hasn't been found (Yang et al, 2012 ). However, IUDs have been used as a part of Hormone Replacement Therapy to provide endometrial protection while estrogen can provide protection against fractures (Mukherjee & Davis, 2025 ). How will I know if I've entered into menopause? The Menopause Society states 90% of women will reach menopause by age 55 and recommends the continued use of contraception until then or menopause is confirmed. There are two main types of test for whether or not menopause has occurred. 1) Stop use of hormonal birth control and watch for a year to see if a period returns. 2) Testing FSH levels. The process here will vary by birth control type. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? 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Menopause occurs as follicle reserves deplete, causing hormone levels to decline. Three leading theories explain why: the Grandmother, Mother, and Reproductive Conflict hypotheses — with the Grandmother Hypothesis having the most supporting data. Why does menopause happen? Summary. While preliminary research and hypothesis exist around drivers for menopause, there's certainly for more research. There are three primary theories around why humans experience menopause The Grandmother Theory, The Mother Hypothesis, and The Reproductive Conflict Hypothesis. The grandmother hypothesis appears to have the most data supporting it. Biologically women go through menses when their reserve of follicles is depleted. However, the decline in sex hormones and lived experiences of changes doesn't appear to be necessarily linear with the decline in follicles. It would be interesting to better understand parallel processes and complimentary drivers of menopause. Theory There are many theories as to why women go through menopause, but there does appear to be an evolutionary reason for women to go through menopause. From our earliest records and across the globe, women have been going through menopause around age 50 and for those women who reach menopause they often live a significant portion of their lives post menopause. Three of the leading theories are: The Grandmother Hypothesis seems to have originated in the 1950s, but who exactly started this theory is a bit unclear. More recently Kristen Hawkes' research on the Hadza people of Tanzania has continued to build on this hypothesis. The hypothesis suggests women's evolution is uniquely focused on altruism (Johnstone & Cant, 2019 ) and are best able to contribute to their communities by helping take care of grandkids as opposed to continuing to have and rear their own children. Data collected by Hawkes and her team found data supporting the theory that grandmothers help increase the wellbeing and survival of their grandchildren. Interestingly, humans and four types of whales are the only large mammals which not only experience menopause but also live a significant portion of their lives post menopause (Landau, 2021 ). The phenomena of post menopausal grandmothers helping the survival of their grandchildren has also been proven with resident killer whales (Nattrass et al, 2019 ) - Further discussion: How does families being spread out today with children going away to college and living further away from their original families as they have their own children impact the longevity and wellbeing of children today? How does this relate back to Ellen Langer's theory of kids living in old age the way they see their grandparents living? The Mother Hypothesis. This hypothesis proposed by George Williams in 1957 , suggests women experience menopause for two reasons. First, pregnancies become riskier as women get older, so it becomes advantageous for survival to stop being able to reproduce. Second, human children have a long period of dependency on their parents at some point it becomes more beneficial to focus on supporting the children which have already been born than to add more children to the family. suggest this tipping point occurs when the next generation begins to reproduce. Assuming passing down genes is the motive for survival, it is more beneficial for women to allow their children to help by passing down their genes. The Reproductive Conflict Hypothesis. In this hypothesis Johnstone & Cant build on the work of George Williams in 1957 by suggesting the tipping point between having kids and focusing on your existing children occurs when the next generation begins to reproduce. Assuming passing down genes is the motive for survival, it is more beneficial for women to allow their children to help them by passing down their genes. Further discussion: This is a particularly prominent example of framing. Who is helping who? Are the grandmothers helping their own children or are their children helping them? How does biology align with how individuals consciously consider the impact their lives will have? Biological Process Menses are driven in large part by the number of follicles carrying oocytes (immature eggs) which women are born with. The number of oocytes a woman has and the number of follicles she has should be approximately synonymous as each oocyte is held by a follicle. Follicles provide a protective environment for the oocyte before and during maturation. Once an oocyte matures, it breaks free of from the follicle and heads to the uterus where it might meet a sperm (Lumen Learning ). Throughout a normal menses FSH (follicle stimulating hormone) and LH (luteinizing hormone) stimulate the growth of follicles and their oocytes. This process also impacts the levels of estrogen, progesterone, and testosterone present for women and these hormones fluctuate regularly with the menstrual cycle. Women are born with roughly 2 million follicles. This number is believed to peak in-utero and decline throughout the rest of a woman's life. As we approach age 50 it is believed very low follicle reserves signal the lack of a need for FSH and LH to continue to develop follicles. This lack of LH and FSH to develop follicles also means the levels of estrogen, progesterone, and testosterone eventually decline (Cox & Takov, 2025 ). As this process winds down, hormone levels may spike unexpectedly. Further discussion: Why are there seemingly random spikes in hormone levels if menopause is driven entirely by the decline in follicle reserves? Why does progesterone decline at a different rate than estrogen? If the two are both linked to follicle reserves, wouldn't they both decline at the same rate? Further discussion or research: What in particular sparks a woman's first period? How might this help us understand why and when periods stop?

Perimenopause is a multi-year transition that affects nearly every system in the body — physical, cognitive, emotional, and relational — yet its changes often arrive so gradually that women and their care teams miss the signals, attributing them to stress or aging instead. Systematic tracking turns periodic observations into clear, actionable patterns. Tracking aka being kind to your future self by logging your observations What & How do I track TLDR. Perimenopause unfolds over years and impacts most systems in your body in ways that can feel disconnected. Tracking your observations enriches your self awareness and builds confidence for conversations with healthcare providers. This can have a huge impact. Perimenopause is not a single event — it is a transition that can unfold over years, touching nearly every system in your body. The changes can be subtle at first. A little more difficulty sleeping here. A shift in your mood there. A joint that aches in a way it never did before. Over time, these changes can add up, quietly reshaping how you feel, how you function, and how you move through your days. Because the changes often arrive gradually, many women and their care teams can miss the signals. It is easy to attribute them to stress, aging, or just "having a bad week" — especially when no single change feels dramatic enough to name. The result is that months or even years can pass before a woman recognizes how much the perimenopause transition has been shaping her experience. Research confirms this: studies find that women report a wide range of physical, cognitive, emotional, and relational changes during the transition, many of which they do not initially associate with perimenopause (Woods & Mitchell, 2005 ). Tracking changes — systematically and honestly — is one of the most powerful tools available to you during this time. It turns sporadic impressions into clear, actionable information. And that information can have a huge impact. Seeing the Full Picture Perimenopause can affect your body, your mind, your emotions, and your relationships — often all at once, and often in ways that feel disconnected from one another. Hot flashes and night sweats are the symptoms most people know about. But the full range of changes women experience is far broader. The Study of Women's Health Across the Nation (SWAN), one of the most comprehensive longitudinal studies of the menopausal transition ever conducted, enrolled over 3,300 women across seven sites and followed them for decades. SWAN has documented changes in cardiovascular health, bone density, sleep, mood, cognition, and metabolism — and importantly, has shown that many of these changes are driven by the transition itself, not simply by aging (Al-Safi & Santoro, 2013 ). Physical changes can include hot flashes, night sweats, shifts in sleep quality , urinary issues, vaginal dryness, energy levels, joint comfort, digestion, skin, hair, nails, oral health , menstrual cycles , and body composition . Cognitive and emotional changes — mood fluctuations , changes in memory or focus , fluctuations in libido , shifts in confidence or anxiety — are also well-documented in research, though they receive less attention in everyday conversation. Social and relational changes, including how you feel about intimacy, your sense of connection with others, and your relationship with yourself, are equally real. When you track changes across all of these areas, you begin to see the transition as the whole, interconnected experience it actually is — rather than a frustrating collection of isolated complaints. Patterns emerge. Connections become visible. And with that clarity comes the ability to respond rather than just react. Symptoms can last longer than most women expect One of the most important things research has clarified is perimenopausal symptoms — particularly vasomotor symptoms like hot flashes and night sweats — last considerably longer than was previously assumed. A landmark SWAN study published in JAMA Internal Medicine found that frequent vasomotor symptoms lasted more than seven years during the menopausal transition for more than half of the women studied, and persisted an average of 4.5 years after the final menstrual period (Avis et al., 2015 ). For African American women, the median total duration was over ten years — significantly longer than for other racial and ethnic groups. This matters for tracking because it means the transition is not a brief disruption you simply wait out. It is a sustained period of change that warrants sustained attention. Women who begin tracking early — before they feel like "real" symptoms have started — often have the most useful longitudinal records to draw on when they need them. Mood, Sleep, and Cognition: What the research tells us Among the most under-recognized — and under-tracked — changes during perimenopause are those involving mood, sleep, and cognitive function. SWAN data have shown that women who were not depressed before the transition had significantly higher odds of developing depressive symptoms as they moved into late perimenopause (Bromberger et al., 2007 ). A subsequent SWAN analysis found that the odds of experiencing a major depressive episode were meaningfully greater during perimenopause and postmenopause than during premenopause, (Bromberger et al., 2011 ). Sleep disturbances are similarly common and frequently overlooked. SWAN research found that the prevalence of sleep difficulty was highest during late perimenopause — and importantly, this finding held even after accounting for the effects of vasomotor symptoms, suggesting that sleep disruption is not simply a downstream consequence of hot flashes but a distinct dimension of the transition (Al-Safi & Santoro, 2013 ). These findings underscore why tracking mood and sleep alongside physical symptoms matters. What looks like isolated irritability, or a stretch of poor sleep, may be part of a coherent pattern that only becomes visible when you can see it across time. Making the connection between changes and daily life One of the most valuable things tracking can reveal is not just what is changing, but how those changes are affecting your ability to live the life you want to live. A night of disrupted sleep may not feel like a big deal in isolation. But when you track it consistently, you may begin to notice that the days after poor sleep are the days when you feel most irritable, least motivated, or most likely to withdraw from social plans. A change in your energy levels may look unremarkable on its own — until you notice that it corresponds with changes in your cycle, or with specific foods, or with periods of higher stress. Research on symptom monitoring in menopausal women supports this: a systematic review and meta-analysis found that consistent symptom tracking was associated with improvements in patient-provider communication, shared decision-making, health and symptom awareness, and goal-setting — and in some studies, with measurable reductions in symptom frequency and severity, including hot flashes (Andrews et al., 2021 ). Women who came to appointments with structured symptom records were better positioned to have productive conversations about their care. Reclaiming your narrative There is something important that happens when you begin to track your experience: you move from being a passive recipient of change to an active, informed participant in your own health. Perimenopause can sometimes feel like something that is happening to you — a loss of control over a body and a life that once felt more predictable. Tracking is an act of reclamation. It says: I see what is happening. I am paying attention. I am gathering information so I can make good decisions. Women who feel dismissed or not heard in clinical settings have worse outcomes and lower treatment satisfaction (Shifren et al., 2014 ). Tracking gives you the language and the evidence to advocate for yourself clearly and confidently — to walk into an appointment not with a vague sense that something is off, but with a documented record of what you have been experiencing, how often, and how much it has affected your daily life. A Note on the research The science of perimenopause is still evolving. We know a great deal about vasomotor symptoms — their prevalence, their duration, their variability across racial and ethnic groups. We know considerably less about many of the subtler changes women experience — partly because perimenopause has historically been under-researched, and partly because the transition is genuinely complex and highly variable between individuals. Much of what we know comes from landmark longitudinal studies — particularly SWAN, which has followed over 3,300 women for nearly three decades. SWAN's particular contribution has been its ability to distinguish the effects of the menopausal transition from the effects of aging per se — a distinction that has turned out to matter enormously for understanding cardiovascular health, bone density, mood, and cognition (Al-Safi & Santoro, 2013 ). This means that your individual experience unique and the data behind it can help shape your journey. What you notice, how you feel, and what changes over time is real and meaningful — even when the research hasn't yet caught up to fully explain it. Read more here. Through & Through - Our tracking app The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Perimenopause is a multi-year transition that affects nearly every system in the body — physical, cognitive, emotional, and relational — yet its changes often arrive so gradually that women and their care teams miss the signals, attributing them to stress or aging instead. Systematic tracking turns periodic observations into clear, actionable patterns. Research aka what we share to help you build your perimenopause acumen TLDR. Perimenopause unfolds over years and impacts most systems in your body in ways that can feel disconnected. Building your perimenopause acumen can help build confidence for conversations with healthcare providers. Why Research Is the Foundation of Your Perimenopause Journey Understanding what evidence actually says—and why it matters—is the first step toward navigating this transition with clarity, confidence, and agency. Something changes in the weeks or months before you can name it. Sleep becomes unpredictable. Energy shifts. Your body offers you signals you haven't received before—and the internet offers you thousands of explanations, many of them contradictory. You read one article that promises a supplement will restore everything and another that dismisses the entire category. A podcast tells you hormone therapy is the answer. A friend tells you it isn't. A social media account with a half-million followers says something that sounds authoritative but cites nothing. This is the information environment that most women navigate during perimenopause. And it is genuinely difficult to find your footing in it. Research—real, peer-reviewed, transparent research—is how Flourishing Through tries to change that. Not by giving you a prescribed path, but by giving you a reliable map. This article explains what that means: why evidence-based information matters, how it affects your experience and outcomes, what standards we use to evaluate what we share with you, how to interpret the citations in our articles, and how research, tracking, and community work together to support you in a way that none of them can alone. Why the Quality of Information Matters Not all health information is created equal. That statement may seem obvious, but in practice it is surprisingly hard to act on, especially when you are experiencing symptoms that are disruptive, confusing, or distressing. When you are not sleeping well, when your mood feels unfamiliar, when your body is doing things you weren't warned about— we’ve all felt the pull toward any confident-sounding answer. Confidence is not the same as validity. A compelling blog post, a credentialed clinician's social media account, and a peer-reviewed study published in The Lancet are not equivalent sources, even if they arrive in the same search results and look similar on a screen. The differences matter—particularly for your health decisions. A 2025 editorial published in The BMJ warned that the rapid rise in commercial menopause services is producing misinformation that can harm care, as commercial products are being marketed as evidence based when they are not (Christakis et al., 2025 ). Credentials—even real ones—do not automatically mean that a specific claim is backed by evidence. Understanding this distinction is not cynicism about healthcare providers or wellness practitioners. It is a practical skill that protects you. The perimenopause space is particularly vulnerable to this dynamic because the research base itself is incomplete. Many studies have historically focused on postmenopausal populations, leaving genuine gaps in what we know about the transition years specifically. Good information sources name those gaps honestly rather than filling them with plausible-sounding substitutes. At Flourishing Through, we name them too. What You Know Shapes What You Experience There is a research tradition in psychology and medicine that most of us encounter only in passing, and it deserves more attention than it typically receives. It is the science of how mindset, expectation, and framing shape physical experience—not metaphorically, but measurably. Ellen Langer, a professor of psychology at Harvard and one of the foundational researchers in this area, has spent more than four decades studying the relationship between how we think and how our bodies respond. Her 1989 book Mindfulness and her 2009 work Counterclockwise: Mindful Health and the Power of Possibility draw on a body of experimental research demonstrating that the expectations we hold about our physical experience are not merely psychological—they have physiological correlates. Her best-known study, often called the Counterclockwise study, placed two groups of elderly men in an environment that recreated the social and sensory world of 1959. One group was asked to actively inhabit that time—to think, speak, and behave as though it were 1959. The other served as a comparison. Both groups showed measurable improvements in physical markers including strength, flexibility, and sensory acuity. The group more actively engaged in the exercise showed greater gains (Langer, 2009 ). Similar results have been drawn across her decades of experimentation. The implication Langer draws from her body of work is consistent: our assumptions about what our bodies can or cannot do, what aging means, what a health challenge signals—these assumptions function as constraints or as permissions, and they are more malleable than we tend to believe and they have a bigger impact on our responses than we often recognize. A Note on Langer's Work: Langer's research belongs to a tradition of social psychology that uses experimental design to examine mind-body dynamics. Her studies are widely cited and have been influential across clinical and educational contexts. They do not suggest that mindset replaces medical care—they suggest that the psychological context in which we approach our health is itself a variable worth attending to. We flag this distinction because it matters for how you apply these ideas. This has direct relevance to how you approach perimenopause. The transition is real, the physiology is real, and the symptoms are real. The story you bring to that experience is important —whether you understand what is happening and why, whether you’re managing through or see this as an invitation to flourish through—shapes your experience in ways the research increasingly supports. A systematic review published in Maturitas examined the relationship between attitudes toward menopause and symptom experience across multiple studies. The review found a consistent pattern: women with more negative attitudes toward the menopausal transition reported higher symptom burden. Social support, education, and experience are all associated with more positive attitudes (Ayers et al., 2010 ). This does not mean symptoms are imagined. It means the psychological context we carry is a real variable in how we experience this transition. Understanding your perimenopause experience—really understanding it, with accurate information about the mechanisms involved, the range of what is normal, and the options available to you—is not a passive academic exercise. It is an active variable in how that experience unfolds. This is one of the reasons research sits at the center of what Flourishing Through offers you. From Understanding to Agency: The Outcome Benefits of Being Informed The connection between health literacy and health outcomes is well-established in the research literature. In the context of menopause specifically, being informed matters in several concrete ways. Better Clinical Conversations Perimenopause is a stage of life during which many women feel chronically under-served by their healthcare encounters. As a part of the 2020 Women Living Better Survey, the qualitative analysis of healthcare interactions identified recurring themes of women feeling dismissed and facing barriers to treatment (Richardson et al., 2023 ) In a study at the Mayo Clinic, Bevry et al . (2024) concluded women’s menopause related healthcare concerns weren’t being addressed. We believe symptoms go unaddressed not because treatment options don't exist but because the right conversations aren’t happening. When support is tailored to women’s individual needs, resources, narratives, and beliefs, research has shown significant improvement in wellbeing for women going through menopause (Rindner et al., 2023 ) Women who arrive at appointments with a working understanding of their own symptoms—what they were, how long they had been occurring, what seemed to affect them—are better positioned to participate in shared decision-making. It helps to understand the landscape your care team is navigating. Menopause medicine has historically been underrepresented in medical training — a 2023 survey of U.S. obstetrics and gynecology residency program directors, published in Menopause, found that while 92.9% agreed residents needed a standardized menopause curriculum, only 31.3% of programs had one in place (Allen et al., 2023 ). The good news is that this is changing. The Menopause Society — the leading professional organization in the field — has offered a rigorous competency certification for healthcare providers since 2002. Practitioners who earn the Menopause Society Certified Practitioner (MSCP) credential have passed a specialized examination in menopause and midlife women's health, and must maintain that certification through ongoing education. Their searchable practitioner directory makes it possible to find an MSCP in your area or licensed in your state. Seeking out a certified provider isn't always possible for everyone, but knowing the credential exists — and that a growing number of physicians, nurse practitioners, and other clinicians hold it — is a meaningful place to start. Even when you are seeing a knowledgeable provider, the structure of a typical clinical encounter creates real constraints. Primary care physicians see an average of 20 patients per day, and a 2022 simulation study from the University of Chicago and Johns Hopkins found that following recommended care guidelines for an average patient panel would require more than 26 hours of a physician's workday — before accounting for documentation and administrative time (Porter et al., 2022 ). This isn't a reflection of your doctor's investment in you. It's a structural reality of how primary care is currently organized, and it means that the shape of your visit often depends significantly on how prepared you arrive. Think about the care you put into an important professional meeting — the agenda you'd draft before a board presentation, the documentation you'd build to make a case for a new initiative, your case for a promotion or raise. Your health is important. Your clinical appointments deserve the same intentionality. When you come in with your symptoms organized, a clear sense of what's changed and when, and the questions you most need answered, you give the conversation its best possible chance. The research in our library, paired with the symptom data you build through tracking, is designed to help you do exactly that. This is not about becoming your own doctor. It is about becoming a more effective partner in your own care. When you know that sleep disruption during perimenopause has distinct physiological mechanisms—that it is not simply stress or aging—you can ask different questions and advocate for different conversations. When you understand the evidence base around hormone therapy, you can engage with a nuanced discussion rather than accepting a confident-sounding dismissal or endorsement. Higher Quality of Life A randomized clinical trial of 100 women in Iran published in BMC Women's Health tested a health literacy-based educational intervention in menopausal women. The intervention group showed significantly higher quality of life scores and stronger self-care behaviors compared to the control group (Hossein Mirzaee Beni et al., 2022 ). The education component—specifically, receiving accurate, accessible information about what menopause involves and how to navigate it—was the active ingredient. Understanding does not eliminate symptoms. But it appears to meaningfully change the experience of living with them—in part because knowledge reduces the anxiety that accompanies the unknown, and in part because it opens up options that were previously invisible. Accurate, well-sourced information is not just reassuring—it is practically valuable in ways that affect your time, money, and wellbeing. The Flourishing Through Research Standard Because we believe the quality of information matters—and because the perimenopause information landscape is full of content that doesn't meet a high bar—we want to be explicit about the standards we apply to everything in our research library. What We Mean by Evidence-Based At Flourishing Through, "evidence-based" has a specific meaning. It does not mean that something has been written by a clinician, endorsed by a wellness brand, or repeated widely enough to feel true. It means that the claim is supported by peer-reviewed research—studies that have been evaluated by independent scientists before publication—and that we are transparent about the strength and limitations of that research. We draw from a defined hierarchy of source types. Longitudinal cohort studies, systematic reviews, and meta-analyses form our Tier 1 sources—these designs produce the most robust evidence because they follow populations over time or aggregate findings across multiple studies. Clinical practice guidelines from bodies such as The Menopause Society (formerly NAMS), the American College of Obstetricians and Gynecologists, and the Endocrine Society represent the translation of that research into clinical recommendations. Where relevant, we also draw on foundational mechanistic research published in peer-reviewed journals including Menopause, Maturitas, JAMA, The New England Journal of Medicine, and The Lancet. Naming What We Don't Know One of the most important commitments we make in our research library is to be honest about the limits of what the evidence actually supports. This matters particularly for perimenopause research for a specific reason: much of the existing literature has focused on postmenopausal populations, and the perimenopause transition itself—which can span the better part of a decade for some women and involves considerable hormonal variability—has been underrepresented in study designs. When research we cite is drawn primarily from postmenopausal or general population samples, we say so. When evidence for a specific symptom or intervention is limited, emerging, or mixed, we say that too. We work to present findings in the way the study designs support. This is not a limitation of our platform—it is a feature of it. You can trust what we tell you precisely because we are willing to tell you when the evidence is uncertain. Perimenopause-Specific vs. General Menopausal Populations Throughout our research library, you will notice language that distinguishes between perimenopausal and postmenopausal populations. This distinction is not pedantic. The hormonal environment of perimenopause—characterized by fluctuating estrogen rather than the stable low-estrogen state of postmenopause—creates a distinct physiological context. Research conducted on postmenopausal women does not automatically translate to perimenopausal experience, and we flag this gap wherever it applies. Our Editorial Commitment Every article in the Flourishing Through research library reflects: peer-reviewed, primary sourcing; transparent acknowledgment of evidence gaps and population-specificity limitations; honest evidence grading that distinguishes robust findings from preliminary or mixed evidence; and second-person, empathetic framing that centers your experience without overstating what the research can tell us. How to Read Our Citations Every claim in a Flourishing Through research article that goes beyond general knowledge is supported by a citation. We know that citation formats can feel opaque and there are lots of reputable formats for citations, so here is a plain-language guide to reading what we share. In-Text Citations Within the body of our articles, you will see references formatted like this: (Author, Year). For example: (Avis et al., 2015). This notation tells you who produced the research and when. "Et al." is Latin for "and others" and indicates that the study had multiple authors. Clicking on the citation link takes you directly to the published source—typically a journal article on PubMed, a professional body's website, or a similar credible destination. Evidence Grading Language Because we want to be transparent about how strong the evidence is for any given claim, we use specific language in our articles to signal confidence levels. Here is what to look for: "Research consistently shows" or "multiple studies have found" — indicates convergent evidence from several independent studies, generally a robust finding. "A study found" or "one study suggests" — indicates findings from a single study; worth noting, but not yet replicated widely enough to treat as established. "Preliminary evidence suggests" or "early research indicates" — indicates emerging findings that have not yet been confirmed through replication or larger study designs. "Evidence is limited" or "research is mixed" — indicates that the available studies do not tell a consistent story, or that few high-quality studies exist on this specific question. "This research focused on postmenopausal women"or “This research from the general population” — indicates that findings may not fully apply to the perimenopausal transition and should be interpreted with that context in mind. If you ever want to go deeper on a source you can click the link we provide in the citation. If you’d like to explore on your own, PubMed (pubmed.ncbi.nlm.nih.gov) is the most reliable freely available database of peer-reviewed biomedical literature. Searching the author name and year will usually surface the abstract and, in many cases, the full text of the article. How Research, Tracking, and Community Work Together Research, tracking, and community are the three pillars of Flourishing Through—not because they are three nice categories, but because they address three genuinely distinct needs that reinforce each other in ways that no single resource can replicate on its own. Research Gives You the Map Evidence-based information tells you what is known about perimenopause broadly—the mechanisms, the range of what is currently covered by research, the options that exist, and the limits of what the research can currently tell us. It gives you context for your own experience and language for conversations with your care team. Without a reliable map, you are navigating unfamiliar territory by feel, relying on whatever confident voice reaches you first. Tracking Gives You Your Data But the map of perimenopause in general is not the same as a map of your perimenopause specifically. Every woman's transition is shaped by her own hormonal patterns, health history, lifestyle, culture, priorities, genetics, and context. Tracking—recording your symptoms, sleep, mood, energy, and other relevant changes over time—generates the personalized data that the general research cannot provide. It reveals your patterns: which symptoms cluster together, what seems to influence their severity, how they change across the cycle and across the months. This is the information that makes a clinical conversation genuinely productive, because you arrive with specific, longitudinal data rather than an approximation of how you've been feeling. Community Gives You Context and Connection Research answers the question of what is generally true. Tracking answers the question of what is true for you. Community answers something neither can: you are not alone in this, and the people around you are navigating it too. The value of community is not just emotional, though the emotional dimension is real and significant. Since 1979, when 6,928 residents of the general adult population in Alameda County in California were followed for 9 years, researchers have been studying how social networks are linked to mortality (Berkman & Syme, 1979)Research from the SWAN studies have shown this phenomena translates to women’s lived experience with perimenopause low social support is correlated with an increase in depression (Bromberger et al., 2007 ), which was also associated with increased vasomotor symptoms (Gibson et al., 2011 ). It’s important to note here strong social support doesn’t necessarily mean a bigger support network. Cohen and Wills (1985) state adequate functional support may be derived from one very good relationship but may not be available for those with multiple superficial relationships. In their study Stress, Social Support and the Buffering Hypothesis, they showed general social support is good for general well being. However, when someone anticipates a stressful event social buffering can help alleviate this stress and improve wellbeing. Social buffering can help provide the skills, information, risk assessment and resources needed and thus shift an individual out of a state of stress and into a state where they’re confident in their ability to handle what’s headed their way (Cohen & Wills, 1985 ). Peer experience also provides a kind of practical wisdom that doesn't appear in journal articles: the conversations that helped, the practitioners worth seeking out, the moments of unexpected levity in a transition that can feel relentlessly serious. The Three Together When all three pillars are active, something distinctive becomes possible. You understand what is happening and why. You have personal data that makes that understanding specific to your experience. And you are connected to a community that validates, informs, and supports you. The combination creates the conditions for what researchers describe as active patient engagement—a posture toward your own health that is associated with better outcomes, more effective care relationships, and greater wellbeing (Greene & Hibbard, 2012 ). That is what Flourishing Through is built to support. You are navigating a real transition with a real physiology. The information landscape around it is genuinely noisy, and the research base, while substantial, still has meaningful gaps—particularly for the perimenopause years. What we can offer you is a commitment to navigating that landscape honestly, sharing what the evidence actually supports, naming what it doesn't, and giving you the tools to engage with both. That is the purpose of research as a pillar of this platform. To help you build your understanding of what’s happening Not to tell you what to decide—but to provide you with a map to build your own plan and your own team to support your journey to Flourish Through perimenopause and onto the best years of your life. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

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Why perimenopause is often associated with an increasing waistline, options for addressing if you're concerned and tracking suggestions. Increasing Waistline This is a common side effect of perimenopause as your body metabolizes differently and lifestyle changes today can have lasting effects. Give me some actionable research TLDR. During perimenopause, hormonal shifts change how women’s bodies store and metabolize fat and muscle. If you’re concerned about an increase in your waistline, making changes can potentially have long term health impacts. Hormonal shifts, particularly declines in estrogen (estradiol, E2) and increases in follicle stimulating hormone (FSH) are associated with shifts in the way the body processes and stores energy, which can often lead to an observable increase in visceral fat (Lovejoy et al, 2009 , Janssen et al, 2010 ) and a decline in lean muscle. In addition to potentially being an annoying increase to a woman’s waistline, visceral fat is also a predictor of diabetes and cardiovascular disease in women. Visceral fat may be associated with increased inflammation, which then further is associated with cardiac and metabolic risk (Lankila et al, 1999 ). Paying attention and making lifestyle adjustments here if this is a concern can have long term health impacts. Increases in visceral fat particularly in the abdomen have been linked with more severe Vasomotor Symptoms (Thurston et al, 2010 , Thurston et al, 2009 ). It is important to note that while weight gain and central fat accumulation is common, it is not without hope for successful intervention. The American Heart Association has issued a research based statement on how early lifestyle intervention with increasing exercise, a diet low in processed food and strength training has been shown to lower increased risk for cardiovascular disease, high blood pressure and diabetes (Khoudary et al, 2020 ). Stabilization over time. These changes typically stabilize within 2 years of experiencing menopause. (Greendale et al, 2019 ) You're not alone. After decades spent establishing trusted exercise routines and diets to build your body up, seeing your body respond differently can be frustrating. It can be overwhelming to think about adjusting physical activity and meal planning. After years spent finding brands, sizes and silhouettes which fit your body and your style, it can be frustrating to need to re-think your strategy for building your wardrobe. You 're not alone as you navigate these changes. Women all over the world are working through similar challenges as they adapt to this new phase of life. There's no need to boil the ocean. Take on the amount which fits within your capacity during this phase. Read more here . The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer. Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Through and Through is Flourishing Through's dedicated perimenopause app, offering daily symptom tracking across physical, mental, and social dimensions. It will be available on the App Store for iPhone and via the web at flourishingthrough.com, each with its own subscription. Through and Through COMING SOON: A Flourishing Through App Through and Through puts symptom tracking and evidence-based education in the palm of your hand. Understand what your body is telling you — and finally feel seen in a transition that too many women navigate alone. What Is Through and Through? Perimenopause brings changes that can feel unpredictable and isolating — from hot flashes and sleep disruption to brain fog, mood shifts, and relationship strain. Flourishing Through is a dedicated platform that helps you make sense of it all. Our app gives you daily symptom tracking across physical, mental, and social dimensions so you can uncover patterns, identify triggers, and walk into your next doctor's appointment with real data in hand. Alongside tracking, you'll find a growing library of research-based articles that explain the science behind what you're experiencing — no guesswork, no trends, just evidence. This isn't a general wellness app with a perimenopause add-on. Every feature was built specifically for this stage of life. What You'll Get **Symptom Tracking That Sees the Full Picture** Log what you're feeling across three dimensions — physical changes like hot flashes and joint pain, mental shifts like anxiety and brain fog, and social impacts like withdrawal and changes in intimacy. Over time, your tracking reveals patterns that help you understand and advocate for yourself. Also Available **Education Grounded in Research via Flourishing Through** Our content library connects your symptoms to current medical research. Learn why these changes are happening, what the science says, and what other women in perimenopause are experiencing too. **A Platform Built for You** Flourishing Through was created because women in perimenopause deserve more than being told "it's just stress." You deserve tools, knowledge, and validation — and that's exactly what we're here to provide. Access Through and Through App or Flourishing Through Website Through and Through is available on the App Store and on the web, giving you flexibility in how you engage with the platform. **On your iPhone:** Download the app from the App Store for on-the-go symptom tracking. (COMING SOON - NOT YET AVAILABLE) **On the web:** Access Flourishing Through right here at flourishingthrough.com f Each access point comes with its own subscription so you can choose the option that works best for you. Your Privacy Is Protected Your data is personal. We comply with Washington's My Health My Data Act and maintain strict privacy practices for all consumer health data. You can review our full Privacy Policy for details. Start Your Journey You don't have to figure perimenopause out alone. Start tracking, start learning, and start flourishing.

Perimenopause affects body, mind, and relationships for 80%+ of women. Flourishing Through offers research-backed articles, symptom tracking, and community to help women navigate this transition and thrive into the best years of their lives Research Flourishing Through Perimenopause Tracking Community (Article Soon) We're here to empower you with information & community around perimenopause. Information comes in the form of research backed articles to help provide context and potential next steps AND from tracking you observations so your healthcare team can help you determine the right next step for YOU. Community comes in the form of the people you'll meet as a part of this platform and healthcare team you build to support your journey. Research Tracking Community (Article Soon) Perimenopause is the time before menopause starting with periods becoming irregular until entering menopause. During perimenopause, hormones are often fluctuating a great deal and these fluctuations impact our body, mind, and community. Menopause is said to have occurred once a woman goes 12 months without her period; this typically happens around age 50 (Soules et al, 2001 ). This is a transition for women and our loved ones into some of the best years of our lives. We may not get to chose when or how this journey starts or ends. We can choose what we learn, how we respond, and the support system we build for ourselves . Research has shown how we move through perimenopause impacts the rest of our lives, and we've got a lot of amazing years ahead of us (SWAN ). Our goal is to get to a spot where we're Flourishing Through this phase and into the best years of our lives . Many women report a greater level of confidence and freedom post menopause, and proactive, well-supported navigation of perimenopause makes that outcome more likely ( Avis & McKinlay, 1991 ). Changes linked to Perimenopause. More than 80% of women experience symptoms of menopause which impact their wellbeing and for some symptoms can last through their 70s (Menopause Society ). If you're experiencing these changes, you're not alone, and there are actions which can be taken to help alleviate symptoms. Body . Period irregularity (Irregular cycles), hot flashes, night sweats, sleep disturbances, changes in body composition (weight gain in new places), changes in composition of hair (hair thinning), changes in composition of nails, changes in composition of skin, urinary tract pain, UTIs, vaginal dryness, and painful sex Mind. Mood, Cognition Community. Sex drive, Confidence, Feelings of closeness with friends and loved ones Every journey through menopause is unique so the combination of and intensity of changes will vary from person to person. These changes can continue to impact women for years after menopause has occurred. Evidence suggests how this phase of life is managed can have lasting impacts on a woman's quality of life. Flourishing through provides research based summaries to help women and their loved ones understand perimenopause and its impacts on the well being of your body, mind, and community. All three of these areas of well-being are undoubtedly connected. We've found sometimes looking at a change from a few different angles helps us frame a more complete picture. Actions. Research based summaries and a call to action. These should provide insights on underlying drivers and potential paths forward to make you more informed as you move through this journey and collaborate with your healthcare providers. Self education and advocacy is particularly important in perimenopause since many healthcare providers aren't formally trained in perimenopause and it's impacts (Christmas, M. , 2023 ) Health tracker. We're working to launch health trackers so you can log your changes, track them over time, and have data based conversations with your healthcare professionals. Curated Community Sessions. In 2026, we're hoping to offer curated community sessions which will provide a safe environment for women and their loved ones to connect with individuals who are also going through this journey for shared learning, belonging, and growth. We can't wait to Flourish Through this journey with you and your loved ones. Read theories behind why menopause happens here.

Oral contraceptives can mask perimenopause symptoms by suppressing hormone fluctuations and regulating bleeding. They may also support bone density. The right contraceptive during this transition is highly individual — work with your healthcare provider to find the best fit. Oral Birth Control 25% of women ages 15 - 44 are estimated to be using oral birth control, which is the most common form of contraception in the US. Give me some actionable research TLDR. Oral birth control can impact symptoms and changes experienced during perimenopause and menopause transition. Why are we talking about this? With an estimated 25% of women ages 15 - 44 using it, the oral birth control pill is the most common form of contraception in the US (Cooper & Patel, 2024 ). Understanding their prevalence and their use of hormones to function, it is important for women to understand how their contraceptives may or may not potentially be impacting how they experience perimenopause and menopause. Types of Oral Birth Control. Combined Oral Contraceptives (COCs). These are the most commonly prescribed pills. They contain both progesterone (prevents pregnancy) & estrogen (controls bleeding) (Baird & Glasier, 1993 ) and typically contain 21 days of hormone pills and 7 days of placebo pills which allows for monthly bleeding. The pill is also prescribed for other issues related to menstruation including pain, irregularity (Bishop et al, 1960 ), migraines without aura, and acne (Redmond et al, 1997 ) to name a few (Maguire & Westhoff, 2011 ). Progestin-Only Pills aka POPs or Minipills. These pills contain progestin only. Opill (norgestrel) is the first daily oral contraceptive approved by the FDA for over the counter use without a prescription and fits within this category. Extended Cycle / Continuous Use Pills . These are COCs which provide a much longer time period between hormone free pills and bleeding. These may be packaged as 84 hormone or active pills and 7 placebo inactive pills. Your health care provider may also instruct you on how to use one of the typical COCs in an extended use fashion. Potential Impact of Oral Birth Control on Perimenopause Symptoms & Changes Regular bleeding . Both the COC and Extended Cycle pills described above provide for more regular bleeding and create a sense of predictability around bleeding. For many women, this removes the bothersome element of unpredictable menstrual bleeding which accompanies perimenopause. The regular bleeding via the contraceptive pill removes the period as a physical indicator for entry into perimenopause transition. Age and symptoms are more likely to help your physician figure out where you MAY be. Physical symptom management . For many women, the peaks and valleys of the variable hormone levels of perimenopause are the most bothersome. These hormone fluctuations can contribute to many of the physical, cognitive, mood and sleep symptoms that disrupt daily function. These peaks and valleys are caused by cycles without ovulation, or cycles with multiple ovulations (LOOP cycles). Often physicians will advise to use hormonal contraception to manage this ovulation variability rather than the postmenopause hormone therapy regimens that will not address ovulation. The birth control pills’s mechanism of suppression of ovulation will “clamp” down this hormone variability and thus help a lot with management of symptoms in perimenopause. (It is important to note that some progesterone only pills do not act by blocking ovulation) Bone mineral density . Both the COC and Extended Cycle pills have been linked to an increase in bone mineral density for those women who are in perimenopause or immediately post menopause roughly age 46 - 53 while those who are not on the pill experience a decrease. The bone mineral density for women who are taking birth control pills prior to perimenopause did not seem to be impacted by COCs. (Isley & Kaunitz, 2011 ) Low bone mineral density can lead to a higher risk of fractures late in life. How will I know if I've entered into menopause? The Menopause Society states 90% of women will reach menopause by age 55 and recommends the continued use of contraception until then or menopause is confirmed. It is a complex question to determine if you are in menopause if you’re on an oral birth control pill. If you are NOT at risk for pregnancy, your physician may advise that you stop taking the pill and monitor natural period patterns as they return. If you don’t have a period for 1 year, then you’re in menopause. Some popular websites and medical providers will advocate for hormone testing to determine where in the process you are. This is not likely to be helpful or predictive. Hormone testing has very limited use and can be very expensive. One month to the next, and one day to the next, is highly variable with regards to hormone levels in perimenopause and tell us nothing about what will happen the next month. Birth control pills will impact the hormone levels that are tested. Working with a knowledgeable health provider certified by The Menopause Society will be helpful in guiding you through this transition. Note : If you're on birth control or considering starting birth control, it is VERY important to collaborate with your healthcare team to find the best form of birth control for you. For women in their 40's the type of birth control is more person-dependent than age-dependent. Health risks change as we get older, and this will influence your choice of safe and effective contraceptive management. Your primary care team will be able to help find the right solution for you. (Primary Care Notebook, 2026) The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Flourishing Through collects health data (symptoms, cycle tracking, mental health) under Washington's My Health My Data Act. Data is used to provide services and is never sold. Users can access, delete, or withdraw consent at any time by emailing admin@flourishingthrough.com Consumer Health Data Privacy Policy Flourishing Through, LLC Effective Date: 12.09.2025 This Consumer Health Data Privacy Policy ("Policy") is provided pursuant to the Washington My Health My Data Act ("MHMDA") and applies to Washington residents and any consumer whose consumer health data is collected in Washington State ("you" or "your"). This Policy describes how Flourishing Through, LLC ("Flourishing Through," "we," "us," or "our") collects, uses, shares, and protects your consumer health data. 1. What is Consumer Health Data? Consumer health data is personal information that is linked or reasonably linkable to you and that identifies your past, present, or future physical or mental health status. Under the MHMDA, this includes: Individual health conditions, treatments, diseases, or diagnoses Social, psychological, behavioral, and medical interventions Health-related surgeries or procedures Use or purchase of prescribed medication Bodily functions, vital signs, symptoms, or measurements Diagnoses or diagnostic testing, treatment, or medication Reproductive or sexual health information Biometric data Genetic data Precise location information that could reasonably indicate an attempt to acquire or receive health services or supplies Data that identifies an individual seeking health care services Any information that is used to associate you with health status information that is derived or inferred from non-health data 2. Categories of Consumer Health Data We Collect We collect the following categories of consumer health data: Perimenopause and Menopause related changes: Information about symptoms you experience, including hot flashes, sleep disturbances, mood changes, cognitive changes, and other perimenopause-related symptoms Physical Health Tracking: Information you track regarding your physical health changes, menstrual cycle patterns, and bodily functions Mental Health Information: Information you provide about your mental and emotional well-being during perimenopause Social and Lifestyle Information: Information about social connections, relationships, and lifestyle factors that may impact your perimenopause experience Account and Profile Information: Name, email address, date of birth, and other information you provide when creating your account 3. Sources of Consumer Health Data We collect consumer health data from the following sources: Directly from you: When you create an account, use our mobile application, complete tracking entries, participate in community discussions, or otherwise interact with our services Automatically collected: Usage information from your interactions with our website and mobile application, such as pages visited and features used 4. How We Use Consumer Health Data We collect and use your consumer health data for the following purposes: To provide our services: To enable you to track your perimenopause symptoms, access educational articles and resources, and participate in our membership platform To personalize your experience: To tailor content and recommendations based on your tracked symptoms and interests To facilitate community support: To connect you with support groups and community features (planned for 2026) To improve our services: To analyze aggregate, de-identified data to improve our platform and develop new features To communicate with you: To send service-related communications, respond to your inquiries, and provide customer support To process payments: To manage your subscription and process payments through authorized payment processors To comply with legal obligations: To comply with applicable laws, regulations, and legal processes 5. How We Share Consumer Health Data We share your consumer health data with the following categories of third parties: Service Providers and Processors We share consumer health data with third-party service providers who perform services on our behalf, including: Technology and hosting providers (including Wix and Adalo, Inc.) Affiliates We do not currently share consumer health data with any affiliates. If this changes, we will update this Policy and obtain your consent as required. Specific affiliates that receive consumer health data: None at this time. Other Disclosures We may also disclose your consumer health data: To comply with legal obligations, court orders, or governmental requests To protect our rights, privacy, safety, or property, or that of our users or the public In connection with a merger, acquisition, or sale of assets (with your consent as required by law) 6. Sale of Consumer Health Data We do not sell your consumer health data. If we ever intend to sell consumer health data, we will obtain your separate written and signed authorization before doing so. 7. Your Rights Under the MHMDA Under the Washington My Health My Data Act, you have the following rights regarding your consumer health data: Right to Confirm and Access You have the right to confirm whether we collect your consumer health data and to access such data. You also have the right to receive a list of all third parties and affiliates (with contact information) that have received your consumer health data from us. Right to Delete You have the right to request deletion of your consumer health data that we have collected. Upon verification of your request, we will delete your consumer health data from our systems, including archives and backups, and direct our service providers and any third parties who received your data to do the same. Right to Withdraw Consent You have the right to withdraw your consent to our collection, use, or sharing of your consumer health data at any time. Withdrawing consent will not affect the lawfulness of processing based on consent before its withdrawal. 8. How to Exercise Your Rights To exercise any of your rights under this Policy, you may: Log into your account and access your privacy settings Email us at: admin@flourishingthrough.com We will verify your identity before processing your request. We will respond to verified requests within 45 days of receipt. If we need additional time, we will notify you of the reason and extension period. 9. Consent for Collection and Sharing We will obtain your informed, affirmative consent before collecting your consumer health data. We will obtain separate consent before sharing your consumer health data with third parties (other than service providers performing services on our behalf). You may withdraw your consent at any time through the methods described in Section 8 above. 10. Data Security We implement reasonable administrative, technical, and physical security measures designed to protect your consumer health data from unauthorized access, disclosure, alteration, or destruction. These measures include: Encryption of data in transit and at rest Access controls limiting employee and contractor access to consumer health data to only those who require it to perform their job functions Regular security assessments and updates to our systems Contractual requirements for service providers to maintain appropriate security measures While we strive to protect your consumer health data, no security system is impenetrable, and we cannot guarantee the absolute security of your information. 11. Data Retention We retain your consumer health data for as long as necessary to provide you with our services, comply with our legal obligations, resolve disputes, and enforce our agreements. When you request deletion of your data, we will delete it from our active systems and direct our service providers to do the same. Backup copies may persist in our systems for a limited period but will not be used for any purpose other than disaster recovery. 12. Children's Privacy Our services are not directed to individuals under the age of 18. We do not knowingly collect consumer health data from children under 18. If we learn that we have collected consumer health data from a child under 18, we will delete such information promptly. 13. Changes to This Policy We may update this Consumer Health Data Privacy Policy from time to time. If we make material changes, we will notify you by email or through a notice on our website prior to the changes taking effect. We will also obtain your consent for any material changes to how we collect, use, or share your consumer health data as required by law. The date at the top of this Policy indicates when it was last updated. 14. Contact Information If you have questions about this Consumer Health Data Privacy Policy or wish to exercise your rights, please contact us at: Flourishing Through, LLC Email: admin@flourishingthrough.com 15. Limitation of Liability This Consumer Health Data Privacy Policy describes our practices regarding consumer health data under the Washington My Health My Data Act. For additional information about how we collect, use, and protect other types of personal information, please refer to our General Privacy Policy available on our website. * * * This Consumer Health Data Privacy Policy is effective as of 12.09.2025 and supersedes any prior Consumer Health Data Privacy Policy.

Perimenopause can impact a woman’s sleep with women in perimenopause waking 1.5x on average per night. There are actions which can help alleviate these sleep disturbances. Changes in Sleep Roughly 40% of women in perimenopause are estimated to suffer from changes in sleep. (Kravitz et al., 2003) Give me some actionable research TLDR. Roughly 40% of women in perimenopause are estimated to suffer from changes in sleep. There are actions which can help alleviate these sleep disturbances. Sleep struggles are among the most common experiences women share during perimenopause, affecting roughly 40% of women (Kravitz et al., 2003 ). A systematic review of eight longitudinal studies involving more than 13,000 midlife women found a small but consistent increased risk of sleep disturbance as women move through the menopausal transition, even after adjusting for age, mood, vasomotor symptoms, and health behaviors (Xu et al., 2014 ). For most women, the most familiar culprit is waking during the night, and can also be driven by other physiological challenges like hot flashes (Xu et al., 2014 ; Maki et al., 2024 ; Lampio et al., 2017 ). What changes, and what do we know about why? Sleep is influenced by many things at once — hormones, body temperature, mood, aging, and life circumstances — and during the menopausal transition, several of these are shifting simultaneously. A systematic review of eight longitudinal studies involving more than 13,000 midlife women found a small but consistent increased risk of sleep disturbance as women move through the transition, even after adjusting for age, mood, vasomotor symptoms, and health behaviors (Xu et al., 2014 ). These changes most often involve waking during the night, though they can take different forms for different women (Maki et al., 2024 ; Lampio et al., 2017 ). Vasomotor symptoms (hot flashes and night sweats) Large longitudinal studies consistently find that women who report more frequent or severe vasomotor symptoms also report worse sleep. In a study of 3,045 midlife women across multiple racial and ethnic groups, more frequent VMS were associated with significantly higher odds of trouble falling asleep, staying asleep, and waking early (Kravitz et al., 2008 ). However, when sleep is measured objectively — using polysomnography rather than self-report — the picture becomes more complicated. A large community-based PSG study of 589 women found that peri- and postmenopausal women, despite reporting significantly less sleep satisfaction, actually showed better objective sleep architecture than premenopausal women, including more deep sleep and longer total sleep time (Young et al., 2003 ). Important limitation: 98% of participants in the Young et al. study were white; these findings may not generalize across racial and ethnic groups. One smaller laboratory study found that approximately 69% of objectively recorded hot flashes coincided with an awakening, but that roughly 20% occurred without disturbing sleep at all — and not all nighttime wakefulness was attributable to hot flashes (de Zambotti et al., 2014 ). Sleep disturbances have also been identified in women without vasomotor symptoms, confirming that VMS alone do not explain the full picture (Hung et al., 2014 ). This gap between subjective experience and objective measurement is important: the distress women report is real, even when it doesn't correspond to measurable changes in sleep architecture. Hormonal changes Estrogen and progesterone both appear to influence sleep regulation, and both decline during the menopausal transition. Evidence suggests these hormonal changes may affect sleep independently of hot flashes, possibly through direct effects on brain regions that regulate sleep and body temperature (Haufe & Leeners, 2023 ). Poor sleep also affects reproductive hormone levels through activation of the hypothalamic-pituitary-adrenal (HPA) axis (Klussman et al., 2022 ). Researchers are still working to understand whether hormonal changes cause sleep disruption, sleep disruption affects hormones, or both are true simultaneously. Aging One of the most important and sometimes overlooked contributors is aging itself. Sleep architecture changes naturally as we get older: sleep becomes lighter, more fragmented, and total sleep time tends to decrease (Ohayon et al., 2004 ). A six-year longitudinal study following women from age 46 to 52 found that aging independently worsened sleep continuity regardless of hormonal status (Lampio et al., 2017 ). Because aging and the hormonal transition happen at the same time, separating their effects is genuinely difficult (Guidozzi, 2013 ). Mood Anxiety and depression are strongly associated with sleep difficulties, and the menopausal transition is also a period of increased vulnerability to mood disturbances. The relationship is bidirectional, and both are connected to vasomotor symptoms (Baker et al., 2018 ). Screening for mood disorders is an important part of understanding sleep difficulties during this time. Sleep-specific conditions Beyond general sleep disruption, the menopausal transition is associated with increased rates of certain sleep disorders. Insomnia Insomnia — dissatisfaction with sleep quantity or quality that causes daytime impairment — is among the most common sleep disorders during the menopausal transition. Estimates suggest roughly 37% of women in peri- and postmenopause experience insomnia (Benjafield et al., 2025 ). If you're unhappy with your sleep quantity or quality because of difficulties falling asleep, waking too early, or difficulty staying asleep, insomnia may be the right framework for conversation with your care team (Haufe & Leeners, 2023 ). Sleep-disordered breathing Sleep-disordered breathing, including obstructive sleep apnea, becomes more common and more severe as women progress through the menopausal transition. A longitudinal study of 219 midlife women with repeated in-home PSG studies found that peri- and postmenopausal women had higher Apnea-Hypopnea Index (AHI) scores compared to premenopausal women, even after adjusting for age and BMI (Mirer et al., 2018 ). Importantly, women with sleep-disordered breathing often present differently than the classic picture. Rather than snoring and daytime sleepiness, women may present with insomnia, restless legs, mood disturbances, palpitations, and nightmares — which can lead to underdiagnosis (Lin et al., 2008 ; Baker et al., 2018 ). If you're experiencing these symptoms, raising the possibility of sleep-disordered breathing with your provider — even without snoring — is worth doing. Restless Legs Syndrome (RLS) Restless Legs Syndrome is more common during the menopausal transition, though prevalence estimates vary widely across studies (Salari et al., 2023 ). RLS occurs more often in women (9%) than men (5%), and risk increases with age. One cohort study found that women who underwent bilateral oophorectomy before natural menopause had a 44% higher risk of developing RLS, suggesting hormonal changes may play a role in its onset or worsening (Huo et al., 2021 ). Will this go away on its own? This is hard to answer with certainty — the research is mixed. Some studies suggest sleep difficulties stabilize or improve after the transition to postmenopause; others suggest they persist (Lampio et al., 2017 ; Soares et al., 2026 ). What the evidence does support is that untreated sleep disorders tend not to resolve on their own, and that addressing contributing factors — vasomotor symptoms, mood, sleep hygiene, and where appropriate medical treatment — can meaningfully improve sleep quality (Maki et al., 2024 ). The uncertainty about long-term course is itself a reason to take sleep difficulties seriously rather than waiting them out. You're not alone. Not being able to rely on old habits and patterns to feel like your best self can be really challenging. Know you're not alone. More than half of the women going through perimenopause are also dealing with changes in sleep. The changes may persist into post menopause so addressing any concerns here may help to provide decades of relief. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Shifting estrogen, progesterone, and testosterone during perimenopause affect sexual desire in 40–55% of women. Changes are common, not a personal failing. Effective options exist — early and proactive care makes a meaningful difference Libido aka sexual desire Declining interest in sex is one of the most common symptoms of perimenopause affecting more than 50% of all women (Nappi & Lachowsky, 2009 ) Give me some actionable research TLDR. If you've noticed your interest in sex shifting - feeling less present, harder to access, or just different than it used to be - you're not alone. There are actions we can take to rebuild sexual desire. Changes in libido are among the most common symptoms of perimenopause, affecting more than 50% of women. Given the self stated importance of maintaining an active sex life, this is also something women are looking to address (Nappi & Lachowsky, 2009 ). They’re also among the least discussed, which means many women spend years wondering if something is wrong with them before they learn that what they’re experiencing has a name, a physiological explanation, and real options. This article is here to give you that foundation. Understanding your desire: a different model While spontaneous desire may have dominated our 20's, it isn't the only type of sexual desire. If you don't feel desire out of nowhere but find you're interested once you're actually engaged, that's not lack of desire, its a different kind of desire. You're experiencing responsive desire, and it's a normal, healthy pattern and type of desire, not a problem to fix. Before diving into hormones and research, there’s a framework worth understanding first — one that changes how many women think about their own sexuality and whether anything has actually gone “wrong.” Most of us grew up with an implicit model of sexual desire as something that arises spontaneously — a feeling that shows up on its own and leads to wanting sex. Researchers call this spontaneous desire. It’s the model underlying most sexual scripts we’ve encountered, and it tends to be more characteristic of how desire works for men and for younger women. But research on female sexual response, most notably the work of Dr. Rosemary Basson (Basson. R, 2000 ), describes a different pattern that is equally healthy and far more common in women, especially in longer-term relationships: responsive desire. In this model, desire doesn’t come first. It follows arousal. A woman may have no spontaneous interest in sex, but when she engages — when the context is right, when there is touch, connection, or stimulation — desire and arousal can develop. She may end up excited to be there, even if that's not the level of enthusiasm she started with. This distinction matters enormously during perimenopause. As hormones shift, many women whose desire was previously spontaneous find it becoming more responsive. The shift can feel like a loss when measured against a prior baseline, or against an implicit standard of what desire “should” look like. Understanding that the model itself may have changed — not disappeared — can reframe the entire conversation. What tends to suffer most during perimenopause is not desire itself, but the conditions that activate responsive desire: uninterrupted time, physical comfort, reduced stress, and emotional connection. Many of the approaches discussed later in this article work precisely by restoring those conditions rather than directly targeting desire as an isolated variable. Physiological Foundations How Common Are These Changes? Changes in sexual desire are among the most common — and least discussed — symptoms of the menopausal transition. Despite the prevalence of reduced desire, sex continues to matter deeply. The SWAN cohort — 3,302 women across five racial and ethnic groups — found that over 75% of middle-aged women reported that sex was moderately or extremely important to them (Cain et al, 2003 ). That gap between how much sex matters and how often it’s disrupted is exactly the reason this topic deserves more airtime than it gets. The Hormonal Picture Estrogen, progesterone, and testosterone are the three primary ovarian hormones influencing female sexual function. Their interconnected decline and fluctuation during perimenopause affect desire, arousal, lubrication, and tissue integrity simultaneously. Estradiol (E2): During perimenopause, estradiol production becomes erratic before declining. Estrogen directly supports vaginal and vulvar tissue health, genital blood flow, nerve function, and lubrication capacity. As levels fluctuate unpredictably, many women notice inconsistent arousal responsiveness and increasing vaginal discomfort. Falling estrogen also contributes to vasomotor symptoms — hot flashes and night sweats — which further compound sleep disruption and fatigue, indirect but significant drivers of reduced sexual interest. Progesterone: Progesterone levels decline steadily during perimenopause. Progesterone insufficiency contributes to mood changes, anxiety, and disrupted sleep — all of which are known correlates of decreased sexual desire. Testosterone: Testosterone plays a central role in female sexual motivation, initiating sexual activity and modulating clitoral and vaginal physiology for lubrication, sensation, and engorgement. Unlike estrogen and progesterone, testosterone levels decline gradually and steadily with aging (Davison et al., 2005 ). The Seattle Midlife Women’s Health Study (SMWHS) — a longitudinal cohort of 286 women followed across early reproductive, menopausal transition, and early postmenopausal stages at a single U.S. site — found that women with higher urinary testosterone levels reported significantly higher levels of sexual desire across the transition (Woods et al., 2010 ). Sex Hormone-Binding Globulin (SHBG) and Your Contraception History An important and often overlooked variable is SHBG, a protein that binds both estrogen and testosterone, rendering them biologically unavailable. Oral estrogen formulations — whether in combined oral contraceptives or oral hormone therapy — stimulate hepatic SHBG synthesis through a first-pass liver mechanism, thereby reducing free (bioavailable) testosterone and estradiol. This mechanism is well-documented in research on oral contraceptives (Zimmerman et al., 2014 ) and applies by the same hepatic pathway to oral hormone therapy preparations. Transdermal and vaginal estrogen routes largely bypass this first-pass effect, and therefore do not raise SHBG to the same degree — a clinically relevant consideration when evaluating both contraceptive choices and hormone therapy route in the context of libido. The same hepatic mechanism applies to combined oral contraceptives , which can raise SHBG substantially and suppress free testosterone both through first-pass liver exposure and by directly suppressing ovarian androgen production. Many perimenopausal women arrive in this transition having used combined oral contraceptives for years or even decades, meaning SHBG elevation from contraceptive history may compound the age-related decline in testosterone bioavailability. A thorough libido assessment during perimenopause should therefore include current and recent contraceptive method as part of the clinical picture — and may warrant a conversation about whether the chosen method still reflects your current needs. This is explored further in the section on pharmaceutical options and COCs. Given the varying delivery mechanism for hormonal IUDs , they do not appear to limit free testosterone. Neurological and Central Mechanisms Sexual desire is not solely a peripheral phenomenon. The brain’s reward circuitry — particularly dopaminergic and noradrenergic pathways — drives the motivational aspects of desire, while serotonin activity tends to inhibit it (Pfaus, 2009 ). Declining estrogen affects neurotransmitter balance, which is why mood disorders common to perimenopause (depression, anxiety) are so closely intertwined with changes in sexual interest (Lambrinoudaki et al., 2024 ). The SMWHS longitudinal data found that depressed mood, fatigue, and sleep difficulty were the most consistent predictors of decreased sexual desire — stronger, in multivariate models, than hormone levels alone. The Cascade Effect: Physical Symptoms as Secondary Drivers Hot flashes, night sweats, sleep disruption, and genitourinary symptoms (vaginal dryness, dyspareunia) do not directly cause low libido but create significant barriers to sexual engagement. Dyspareunia — pain during intercourse resulting from genitourinary syndrome of menopause (GSM) — can condition a learned aversion to sexual activity over time, further reducing desire through anticipatory pain response (Brauer et al, 2017 ). The Study of Women’s Health Across the Nation (SWAN) — a prospective longitudinal cohort of 3,302 women aged 42–52 at baseline, recruited across seven U.S. sites and representing five racial/ethnic groups (white, Black, Japanese American, Chinese American, and Hispanic) — confirmed that pain during intercourse often increases as women progress through perimenopause (Avis et al., 2009 ). Will It Come Back? What the Long-Term Research Shows This is one of the questions women most want answered. The honest answer is nuanced: for most women without treatment, libido changes are more likely to persist and gradually progress than to resolve on their own — which is precisely why early assessment and proactive care matter. The most rigorous long-term data come from SWAN. In the 2017 analysis by Avis et al. , which tracked 1,390 women across up to 14.5 years using 5,798 repeated sexual function assessments, the steepest decline occurred in the 20 months before and the year following the final menstrual period. After that, the decline continued but slowed meaningfully. Important limitation: These studies tracked women who were not using hormone therapy, reflecting the untreated natural history. Women using effective treatment may have meaningfully different trajectories. Here's the important nuance SWAN also found: when social, psychological, and health factors were controlled for, perimenopause was not independently associated with changes in the importance women placed on sex, their emotional satisfaction with a partner, or their experience of physical pleasure. Only desire and pain showed a transition-specific decline (Avis et al., 2009 ). The meaning and emotional quality of sex does not have to follow the same trajectory as desire frequency — and for many women it doesn’t. Some postmenopausal women describe a sense of greater ease and freedom in their sexuality once hormonal fluctuation settles and pregnancy concern is gone. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Periodontal disease (gum disease) is an inflammatory condition affecting the gums, the ligament anchoring teeth, and the jawbone, with links to broader health conditions like cardiovascular disease. Shifting estrogen levels during perimenopause and menopause can disrupt the mouth's microbiome, increasing the risk of developing or worsening the disease. Periodontal Disease aka. Gum Disease 1 in 3 women is estimated to experience periodontal disease in her lifetime (Medline) Give me some actionable research TLDR. Changes in hormones impact the dental health. With the right care team and plan disease progression can be managed. Due to lack of menopause certifications for dentists, building a care team in this area may take some extra time and consideration. What is Periodontal Disease? An inflammatory condition affecting gums, the ligament holding teeth in place (periodontal ligament), and jawbone (Mehrotra & Singh, 2023 ). The impacts of periodontal disease aren't limited to the mouth; there is also research linking this to other chronic conditions like cardiovascular disease (Beck et al, 2000 ). This takes hold when there is a shift in the bacterial population and is sustained by the body's own immune response as bacteria feed off of the cells who have come to fight the infection causing a vicious cycle of chronic inflammation (Hajishengallis et al, 2000 ). The link between shifts in estrogen and it's impact on the microbiomes of the body is well documented. This includes the biome in the mouth. As estrogen levels shift potentially impacting the mouth microbiome, there's an increased likelihood of developing periodontal disease in perimenopause and post menopause (Nieto, M. et al, 2025 , Thomas et al, 2025 ). Once it has moved past gingivitis, Periodontal Disease is called Periodontitis and is ranked in terms of severity based on how far the gums are pulling away from the teeth, the amount of bone loss on the teeth, and any tooth loss. The disease is also graded based on how quickly it is progressing. There is no set progression path or timeline (Gasner & Schure, 2025 ). This is important to note, because if you have a mild form of periodontitis you may be at risk for the disease to progress more quickly as you enter into perimenopause and menopause. Symptoms & Diagnosis from the Mayo Clinic Swollen or puffy gums bright red, dark red, or dark purple gums, gums which feel tender when touched gums that bleed easily spitting out blood when brushing or flossing bad breath that won't go away pus between teeth and gums loose teeth painful chewing receding gums a shift in the teeth A dentist or periodontist can provide a diagnosis if you're concerned about periodontal disease. Those who are also experiencing dry mouth may be at increased risk for periodontal disease (Mayo Clinic ) This is a disease which typically progresses slowly over time, so regular cleanings with your dentist can help catch this early and provide you with mitigation strategies. Additional research addressing the oral health concerns of women in perimenopause and post menopause is needed to inform women and to guide health care providers as they practice (Thomas et al, 2025 ) The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Flourishing Through collects account, health tracking, and usage data to deliver and improve its services. Personal data is never sold. The company complies with Washington's My Health My Data Act, giving users rights to access, delete, and export their data. Privacy Policy Privacy Policy - the basics Flourishing Through LLC Effective Date: 10.01.2025 Last Updated: 12.09.2025 1. INTRODUCTION Welcome to Flourishing Through ("we," "our," or "us"). We are committed to protecting your privacy and being transparent about how we collect, use, and share your information. This Privacy Policy explains how we handle your personal information when you: Visit our website at [website URL] Use our mobile application ("App") Subscribe to our membership services Interact with our content and community features By using our services, you agree to the collection and use of information in accordance with this Privacy Policy. If you do not agree with this policy, please do not use our services. 2. INFORMATION WE COLLECT 2.1 Information You Provide Directly Account Information: Name and email address Username and password Payment information (processed by third-party payment processors) Subscription preferences Profile Information: Age or date of birth General health interests and goals Communication preferences Health and Wellness Tracking Data: Physical changes you choose to track Mental health observations you choose to record Social well-being notes you choose to document Personal journal entries and notes Community Participation: Posts, comments, and messages in community features Feedback and survey responses 2.2 Information Collected Automatically Usage Information: Pages viewed and features accessed Time spent on different sections Articles read and content interactions Search queries within the platform Device Information: Device type and operating system Mobile device identifiers IP address Browser type and version Analytics Data: App performance data Error reports and crash logs General usage patterns and statistics 2.3 Information from Third Parties Payment confirmation from Apple App Store or Google Play Store Authentication information if you use social login (future feature) 3. HOW WE USE YOUR INFORMATION We use your information for the following purposes: Service Delivery: Provide access to membership content and features Process and manage your subscription Enable tracking and journaling features in the App Deliver personalized content recommendations Communication: Send account-related notifications Provide customer support Send newsletters and updates about our services (with your consent) Notify you about changes to our services or policies Improvement and Development: Analyze usage patterns to improve our services Develop new features and content Conduct research on perimenopause and women's health (in aggregate, de-identified form) Troubleshoot technical issues Legal and Safety: Comply with legal obligations Enforce our Terms of Service Protect against fraud and abuse Defend our legal rights 4. WASHINGTON STATE HEALTH DATA PROTECTIONS 4.1 My Health My Data Act (MHMDA) Compliance As a Washington State-based company collecting health data from Washington consumers, we comply with the Washington My Health My Data Act (RCW 19.373). Consumer Health Data includes information that: Identifies or is reasonably capable of being associated with you, AND Relates to your past, present, or future physical health, mental health, disability, diagnosis, or healthcare Your Rights Under MHMDA: Right to Access: You can request access to your consumer health data Right to Delete: You can request deletion of your consumer health data Right to Withdraw Consent: You can withdraw consent for processing at any time Right to Data Portability: You can receive your data in a portable format Our Commitments: We will not sell your consumer health data We will not share your health data without your explicit consent, except as required by law We implement reasonable security measures to protect your health data We conduct regular security assessments We limit access to health data to authorized personnel only 4.2 Geofencing Restrictions We do not: Use geofencing technology around healthcare facilities Collect location data to identify individuals seeking health services Track your visits to health-related locations 5. HOW WE SHARE YOUR INFORMATION We do not sell your personal information or consumer health data. We may share your information in the following limited circumstances: Service Providers: Payment processors (Apple, Google) to process subscriptions Cloud hosting providers for data storage Analytics providers to understand usage patterns (using de-identified data when possible) Email service providers for communications All service providers are contractually obligated to protect your information and use it only for the purposes we specify. Legal Requirements: When required by law, regulation, or legal process To protect our rights, property, or safety To prevent fraud or security threats In connection with legal proceedings Business Transfers: In the event of a merger, acquisition, or sale of assets, your information may be transferred (you will be notified of any such change) With Your Consent: When you explicitly authorize us to share information For community features, as described in Section 11 Aggregated Data: We may share de-identified, aggregated data for research or informational purposes 6. DATA SECURITY We implement reasonable administrative, technical, and physical security measures to protect your information, including: Encryption of data in transit and at rest Secure authentication protocols Regular security assessments and updates Limited access to personal data on a need-to-know basis Employee training on data protection However, no method of transmission over the internet or electronic storage is 100% secure. While we strive to protect your information, we cannot guarantee absolute security. 7. DATA RETENTION We retain your information for as long as necessary to: Provide our services to you Comply with legal obligations Resolve disputes Enforce our agreements Account Data: Retained while your account is active and for a reasonable period after closure (typically 90 days, unless legally required to retain longer) Health Tracking Data: Retained according to your preferences; you can delete this data at any time through the App Financial Records: Retained as required by law (typically 7 years for tax purposes) Anonymous Usage Data: May be retained indefinitely in aggregated form 8. YOUR PRIVACY RIGHTS 8.1 General Rights Access: Request access to the personal information we hold about you Correction: Request correction of inaccurate information Deletion: Request deletion of your information (subject to legal retention requirements) Opt-Out: Unsubscribe from marketing communications Data Portability: Receive your data in a portable format 8.2 Washington State Residents If you are a Washington resident, you have additional rights under MHMDA (see Section 4.1) and the Washington Privacy Act (if enacted). 8.3 How to Exercise Your Rights To exercise any of these rights, contact us at: Email: privacy@flourishingthrough.com In-App: Settings > Privacy > Submit Request Mail: [Physical Address] We will respond to your request within 45 days (or as required by applicable law). 9. CHILDREN'S PRIVACY Our services are intended for adults aged 18 and over. We do not knowingly collect information from children under 18. If we discover we have collected information from a child under 18, we will delete it promptly. 10. THIRD-PARTY SERVICES 10.1 Payment Processing Subscription payments are processed through: Apple In-App Purchase (for iOS users) Google Play Billing (for Android users) Wix Payments (powered by Stripe) for website-based memberships and services These services are governed by Apple's, Google's, and Wix's respective privacy policies. We receive only confirmation of payment, not your payment card details. 10.2 Third-Party Links Our services may contain links to third-party websites or resources. We are not responsible for the privacy practices of these third parties. We encourage you to review their privacy policies. 11. COMMUNITY FEATURES 11.1 Current Features Currently, community features are limited. Any future community features will include: Clear privacy controls Options to participate with a username 11.2 Future Community Groups (Planned 2026) When we launch community support groups: You will be able to control what information you share Group interactions may be visible to other group members We will provide detailed privacy settings before launch Moderators may have access to group content for safety purposes 11.3 User-Generated Content Any information you choose to share in community features may be visible to other members. Do not share: Sensitive personal health details you wish to keep private Information that identifies you if you prefer anonymity Protected health information covered by HIPAA 12. INTERNATIONAL DATA TRANSFERS Our services are based in the United States. If you access our services from outside the U.S., your information will be transferred to and processed in the United States, which may have different data protection laws than your jurisdiction. 13. CALIFORNIA RESIDENTS If you are a California resident, you may have additional rights under the California Consumer Privacy Act (CCPA). Please contact us for information about exercising these rights. 14. COOKIES AND TRACKING TECHNOLOGIES 14.1 What We Use Essential Cookies: Required for the App and website to function Analytics Cookies: Help us understand how users interact with our services Preference Cookies: Remember your settings and preferences 14.2 Your Choices You can manage cookie preferences through: Your device settings Browser settings (for website) App settings > Privacy Note that disabling certain cookies may limit functionality. 15. DO NOT TRACK SIGNALS Our services do not currently respond to "Do Not Track" browser signals, as there is no universally accepted standard for how to respond to such signals. 16. CHANGES TO THIS PRIVACY POLICY We may update this Privacy Policy periodically to reflect: Changes in our practices New legal requirements Additional features or services We will notify you of material changes by: Posting the updated policy with a new "Last Updated" date Sending an email notification to registered users Displaying a prominent notice in the App Your continued use of our services after changes take effect constitutes acceptance of the updated policy. 17. CONTACT US If you have questions, concerns, or requests regarding this Privacy Policy or our privacy practices: Email: admin@flourishingthrough.co Response Time: We will respond to privacy inquiries within 10 business days. 18. DISPUTE RESOLUTION Any disputes regarding privacy or personal information will be subject to the dispute resolution provisions in our Terms of Service, including: Initial good-faith negotiation Arbitration (if required) Governing law: Washington State CONSENT ACKNOWLEDGMENT By using Flourishing Through's services, you acknowledge that you have read, understood, and agree to this Privacy Policy. For Washington residents: You acknowledge your rights under the My Health My Data Act and consent to our collection and processing of consumer health data as described in this policy. Flourishing Through

Menstrual cycle changes are often one of the first signs of perimenopause. In early perimenopause, rising FSH causes cycles to shorten; over time they become longer and more irregular, with gaps of 60 days or more common toward the end of the transition. The STRAW framework maps these stages to help women and providers understand where they are. This phase has a definitive end — menopause is confirmed one year after the final menstrual period. Changes in Menstrual Cycle aka. Changing cycle times This can be one of the first signs of perimenopause. Give me some actionable research TLDR. Changes in period or menstrual cycles are commonly associated with perimenopause. What to expect varies based on the stage of perimenopause you're in. Towards the end of perimenopause, it is common for women to have menstrual cycles which last 60 days or more. Cycle irregularity has been linked to reproductive aging (we don’t love this wording either, but it’s how the medical field refers to this) and more importantly these irregularities can provide a window into how your hormone levels are shifting. The Stages of Reproductive Again Surrounding the Menopausal Transition have been studied and established well enough to create a framework called STRAW. STRAW: Stages of Reproductive Aging Surrounding the Menopausal Transition (Soules et al, 2001 ) *This update to FSH levels and likelihood of symptom presence was added in the 2012 update to the STRAW Framework (Harolow, et al, 2012 ) What causes periods to become irregular? FSH . As women age, we have less follicles. As we enter into early perimenopause, there is an increase in FSH (follicle stimulating hormone) which gets follicles to mature more rapidly and as a result, menstrual cycles are often shortened in the early phases of perimenopause (Santoro, 2016 ) LOOP Cycles (aka luteal-out-of-phase events). This happens when ovulations happen in really short succession, think multiple ovulations between periods. This can be associated with other hormone fluctuations which drive additional irregularities (Santoro, 2016 ) Over time, these short menstrual cycles will give way to longer and longer menstrual cycles You're not alone. Periods will eventually stop and a woman is in menopause one year after her last period. So, this is a phase which will eventually end. Not knowing when your period is coming and what it might look like can be particularly challenging if you've been fairly regular for decades. This can be a big change, and change can be hard. Know you're not alone. This is a natural transition, has a definitive end with menopause. Women all over the world are going through this change with you. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Declining estrogen narrows the body's temperature comfort zone, causing hot flashes and night sweats in 80% of women — lasting an average of 10 years. Symptoms disrupt sleep, mood, and daily function. Effective hormonal and non-hormonal treatments exist. Hot Flashes & Night Sweats aka. Vasomotor Symptoms Roughly 80% of women experience hot flashes, which llast an average of 10 years and average 4 - 20 per day (Avis et al, 2018 ) Give me some actionable research TLDR. Changes in hormones can impact the body's temperature comfort zone. Vasomotor Symptoms (aka Hot Flashes and Night Sweats ) are experienced by 80% of women and last approximately 10 years on average. Hot flashes are a sudden sensation of warmth that typically will last for about 15 minutes, and will vary in impact on activities. Some women experience them as a mild sensation of heat, but they can be severe enough to significantly disrupt activity. During a “severe” hot flash, it is difficult to continue normal activity. Hot flashes most often will peak in the late perimenopause and the few years of postmenopause, but it is highly variable. Most women eventually have improvement in hot flashes, but some are “superflashers” and have symptoms that start earlier in the transition and last longer. Night sweats are thought to be due to a similar phenomenon occurring during sleep and they can significantly disrupt sleep. What causes hot flashes & night sweats? As the ovary makes less estradiol, a group of neurons called the KNDy neurons (kisspeptin - neurokinin B - dynorphin) become overactive, which in turn causes the temperature regulation center of the hypothalamus to have a narrowed “comfort zone” of temperature. Small variations in temperature that would have previously been fine for the body now prompt large responses of flushing and sweating (Deecher and Dories, 2007 and Rapkin, 2006 ). Relationship to other symptoms Newer research also suggests that patients with vasomotor symptoms may also have a higher rate of other complications such as cardiovascular disease (Thurston et al, 2021 ), low bone density (Anagnostis et al, 2024 ), high blood pressure (Lee et al, 2024 ), and cognitive decline (Thurston et al, 2023 ). It is unclear at this time if severe vasomotor symptoms cause the health issues, or if they are associated with the health issues. Ongoing research is needed. The data are complex around the question of: “will treatment of the vasomotor symptoms reduce my risk?”. There are specifics of age, timing of menopause, personal medical history and goals that need to be discussed with your physician that will impact how this question is answered for you. The primary reason to treat vasomotor symptoms is the significant impact on sleep and daily function that it can have on many people. The lack of sleep can make mood regulation and brain fog symptoms worse. There are treatments that are effective, both hormonal and non-hormonal. You're not alone. Not knowing when hot flashes might be coming and knowing those around you can see what's happening can be incredibly difficult and may feel isolating. Know you're not alone in dealing with these changes, and that these changes typically end in post menopause. Leverage your support network to make adjustments, seek additional options if what you try initially doesn't work, and emotional support as you navigate this new phase of life. The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer . Want more research like this, but not ready to join yet? Get our free Perimenopause Starter Guide and email updates on content delivered to your inbox. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Flourishing Through is seeking the input of founding members to shape the future of our platform. Flourishing Through will be running a three month test for Founding Members which will enable your voice to shape the future of our platform. Before we kick off, we'll start with some brief phone calls to understand what you'd find valuable. Time commitment for feedback is estimated to be less than 90 minutes a month. We're still working through the details and will share more with those who are interested! I am excited about participating in Flourishing Through's Founding Test Member Group! * I am 18+ years old Email* User Name * Submit The information provided on the Flourishing Through website and mobile application is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. For additional information view our Medical Disclaimer .

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