Lifestyle•Feb 25, 2026

How Perimenopause and Menopause Affect Your Body

By The Sculpt Society

Perimenopause and menopause are huge life shifts, but so many women face them without the right guidance, support, or care. The physical and emotional changes that come with midlife are a lot to process, with a wide range of symptoms that can be all over the place. To give women more clarity on perimenopause and menopause symptoms, The Sculpt Society has partnered with Midi Health—a women-founded virtual healthcare company dedicated to providing expert, personalized, insurance-covered care for midlife in all 50 states. We’re thrilled to have Dr. Mindy Goldman, Chief Clinical Officer at Midi Health and a nationally recognized menopause expert, to walk us through the science. She’s a longtime UCSF OB/GYN Clinical Professor who has helped shape national guidelines for menopause and cancer survivorship care. Together, we're pulling back the curtain on what's really happening inside your body during perimenopause and menopause…because understanding the why behind your symptoms is the first step toward feeling like yourself again.

Hormonal fluctuations in midlife

Perimenopause doesn't kick off with a single dramatic shift—rather, hormones like estrogen and progesterone fluctuate unpredictably for years before menopause officially arrives (which is why symptoms can feel so random and hard to pin down). The ripple effects of these fluctuating hormones can show up almost anywhere: sleep disruption, mood changes, anxiety, brain fog, hot flashes, night sweats, joint pain, itchy ears, and more. For decades, many women were told these experiences were simply part of aging, but that narrative is changing, along with our understanding of hormone therapy. Modern hormone therapy (MHT) can be highly effective for many women when appropriately prescribed—treatment options range from oral medications to patches, gels, and vaginal formulations; and testosterone is increasingly recognized as an important piece of the puzzle (for some women, not everyone). That being said, hormone therapy isn't the right fit for everyone, and it’s not a cure-all (movement and mental health support also help alleviate symptoms). It’s important to work with menopause-trained clinicians who’ll treat your symptoms, not just your labs. Midi Health takes a personalized approach; virtually connecting women with providers who listen first, then create care plans that reflect patient history, symptoms, and goals.

Hot flashes and night sweats

Hot flashes and night sweats are actually the same physiological phenomenon (occurring at different times of day) and they're rooted in a surprising place: the brain. As estrogen levels fluctuate during perimenopause and menopause, the hypothalamus, which acts as the body's internal thermostat, becomes hypersensitive to even the smallest changes in core body temperature. This triggers an outsized heat response that can feel like it comes out of nowhere. At night, this same mechanism interrupts the body's natural temperature drop that's essential for deep sleep, and even if you fall back asleep quickly after a night sweat, your quality of sleep is compromised—setting off a ripple effect of fatigue, brain fog, and often even more hot flashes the following day. Alcohol, caffeine, spicy foods, and overexertion can all worsen symptoms, but there’s no universal list of triggers. Stress also plays a significant role in worsening perimenopause and menopause symptoms—periods of high stress can trigger negative side effects like hot flashes, poor sleep, and brain fog. The good news is that many effective options exist—from hormone or non-hormonal treatments, to lifestyle supports like improving your sleep environment and better managing stress—and Midi Health’s virtual care model makes it easier than ever to connect with menopause-trained clinicians who can help.

Brain fog, insomnia, and fatigue

Feeling forgetful, unfocused, or exhausted are all hallmarks of perimenopause and menopause. Estrogen plays a significant role in brain function, neurotransmitter regulation, and energy metabolism, so when levels begin to fluctuate, the effects show up cognitively and physically in ways that can feel deeply disorienting. Poor sleep makes everything harder; even if you’re in bed long enough, hormonal changes can disrupt your body’s natural sleep patterns, so you may miss the deep, restorative rest your brain and body need. Cortisol adds another layer of complexity: chronic stress elevates cortisol, which in turn disrupts sleep, blunts stamina, and accelerates that familiar cycle of fatigue creating more fatigue. Think of low energy not as a willpower issue, but a neurological and hormonal one—which means the fix isn’t pushing harder, but supporting your body with good food, quality sleep, stress management, and movement that feels restorative. When fatigue, brain fog, and insomnia start affecting your daily life, it’s worth it to seek medical support. Midi Health’s menopause-trained providers can help you sort out what’s hormonal, what's not, and come up with a personalized plan to help you feel better.

During perimenopause and menopause, your body changes in ways that are difficult to predict. Every woman's midlife journey looks different, which is exactly why personalized, informed care matters so much more than generic advice or being told your symptoms are “just part of aging.”. Learning what’s happening in your body, from hormones to symptoms, is a powerful first step, and you don’t have to navigate it alone. Midi Health offers expert, compassionate, insurance-covered care to help you feel supported and informed.

Please note: This post is intended for education and support only, and should not be considered a substitute for professional medical advice, a diagnosis, or a treatment plan. If you’re experiencing perimenopause symptoms or have additional questions about perimenopause, please speak to a qualified healthcare professional.

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