The 7 Things I’d do if I was starting perimenopause over again:
Now let me take you back to the summer of 2020.
I had just given birth to my fourth baby.
The previous five months had been a whirlwind – pandemic chaos, hospital restrictions, fear and fatigue (actually, exhaustion).
I was working full-time as a midwife in a busy practice, navigating endless on-call nights, running on adrenaline and caffeine, trying to hold it all together for everyone else.
When my maternity leave started, I thought I’d go back.
I even told myself I should. Many, many times.
But somewhere in those postpartum weeks, something in me shifted.
Two days before my maternity leave expired, I resigned.
That moment was both terrifying and freeing.
It was the first time in my career I chose myself.
Postpartum is a period of massive hormonal change. Estrogen and progesterone fall off a cliff. And if you’re breastfeeding, your hormones stay profoundly suppressed for months – sometimes longer.
You go from the highest highs of late pregnancy to some of the lowest lows you’ll ever experience hormonally.
And somewhere in that crash, a kind of clarity emerged.
Call it motherhood.
Call it wisdom.
Or call it hormones.
I suddenly couldn’t tolerate suffering anymore.
Not for my patients. And not in myself.
The sleepless nights, the stress, the heartbreak of the work – it had created a storm in my body.
My metabolism was shot.
My cycles were exhausting.
My brain was tired.
I knew enough to know I couldn’t keep going like that. And what I knew to do about it wasn’t precise enough.
If I had to do it all over again, here’s exactly where I’d start….
1. Trim what’s not essential
You cannot heal, or thrive, if your life is full of noise.
Midlife health requires margin.
And that means cutting the things that drain you: the unnecessary obligations, the relationships that take more than they give, the commitments that sound good but don’t serve your current priorities.
Your hormones are already placing new demands on your system.
You need bandwidth for that work: for nourishment, for rest, and for recalibration.
Start saying no more often. NO. It’s a one word sentence. Fully complete.
The freedom you’ll feel will initiate a cascade of healing.
2. Start tracking your cycles, and your hormones too
Knowledge is agency.
And when it comes to your hormones, no one will hand that agency to you. You have to take it.
Most providers still give you blank stares if you ask to check your hormones.
But the good news?
You don’t have to wait for permission anymore.
I use an Oura ring, Natural Cycles, and a Mira monitor to track my body in real time.
These tools show me patterns that no single lab draw could.
Start by determining when you ovulate (if you still get a cycle).
Then, note your symptoms: sleep, mood, energy, digestion, and start associating them with points in your cycle.
Even if you’re postmenopausal and on HRT, the Mira can help you see fluctuations in your estrogen from day to day.
That data helps you tune in to what your body actually feels like at different levels of balance.
This isn’t about perfection.
It’s about awareness.
Awareness is essential for healing.
3. Prioritize sleep like it’s your job
I know. Everyone says this.
But few women understand why it matters so much in midlife.
Sleep isn’t just restoration, it’s biochemical repair.
When we don’t sleep deeply, we can’t clear glutamate, the excitatory neurotransmitter that builds up in our brain during waking hours.
Over time, too much glutamate contributes to anxiety, brain fog, and even neuroinflammation.
And without enough REM, we can’t integrate new memories, process emotion, or grow spiritually and intellectually.
Sleep is where your brain becomes resilient.
Where your spirit catches up to your body. It’s how you use midlife as a portal for transformation.
Without it, your growth stagnates.
Track your sleep the way you track your hormones (if you like to track and it feels supportive).
Notice the connection between sleepless nights and hormonal phases.
Low estrogen? Progesterone drop? You’ll see it.
Once you understand the pattern, you can start to work with it, adjusting timing, light exposure, meals, and movement to support deeper rest.
4. Move your body, every day, with joy
The key word here is JOY. You should like it!
Movement shouldn’t feel like punishment. It should feel like coming home to yourself.
For me, that’s Pilates. It’s not just the workout, it’s the people.
We cheer each other on. We show up even when we’re tired.
That sense of belonging keeps me consistent.
If you live somewhere cold, get a walking pad.
If you can, make a post-dinner walk a nightly ritual.
Walking after meals is one of the simplest and most powerful ways to improve insulin sensitivity.
And insulin resistance starts creeping up in midlife whether you notice it or not.
Your goal isn’t to chase calories. It’s to create rhythm, strength, and connection.
5. Ditch processed foods, and build a system that works
Forget perfection.
Forget the next diet trend.
The goal is to make real food your default.
That might mean finding a local meal service that does the heavy lifting for you.
Or keeping a few cookbooks in rotation that make you actually want to cook.
Or even using AI to meal plan around your family’s preferences.
What matters is that whole foods, protein, fiber, and plants, make their way into your home and onto your plate, consistently.
Aim for at least 30 grams of fiber a day and 1–1.2 grams of protein per pound of body weight.
Yes, really.
Undereating protein is one of the fastest routes to fatigue, digestive issues, and loss of muscle and bone density.
Your body can’t repair what it doesn’t have the building blocks for.
And as hormones shift, so does your metabolism – so feed it well.
6. Replace alcohol, or let it go entirely
I know this one’s uncomfortable.
But midlife is not forgiving when it comes to alcohol.
It disrupts sleep.
It impairs detoxification.
It worsens anxiety and interferes with the very neurotransmitters that keep you calm and steady.
And if you have a family history of breast cancer, it’s simply not worth the risk.
Start by replacing it a few nights a week.
Try adaptogenic mocktails, sparkling waters with herbs or bitters, or a magnesium-rich tea ritual.
You’ll feel the difference fast, especially in your sleep and mood.
7. Find your medical partner
You can’t do this alone.
Even I don’t.
Every woman deserves a partner in her health – someone who can see the full picture, decode her labs, and help her connect the dots between symptoms and systems.
Find that person.
Get comprehensive labs.
Track trends over time.
Look for patterns, not isolated numbers.
And if it looks like menopause is ten or fewer years away, start hormone therapy.
Recent data out of Case Western suggests that starting earlier is protective: women who begin HRT early, ten years before menopause, have dramatically lower rates of breast cancer and cardiovascular issues. The results are not conclusive, but confirm what I see every day – hormone decline takes many years, and is the catalyst for metabolic fall-apart. In other words, loss of estrogen ignites inflammation, immune system issues and leaves women more vulnerable to all disease.
Early intervention is always my goal.