What Is Perimenopause? Dr. Mary Claire Haver Says the First Sign Is ‘I Don’t Feel Like Myself’
The ob-gyn reveals it took her a decade to recognize the symptoms in herself
You know that nagging feeling—the one where you catch yourself mid-sentence, foggy and frustrated, or snap at someone you love over something small, then spend the rest of the day wondering what just happened? If you’re over 40 and the phrase “I don’t feel like myself” has crossed your mind (or your lips), it could be the single most telling sign that you’ve entered perimenopause. But what is perimenopause, exactly, and what are the symptoms women should be aware of?
Mary Claire Haver, MD, is a board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author. She recently sat down with Woman’s World editor-in-chief Liz Vaccariello on her podcast What Matters With Liz to talk about what she’s learned both as a physician and as a woman who went through it herself. Her new book, The New Perimenopause, lays out a detailed roadmap for a phase of life that too many of us enter blind.
And her starting point? Those five key words so many of us have found ourselves uttering.
Woman's World Answers
There’s no test confirm perimenopause
When a woman over 40 walks into Dr. Haver’s office and says she doesn’t feel like herself, it’s a significant signal that perimenopause may have begun. Dr. Haver acknowledged that a doctor will still want to run tests to rule out other conditions such as thyroid issues or inflammation. But she described that sentiment as “a predictable biological response to hormonal chaos.” Sleep disturbances, she noted, are another good hint.
Here’s the frustrating part: There’s no simple blood or urine test that can confirm perimenopause. No lab result will light up and say, “This is it.” That’s why so many women spend months—sometimes years—searching for an explanation that keeps eluding them.
How menopause differs from perimenopause
As Dr. Haver explains, menopause itself is actually one single day in a woman’s life: the day she runs out of eggs. Human females, she notes, are unique among mammals in that we are born with our entire egg supply. Those eggs deteriorate with age through a normal process called atresia. When a woman is born, she has one to two million eggs. By the time she reaches 30, she’s down to roughly 10 percent of that supply. By 40, she’s down to about three percent.
At menopause, there are no more eggs left. The cells surrounding each egg are where estrogen, progesterone and testosterone are produced. When the eggs are gone, those hormones are done too. But perimenopause is really about what happens in the years leading up to that moment. And it starts not in the ovaries, but in the brain.
What is perimenopause?
Dr. Haver describes perimenopause as “the zone of chaos,” and once you understand what’s actually going on inside your body during this transition, that phrase makes perfect sense.
Here’s how it works: The ovaries don’t operate independently; they receive signals from the brain. “The brain sends signals saying, ‘Estrogen is low—let’s stimulate these cells to create hormones,’” Dr. Haver explained. In a premenopausal person with a regular cycle, that creates a predictable monthly ebb and flow, “like an EKG.”
Perimenopause disrupts that. A critical egg threshold is reached, and the ovaries become resistant to the brain’s signals because there aren’t enough eggs to maintain the feedback loop. “The brain gets frustrated. It sends more and more stimulating hormone trying to force ovulation,” she said. “And when ovulation does finally happen, you get these wild spurts of estrogen followed by crashes—and the progesterone never quite keeps up like it used to.”
The analogy she used to describe the resulting hormone pattern: “Take spaghetti and throw it at the wall. That’s what the hormone levels look like. On a downward trend until you reach zero.”
Why your brain feels it first
According to Dr. Haver, this process can last up to 10 years, and its earliest effects are neurological. “The top two things you’re going to feel first are brain fog and mental health changes: mood shifts directly related to your norepinephrine, serotonin and dopamine levels,” she said.
That explains why so many of us reach for psychological explanations first. The mood swings, the fog, the emotional volatility—these feel like mental health issues because they present that way. But the underlying driver, according to Dr. Haver, is hormonal.
She described what she calls “the loss of hormones” as having “a domino effect on social interactions, mental health, cognitive health, heart health, brain health, bone health.” But knowing the signs could help your doctor connect the dots sooner.
Dr. Haver missed the symptoms of perimenopause herself
For years, Dr. Haver said she didn’t recognize what was happening. She recalls the week each month when she went off her birth control pill to have her period—seven days without hormones. During those days, she describes being “out of my mind.” “The things I said to my children. My resilience was off. I would fly off the handle for the littlest thing,” she recalled during the podcast. “I kept thinking, ‘This isn’t me. Who is this woman?’”
Vaccariello shared that several years ago, she, too, went through what she now knows was perimenopause. But at the time, she had no framework for understanding it. “I had gained 10 pounds even though I was exercising constantly and cooking all my own meals. I had mood swings, crying every day,” she recounts. “I didn’t know if it was the pandemic, perimenopause or the fact that I was parenting teenagers.”
For Dr. Haver, “It took about 10 years to look back and realize this was biology, not psychology,” she said. “This was a predictable response to what my body was going through.” Ten years. That’s how long it took an ob-gyn to connect the dots in her own body. If you’ve been struggling to make sense of changes you can’t quite explain, give yourself some grace.
Why you shouldn’t fear perimenopause
Dr. Haver was clear that she doesn’t want women to approach perimenopause with dread. “I don’t want women to be scared of it. This can be a brilliant transition,” she said. “It really is a time when a lot of women are cutting the fat out of their lives, focusing on what really matters, being forced to say: I can’t be all things to all people. I have to take care of me first.“
Dr. Haver’s mission, as she describes it, is ensuring “that women can approach this transition, go through this transition and live the next 30 years of their life with agency and education and options.”
What you can do right now
Here’s what you can take from her approach: Start a conversion with your doctor and ask about perimenopause. Track your symptoms, knowing that the early warning signs are often neurological (brain fog, mood changes). And finally, understand that what you’re feeling isn’t your body being “broken,” it’s a normal biological process.
Check out Dr. Haver’s upcoming book, The New Perimenopause, and her conversation on What Matters With Liz for a detailed roadmap on understanding what’s ahead—or what’s already underway.
Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.
Conversation
All comments are subject to our Community Guidelines. Woman's World does not endorse the opinions and views shared by our readers in our comment sections. Our comments section is a place where readers can engage in healthy, productive, lively, and respectful discussions. Offensive language, hate speech, personal attacks, and/or defamatory statements are not permitted. Advertising or spam is also prohibited.
