Perimenopause: The Plot Twist Nobody Warned Us About

You’re not alone and it’s not the end of the world. This is what you can do if you think you’ve entered perimenopause.

There comes a moment in many women’s lives when they find themselves standing in  the kitchen, wondering why they walked in there, while simultaneously sweating through their pajamas in the middle of July with the AC blasting and suddenly feeling irrationally annoyed  that someone is breathing too loudly. 

We all know it’s coming, yet somehow no one actually explains it. 

We prepare girls for puberty. We teach kallahs about marriage. We talk about pregnancy, birth, nursing, and postpartum recovery. But menopause? It often gets summarized with one sentence: “You’ll probably have hot flashes.” 

Well… yes. 

But that’s a bit like describing motherhood as “occasionally being tired.” 

Menopause is officially defined as twelve consecutive months without a menstrual period.  But the transition, called perimenopause, can begin years earlier, often in your forties (and sometimes even your late thirties). During this time, estrogen and progesterone don’t simply decline in a neat,  orderly fashion—they fluctuate dramatically. Think less graceful sunset and more emotional  roller coaster. 

That hormonal unpredictability affects nearly every system in the body. 

Sleep may suddenly become elusive. Anxiety can appear in women who have never  considered themselves anxious. Mood swings become less “I’m emotional” and more “I cried  because the grocery store rearranged the cereal aisle.” This explains why you might wake up  sweating, spend the afternoon freezing, forget your best friend’s phone number, cry during a  commercial, and feel completely normal again by bedtime. 

Memory may feel less reliable. Concentration becomes harder. Energy changes. Joints ache. Migraines may appear or disappear. The body stores fat differently. Skin changes. Hair changes. Libido changes. 

And yes, sometimes you feel hot enough to roast marshmallows. 

Menopause often arrives during an incredibly full season of life. Many are caring for aging parents while still raising children. Some are becoming grandmothers. Careers are  demanding. Community responsibilities continue. There are simchas to celebrate, meals to  prepare, guests to host, and everyone still expects you to remember who needs white shirts for  tomorrow. Oh, and it’s somehow Thursday again, and Shabbos somehow still needs to happen  every single week. 

It is no wonder that so many women assume they’re simply “not handling life as well as  they used to.” 

But this isn’t a character flaw: it’s biology.

The good news is that these symptoms are highly treatable. Whether it’s simple over-the-counter products, prescription medications, pelvic floor therapy, or working with a knowledgeable healthcare provider, help exists. You don’t have to simply live with it.  And this list is only the beginning. 

A Few Things You Can Do Today 

You don’t have to figure everything out overnight, but there are a few evidence-based steps that  can make a meaningful difference: 

Don’t suffer in silence. If something feels different—whether it’s sleep, mood, memory,  hot flashes, or intimacy—bring it up with your healthcare provider. These symptoms are  common, and many are highly treatable. 

Know that hormone therapy has changed. Hormone replacement therapy (HRT) isn’t  right for everyone, but for many healthy women it is both safe and remarkably effective  for relieving symptoms and improving quality of life. An informed conversation with a  knowledgeable provider is worthwhile. 

Move your body. Regular strength training, walking, and weight-bearing exercise support bone health, muscle mass, mood, sleep, and metabolism—all areas that can be  affected during perimenopause. 

Protect your relationships. Your spouse can’t understand changes that haven’t been  explained. Honest, compassionate conversations about what you’re experiencing can  reduce misunderstandings and strengthen connection. Remember that this season  belongs to both spouses. Perimenopause affects your body, but open communication  can protect your marriage from unnecessary loneliness and misunderstanding. 

Give yourself more grace than criticism. You’re navigating a major hormonal  transition while often caring for everyone around you. Rest isn’t laziness, and asking for support isn’t weakness. 

Perimenopause isn’t only a medical story, it’s also an identity story, and the emotional changes that accompany this change deserve attention too. Many women describe feeling as though they’ve become strangers to themselves. The strategies that worked for decades suddenly don’t. Patience feels shorter. Resilience feels harder to access. Confidence takes unexpected hits. 

Judaism understands transitions remarkably well. We mark them with rituals, blessings, community, and reflection. Yet perimenopause often happens quietly, without  acknowledgment, leaving many women to wonder if they’re the only ones struggling. 

You’re not. 

If you’re finding yourself forgetting words, sleeping poorly, crying unexpectedly, avoiding intimacy because it hurts, or wondering whether you’ve somehow become “less  yourself,” know this: 

You are not failing. Your body is adapting to one of the most significant hormonal transitions  of your life. 

While that transition can be challenging, it can also be navigated with good medical care, accurate information, compassionate support, and—perhaps most importantly—a healthy   sense of humor.

Because sometimes the most spiritual response to waking up drenched in sweat at 2:00 a.m. is simply changing your pajamas, laughing at the absurdity of it all, and remembering that you’re not at the end of your story. You’re not fading. You’re changing. And there is still so  much life waiting to be lived. Generations of women have walked this path before you. 

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Carly Chodosh, LCSW

Carly Chodosh, LCSW, CST, PMH-C, C-PST is a psychotherapist, Mikvah Director in Lower Merion, PA, and Clinical Program Director at Jewish Family and Children’s Service of Greater Philadelphia. Carly is one of the only dual-certified intimacy specialists (AASECT) and perinatal mental health clinicians (PMH-C) working within the Orthodox Jewish community.

In addition to her clinical work with individuals, couples, and developing clinicians, Carly lectures nationally on topics related to intimacy, perinatal mental health, trauma, and Shalom Bayis. She provides consultation and continuing education for Mikvaos around the world, as well as training for Kallah teachers, Yoatzot, and Rebbetzins at the intersection of halachic practice, intimacy, and mental health. Join Carly for her FREE LIVE webinar: Understanding the Perimenopause Shift

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