Are you experiencing insomnia, brain fog, irregular periods, or crushing fatigue in your 40s? You might be in perimenopause—and it could be lasting longer than you think.
In this foundational episode of our Perimenopause Deep Dive series, Dr. Alison DiBarto Goggin, functional medicine physician, breaks down:
✅ What perimenopause actually is and why it can last up to 10 years (not the 5 years we were taught)
✅ The most common early symptoms women notice (hint: it’s not just hot flashes)
✅ Why viral infections like COVID-19 and Epstein-Barr may be triggering earlier perimenopause
✅ The truth about hormone testing—why your doctor won’t run labs and what tests actually help
✅ A simple, whole-body foundational protocol supporting the brain, adrenals, liver, gut, and blood sugar balance
Dr. Alison shares the exact supplement and essential oil protocol that’s helping her patients regulate cycles, reduce symptoms, and regain their energy—without chasing 100 different solutions.
Perfect for:
Women in their 40s experiencing unexplained symptoms
Anyone told “this is just part of aging” by their doctor
Women seeking natural, functional medicine approaches to hormone balance
Those frustrated with conventional medical options for perimenopause
Coming up in this series: Sleep optimization, weight management, brain health, ADHD in perimenopause, expert interviews, and more.
Resources mentioned:
Foundational Perimenopause Protocol: https://link.doterra.com/BWYqQE
Book a consultation: littleblackbagmedicine.com
Listen Here:
Transcript Here:
Welcome to Functional Wellness with Dr. Alison, medicine for the body, heart, and soul. I’m Dr. Alison DiBarto Goggin, and today we’re kicking off a brand new series that I am genuinely excited about: perimenopause.
I know, I know. There is so much overwhelming information out there we don’t know where to start. But here’s the thing: I have watched so many brilliant, capable women walk into my office feeling like they’re losing their minds. They can’t sleep. Their brain feels foggy. Their periods have gone rogue. And when they go to their doctor, they’re told “this is just part of getting older” or worse, they’re handed a dementia screening test because their brain fog is that severe.
That’s not okay. And that’s why we’re doing this series.
Over the next several weeks, I’m bringing you deep dives into sleep, weight changes, anxiety, nervous system support, brain health, and even ADHD in perimenopause. We’ll have interviews with other experts, and I’m going to give you practical, evidence-based tools you can actually use to support your whole health during this transition.
But today? Today we’re laying the foundation. We’re talking about what perimenopause actually is, why it seems to be starting earlier for so many women, what testing can and can’t tell us, and most importantly, what you can do right now to support your body through this shift.
Let’s dive in.
WHAT IS PERIMENOPAUSE?
So first, let’s define our terms. What exactly is perimenopause?
Perimenopause is the transitional phase when your ovaries start slowing down hormone production. Your adrenal glands begin taking over some of that production, but at a much lower rate. Ovulation becomes sporadic and irregular until it eventually stops completely. And once you’ve gone 12 consecutive months without a period, you’re officially in menopause.
When I was in medical school, we were taught that perimenopause lasted about five years, typically from ages 48 to 52. That was considered the standard timeline. But what we’re seeing now, in clinical practice, is that perimenopause can last 10 years or more for many women. The timelines we learned are simply outdated.
Common Symptoms
So what does perimenopause actually feel like? I think most women first notice the subtle symptoms: insomnia that seems to come out of nowhere, itchy ears (yes, really), and brain fog. They know something is off, but they can’t quite name it.
Then come the more obvious changes. Hot flashes that wake you up drenched in sweat. Periods that show up at the worst possible times, like every two weeks instead of every month. Maybe they’re lasting longer or getting heavier. You might go a few months without a period and think, “This is it! I’m done!” But then it comes back, and you start the whole cycle all over again.
Other common symptoms include mood swings, anxiety, weight gain (especially around the middle), joint pain, changes in libido, vaginal dryness, and that crushing fatigue that makes you feel like you’re moving through water.
Why Are Women Entering Perimenopause Earlier?
Now here’s the million-dollar question: why are we seeing women enter perimenopause earlier than previous generations?
First, let’s acknowledge that we don’t have a complete scientific explanation for why menopause happens at all. There are anthropological theories about the evolutionary advantage of older women caring for community children and shifting focus from reproduction to nurturing. We know that egg quality declines with age and the ability to have a healthy pregnancy becomes harder after 40, so there’s likely a protective factor there.
But what I’ve been seeing clinically, and what the research is starting to support, is something I call viral-induced perimenopause. The stress of a viral infection, particularly COVID-19 or Epstein-Barr virus, can cause a significant shift in immune function. Sometimes that shift triggers autoimmunity, mast cell activation syndrome, and then a cascade that affects hormone production and can push women into perimenopause earlier than expected.
Research published in BMC Women’s Health and the Journal of Clinical Medicine has documented cases of menstrual cycle changes and early ovarian insufficiency following COVID-19 infection. We’re seeing inflammation at the level of the hypothalamus and pituitary, the brain centers that direct hormone production, which can disrupt the entire hormonal axis.
We also know that women who have hysterectomies, even with ovarian retention, are more likely to enter menopause about four years earlier due to the loss of blood flow and arterial supply to the area. That’s well-documented in the literature.
And I absolutely believe that chronic stress and unresolved trauma impact this timeline as well. Chronic inflammation, particularly neuroinflammation affecting the hypothalamus, can interfere with proper hormone signaling. The brain-hormone connection is real and powerful.
TESTING: THE BIG QUESTION
Okay, so let’s talk about testing, because this is the question every woman wants answered: “Can’t you just run some labs and tell me what’s going on?”
I wish it were that simple. Here’s why your doctor often doesn’t want to run hormone testing for perimenopause, and honestly, they have a good reason.
Why Hormone Testing Is Tricky
Your hormones are fluctuating dramatically from day to day, sometimes even hour to hour during perimenopause. One blood test at one point in time is not going to give us reliable information. It’s frustrating, I know. But it’s the reality.
The lab ranges we use are incredibly wide because they have to account for both the follicular phase (the first half of your cycle) and the luteal phase (the second half), when hormone levels are completely different. Most women don’t have a baseline hormone test from before symptoms started, so we have nothing to compare against.
And even if we run labs and find that your hormones are “off,” the standard medical approach often doesn’t offer much beyond birth control pills. Many OB/GYNs will prescribe birth control to help stabilize hormones and keep you on it until around age 55, hoping you’ll be in menopause by then. Some doctors, and this is growing, will prescribe hormone replacement therapy (HRT), and we do have more options now than ever before, which is fantastic.
There are also newer medications on the market specifically for hot flash suppression. But overall, we’re stuck in this uncomfortable middle ground where women desperately need support, but conventional medicine doesn’t have a lot to offer.
Women come in complaining of brain fog and crushing fatigue. They can’t think straight. And the only tool their doctor has is to run a dementia screening test, which they pass because this isn’t dementia. It’s perimenopause. So we just wait until cognitive decline becomes more severe, and then we address it. It’s a horrible system.
Functional Medicine Approach to Testing
This is where functional medicine steps in. In my practice, I will run blood work. We can use insurance, or I work with a cash co-op through Quest that gets labs at incredibly affordable prices.
What we’re looking for:
FSH and LH: These are the two hormones that stimulate ovulation. As you enter perimenopause, these hormones start to increase. They get louder and louder because the ovaries aren’t responding and ovulation isn’t happening consistently. These hormones are typically low throughout most of your cycle, except for the few days leading up to ovulation. So we try to do labs on day 3 or day 21 of your cycle. Once FSH and LH are consistently over 16 to 20, and you know you’re not ovulating, that’s a strong clue that you’re moving into perimenopause.
But here’s what’s interesting: many women who think they’re in perimenopause actually have perfectly normal hormone levels. Their symptoms are coming from somewhere else. That’s when it’s time to dig deeper.
Other Essential Labs:
We need to check thyroid function, autoimmune markers, inflammation markers like CRP, and iron and ferritin levels. Low ferritin alone can cause crushing fatigue, hair loss, and brain fog that mimic perimenopausal symptoms.
And this is critical: we need to run viral immune labs to rule out Epstein-Barr virus or other reactivated infections. According to research in Frontiers in Immunology and Clinical Infectious Diseases, EBV reactivation can cause symptoms identical to perimenopause, including fatigue, brain fog, and mood changes. These viruses can mimic hormonal shifts, and if we don’t catch them, we’re treating the wrong problem.
FOUNDATIONAL SUPPORT: THE WHOLE-BODY APPROACH
So now let’s talk about what we can actually do to support you. Over the next few weeks, we’re going to do deep dives into specific topics like sleep, weight, anxiety, and nervous system regulation. But today, I want to give you my foundational support protocol and explain why I use it.
Why a Whole-Body Approach Matters
When we talk about perimenopause, we have to look at the whole body, not just hormones. It’s tempting to think that getting on HRT will fix everything. But if your organs and body systems aren’t set up for success, HRT either won’t be helpful, or it can actually make you feel worse.
So what systems do we need to support?
1. The Brain: The hypothalamus and pituitary are directing these hormone changes to the ovaries and adrenals. If there’s inflammation or dysfunction at this level, the whole system suffers.
2. The Adrenals: They’re taking over hormone production from the ovaries. And honestly, who hasn’t experienced chronic stress by the time they hit 45? Most women have some degree of adrenal fatigue and improper cortisol release.
3. The Ovaries: They still need support so they can either keep cycling properly or transition smoothly into stopping. This is where a lot of symptoms come in. The ovaries are confused, for lack of a better word.
4. The Liver: The liver processes hormones and packages them into bile for elimination. If your liver is congested or sluggish, hormones aren’t being cleared properly.
5. The Gut: If you have leaky gut, poor bacterial balance, or inflammation, those toxins and hormones get recycled back into the bloodstream instead of being eliminated. This is called enterohepatic recirculation, and it’s a huge driver of hormonal imbalance. Taking hormones isn’t going to fix that.
6. Blood Sugar Balance: This is why you’re seeing the huge push for protein right now. When blood sugar is unstable because we’re skipping meals, fasting, just having coffee for breakfast, eating restaurant or drive-through food, or waiting to eat until we’re hangry, the whole system breaks down. Unstable blood sugar creates inflammation, brain fog, loss of cognitive function, and worsens hormonal symptoms.
My Foundational Protocol
What I’ve seen work best for my clients is actually really simple. I can’t tell you how many times a woman has told me that her period is starting and stopping unpredictably, she feels like she’s losing her mind, her energy is completely tanked. I give her this protocol, and within a month or two, she’s telling me her cycles are either back to normal or she’s finally stopped cycling and is feeling so much better.
1. ClaryCalm Essential Oil Blend
This blend works on all the organ systems I just mentioned: the brain, thyroid, ovaries, and adrenal glands. It supports healthy hormone communication throughout the entire system. It’s marketed for supporting pain and periods, but when we use it daily, it creates open communication from the brain down through the hormonal axis.
I’ve had women tell me their body skipped ovulation, they used ClaryCalm, and the next day they ovulated. The more consistent you are with this, the better results you’ll see. Keep it in your bathroom and use it morning and night. Just swipe it across your lower belly.
2. RevitaZen
This works on supporting the detoxification systems, specifically liver phase conjugation, kidney clearance, and the small and large intestines. This clearance means full hormone cycling and proper elimination. It also works on reducing opportunistic bacteria in the gut. Think of it as a gentle reset for your detox pathways.
3. PB Restore Probiotic
I recommend adding in PB Restore as a probiotic to rebuild a healthier bacterial foundation. This includes prebiotics and postbiotics, so the bacteria continue to be fed and supported. It also includes bacteriophages to help remove unwanted bacteria. A healthy gut microbiome is essential for hormone metabolism.
4. Fiber or Binders
Fiber is a must-have because it helps grab onto what the bile is carrying and moves it out through stool. Some women do well with fiber. Others do better with binders like activated charcoal, fulvic acid, or even arrowroot powder. Find what works for your digestive system.
5. MetaPWR Assist
This supports blood sugar regulation with herbs that help improve insulin resistance and insulin signaling. It also works on cellular health for energy and mood. Blood sugar stability is foundational for everything else.
Why This Works
This is such a simple protocol to get started with, and I’ll link it in the show notes for you. You don’t have to go chasing 100 different supplements, protocols, diets, or crazy workout plans. Start simple and slow, and get the support you need. From there, you can build on what else is still affecting you. But in my experience, this takes care of the whole system, which is why I love the simplicity.
WHAT’S COMING NEXT
So what’s coming up in this series?
Next week, we’ll be interviewing Nurse Coach Jen, who is an expert on perimenopause and how to feel your best with simple, sustainable support. And here’s a sneak preview: we’re offering a program together where you can work with both of us.
Over the next several weeks, we’ll be covering:
Deeper functional medicine support for perimenopause
Sleep optimization
Weight and metabolism
Brain health and cognitive function
ADHD and neurodivergence in perimenopause
Libido and intimacy
Interviews with experts in hormone therapy, nutrition, and nervous system regulation
Each episode will give you practical tools, evidence-based information, and real talk about what this transition actually looks like.
I want to close with this: perimenopause is a natural transition. But that doesn’t mean you have to suffer through it. You deserve support. You deserve answers. And you deserve to feel like yourself again.
If you’re experiencing symptoms and your doctor has dismissed you or told you to just wait it out, I want you to know that there are options. Functional medicine offers a different approach, one that looks at root causes and supports your whole body through this transition.
You can find more resources, book a consultation, or join our email list at littleblackbagmedicine.com. I also have the foundational protocol I mentioned linked in the show notes.
Thank you for being here. Thank you for prioritizing your health. And I can’t wait to walk through this perimenopause series with you.
Until next time, this is Dr. Alison. Take care of your body, heart, and soul.
Research References:
BMC Women’s Health: Menstrual cycle changes and early ovarian insufficiency post-COVID-19
Journal of Clinical Medicine: Impact of viral infections on ovarian function
Frontiers in Immunology: EBV reactivation and perimenopausal symptoms
Clinical Infectious Diseases: Viral triggers for hormonal dysregulation