For many, menopause arrives with more questions than answers. For some of us, changes seem to begin gradually, then all at once. You may experience a difference in your sleep, mood shifts or anxiety, your energy may fluctuate, you may endure waves of brain fog and changes in libido. The body starts to feel eerily unfamiliar, and many find that even their healthcare professionals lack a clear explanation for why. For those moving through perimenopause and menopause, the hardest part isn’t just the symptoms. It’s the lack of clarity and understanding around how to address them. During midlife we experience phases of the body’s hormonal transition—less about an abrupt ending and more about a gradual shift in reproductive and whole-body rhythms. Perimenopause is the transition period leading up to menopause, often beginning in the 40s. Hormones—specifically estrogen and progesterone—start to fluctuate causing symptoms can feel unpredictable. Menopause is defined as the point when someone has gone 12 consecutive months without a menstrual period. It marks the end of reproductive cycling. After this point, hormone levels stabilize at a lower baseline, particularly estrogen.
At The Soft Space by Mama Glow in Brooklyn, NY that uncertainty was finally met with warmth, compassion, and clarity during the panel discussion, Navigating Menopause: Symptoms, Solutions & Support, presented by the Mama Glow Foundation and organized and moderated by fellows from the Einstein School of Medicine. Event sponsors included Dame sexual health brand and Perelel Health. The evening brought together Dr. Whitney Clearwater, Assistant Professor and board-certified obstetrician-gynecologist specializing in Female Pelvic Medicine and Reconstructive Surgery at Montefiore Einstein, Dr. Karinn Glover, a board-certified physician specializing in psychiatry and mind-body health, and Shanika Clarke, a full-spectrum doula supporting clients across fertility, prenatal care, labor and delivery, postpartum, loss, menopause, and end-of-life. Each panelist approached perimenopause and menopause from a different perspective, including pelvic health, mental health, and community-based care. As the conversation unfolded, several themes came into focus, offering a more complete picture of what this transition can look like—and how its changes can be navigated with the right information and support.
The Symptoms that go Unrecognized
One of the first ideas to surface was how wide-ranging perimenopause can be. Many people expect a short list of symptoms. The reality is far broader.
Insomnia, brain fog, mood changes, shifts in libido, and urinary symptoms were all discussed as common experiences. Some appear gradually. Others feel sudden and the variability makes it difficult to recognize what is happening in real time.
Each noted that many patients attend multiple appointments before a hormonal pattern or metabolic issue is identified. Symptoms are often addressed one at a time, rather than understood as part of a larger transition. Perimenopause itself, the transitional phase before menopause when hormonal patterns begin to fluctuate, can last for years. That unpredictability can make the experience feel disjointed without a clear path forward for solutions.
Hormones, Mood Swings, and the Feeling of Not Being Yourself
The conversation then moved toward the emotional and psychological dimensions of this phase. A phrase that surfaced repeatedly was simple and direct: “I just don’t feel like myself.”
Hormonal changes can influence sleep, mood, and cognitive function. Disrupted sleep can heighten anxiety. Shifts in estrogen and progesterone affect how the brain regulates emotion. These changes often occur alongside major life responsibilities, including career demands, caregiving, and evolving family roles.
The biological and the environmental factors are closely linked, shaping how this transition is felt day to day. Dr. Karinn Glover shared that for Black perimenopausal patients, systemic inequities can compound as racial trauma and chronic stress weather the body over time and worsen symptoms like poor sleep and can even lead to delayed diagnosis.
Navigating a System That Doesn’t Always Listen
Seeking care can add another layer of complexity. Appointments are often brief, which makes it difficult to fully explain patterns or concerns. Without that context, symptoms can remain disconnected.
One of the clearest takeaways from the evening centered on patient agency. Attendees were encouraged to ask direct questions, request appropriate testing, and seek providers who are open to collaboration.
The idea was framed simply. You are the primary decision-maker—the CEO, as Dr. Whitney L. Clearwater, MD, MPH, phrased it—when it comes to your health. Medical providers offer guidance and expertise, but that guidance is most effective when it is part of an ongoing conversation that reflects the patient’s lived experience.
Treatment, Options, and What’s Changed
Treatment was discussed in terms of both evolution and choice. Hormone therapy, which many providers avoided in the past, is now being reconsidered with updated research and clinical experience. For some patients, it offers meaningful relief from symptoms that affect quality of life, including sleep disruption and mood changes.
At the same time, each speaker emphasized the importance of individualized care. Non-hormonal approaches, including lifestyle adjustments, supplements, and targeted therapies, can also be effective depending on the person and their symptoms. “You may only have 15 or 20 minutes with your doctor,” said Shanika Clarke, Certified Menopause Advocate, in explaining how she empowers patients to navigate their provider appointments with education and insight as a full-spectrum doula. “Having someone who can spend more time with you, talk through your symptoms, and help you understand what to ask for can make a real difference.”
Why Community Matters in During Perimenopause
Beyond clinical care, the role of community was a central theme throughout the evening. Many move through this transition without language for what they are experiencing and that needs to change. Conversations around what to expect during menopause can still feel limited and creating space for dialogue changes that experience. Sharing information, speaking about symptoms, and hearing from others in similar stages of life can create a sense of recognition and and connection. Support in this phase can take many forms and education, guidance, and advocacy extend far beyond the exam room. In many ways, an ideal model mirrors the kind of care more commonly associated with pregnancy and postpartum support. The need for sustained, informed support remains just as relevant here.
Beyond biology, many people experience this time as a reorientation—physically, emotionally, and socially. Energy, boundaries, and priorities often shift. For caregivers and birth workers especially, it can be a period that invites a different relationship to rest, resilience, and self-support.
Menopause is often treated as something to manage quietly, with information gathered over time. What this evening made clear is that access to clear, direct knowledge changes that process. When people have the language to describe what they are experiencing, and the support to act on that knowledge, the transition becomes easier to navigate with confidence.
