Perimenopause Anxiety, Weight Gain, and Fatigue: A Christian Woman’s Functional Medicine Guide

Have you been feeling not like yourself lately? Maybe you feel anxious when nothing obvious seems wrong. Your clothes fit differently, even though your habits haven’t changed much. You’re tired even after a full night of sleep, or you find yourself waking in the middle of the night and struggling to fall back asleep.

If you’re in your 40s, you may be wondering whether perimenopause could be part of the picture. It could be, but hormones aren’t the only possible explanation. You deserve more than a quick assumption that this is simply part of getting older.

Perimenopause is the transition leading up to menopause. During this time, estrogen and progesterone fluctuate, periods may change, and symptoms can show up in ways that don’t always seem connected. Your body is communicating, and learning to understand those signals can help you have more informed conversations with your doctor and make thoughtful decisions about your health.

As a functional medicine practitioner, I believe it’s important to look at the whole picture: your symptoms, sleep, nutrition, stress, movement, and the season of life you’re walking through. And as a Christian, I believe caring for your health is an act of stewardship, not a pursuit of perfection or a way to earn your worth.

In this guide, we’ll walk through common perimenopause symptoms, what may be contributing to them, when to seek medical care, and how you can approach this season with both wisdom and faith.

This article is for educational purposes only. It is not medical advice or medical care. Please talk with your doctor before changing any medication or supplement.

In this guide:

What Is Perimenopause? (And Is It Starting for Me?)
Why Does Perimenopause Cause Anxiety?
Why Am I Gaining Weight in Perimenopause?
Why Am I So Tired in Perimenopause?
Can Perimenopause Cause Heart Palpitations?
Can Perimenopause Cause Joint Pain?
When to See Your Doctor (and When to Call 911)
What Helps: Hormone Therapy, Progesterone, and Your Options
What Does the Bible Say About Perimenopause?
What a Functional Approach Adds (and What It Doesn’t)
Frequently Asked Questions
Your Next Step

What Is Perimenopause? (And Is It Starting for Me?)

Perimenopause is the transition before menopause. Estrogen and progesterone can fluctuate during these years, and you may notice changes in your menstrual cycle. Your periods may come closer together or farther apart, become lighter or heavier, or occasionally skip a month (Mayo Clinic).

For many women, changes in their periods are one of the first clues. Menopause itself is confirmed after you’ve gone 12 consecutive months without a period. The average age of the final menstrual period is about 51 (ACOG).

Other symptoms can include (National Institute on Aging; ACOG):

Hot flashes or night sweats
Trouble sleeping
Mood changes, irritability, or changes in sex drive
Joint and muscle discomfort
Forgetfulness or difficulty concentrating
Changes in your menstrual cycle

You don’t have to experience every symptom, and symptoms don’t necessarily arrive in a predictable order. If you have bleeding or spotting after going 12 months without a period, contact your doctor promptly.

Is It Perimenopause or Stress?

Sometimes it’s difficult to separate the two, and often, more than one thing is happening at once.

Hormone changes can overlap with the demands of midlife: raising children, caring for aging parents, working, navigating relationships, and trying to keep up with the many responsibilities on your plate. Stress, poor sleep, depression, and other health concerns can affect mood and energy, too (National Institute on Aging). It’s not helpful to assume everything is hormones, but it’s not helpful to dismiss hormone changes either.

One practical place to start is by keeping a simple symptom log for two to three months. Note your cycle, sleep, mood, energy, and anything that feels new or different. Bring that information to your doctor. You don’t need to have all the answers before you make an appointment; the goal is to give yourself and your doctor a clearer picture of what you’re experiencing.

When I walk alongside a woman, I want to understand the story behind what she’s noticing, not just collect a list of symptoms. Sometimes, having the space to slow down, connect the dots, and put your experience into words helps you identify better questions to bring to your doctor.

If your labs have come back “normal” but you still don’t feel like yourself, my free Normal Labs checklist can help you prepare for a more informed conversation with your doctor and track what you’re experiencing.

Why Does Perimenopause Cause Anxiety?

If you’ve found yourself feeling anxious, overwhelmed, or unusually on edge, you may be wondering what has changed. Hormone fluctuations can affect mood, and symptoms such as hot flashes and disrupted sleep can add another layer of strain (ACOG). Research suggests that some women have an increased risk of anxiety or depression during the menopause transition, even if they haven’t experienced these symptoms before. A history of PMS, PMDD, postpartum depression, depression, or anxiety may also be relevant (Mayo Clinic; Santoro et al.).

Sleep matters, too. When you aren’t sleeping well, it can be harder to regulate emotions and feel like yourself. If you’re waking in the middle of the night, you may find my article on waking at 3 a.m. in perimenopause helpful. And if irritability feels more like a short fuse than worry, I’ve also written about hormonal rage in moms.

A few places to start include:

Keeping a consistent sleep and wake time, and making your bedroom cool, dark, and comfortable
Moving your body regularly in ways that are appropriate for you
Eating regular, nourishing meals
Noticing whether caffeine, especially later in the day, or alcohol affects your sleep or anxiety
Reaching out to people you trust rather than carrying everything alone
Considering counseling or therapy if you need additional support
Talking with your doctor about treatment options, which may include medication or hormone therapy for some women

One perimenopausal client I was working with didn’t realize how alcohol in the evening was impacting her sleep and mood. She was drinking socially when she went out with friends. When she stopped drinking alcohol, her sleep improved and anxiety reduced with this one simple lifestyle change.

This was her experience; every woman’s body and story are different.

There is no shame in needing support. And anxiety does not mean your faith is weak or that you haven’t prayed enough. We are whole people, and our physical, emotional, and spiritual lives can affect one another. Seeking medical or mental health support can be part of caring for yourself wisely.

Bringing Your Worries to God

God does not ask us to pretend we’re fine when we aren’t. He invites us to bring our worries to Him honestly.

“Don’t worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done. Then you will experience God’s peace, which exceeds anything we can understand. His peace will guard your hearts and minds as you live in Christ Jesus.” (Philippians 4:6–7, NLT)

“Give all your worries and cares to God, for he cares about you.” (1 Peter 5:7, NLT)

When anxiety rises, you can pause, take a few slow breaths, and bring what you’re feeling to God in prayer. You don’t have to find perfect words. Ask Him for wisdom for the next step, and let yourself receive support from the people and professionals He may use to help you.

If anxiety comes with hopelessness or thoughts of harming yourself, call or text 988 (Suicide & Crisis Lifeline). In an emergency, call 911.

Why Am I Gaining Weight in Perimenopause?

Maybe the number on the scale hasn’t changed much, but your body feels different. Your clothes fit differently, or you’re noticing changes around your middle. You’re not imagining that body composition can shift during the menopause transition.

In the Study of Women’s Health Across the Nation (SWAN), researchers found that around two years before the final menstrual period, the rate of fat gain roughly doubled while lean muscle mass began to decline. Overall weight continued to rise at a steadier pace, partly because these changes happened alongside one another (Greendale et al., JCI Insight, 2019).

This is not a reason to criticize your body or respond with extreme rules. It’s an invitation to understand what may be changing and consider how to support your health.

Some helpful foundations include:

Strength training: Resistance exercise two to three days a week can help maintain muscle mass, when appropriate for your body and fitness level (AAOS OrthoInfo).
Nourishing meals: Include protein and fiber-rich foods as part of a balanced eating pattern.
Sleep and stress support: Both can influence energy, appetite, and the choices you have capacity for.
Being mindful of alcohol: Alcohol can affect sleep and overall health, so notice how it affects you.

I think about health through the lens of stewardship, not control. The question isn’t, “How do I force my body to look a certain way?” It’s, “How can I care for the body God has entrusted to me?”

What I Do

I can only share what I do in my own routine. It isn’t a plan for you, and I can’t promise it will change your weight.

I try to eat protein with each meal.
I pray before I check my phone in the morning.
I move in ways that feel good, like a power walk or a swim.
I do light-to-moderate weight training on my Tonal at home.

These habits help me feel more grounded in this season. Your doctor can help you figure out what’s right for your body.

What About GLP-1 Medications?

Many women have questions about GLP-1 medications, including Ozempic, Wegovy, and Mounjaro, when they’re navigating weight changes. Whether a medication is appropriate depends on your individual health history, risks, benefits, and goals. That’s a conversation to have with a qualified prescribing clinician. If you’re interested in my perspective, you can read my thoughts on GLP-1 peptides.

Blood sugar regulation and insulin are also part of the broader picture I consider when thinking about metabolic health. Rather than assuming one explanation for every woman, I believe it’s important to look at the person’s full story and work with her healthcare team to decide what deserves further attention.

Why Am I So Tired in Perimenopause?

There is a particular kind of frustration that comes with sleeping for what should be enough hours and still waking up exhausted. If that’s you, please don’t assume you simply need to push through.

Night sweats and changes in sleep are common during perimenopause, and mood changes can affect energy as well (National Institute on Aging; Mayo Clinic). At the same time, midlife can be a full season. Many women are caring for children, supporting parents, working, and carrying responsibilities that leave little room to rest.

If you’re waking during the night, read my article on waking at 3 a.m. in perimenopause. If you’re exhausted even when you sleep, I explore that experience in more detail there, too.

Other Things to Discuss With Your Doctor

Fatigue is not always caused by hormones. Thyroid conditions, low iron (with or without anemia), sleep apnea, depression, diabetes, and some medications can contribute to low energy (MedlinePlus). Depending on your symptoms and medical history, your doctor can help determine whether an evaluation or testing makes sense.

My free Normal Labs checklist can help you prepare questions if you’ve been told your results are normal but you still don’t feel like yourself. You can also read what your cortisol pattern may be telling you.

My approach is to resist the urge to jump to one explanation. We look at the bigger picture with sleep, nutrition, stress, daily demands, and what you’ve already explored, so you can have a clearer conversation with your doctor about possible next steps.

Can Perimenopause Cause Heart Palpitations?

Yes, some women experience palpitations during the menopause transition. They may feel like your heart is pounding, racing, fluttering, or skipping a beat, and you may notice the sensation in your chest, throat, or neck (MedlinePlus).

In a 2023 study, many participants reported a moderate or high likelihood of palpitations during perimenopause and early postmenopause. Although that research offers useful context, it does not mean every palpitation is harmless or caused by hormones (Menopause, 2023).

Stress and anxiety, caffeine, nicotine, alcohol, decongestant medications, fever, and exercise can contribute to palpitations. They can also be related to an abnormal heart rhythm, an overactive thyroid, or another heart condition (MedlinePlus). That’s why new or changing symptoms should not automatically be attributed to perimenopause.

While you’re arranging appropriate medical guidance, it may help to notice whether stimulants affect your symptoms, use slow breathing to settle yourself when appropriate, and keep a brief log of when palpitations happen, what you were doing, your caffeine intake, and where you are in your cycle. Prayer may also help you pause and turn your attention to God, but it is not a substitute for medical evaluation.

If palpitations are new for you, or if they occur with any of the symptoms in the next section, seek medical attention promptly.

Can Perimenopause Cause Joint Pain?

It can. Joint and muscle discomfort are recognized symptoms of the menopause transition (National Institute on Aging). A 2024 review discussed what some researchers call the “musculoskeletal syndrome of menopause,” describing changes in muscles, joints, and bones that may be associated with declining estrogen (Wright et al., 2024). Estrogen plays a role in several tissues throughout the body, including our bones, and changes during this transition may contribute to stiffness or aches (AAOS OrthoInfo).

Depending on your health and abilities, strength training, balance exercises, and regular movement may be helpful. A balanced eating pattern that includes protein, fiber, colorful fruits and vegetables, and fewer highly processed foods and added sugars can also support overall health. Talk with your doctor about whether hormone therapy or another approach makes sense for you.

Joint pain has many possible causes, including injury, overuse, and autoimmune conditions such as rheumatoid arthritis (MedlinePlus). New or worsening pain, swelling, or symptoms that persist deserve medical attention rather than being assumed to be part of menopause.

When to See Your Doctor (and When to Call 911)

Call 911 right away if palpitations or other heart symptoms occur with chest pain, shortness of breath, fainting or loss of consciousness, unusual sweating, or dizziness or lightheadedness. Do not drive yourself (MedlinePlus).

Contact your doctor soon if:

Palpitations are new or different for you.
You frequently feel extra heartbeats or they occur in clusters.
You have heart disease or risk factors such as high blood pressure, diabetes, or high cholesterol.
Your pulse is over 100 beats per minute at rest without an obvious cause such as exercise, anxiety, or fever.

Also speak with your doctor about:

Bleeding or spotting after 12 months without a period
Periods that are unusually close together, last longer than a week, or bleeding between periods or after sex
Anxiety, low mood, or hopelessness that persists or interferes with daily life
New or worsening joint pain or swelling
Fatigue that is persistent or getting worse

If you have thoughts of harming yourself or are in crisis, call or text 988 (Suicide & Crisis Lifeline). In an emergency, call 911.

What Helps: Hormone Therapy, Progesterone, and Your Options

There are options for managing perimenopause symptoms, and you don’t have to simply endure symptoms that are affecting your quality of life. Depending on your symptoms and health history, your doctor may discuss hormone therapy or other treatment options (ACOG).

I don’t prescribe hormones or medications. My role is to help women understand the lifestyle and wellness factors within my scope, recommend lifestyle changes and supplements for support if appropriate, organize their questions, and work alongside their own healthcare providers, not instead of them. You can also read more about Christian hormone support for women.

What About Progesterone?

Progesterone is a common question, especially when sleep becomes more difficult. Research on progesterone and sleep is still mixed. A 2021 meta-analysis found that micronized progesterone shortened the time it took participants to fall asleep, but did not clearly increase total sleep time; most of the studies included postmenopausal women (Journal of Clinical Endocrinology & Metabolism, 2021). A small 2023 trial found improvements in women’s reported sleep and night sweats, although its primary outcome did not differ significantly (Scientific Reports, 2023).

Progesterone is not a one-size-fits-all answer for sleep or other symptoms. If you’re considering it, discuss the potential benefits, risks, and appropriate formulation with your doctor.

Understanding Estrogen Through God’s Design

Estrogen does much more than influence your menstrual cycle. It plays a role in many parts of the body, including the brain, bones, muscles, and joints. That helps explain why hormonal changes can be felt in ways that seem unrelated to your period.

I wrote Estrogen By Design to help women better understand estrogen through God’s design, functional medicine, and faith. My hope is that learning more about your body helps you approach this season with greater understanding instead of fear, shame, or the belief that your body is working against you.

Join the Estrogen By Design waitlist and receive a free devotional as a thank-you.

What Does the Bible Say About Perimenopause?

The Bible doesn’t use the word perimenopause, but God’s Word speaks to every season of our lives. It reminds us that we are His workmanship, that our strength is not meant to come from ourselves alone, and that His care for us does not end as our bodies change.

“For everything there is a season, a time for every activity under heaven.” (Ecclesiastes 3:1, NLT)

“I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.” (Psalm 139:14, ESV)

“My health may fail, and my spirit may grow weak, but God remains the strength of my heart; he is mine forever.” (Psalm 73:26, NLT)

“He gives power to the weak and strength to the powerless.” (Isaiah 40:29, NLT)

“I will be your God throughout your lifetime—until your hair is white with age. I made you, and I will care for you. I will carry you along and save you.” (Isaiah 46:4, NLT)

“That is why we never give up. Though our bodies are dying, our spirits are being renewed every day.” (2 Corinthians 4:16, NLT)

These verses aren’t promises that we’ll never experience symptoms, illness, or hard seasons. They remind us who God is and where our hope rests, even when we don’t have an easy explanation for what we’re experiencing.

Our bodies change throughout our lives, but our identity is not defined by our hormones, our appearance, our fertility, or how much we can accomplish in a day. We belong to God. Caring for our bodies can be one way we steward what He has entrusted to us, but our worth was never something we had to earn by being healthy or doing everything “right.”

I believe faith belongs in the conversation about health because we are not just a collection of symptoms. We can bring our questions, fears, and frustrations to God while also seeking wise medical care. Prayer and Scripture are part of how I walk alongside women, and discernment matters as we consider the many wellness practices and claims we encounter online. If you’re wondering how to think about functional medicine through a biblical lens, you can read Is functional medicine biblical?.

What a Functional Approach Adds (and What It Doesn’t)

A functional approach gives us space to look at your health in context. When I work with a woman, we talk through her symptoms and history, changes in her cycle, sleep, meals, stress, movement, and the demands of her current season. We look for patterns and consider what questions may be worth bringing to her doctor.

This isn’t about chasing every lab marker or trying to optimize every part of your life. It’s about slowing down enough to understand your story, considering the factors that may be contributing to how you feel, and choosing thoughtful next steps. Faith and Scripture are woven into my work because my relationship with God shapes how I understand health, stewardship, and the person sitting across from me.

I’m trained in functional medicine through the Institute for Functional Medicine, and my work is focused on lifestyle, supplement, and faith-integrated guidance. I do not practice as a physician assistant in this setting, prescribe medication or hormones, or replace your medical care. A functional approach should complement, not replace your doctor, prescribed treatment, or appropriate medical evaluation.

My work is virtual, so I can walk alongside women across the United States and internationally.

Book Your Free Connection Call

Frequently Asked Questions

What are the first signs of perimenopause?

For many women, changes in their periods are an early sign. Cycles may become shorter or longer, bleeding may be lighter or heavier, or periods may occasionally be skipped. Hot flashes, sleep problems, mood changes, and changes in sex drive can also occur. Talk with your doctor about symptoms that are new or concerning.

Is it perimenopause or stress?

It can be both. Hormone fluctuations, disrupted sleep, family responsibilities, and stress can overlap and affect mood and energy. Other conditions, including depression and thyroid problems, may cause similar symptoms. Tracking your cycle and symptoms for a few months can help you and your doctor see patterns.

Can perimenopause cause anxiety?

Yes, some women experience anxiety or mood changes during perimenopause. Hormone fluctuations and poor sleep may contribute, and a history of PMS, postpartum depression, or anxiety may be relevant. If anxiety is new, severe, persistent, or interfering with daily life, speak with your doctor.

Why am I gaining weight in perimenopause?

Research suggests that fat gain can increase and muscle mass can begin to decline during the menopause transition, even when overall weight changes gradually. Strength training, nourishing meals with protein and fiber, adequate sleep, and stress support are useful foundations. Your own needs and medical history matter, so avoid assuming there is one answer for everyone.

Can perimenopause cause heart palpitations?

Some women experience palpitations during the menopause transition, but they can also be related to caffeine, stress, thyroid problems, or a heart rhythm condition. Have new or changing palpitations evaluated. Call 911 if they occur with chest pain, shortness of breath, fainting, unusual sweating, or dizziness.

Can perimenopause cause joint pain?

Joint and muscle aches can occur during the menopause transition and may be related to changing estrogen. Strength training and an anti-inflammatory style of eating may help. Have new, swollen, or worsening joint pain checked by your doctor, since autoimmune conditions and injuries can cause joint pain too.

Why am I so tired in perimenopause?

Night sweats, broken sleep, mood changes, and the stress of a full season of life can all drain energy. Fatigue can also come from thyroid changes, low iron, or other conditions, so it’s worth asking your doctor which labs make sense for you, especially if you’re exhausted even after a full night’s sleep.

What does the Bible say about perimenopause?

The Bible doesn’t use the word perimenopause, but it speaks to every season of a woman’s life. It calls our bodies God’s workmanship, reminds us that “God remains the strength of my heart” (Psalm 73:26, NLT), and speaks of His care through every age (Isaiah 46:4). You can bring this season to Him honestly.

Can functional medicine help with perimenopause?

I walk alongside women with lifestyle, nutrition, supplement, and faith-integrated guidance, working with your own doctors. That can include looking at sleep, meals, stress, movement, and the supplements you already take, and helping you prepare questions for your doctor. It doesn’t replace your doctor or prescribed medication. The free Connection Call is a good place to start.

Your Next Step

You don’t have to figure this season out alone.

If you’d like a starting place, grab my free Normal Labs checklist and begin tracking what you notice. And if you’d like someone to walk alongside you, I’d love to hear your story.

The Connection Call is a free, 30-minute video call. We’ll talk through what you’re experiencing and what you’re hoping for, and decide together if working with me is a good fit. It’s 100% virtual, and I work with women across the US and internationally. You can see how working with me works.