Hormonal Warfare: Perimenopause, Puberty, and One Brave Husband

Today, I had a patient and her husband come in to talk about her sudden bursts of rage. They made the appointment thinking her hormones were completely out of whack. And you know what? They weren’t wrong. Welcome to perimenopause.

At 47 years old, she was deep in the hormonal rollercoaster that is the lead-up to menopause. But wait, there’s more—she also has a 13-year-old daughter riding the puberty train at full speed. This poor husband was living in a hormonal battleground, unsure whether to duck or run on any given day. He admitted he was constantly on guard, not knowing what response he’d get from either of them. 

As she listed her symptoms—mood swings, heart palpitations, night sweats so intense she has to change her clothes multiple times a night, brain fog, and just an overwhelming sense of not feeling right—we dug into what’s really happening during perimenopause. The rapid, unpredictable fluctuations of estrogen and progesterone make this phase feel eerily similar to puberty but in reverse. And this husband? He was getting the full experience in stereo.

So, what’s the game plan? Since she’s still making estrogen and progesterone (just in wild, unpredictable amounts), we decided to try a low-dose birth control pill to stop the hormonal mayhem at the brain level. She was hesitant at first because, years ago, the pill made her feel "crazy." I reassured her that today’s options, at the right dose, can be a game-changer. We agreed to a trial run for 2–3 months, with a follow-up to adjust as needed.

To help with sleep (which, let’s be honest, is a cruel joke during perimenopause), I also prescribed micronized progesterone. This can be a lifesaver for those nighttime wake-ups. Additionally, since she mentioned frequent bathroom trips at night, I sent her home with vaginal estradiol cream to help with urinary urgency. Fewer nighttime disturbances = better sleep = a slightly less rage-filled existence.

She’ll return in three months (or sooner if this plan doesn’t cut it). From experience, though, the low-dose pill usually helps calm the madness in the brain perimenopause. Some women need birth control in this final phase of reproductive life—not this patient her partner had a vasectomy. For others, perimenopause comes with heavy, unpredictable periods, and the pill helps prevent those “crime scene” moments. Thankfully, in her case, she’d had an endometrial ablation, so at least we weren’t dealing with that battle—just the internal hormonal war that can take down even the strongest women.

This is just one of the many treatment options for perimenopause. Menopause treatments are different, and we’ll dive into those another time.

If any of this sounds familiar, please follow up with your medical provider to talk about perimenopause and your options. You don’t have to suffer through it. And if you need an appointment? You know where to find me.

Stay strong, stay balanced, and always advocate for your health.

Andrea Driggs, DNP
Women's Health Nurse Practitioner