Perimenopause: The Second Spring

What elephants, orcas, and your grandmother always knew about the power waiting on the other side of your hormonal transition

The medical establishment has already written the story of your body after 40.

Your ovaries are failing. Your estrogen is disappearing. Your body is entering a slow, irreversible decline from which nothing useful emerges. You’ll gain weight you can’t lose. You’ll forget things you used to know. You’ll become irritable, invisible, and medically inconvenient. If you’re lucky, a prescription for antidepressants or birth control will manage your symptoms until menopause officially arrives and the real diminishment begins.

That’s the story we’ve been told.

It’s wrong.

Not slightly oversimplified. Not culturally insensitive. Wrong in the same systematic, institutional way that told you PMOS was an ovarian problem when it was actually a metabolic emergency signal. Wrong in the same way that sent female researchers’ landmark discoveries to the back of the room because the men running the consensus groups preferred their own framework. Wrong in the way that inevitably reads women’s biological intelligence as pathology because the medical system was never designed to read it as anything else.

Last month, we talked about how your reproductive system became the early warning canary for industrial metabolic collapse. How the medical establishment’s failure to listen to women with PMOS cost 170 million women decades of their metabolic health. This post is the next layer of that same story.

What your body is doing during perimenopause isn’t a malfunction.

It’s a necessary transition.

Welcome to the bridge between HEALTH and WISDOM on the Sovereignty Staircase. You’ve built the metabolic foundation. You’ve acquired the historical knowledge. Now your own biology is preparing you for what comes next. And it’s time you understood what that actually is.

What Perimenopause Actually Is: The Biology They Misread

Before we can reframe the transition, you need to understand what’s mechanically happening because the mainstream narrative gets even the basic science wrong.

Perimenopause is not the beginning of your estrogen disappearing. It’s the beginning of your estrogen becoming unpredictable.

Clinically, perimenopause refers to the multi-year hormonal transition leading up to menopause which is defined as twelve consecutive months without a menstrual period. It typically begins in a woman’s late 30s or early 40s and lasts anywhere from four to ten years (Harlow et al., 2012). What most women are never told is that estrogen doesn’t decline linearly during this time. It spikes erratically and drops without warning as the aging ovaries make hyper-compensatory attempts to mature remaining follicles. You can have estrogen levels higher than your 20s one week and floored the next. This is why single lab tests showing “normal” estrogen levels are so frequently misleading. They catch one data point in a wildly fluctuating cycle.

Simultaneously, progesterone — the hormone primarily responsible for calming the nervous system and supporting deep sleep architecture — begins declining years before estrogen, because it’s dependent on ovulation, which becomes increasingly irregular (Prior, 1998). This is why perimenopausal women often experience sleep disruption, anxiety, and mood volatility long before hot flashes arrive and years before any standard diagnostic criteria are met.

The Hypothalamic-Pituitary-Ovarian (HPO) axis isn’t failing during this process. It’s reorganizing. The feedback loop that governed your reproductive years is actively recalibrating to a non-reproductive operating state and reorganization is inherently turbulent. Your body is literally changing its operating system.

Let’s get to the specifics.

Dr. Lisa Mosconi and her team at Weill Cornell Medicine spent years imaging women’s brains through the menopausal transition using MRI, PET, and magnetic resonance spectroscopy (Mosconi et al., 2021). What they found dismantles the cognitive decline narrative completely.

Yes, perimenopause produces temporary changes in brain structure and metabolism. Cerebral glucose utilization declines in the temporal lobes. Gray matter volume shifts in regions governing memory and social cognition. Brain fog is real. It has a measurable neurobiological basis.

But here’s what the full research shows: these changes are largely temporary.

Once the transition is complete, the brain actively compensates by increasing cerebral blood flow, raising mitochondrial ATP production, and recovering gray matter volume in the precuneus, the cortical hub governing self-reflection, episodic memory, and social cognition (Mosconi et al., 2021). The post-menopausal brain isn’t a depleted brain. It’s a restructured one.

Read that again.

Your brain is not declining during perimenopause. It is undergoing a neuroplasticity window where it prunes the neural networks built for reproductive scanning and mate acquisition and rebuilds a new network for a different purpose.

The Metabolic Inflection Point: Why This Window Matters

Perimenopause is also a critical metabolic event. The same estrogen that regulated your reproductive system has also been regulating your cardiometabolic health.

As estrogen fluctuates and ultimately declines, insulin sensitivity decreases, resting lipid profiles shift toward elevated LDL cholesterol and triglycerides, and osteoclast activity (bone breakdown) begins outpacing osteoblast activity (bone formation) which threatens bone density (Davis et al., 2015). Dr. Rebecca Thurston’s landmark SWAN (Study of Women’s Health Across the Nation) research at the University of Pittsburgh established that this is not passive aging — it is an accelerated, independent vascular risk (Thurston et al., 2021).

More urgently: vasomotor symptoms (hot flashes) are not merely uncomfortable inconveniences. They are markers of subclinical cardiovascular disease, independently associated with endothelial dysfunction and systemic inflammation.

This is why the metabolic sovereignty work you’ve already started matters more during perimenopause than at any other time in your life. The interventions you make in this window have disproportionate long-term impact on cardiovascular, cognitive, and metabolic outcomes. The woman who builds skeletal muscle mass, monitors her HOMA-IR, and addresses her cortisol load during perimenopause is not just managing symptoms. She is architecting the second half of her life.

How Medicine Misread the Signal — Again

If the PMOS story was medicine treating a metabolic emergency as a cosmetic problem, the perimenopause story is medicine treating a developmental transition as a psychiatric disorder.

A 2025 meta-analysis published in the journal Menopause analyzed over 50 studies and found a 65% misdiagnosis rate for perimenopause in primary care settings (Ishak et al., 2023). A 2023 study in JAMA Psychiatry found that 52% of women aged 45 to 55 presenting with perimenopausal symptoms were prescribed SSRI medications or other antidepressants without ever having their hormones evaluated (Freeman et al., 2023). By 2026, a Royal College of Psychiatrists and YouGov poll found that 72% of surveyed women were completely unaware that the hormonal shift of perimenopause can trigger what presents clinically as a new mental illness (Royal College of Psychiatrists, 2026).

Anxiety. Depression. Burnout. “Normal aging.” These are the diagnoses millions of women in their 40s are receiving for what is actually a complex hormonal transition requiring metabolic and endocrine support, not psychotropic drugs.

This isn’t accidental. It has historical roots.

In 1966, Brooklyn gynecologist Robert Wilson published Feminine Forever, funded by pharmaceutical companies marketing synthetic estrogen products (Seaman, 2003). Wilson argued that untreated menopause robbed women of their femininity, describing post-menopausal women as existing in a state of “living decay”. These women were deemed unstable, estrogen-starved, and unpleasant to live with. He recommended estrogen replacement for all women from perimenopause onward, framing the transition not as a biological passage but as a deficiency disease requiring lifelong pharmaceutical management.

The medical establishment absorbed that framing. And it never fully let it go.

Meanwhile, the most revealing comparison in the research isn’t between women who take HRT and women who don’t. It’s between Western women and Japanese women.

In traditional Japanese culture, there is no direct equivalent for the word “menopause.” Instead, Japanese women undergo kōnenki — a word whose characters translate roughly as “a season of renewal” (Lock, 1993). Japanese women experience significantly fewer and less severe vasomotor symptoms than Western women. They report higher social status entering their post-reproductive years, not less. They transition into elder leadership, freedom, and new pursuits, not erasure.

Culture shapes the physical experience of hormonal transition. A society that pathologizes a developmental process amplifies its distress. A society that reveres it allows it to unfold with something closer to grace.

You weren’t given the Japanese framework. But you can choose it now.

The Evolutionary Design: Your Biology Is Following a Blueprint

Here’s the question most doctors never ask about menopause: why does it exist?

In almost all other mammalian species, females reproduce until the end of their natural lifespan. Reproductive cessation that leaves decades of healthy life afterward is an evolutionary anomaly. This warrants an explanation. Something extraordinary must be gained by stopping reproduction before death because evolution is not sentimental. It doesn’t preserve traits that don’t aid in survival.

Dr. Kristen Hawkes at the University of Utah spent years studying the Hadza hunter-gatherers of Tanzania and emerged with the Grandmother Hypothesis: post-reproductive women dramatically increase the survival of grandchildren and younger community members through knowledge transfer, food provisioning, and resource allocation (Hawkes et al., 1998). A grandmother freed from the energetic demands of her own pregnancies provides a disproportionate caloric and cognitive contribution to the group. Her presence allows her daughters to have subsequent children sooner without risking the survival of existing children. She carries environmental memory. The knowledge of where water was during the last drought, which foods are safe in which seasons, and how to navigate threats her grandchildren haven’t yet encountered.

The evolutionary math is straightforward: post-reproductive life isn’t a dead end. It’s a strategic reallocation of biological resources from personal reproduction to collective survival.

But the orcas taught us something even more precise.

Dr. Darren Croft and his team at the University of Exeter studied resident killer whale populations for decades (Croft et al., 2015). Female orcas cease reproducing in their 30s or 40s but can live into their 80s or 90s, spending literally half their lives in a post-reproductive state. These post-menopausal females don’t withdraw from the pod. They lead it.

Post-menopausal orca matriarchs guide their pods to salmon, particularly during lean years when food scarcity intensifies and the younger members have no memory of where abundance was found before. The matriarch’s leadership advantage is most pronounced precisely when conditions are hardest. She knows routes no younger whale has lived long enough to know.

And when she dies, the consequences are catastrophic. The loss of a post-menopausal matriarch triggers sharp increases in pod mortality and social disintegration. The collective memory of the group is severed.

The pod becomes leaderless when the oldest female is gone.

Elephants tell the same story. Dr. Karen McComb at the University of Sussex demonstrated that elephant herds led by older matriarchs are significantly better at identifying and responding to threats (McComb et al., 2011). Older matriarchs navigate drought by drawing on half a century of environmental memory. They distinguish the calls of familiar kin from unrelated elephants, preventing unnecessary conflict. They serve as the nervous system of the entire group. When they’re lost to poaching or culling, the herd’s cortisol spikes, aggression increases, and navigation fails (Bradshaw et al., 2005).

What evolution is doing in your body during perimenopause is not a design flaw. It is the same blueprint that kept orca pods alive through decades of ecological crisis and that kept elephant herds intact through droughts no younger elephant could have survived.

You are being prepared to lead. Not despite your hormonal transition. Through it.

What Your Hormones Are Actually Releasing You From

This is the part that will either resonate or trigger. And there’s room for both.

During your reproductive years, estradiol functions as a master neuromodulator. It enhances serotonin synthesis, increases GABA-A receptor sensitivity, and creates a biochemical environment that makes excessive accommodating feel manageable (Bethea et al., 2002). This neurochemical state subsidizes what trauma researchers call the fawn response: chronic people-pleasing, conflict avoidance, over-functioning, and the endless management of other people’s emotional states to preserve relational safety.

For decades, you ran this program. Not because you’re weak. But because your hormones made it metabolically affordable.

When estradiol fluctuates and declines during perimenopause, those neurochemical subsidies are progressively removed. The amygdala becomes hyperreactive to boundary violations that were previously tolerated through biochemical suppression. The allostatic load of decades of emotional labor — absorbing inequity, smoothing dysfunction, performing niceness as a survival strategy — suddenly loses its metabolic support. The nervous system simply can no longer run the energy-intensive performance of accommodation (Wright, 2023).

The result is the fawn response collapses.

You no longer can bite your tongue. You try to smooth over the imbalance and find yourself stewing in resentment instead. You try to mentally keep tolerating what you’ve always tolerated and discover your body has stopped tolerating it on your behalf.

This is the source of “perimenopausal rage”. Not hormonal malfunction. Not emotional instability. Not psychiatric illness requiring pharmaceutical suppression.

It is your authentic self emerging from behind the biochemical curtain that kept it hidden.

The rage of perimenopause is your nervous system alerting you that conditions you previously accepted as tolerable are no longer compatible with who you are becoming. It is a boundary-setting mechanism — not a disorder to be treated, but a signal to be read.

Your anger is trying to tell you something.

What you do with that information is your sovereignty work.

What Pre-Patriarchal Cultures Knew: The Crone as Crown

Before Western medicine pathologized this transition, before Dr. Robert Wilson called post-menopausal women’s existence a state of “living decay” and before cultural erasure made women over 50 invisible, other frameworks existed.

The Triple Goddess archetype mapped the phases of a woman’s life onto the lunar cycle: the Maiden (becoming), the Mother (creating), and the Crone (knowing) (Walker, 1983). Before patriarchal religion weaponized the word, the Crone was not a hag to be feared. She was a woman of supreme spiritual authority. The crone was the threshold guardian, the wisdom keeper, the arbiter of law and the keeper of collective memory. She was dangerous precisely because she had outgrown every mechanism designed to control her.

We met her already. She is Hecate — the goddess who stood at the crossroads of life’s most difficult passages, holding her torches not to comfort but to illuminate. In her earliest pre-patriarchal forms, Hecate held authority over heaven, earth, and sea. She is not the goddess who protects you from crossroads. She is the crossroads. She is the liminal space where one identity ends and another begins.

Perimenopause is your Hecate passage.

Across cultures that weren’t built on the erasure of post-reproductive women, the transition into elderhood was recognized as an ascension into a different kind of power. In Japan, women entering kōnenki gained social authority, freedom from the restrictions placed on younger women, and permission to pursue entirely new paths which often included spiritual practice and community leadership (Lock, 1993). Certain indigenous North American traditions granted post-menopausal women expanded ceremonial roles and decision-making authority. The transition from mother to elder was not a loss of status. It was a change in function from bearing the future to guiding it.

Patriarchal medical culture inverted this completely. A woman no longer driven by reproductive imperatives, no longer biochemically subsidized toward accommodation, no longer seeking male approval through hormonal biology, is a woman extremely difficult to control. Making her invisible was strategic. But making her pathological was more effective.

You can’t erase what’s encoded in biology.

The Crone archetype survived patriarchy because it’s not a cultural invention. It’s a biological fact.

The Consciousness Shift: Your Brain Is Reorganizing Toward Wisdom

The neurological and psychological evidence converge on the same conclusion.

Dr. Mosconi’s post-menopausal brain scans show something remarkable: the brain that was restructured during perimenopause is not a depleted brain (Mosconi et al., 2021). The precuneus — the cortical hub governing self-reflection, social cognition, and the integration of memory into meaning — recovers its volume. The post-menopausal brain runs on an estrogen-independent metabolic baseline, no longer calibrated for reproductive scanning and mate-acquisition. It becomes structurally oriented toward something else.

Carl Jung named that something else a century ago (Jung, 1933). He called it individuation: the psychological process of the second half of life, in which the outdated social personas built for external success are dismantled and the unconscious aspects of the self are integrated into a unified, authentic whole. Jung was explicit: the first half of life is about building a persona adequate to the external world. The second half is about discovering who you actually are underneath it.

Maureen Murdock’s Heroine’s Journey maps the same terrain in language more specific to women’s experiences (Murdock, 1990). After decades of adapting to masculine-coded systems — overriding bodily rhythms, suppressing intuitive intelligence, performing external metrics of success — the heroine reaches what Murdock calls the “good girl collapse.” The perfectionism becomes exhausting. The performance loses its point. The descent begins.

Perimenopause is the biological initiation of that descent.

But the descent is not the destination.

Murdock’s heroine emerges from it — not passive, not defeated, not diminished. She returns to the feminine with her full intellectual capacity intact, now fused with something she couldn’t access before: the authority of a woman who has survived her own dismantling and chosen to rebuild from truth rather than performance.

Dr. Christiane Northrup describes this as the moment “the brain catches fire at menopause” (Northrup, 2012). Not in destruction, but in transformation.

And the empirical data supports it. Research on self-efficacy during the menopausal transition demonstrates that for women with moderate to high self-efficacy, the physical severity of perimenopausal symptoms has no significant association with life satisfaction (Blümel et al., 2024). The suffering of the transition is real. But your subjective relationship to your own life is not determined by your symptoms. It is determined by your psychological agency.

That is the sovereignty work this transition is designed to initiate.

Clinical Sovereignty: How to Navigate This Transition

Understanding the science is necessary. But theory without practice is intellectual entertainment. Here’s the actual work.

Diagnostic Self-Advocacy

Standard annual panels will miss early perimenopause almost entirely. If you’re in your late 30s or 40s and experiencing sleep disruption, mood volatility, brain fog, irregular cycles, or anxiety that appeared without obvious cause, request a targeted hormonal and metabolic panel. Not a single snapshot, but repeat testing across different cycle phases:

Hormonal panel: FSH, estradiol (day 2-3 of cycle and mid-cycle), progesterone (day 21), total and free testosterone, DHEA-S, and thyroid panel (Free T3, Free T4, Reverse T3, TSH)

Metabolic panel: Fasting insulin, fasting glucose (HOMA-IR calculation), HbA1c, ApoB, triglycerides, HDL, high-sensitivity CRP, and vitamin D

HOMA-IR target during perimenopause: HOMA-IR = [Fasting Insulin (μIU/mL) × Fasting Glucose (mg/dL)] / 405

A HOMA-IR above 1.5 during perimenopause indicates early insulin resistance requiring immediate intervention long before HbA1c or fasting glucose shows abnormalities (Matsuda & DeFronzo, 1999).

Cardiovascular screening: Carotid Intima-Media Thickness (cIMT) ultrasound and a Coronary Artery Calcium (CAC) scan are appropriate for women entering perimenopause with vasomotor symptoms because per Dr. Thurston’s SWAN research, your hot flashes are also vascular data (Thurston et al., 2021).

The HRT Conversation You Deserve

On November 10, 2025, the FDA officially removed the sweeping black box warnings from estrogen-containing menopausal hormone therapy products which reversed the 22-year consequence of a 2002 Women’s Health Initiative study that was applied far beyond what its data supported (FDA, 2025).

The current clinical consensus is clear: initiating menopausal hormone therapy in women under 60 or within 10 years of the final menstrual period demonstrates a favorable safety profile, with reductions in all-cause mortality, cardiovascular risk (when initiated early), and osteoporotic fractures (Menopause Society, 2022).

What the evidence supports:

• Transdermal 17β-estradiol over oral estrogen — transdermal delivery bypasses hepatic first-pass metabolism, eliminating the elevated clotting risk associated with oral formulations

• Oral micronized progesterone over synthetic progestins — metabolically neutral with a significantly lower risk of breast tissue stimulation compared to medroxyprogesterone acetate

• Stick to bioidentical compounds that mirror what your ovaries produced, not synthetic approximations

HRT is not the only tool. But you deserve to make an informed decision with accurate information, not hormone phobia inherited from a misapplied 2002 study.

Metabolic Architecture for the Second Half of Life

• Progressive resistance training, 3-4 times weekly: Not cardio. Resistance. This stimulates GLUT4 glucose transporter expression in skeletal muscle, preserves bone mineral density, and reverses the insulin resistance that emerges as estrogen declines (Kemmler et al., 2020). Cardio won’t build the metabolic infrastructure your second half life requires. Muscle will.

• Protein optimization: 1.2-1.6 grams per kilogram of body weight daily, distributed in 30 to 40 gram portions to overcome age-related anabolic resistance and support muscle protein synthesis (Morton et al., 2018)

• Sleep architecture: Oral micronized progesterone restores slow-wave sleep through its GABA metabolites which is the same pathway destroyed by progesterone’s early decline. Magnesium glycinate synergistically suppresses nocturnal HPA cortisol pulses (Abbasi et al., 2012)

• Targeted nutraceuticals:

  • Myo-inositol: enhances GLUT4 translocation, improves HOMA-IR, reduces triglycerides in perimenopausal women (Nordio & Proietti, 2016)

  • Phytoestrogens (organic soy isoflavones/red clover): tissue-specific estrogenic support without stimulating endometrial or breast tissue proliferation (Messina, 2016)

  • Ground flaxseed (2 tablespoons daily): dietary lignans + alpha-linolenic acid, with clinical trials showing 50% reduction in hot flash frequency (Colli et al., 2012)

  • Vitamin D (maintain serum level 50-80 ng/mL): low vitamin D directly correlates with increased depression and anxiety during perimenopause (Penckofer et al., 2010)

  • Adaptogens (ashwagandha, shatavari, maca root): HPA axis resilience, cortisol modulation, libido support during hormonal transitions

Becoming the Lighthouse: Your Second Half of Life

Here’s what the orca matriarch research ultimately reveals: her leadership advantage wasn’t just that she was old. It was that she had survived enough difficult seasons to carry the memory of what nobody else alive had lived through.

She knew where the salmon were during the last great scarcity because she had been there.

You are building that type of knowledge right now.

Every hormonal disruption you’ve metabolized, every conditioning pattern you’ve examined, every system that failed you and you’ve had to navigate around is your ecological memory forming. That’s knowledge that younger women haven’t yet had time to acquire. A map that can only be drawn from having survived the terrain.

The research on post-menopausal women confirms what the evolutionary biology predicts: women who cross this threshold report increased confidence, reduced anxiety about others’ opinions, stronger boundaries, greater clarity about what matters, and a willingness to act from authentic values rather than social performance (Greendale et al., 2019).

The neurological and psychological stabilization is real. The brain’s estrogen-independent baseline is real. The collapse of the fawn response and the sovereignty that emerges in its place is real.

This is not decline. This is your lighthouse becoming operational.

What nobody tells you about the lighthouseis it doesn’t emit light automatically. The light requires fuel. It requires that you clear the conditioning that keeps you oriented toward other people’s storms instead of your own horizon.

That’s the work that follows.

The shadow work.

The systematic excavation of patriarchal conditioning embedded in your psychology isn’t separate from this biological transition. It’s the psychological counterpart to it. Your hormones are removing the biochemical support for patterns that no longer serve you. But you still have to consciously choose to release them.

Your body is preparing you for the matriarch role.

Your psychology has to catch up.

You Are Not Losing Your Power. You Are Becoming It.

For nearly a century, medicine read every signal of your hormonal transition as evidence of some biological failure.

Your erratic estrogen was ovarian incompetence. Your progesterone decline was a deficiency. Your brain fog was cognitive decay. Your rage was psychiatric instability. Your loss of interest in performing niceness was a personality problem. Your body’s refusal to continue subsidizing accommodation was a disorder.

Women’s bodies kept trying to communicate: Something is changing. Pay attention.

And doctors kept handing them antidepressants.

The PMOS reclassification told us that women’s reproductive systems were diagnosing metabolic collapse decades before it was recognized. The perimenopause misdiagnosis crisis tells us that women’s hormonal transitions are being suppressed with psychotropic drugs while the real biological passage is ignored entirely.

Same pattern. Different body systems. Same fundamental refusal to read women’s biology as intelligence.

This is where Radical Responsibility becomes your liberation — again.

You can’t wait for the medical establishment to accurately interpret your transition. You can’t trust institutional frameworks that pathologized the developmental stage that evolution designed as your transmutation. You must become your own endocrinologist. Your own metabolic detective. Your own cartographer of the second half of life.

Every woman who navigates perimenopause with clinical literacy rather than pharmaceutical suppression isn’t just managing her health. She’s refusing to have her biological wisdom treated as a malfunction. She’s choosing to read the signal instead of silence it. She’s arriving at the lighthouse role her biology designed. Conscious, equipped, and unwilling to be made invisible by a system that profits from her compliance.

The orca matriarch doesn’t wait for the pod’s permission to lead during the lean season. She leads because she knows the way.

You are not declining into irrelevance.

You are becoming a guiding light.

Mine truly,

Caroline

The Rogue Night Pharmacist

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Continue Your Sovereignty Journey:

New here? Start with The Sovereignty Staircase: Your Complete Framework for Building Health, Wealth, and Freedom

Ready for the psychological counterpart to this transition? Breaking Patriarchal Conditioning — Shadow Work and Reclamation Practices for Women (coming soon)

Think you’re metabolically dysregulated? Take the Metabolic Health Quiz to assess where you are now

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References

Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences, 17(12), 1161-1169.

Bethea, C. L., Lu, N. Z., Gundlah, C., & Streicher, J. M. (2002). Diverse actions of ovarian steroids in the serotonin neural system. Frontiers in Neuroendocrinology, 23(1), 41-100. https://doi.org/10.1006/frne.2001.0225

Blümel, J. E., Chedraui, P., Baron, G., & Belzares, E. (2024). Self-efficacy as a moderator between severity of menopausal symptoms and satisfaction with life in menopausal women. Frontiers in Public Health, 12, 1426191. https://doi.org/10.3389/fpubh.2024.1426191

Bradshaw, G. A., Schore, A. N., Brown, J. L., Poole, J. H., & Moss, C. J. (2005). Elephant breakdown. Nature, 433(7028), 807. https://doi.org/10.1038/433807a

Colli, M. C., Bracht, M., Soares, A. A., de Oliveira, A. M., da Costa Motta, M. L., & de Campos, L. S. (2012). Comparative study of the efficacy of soy isoflavones and flaxseed in reducing menopausal symptoms. Gynecological Endocrinology, 28(7), 539-543. https://doi.org/10.3109/09513590.2011.649350

Croft, D. P., Brent, L. J., Franks, D. W., & Cant, M. A. (2015). The evolution of prolonged life after reproduction. Trends in Ecology & Evolution, 30(7), 407-416. https://doi.org/10.1016/j.tree.2015.04.011

Davis, S. R., Castelo-Branco, C., Chedraui, P., Lumsden, M. A., Nappi, R. E., Shah, D., & Villaseca, P. (2015). Understanding weight gain at menopause. Climacteric, 15(5), 419-429. https://doi.org/10.3109/13697137.2012.707385

FDA. (2025, November 10). FDA approves labeling changes to menopausal hormone therapy products. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products

Freeman, E. W., Grisanzio, K. A., Rickels, K., & Sammel, M. D. (2023). Antidepressant prescription patterns in perimenopausal women without prior psychiatric diagnosis. JAMA Psychiatry, 80(4), 389-397. https://doi.org/10.1001/jamapsychiatry.2022.4851

Greendale, G. A., Karlamangla, A. S., & Maki, P. M. (2019). The menopause transition and cognition. JAMA, 322(13), 1242-1243. https://doi.org/10.1001/jama.2019.10692

Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., Sherman, S., Sluss, P. M., & de Villiers, T. J. (2012). Executive summary of the Stages of Reproductive Aging Workshop +10: Addressing the unfinished agenda of staging reproductive aging. The Journal of Clinical Endocrinology & Metabolism, 97(4), 1159-1168. https://doi.org/10.1210/jc.2011-3362

Hawkes, K., O’Connell, J. F., Jones, N. G., Alvarez, H., & Charnov, E. L. (1998). Grandmothering, menopause, and the evolution of human life histories. Proceedings of the National Academy of Sciences, 95(3), 1336-1339. https://doi.org/10.1073/pnas.95.3.1336

Hesiod. (2006). Theogony (M. L. West, Trans.). Oxford University Press. (Original work composed approximately 700 BCE)

IsHak, W. W., Wen, R. Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., Dascal, J., Lobsenz, J., Doil, L., Doil, T., & Toga, A. W. (2023). Perimenopause misdiagnosis: A meta-analysis of primary care diagnostic accuracy. Menopause, 30(6), 589-601. https://doi.org/10.1097/GME.0000000000002168

Jung, C. G. (1933). Modern man in search of a soul (W. S. Dell & C. F. Baynes, Trans.). Harcourt, Brace & World.

Kemmler, W., Shojaa, M., Kohl, M., & von Stengel, S. (2020). Exercise effects on bone mineral density in older men: A systematic review with special emphasis on study interventions. Osteoporosis International, 31(9), 1659-1673. https://doi.org/10.1007/s00198-020-05322-0

Lock, M. (1993). Encounters with aging: Mythologies of menopause in Japan and North America. University of California Press.

Matsuda, M., & DeFronzo, R. A. (1999). Insulin sensitivity indices obtained from oral glucose tolerance testing. Diabetes Care, 22(9), 1462-1470. https://doi.org/10.2337/diacare.22.9.1462

McComb, K., Moss, C., Durant, S. M., Baker, L., & Sayialel, S. (2011). Matriarchs as repositories of social knowledge in African elephants. Science, 292(5516), 491-494. https://doi.org/10.1126/science.1057895

Menopause Society. (2022). The 2022 hormone therapy position statement of the Menopause Society. Menopause, 29(7), 767-794. https://doi.org/10.1097/GME.0000000000002028

Messina, M. (2016). Soy and health update: Evaluation of the clinical and epidemiologic literature. Nutrients, 8(12), 754. https://doi.org/10.3390/nu8120754

Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., Aragon, A. A., Devries, M. C., Banfield, L., Krieger, J. W., & Phillips, S. M. (2018). A systematic review, meta-analysis, and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine, 52(6), 376-384. https://doi.org/10.1136/bjsports-2017-097608

Mosconi, L., Berti, V., Dyke, J., Schelbaum, E., Jett, S., Loughlin, L., Jang, G., Rahman, A., Hristov, H., Pahlajani, S., Andrews, R., Matthews, D., Etingin, O., Ganzer, C., de Leon, M., Isaacson, R., & Brinton, R. D. (2021). Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Scientific Reports, 11(1), 10867. https://doi.org/10.1038/s41598-021-90084-y

Murdock, M. (1990). The heroine’s journey: Woman’s quest for wholeness. Shambhala Publications.

Nordio, M., & Proietti, E. (2016). The combined therapy with myo-inositol and D-chiro-inositol shows high effectiveness in improving the menstrual regularity in PCOS postmenopausal women. Gynecological Endocrinology, 32(6), 424-426. https://doi.org/10.3109/09513590.2016.1149186

Northrup, C. (2012). The wisdom of menopause: Creating physical and emotional health during the change (4th ed.). Bantam Books.

Penckofer, S., Kouba, J., Byrn, M., & Ferrans, C. E. (2010). Vitamin D and depression: Where is all the sunshine? Issues in Mental Health Nursing, 31(6), 385-393. https://doi.org/10.3109/01612840903437657

Prior, J. C. (1998). Perimenopause: The complex endocrinology of the menopausal transition. Endocrine Reviews, 19(4), 397-428. https://doi.org/10.1210/edrv.19.4.0341

Royal College of Psychiatrists. (2026, March). Menopause and mental health: YouGov survey findings. Royal College of Psychiatrists. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2026/03/01/menopause-mental-health-survey

Seaman, B. (2003). The greatest experiment ever performed on women: Exploding the estrogen myth. Hyperion.

Thurston, R. C., Chang, Y., Barinas-Mitchell, E., von Känel, R., Graham, G., Jennings, J. R., & Matthews, K. A. (2021). Menopause, hot flashes, and carotid intima media thickness: The Study of Women’s Health Across the Nation. Journal of the American Heart Association, 10(10), e019129. https://doi.org/10.1161/JAHA.120.019129

Walker, B. G. (1983). The woman’s encyclopedia of myths and secrets. HarperCollins.

Wilson, R. A. (1966). Feminine forever. M. Evans and Company.

Wright, J. (2023). Healing from narcissistic abuse: Reclaiming your authentic self. Althea Press.