The First Sign of Perimenopause Isn't What You Think

PLUS: A promising non-hormonal option in trials + new guidance for early menopause

Welcome to the September 1st edition of Menopaussible—bringing you the news you can use and the ⚡ energy ⚡ you need to support your menopause journey. I'm Maria Caracci Ciccolella—mindset coach and menopause advocate. (Connect with me on IG or LinkedIn!)

Time feels like it’s moving so fast today—the summer went by in a blink and now Labor Day is upon us. Some have been easing back in routines for a few weeks, while others are just returning to their pre-summer rhythms. That familiar schedule is, as they say, what keeps the trains on the tracks.

But there's another rhythm many of us stop noticing until it is clearly off tempo. Your cycle has been the metronome running underneath every other schedule since you were a teenager—reliable enough that you never had to think about it. Perimenopause doesn’t announce itself. It just quietly starts skipping beats.

In this issue, and for the start of Perimenopause Awareness Month, we’re going to get into the timing mechanism behind your period, and why your period is rarely the first obvious sign that the menopause transition has begun. That rhythm draws from a reserve that's been in motion since before you were born.

You Were Already in Motion Before Birth

Here’s something wild: the peak number of eggs in your ovaries happened long before you were born—at just 20 weeks gestation (yes, when YOU were in the womb!). By birth, you had about 1–2 million egg follicles. By puberty, around 300,000. And once ovulation began, that count only continued to decline.

(Something wilder: some part of you was quite literally in your grandmother’s womb!)

Why does this matter? Because menopause is essentially “planned” before birth. As egg follicle count and quality decline with age, ovulation becomes less consistent—cycles shorten or lengthen (but maybe by only a few not-really-noticeable days), before they skip altogether—and that’s what sets the hormone chaos in motion.

The Rhythm Was Always a Conversation

We tend to think of the ovaries as egg-makers, but they’re also part of the endocrine system, in constant communication with the brain.

Here’s the TLDR on that talk:

• Your pituitary gland sends out FSH (follicle-stimulating hormone) and LH (luteinizing hormone)—hormone signals that tell the ovaries to develop a follicle and release an egg
  ​
• In response, the ovaries produce estradiol (estrogen), which supports ovulation
  ​
• After the egg is released, that follicle becomes the corpus luteum and produces progesterone

Month after month, it’s a mostly rhythmic system—until it isn’t.

When the Signal Gets Static-y

As egg count and quality fall below a threshold, the ovaries stop reliably releasing eggs. These “anovulatory cycles” throw off the brain–ovary conversation entirely.

Your body senses something is off and tries to compensate—sending stronger signals, working harder to get a response. Over time: FSH and LH levels rise. Estradiol spikes unpredictably. Progesterone drops because no egg means no corpus luteum to produce it.
​
The result? A once-steady rhythm turns into a rollercoaster 🎢. And here’s the kicker: zoom out over 5 years or zoom in to a single day, and that up and down chaos shows up. (It’s also why hormone testing during perimenopause is often unreliable—it’s truly the luck of the blood draw.)

That rollercoaster is at the root of what you might be feeling. We call them symptoms, but I like to reframe them as signals. Communication that your body is recalibrating for life ahead.

The Symptoms Are The First to Tell You What’s Up

A study by Women Living Better presented at the 2025 Annual Meeting of the Menopause Society validated what many women have been feeling for years—that “not feeling like yourself” is often the first broad signal that something is changing.
​
And why is that? Because estrogen and progesterone aren't just reproductive hormones. They have 400+ receptors each, in nearly every organ, bone, and tissue of the body. (Think of a receptor as a lock, the hormone as the key. When they fit, something happens: a function, an instruction, a signal.)

During perimenopause, those hormones stop arriving on their usual schedule. Sometimes they surge, sometimes they vanish. With the routine no longer in place, the train starts coming off the tracks. The body struggles to adjust and that disruption shows up everywhere those receptors live, not just in your cycle.

Which is why your period is often the last thing to change, not the first. Sleep gets lighter. Mood swings wider. Focus gets foggier. Those are the signals being sent up—months, sometimes years, before your cycle visibly shifts. Your body is now working toward a new norm, a new way of functioning—and it not only wants your attention, it wants you to make decisions decidedly in your best interest.

All the Paussibilities

Now all that being said, routine disruption—while jarring at first—is an opportunity to recalibrate: to step back, take inventory, and align with your goals and priorities. With women living until, on average, the age of 81—there’s still a lot of life ahead—why not make sure it’s fulfilling?

So what would it look like to actually take stock? Start here:

You Just Learned to Read Your Body's Signals. What About the Rest?​ Recalibration doesn't stop with hormones—it's just where it starts. Is something in your life asking too? Book a free clarity consult here.

Plus: News Items

A Non-Hormonal Option Just Cleared a Real Hurdle

AbCellera's ABCL635 significantly cut the frequency and severity of hot flashes in a mid-stage trial recently, and investors noticed—shares jumped nearly 40%, BNN Bloomberg reports. What sets it apart: it's an antibody, not a daily pill—a single dose targeting the same NK3 receptor pathway as existing non-hormonal options like Veozah, but delivered differently. That distinction matters for the women who can't or won't take hormone therapy and have been stuck choosing between symptoms and side effects. This is still mid-stage, not on pharmacy shelves yet, but it's real data, not a supplement claim dressed up as one. More choice on the table is never a small thing.
​

The Guidance Is Finally Catching Up to Early Menopause

The International Federation of Gynecology and Obstetrics (FIGO) and the International Menopause Society just published joint guidance calling for a different approach to hormone therapy for women with premature ovarian insufficiency and early menopause. Translation: the medical establishment is formally acknowledging that a 35-year-old whose cycle disappears needs different care than a 52-year-old going through it on schedule. It's a policy-level nudge toward listening to women whose timeline didn't match the textbook.
​

A Chance to Help Build the Research That Doesn't Exist Yet Women Living Better and 4YouAndMe are recruiting women 35–55 for a first-of-its-kind study tracking what's actually happening in the body during the years before and through perimenopause and menopause—a stretch of life that's chronically understudied. Participants wear an Oura Ring and Fitbit Sense 2, complete daily check-ins over six to nine months, and get access to their own data along the way. Some will also track daily hormones at home or test a new wearable that measures core body temperature shifts. If you've ever wished someone were actually measuring what you're feeling instead of guessing, you can sign up to participate here.