Your Whole Body

If it feels like everything is changing at once, that’s because it is.

Estrogen isn’t just a reproductive hormone. It has receptors in over 400 tissues throughout your body—your heart, your bones, your brain, your skin, your eyes, your gut, your joints. Every one of those tissues is responding to the hormonal shifts of perimenopause.

This isn’t a malfunction. It’s a whole-body recalibration. But knowing what’s happening can help you understand why you feel the way you do—and what deserves attention.

Your Heart

Estrogen has been quietly protecting your cardiovascular system for decades:

• It keeps blood vessels flexible and dilated
• It helps maintain healthy cholesterol ratios
• It reduces inflammation in artery walls

As estrogen fluctuates and eventually declines, that protection changes. After menopause, cardiovascular disease risk rises to match men’s.El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. A Scientific Statement From the American Heart Association. Circulation. 2020;142(25):e506-e532. This doesn’t mean heart disease is inevitable—it means this is a time to pay attention to heart health if you haven’t been.

The connection between hot flashes and cardiovascular health is still being studied, but there’s growing evidence that frequent vasomotor symptoms may be a marker for cardiovascular risk.Zhu D, et al. Vasomotor Menopausal Symptoms and Risk of Cardiovascular Disease: A Pooled Analysis of Six Prospective Studies. American Journal of Obstetrics & Gynecology. 2020;223(6):898.e1-898.e16. Another reason to take these symptoms seriously.

Your Bones

Here’s something most women don’t know: bone loss begins during perimenopause, before menopause itself.Finkelstein JS, et al. Bone Mineral Density Changes During the Menopause Transition in a Multiethnic Cohort of Women. Journal of Clinical Endocrinology & Metabolism. 2008;93(3):861-868. You don’t have to wait until your periods stop to start losing bone density.

Estrogen helps keep the balance between bone-building cells (osteoblasts) and bone-removing cells (osteoclasts). When estrogen becomes erratic, that balance shifts toward loss.

Your Metabolism

You’re not imagining it:

• Insulin sensitivity decreases
• Visceral fat (around the organs) accumulates more easily
• Your body composition shifts even if your weight doesn’t change

These changes happen independent of aging and independent of what you eat. That doesn’t mean diet and exercise don’t matter—they do, more than ever. But it does mean that the changes you’re seeing aren’t simply a failure of willpower.

The metabolic shifts of perimenopause are real, and they may require different strategies than worked before. More on this in Lifestyle Support.

Your Brain

I’ve written more about this in What Your Brain Is Doing, but the short version: estrogen affects multiple neurotransmitter systems, supports the growth factor that keeps neurons healthy (BDNF), and influences verbal memory and processing speed.

Brain fog is real. Word-finding difficulties are real. The feeling that you’re not as sharp as you used to be—real.

The reassuring news: for most women, cognitive function stabilizes and often improves once you reach stable postmenopause. The chaos of the transition is often harder than the destination.

Your Eyes

If your eyes feel drier, grittier, more irritated—that’s not coincidence. About 57% of menopausal women experience dry eye symptoms.Menopause Society. Dry Eye and Menopause: Mechanisms and Management. 2025. Over 57% of menopausal women report dry eye symptoms. Estrogen affects tear production and tear film composition.

This is one of those symptoms that often gets overlooked or attributed to screens and aging, but the hormonal connection is real.

Your Skin

Estrogen receptors in skin help maintain collagen production, elasticity, and moisture. As estrogen changes:

• Skin may thin
• Collagen production decreases
• Wounds may heal more slowly
• You might notice changes in texture or resilience

This isn’t vanity—skin is your largest organ, and its changes reflect what’s happening systemically.

Your Urogenital System

Vaginal and urinary tissues are particularly estrogen-sensitive. Changes here—dryness, irritation, increased urinary frequency or urgency, more frequent UTIs—are among the most common and persistent symptoms of menopause.

Unlike hot flashes, which often improve over time, urogenital symptoms typically persist or worsen without intervention. They’re also among the most treatable. Local estrogen, which stays in the vaginal tissue and doesn’t significantly raise blood levels, is safe for most women including many who can’t take systemic hormones.

The Bigger Picture

All of this can feel overwhelming. Everything at once. But understanding that these changes are connected—that they share a common cause—can actually be reassuring.

You’re not falling apart in a dozen different ways. Your body is going through one profound transition, and that transition touches everything.

The good news: most of these changes can be supported. Some with hormones, some with lifestyle changes, some with targeted medications, some simply with time and patience.

You don’t have to address everything at once. Start with what bothers you most. And know that your body is doing exactly what it’s designed to do—it’s just doing it loudly right now.