Why You Don’t Feel Like Yourself in Perimenopause (& How to Get Your Groove Back)
Dr. Prudence Hall
Gynecological Surgeon, Regenerative & Integrative Medicine Practitioner, Founder of The Hall Center, Author
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If you’ve hit your 40s and found yourself thinking, “I don’t feel like myself anymore,” you are in extremely good company. This is one of the most common—and most misunderstood—symptoms of perimenopause.
In this episode of Midlife Advice, I’m joined by Dr. Prudence Hall, a gynecological surgeon turned regenerative medicine practitioner, who helps women decode their symptoms and reclaim their energy, clarity, libido, and spark.
This conversation is packed with practical explanations, clear hormone education, and a refreshing amount of hope.
Why You Don’t Feel Like Yourself in Perimenopause
Perimenopause isn’t just night sweats and skipped periods. Dr. Hall explains that the earliest signs are often emotional and neurological:
• Mood swings or irritability
• Sudden anxiety
• Low motivation
• Loss of joy or zest
• Feeling “flat” or disconnected
• Brain fog
• Fatigue that makes basic tasks feel hard
These changes are tied to fluctuating estrogen, progesterone, and testosterone, which create internal conditions your brain and body have never experienced before.
You’re not imagining it—and you’re definitely not crazy.
“Measure, Don’t Guess”: The Labs That Matter
One of the biggest frustrations women face is being told everything is “normal” when they feel anything but. Dr. Hall’s advice is clear:
Track your symptoms and ask for labs.
Here are the labs she recommends for perimenopause:
Hormone Panel
• Estradiol (E2)
• Progesterone
• Total & Free Testosterone
• FSH (follicle-stimulating hormone)
• SHBG (optional but helpful)
Thyroid Panel
• TSH
• Free T3
• Free T4
• Thyroid antibodies (TPO, TgAb)
• Consider Reverse T3
Even “slightly low” levels can create very real symptoms.
Can Bioidentical Hormones Help You Feel Like Yourself Again?
Short answer: for many women, yes.
Dr. Hall explains that BHRT (bioidentical hormone replacement therapy) can:
• Improve mood
• Restore energy
• Improve sleep
• Reduce PMS
• Support libido
• Calm anxiety
• Improve brain clarity
• Help you feel more like you
And when your hormones aren’t fighting you anymore, lifestyle changes—like eating better, building muscle, managing stress, sleeping well—become exponentially easier.
Birth Control Pills and Hormonal IUDs in Perimenopause
Dr. Hall shares a perspective many women don’t hear:
• Birth control pills can suppress your own estradiol and testosterone, sometimes leaving women feeling worse in perimenopause.
• Hormonal IUDs can help some women, but may also lower estrogen in others—labs are essential to know.
• Non-hormonal options like Paragard or fertility-tracking apps may be better aligned for some midlife women.
If you’re feeling off and you use hormonal contraception, it’s worth evaluating.
Thyroid Health Often Gets Overlooked
Hypothyroidism and perimenopause share nearly identical symptoms. Dr. Hall reminds women to look for:
• Fatigue
• Weight gain
• Dry skin and hair
• Constipation
• Low mood
• Brain fog
• Feeling cold all the time
Make sure your provider runs a full thyroid panel, not just TSH.
Final Takeaways from Dr. Hall
1. You are not broken—feeling off in perimenopause is common and treatable.
2. Measure, don’t guess. Labs + symptom tracking give you real answers.
3. You deserve a clinician who understands midlife hormones. If you’re dismissed, find someone else.
4. BHRT can be a game-changer, but it’s not your only tool.
5. Your 40s and 50s can feel amazing with the right support.
Chapters:
02:01 Why We Don't Feel Like Ourselves in Perimenopause
07:22 Why Labs are Important in Perimenopause
10:11 When Your Labs Look "Normal" in Perimenopause
13:05 HRT or Diet/Lifestyle? Which Comes First?
15:33 Can Midlife Women Feel Like We're 30 Again?
19:05 The WHI Study and What We Know Now About HRT
22:11 Birth Control Pills & IUDs in Perimenopause: Dr. Hall's Take
27:59 What Perimenopausal Women Need to Know About Their Thyroid
35:06 Key Takeaways
About Dr. Prudence Hall:
Dr. Prudence Hall started as a traditional gynecological surgeon and transitioned her career to focus on regenerative and integrated medicine. As the founder of The Hall Center in Santa Monica, California, she saw a critical need to address the problems confronting women and men experiencing the stubborn and often debilitating symptoms associated with aging.
Her practice is focused exclusively on regenerative medicine, looking into the root causes of conditions and diseases rather than simply treating symptoms. She strives to help clients achieve optimal health and actively prevent disease without the use of pharmaceutical drugs when appropriate.
@drprudencehall | Get her free book: Radiant Again & Forever | The Hall Center
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Disclaimer:
Belong Wellness and its members, managers, employees, contractors, and other agents or representatives are not licensed medical care providers and do not provide medical services or advice, including without limitation diagnosing, examining, preventing, treating, or curing any medical conditions. The information shared in this podcast is meant to be educational, not prescriptive. Please consult your medical doctor before making any changes to your diet or lifestyle. Further, the opinions of guests on this show do not necessarily reflect the opinions of Jessica or anyone affiliated with Belong Wellness.
