The Menopause Guidebook: From Overwhelm to Empowerment

Dedication

I wish I could dedicate this guide to every young woman between 12 and 18. Menopause may feel like it’s a lifetime away, something you don’t need to think about yet. But the habits you build now—in nutrition, exercise, sleep, and hydration—will strengthen your body throughout your life and make menopause much easier when the time comes. Even more, learning early how to minimize exposure to xenoestrogens and synthetic estrogens can greatly improve your future perimenopausal health while also supporting your well-being right now. Start today—the benefits will enrich your life both now and for years to come. -Dr. Alison Caldwell-Andrews

Introduction: The Royal Years

To understand how a woman’s body works is to recognize the central role of her fertile, childbearing years. Much of female physiology is anchored in the fundamental cycle of fertility. But menopause is not the dried-up remains of this story—it is a powerful new chapter. Rather than viewing menopause as a slow decline or postscript, we should see it instead as a crowning culmination of decades of deep physical and psychological work. These are the royal years. And like any transition to power, they deserve preparation.

Unfortunately, women have long been under served by the medical system, especially when it comes to menopause. This vital phase of life has been reduced to a problem to fix or avoid. Our silvered hair, expressive faces, and bodies that have carried so much are dismissed and devalued. Rather than revering these visible signs of age, women are encouraged to hide or delay them. We are taught to be embarrassed about growing older instead of anticipating a glorious phase of increased power and prestige.

What Is Menopause?

Ask many doctors—or worse, social media influencers—and they’ll say menopause is simply a lack of estrogen. The response? Hormone replacement therapy (HRT) or, even more concerning, antidepressants, to treat what are often framed as mental health issues. But these "solutions" fall short and sometimes carry serious risks.

Menopause begins when a woman has gone 12 consecutive months without a period. It marks the end of ovulation, the end of the ovaries’ monthly cycle of releasing eggs and producing the hormones estrogen, progesterone, and testosterone. But this is not the end of a woman’s hormonal story—just a shift in the way we function.

Menopause Is our Glorious Autumn. Just as trees blaze with brilliance before winter, women enter a radiant phase of transformation. Menopause is not a simple loss of hormones, but is rather, a new hormonal rhythm.

The Long Transition

The menopausal journey begins many years before periods stop. Around a decade prior, ovulation becomes inconsistent, progesterone drops, and symptoms like mood swings, anxiety, or spotting may begin. You may still have regular periods, but ovulation is less frequent, and the resulting hormonal imbalance begins to show. 

Estrogen becomes erratic—sometimes surging, sometimes dipping. And because progesterone declines earlier and more sharply, symptoms of estrogen dominance (like breast tenderness, irritability, and heavy periods) appear, even if estrogen levels look “normal.”

Pre-menopause

As women enter their mid-30s—or sometimes earlier due to factors like chronic stress, exposure to environmental toxins or synthetic estrogens—it becomes increasingly common to experience anovulatory cycles, where the body doesn't release a mature egg. Without ovulation, the corpus luteum doesn’t form. T The corpus luteum is a temporary helper gland, a yellow patch in the ovary that forms after the egg is launched from the ovary. This corpus luteum is the primary source of progesterone, and some testosterone. This is why hormone levels go down so much when women stop ovulating. While the adrenal glands can produce small amounts of progesterone, these amounts are not nearly enough to maintain hormonal balance.

In your 30s, these shifts often go unnoticed or are dismissed as mere stress responses or random hormonal fluctuations. But behind the scenes, progesterone and estrogen levels are beginning to swing more dramatically. Although you are not yet in perimenopause, you could consider this to be premenopausal, and environmental estrogen (xenoestrogens, etc.) or stress can make this happen earlier. 

Low progesterone has wide-reaching effects—impacting mood, sleep quality, bone density, and more. It also plays a role in balancing testosterone; when progesterone is low, this balance is disrupted, potentially resulting in acne, increased facial hair, or other androgenic symptoms.

Meanwhile, declining testosterone adds to the challenges of lower estrogen and progesterone, contributing to reduced libido, lower energy, and diminished muscle mass.

The symptoms and timing of this transitional phase—sometimes called early perimenopause—can vary greatly from woman to woman, making it easy to overlook or misattribute what’s really going on hormonally.