“From Maiden to Mother to Matriarch: Understanding the Transition of Perimenopause”

Prairie Doc Perspective Week of October 5th, 2025
“From Maiden to Mother to Matriarch: Understanding the Transition of Perimenopause”
By Jill Kruse, DO
Women experience distinct stages throughout their lives.  In literature, these are often described as the maiden, the mother, and the matriarch phases.  The transitions between these phases can be challenging times for a woman.  Perimenopause is the transition between mother to matriarch.  
The prefix peri- means around, about or near, and menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months.  The average age of menopause is 51 years old.  Perimenopause typically starts for women in their 40s and lasts between four to ten years. In some cases, it can start as early as 30s or as late as 50s.  
During perimenopause, the ovaries start producing fewer hormones. Estrogen and progesterone levels can vary significantly week to week leading to the symptoms associated with perimenopause. Because of these hormonal shifts, lab tests for hormone levels can be unreliable for diagnosis. Elevated Follicle Stimulating Hormone (FSH) and low Estradiol levels in a woman over the age of 45 can suggest menopause, although repeated testing is usually needed to confirm a diagnosis.  Thyroid Stimulating Hormone (TSH) is often checked in women, since low TSH can mimic perimenopause or menopause symptoms.  
One of the first perimenopause symptoms many women experience is menstrual cycle changes.  Menstrual cycles may become more irregular, longer, shorter, heavier or lighter. Hormonal changes can also lead to hot flashes, night sweats, vaginal dryness, sleep problems, mood changes, and ‘brain fog’. Slower metabolism during perimenopause can also lead to weight gain in some women.  
While perimenopause is a natural part of aging, there are lifestyle changes and medications that can help minimize its symptoms.  Limiting alcohol and caffeine, improving sleep quality, and reducing stress can all help diminish hot flashes.  Doing more weight bearing exercises and taking a Calcium with Vitamin D supplement can help reduce the increased risk of osteoporosis and heart disease, which is caused by the decrease in estrogen.  Quitting smoking is also an important step to help minimize symptoms of perimenopause and menopause.  Discussing with your physician can help you find one of the multiple prescription medications that are available to help reduce symptoms.  
Although this transition from mother to matriarch is not always smooth or easy, knowing what to expect can help alleviate anxiety and fear.  Making healthy lifestyle choices and maintaining regular doctor visits are key. If you are experiencing symptoms, speak with your doctor about possible treatments and how to best support your well-being through this important life phase. 
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).