I’m turning 40 this year. And somewhere in the last year or so, my body started sending memos I didn’t ask for. The sleep that won’t stay. The brain fog that rolls in like weather. The weight that parks itself in new places regardless of what I eat. The joint days that feel different than they used to.
Welcome to perimenopause. Except nobody really tells you it can start this early — and if you have EDS, PCOS, or both, the whole hormonal picture gets significantly more complicated. I’ve been researching this extensively, and this is the post I wish had existed when I started connecting the dots. 🌙
What Is Perimenopause — And When Does It Actually Start?
Perimenopause is the transitional phase before menopause during which estrogen and progesterone levels begin their erratic, eventually declining journey. Menopause itself is defined as 12 consecutive months without a period — perimenopause is everything leading up to that point, which can last anywhere from 2 to 10 years.
Most mainstream sources will tell you perimenopause typically begins in the mid-to-late 40s. What they often leave out is that symptoms can begin much earlier — in the late 30s or even mid-30s — and that certain health conditions appear to be associated with an earlier, more symptomatic transition. According to Harvard Health Publishing, perimenopause commonly begins in a woman’s 40s but can start as early as the mid-30s.
The hormones involved aren’t just estrogen and progesterone — FSH (follicle-stimulating hormone), LH (luteinizing hormone), and testosterone all shift during this transition, and their interplay affects virtually every system in the body.
The Perimenopausal Symptom List Nobody Prepares You For
The mainstream conversation around perimenopause focuses on hot flashes and irregular periods. But the actual symptom list is much broader — and much of it overlaps with conditions like EDS, POTS, and PCOS in ways that make things genuinely complicated to parse:
| Symptom | What’s driving it |
|---|---|
| Hot flashes & night sweats | Estrogen decline disrupts the hypothalamus’s temperature regulation center; worsened by insulin resistance |
| Weight gain (especially belly fat) | Rising insulin resistance + declining estrogen shifts fat storage centrally; FSH may play a direct metabolic role |
| Brain fog & memory changes | Estrogen supports brain glucose metabolism; its decline impairs cognitive fuel efficiency |
| Sleep disruption | Night sweats, anxiety, cortisol dysregulation, and progesterone decline all fragment sleep |
| Mood swings & anxiety | Erratic estrogen fluctuations affect serotonin and GABA neurotransmitter systems |
| Joint pain & increased instability | Estrogen supports collagen production and joint stability; its decline directly affects connective tissue |
| Fatigue | Poor sleep, hormonal shifts, and thyroid changes compound |
| Irregular periods | Erratic ovulation as follicle reserves decline |
| Increased hunger & cravings | Ghrelin (hunger hormone) rises during perimenopause; insulin dysregulation drives sugar cravings |
| Hair thinning, dry skin | Collagen decline + hormonal shifts affect skin and hair structure |
The EDS-Perimenopause Connection 🦓
This is the part of the post I care most deeply about — and where I want to be careful to distinguish between what the research confirms and what the community widely reports but science hasn’t yet fully documented.
What the research does confirm:
Estrogen is deeply intertwined with connective tissue health. Estradiol receptors — the proteins activated by estrogen — are present in skin, cartilage, ligaments, tendons, and other connective tissues. Estrogen helps regulate the metabolism of collagen-producing cells and directly influences collagen synthesis. (Source: Hugon-Rodin et al., Orphanet Journal of Rare Diseases, 2016 — PMC5020453)
The perimenopause transition is particularly disruptive for hEDS. Research shows that approximately 61% of people with hEDS report symptom worsening during or after menopause — and perimenopause, with its erratic hormonal fluctuations, is often the most destabilizing phase. (Source: Jeannie Di Bon, Movement Therapist specializing in EDS)
The “sawtooth pattern” of perimenopause is especially impactful for zebras. Unlike the steady estrogen decline of full menopause, perimenopause is characterized by wildly erratic estrogen spikes and drops. For someone with EDS, estrogen spikes can cause periods of extreme joint laxity (estrogen can increase relaxin production, a hormone that further loosens ligaments), while estrogen drops lead to decreased collagen production, stiffness, and increased pain. This unpredictable seesaw is genuinely harder to manage than either extreme alone.
Low estrogen directly reduces Type I and Type III collagen production — the exact collagen types most implicated in EDS gene mutations, as I covered in depth in my collagen on keto guide. For someone already producing insufficient or structurally abnormal collagen, declining estrogen removes an important driver of collagen synthesis.
POTS symptoms may also shift during perimenopause. The Hypermobility Syndromes Association notes that estrogen helps regulate vascular tone via nitric oxide production — and its fluctuation makes the already stretchy veins in EDS/POTS even less responsive. Blood volume regulation, which is already compromised in POTS, can be further disrupted by hormonal flux.
What the community reports but research hasn’t yet confirmed:
Many women with EDS anecdotally report earlier onset of perimenopausal symptoms — and this matches my own experience. However, it’s important to be honest: formal research does not currently confirm that EDS causes earlier menopause onset specifically. What is documented is that EDS is associated with a range of gynecological complications, hormonal sensitivity, and a high rate of symptom fluctuation with hormonal changes throughout the reproductive lifespan, including puberty, menstrual cycles, and perimenopause. (Source: PMC5020453) We need more research. We always need more research.
The PCOS + Perimenopause Complication 💛
If you have PCOS — as I do — the perimenopause transition has an additional layer of complexity that most mainstream content completely ignores. PCOS already involves:
- Difficulty with weight regulation
When perimenopause arrives on top of PCOS, the insulin resistance that was already a feature of PCOS gets amplified by declining estrogen. Hot flashes may be more frequent and severe because of the combination of both insulin resistance drivers. And irregular cycles — already a PCOS hallmark — make it harder to track where you are in the perimenopause transition in the first place.
The good news: keto addresses insulin resistance at its root — making it one of the most powerful dietary tools for both PCOS and perimenopause. I’ve written about the PCOS-keto connection in detail in my PCOS and keto post — this post builds on that foundation. A 2025 systematic review and meta-analysis found that ketogenic diets led to significant improvements in weight, body composition, and insulin handling in women with PCOS. (Source: Xing et al., Food & Nutrition Research, 2025)
How Keto Specifically Helps With Perimenopausal Symptoms 💪
🔥 Hot Flashes
Hot flashes aren’t just about low estrogen — insulin resistance and chronic inflammation make them significantly worse by disrupting the hypothalamus’s temperature regulation center. Research shows that women with higher insulin levels experience more frequent and severe hot flashes. A 2024 study in the journal Menopause found that women following a ketogenic diet for 8 weeks showed a 30% reduction in inflammatory markers and a significant decrease in hot flash frequency. Keto addresses both the insulin resistance and the inflammation driving this symptom. (Source: Menopause journal, 2024)
🧠 Brain Fog
Declining estrogen impairs the brain’s ability to efficiently use glucose for fuel — think of it as the brain’s primary energy supply becoming unreliable. Ketones are a direct, alternative fuel source for the brain that bypass this glucose dependency entirely. This is one of the most well-documented subjective benefits of keto in perimenopausal women: the mental clarity that comes from stable, ketone-based brain fuel rather than an erratic glucose supply. (Source: Henderson, S.T., Neurobiology of Aging)
⚖️ Weight Gain & Belly Fat
The perimenopausal weight gain — especially the midsection shift — is driven by rising insulin resistance, declining estrogen, and increasing FSH levels that may directly impact metabolism. A 2024 meta-analysis in Frontiers in Nutrition confirmed that ketogenic diets significantly reduce appetite hormones (ghrelin) and drive meaningful weight loss in menopausal women — an average of 10-15% over 6 months. Keto’s core mechanism of reducing insulin is precisely what’s needed here. (Source: Frontiers in Nutrition, 2024)
😴 Sleep Disruption
Blood sugar spikes and crashes are a primary disruptor of sleep architecture — they trigger cortisol release in the early hours, causing that 2-3am wake-up pattern many perimenopausal women know all too well. Keto stabilizes blood sugar through the night, removing this major sleep disruptor. Combine that with the magnesium support I recommend (and covered in detail in my electrolytes guide), and the sleep strategies in my keto sleep post, and you have a meaningful toolkit.
💪 Joint Health & Collagen
For the EDS community especially: keto’s elimination of sugar-driven AGEs (advanced glycation end products — compounds that cross-link and destroy collagen) is protective during a phase when estrogen-driven collagen synthesis is already declining. Pairing keto with consistent collagen supplementation and bone broth becomes even more important during perimenopause. See my collagen on keto complete guide for the full breakdown.
😤 Mood & Anxiety
The erratic estrogen fluctuations of perimenopause directly affect serotonin and GABA systems — the neurotransmitters governing mood stability and anxiety. Blood sugar instability amplifies this significantly. Keto’s stabilizing effect on blood sugar removes a major mood-destabilizing variable. I’ve written about the keto-mental health connection in detail in my keto and mental health post.
The Honest Caveats: Where Keto Needs Adjustment for Perimenopause
I always want to give you the complete picture, not just the exciting parts. There are a few areas where perimenopause requires you to be more thoughtful about how you do keto:
- Bone density: Declining estrogen increases bone loss risk, and some research suggests very low calorie ketogenic diets may affect bone density markers. Counter this by ensuring adequate calcium, vitamin D, and magnesium; prioritizing resistance training; and not under-eating on keto. This is not a reason to avoid keto — it’s a reason to do it thoughtfully.
- Cholesterol monitoring: Menopause itself increases cardiovascular risk, and some people see LDL rise on keto. Work with your doctor to monitor lipid panels, emphasize healthy fats (avocado, olive oil, fatty fish, nuts) over saturated fat, and track particle size rather than LDL alone.
- Protein needs increase: Perimenopause accelerates muscle loss (sarcopenia). Adequate protein — not just moderate protein — becomes more important. Don’t let keto become an excuse to under-eat protein in pursuit of deeper ketosis.
- Consider cycling: Some women feel better with a modified or cyclical keto approach during perimenopause — strict keto most of the time with slightly higher carbs during certain phases. This is an individual decision worth exploring with a healthcare provider, especially if you notice thyroid or adrenal stress signals.
Key Nutrients for Keto in Perimenopause
Beyond the standard keto electrolytes, perimenopause specifically increases your need for:
- 🦴 Magnesium glycinate — supports sleep, muscle function, mood stability, and cortisol regulation, all of which are perimenopausal battlegrounds. This is the form I recommend — most bioavailable and gentlest on the gut.
- 🧬 Collagen peptides — as estrogen’s collagen-supporting role declines, dietary collagen amino acids become more important. Sports Research Collagen Peptides in your morning coffee is an easy daily habit. Covers Types I & III — exactly the EDS-relevant types.
- 🐟 Omega-3 fatty acids — anti-inflammatory, supports brain health, cardiovascular protection, and may reduce cortisol. Fatty fish 2-3x weekly plus a quality fish oil supplement.
- 🍗 Protein — aim higher than you think you need. 1.2-1.6g per kg of body weight supports muscle preservation during perimenopause-related sarcopenia risk. Premier Protein shakes and Quest bars make hitting targets easy.
- 🥩 Bone broth — collagen, glycine, minerals, and gut support all in one. Bare Bones bone broth is my go-to. Especially important for the EDS community where connective tissue is under additional stress.
- ⚡ Electrolytes — POTS-related electrolyte needs don’t decrease in perimenopause. If anything, vascular tone changes make adequate sodium, potassium, and magnesium more critical. LMNT and Ultima Replenisher remain my recommendations.
A Note on HRT and Keto
Hormone Replacement Therapy (HRT) or Menopausal Hormone Therapy (MHT) is a separate, deeply personal medical decision that deserves a conversation with a knowledgeable healthcare provider — and for EDS patients specifically, with a provider who understands the connective tissue implications. Research suggests HRT can be a meaningful tool for stabilizing estrogen levels, improving collagen production, and alleviating perimenopausal symptoms including chronic pain and tissue fragility. (Source: Minter et al, Hormone Health Clinic)
Keto and HRT are not mutually exclusive — many women use both. The important nuance for EDS is that progesterone specifically may worsen tissue laxity in some individuals, so the type and formulation of HRT matters. This is a conversation for your doctor, not a blog post — but I wanted to name it because it comes up constantly in the EDS community. The Hypermobility Syndromes Association has a helpful resource on hormones and hypermobility worth reading before your next appointment.
The Bottom Line
Perimenopause is not a character flaw, a failure, or something to just white-knuckle through. It is a profound hormonal transition that affects every system in your body — and for those of us with EDS, PCOS, POTS, or scoliosis, it lands on a body that is already navigating complexity.
What I can tell you from my own experience and from the research: keto is one of the most metabolically appropriate tools for this transition. Stabilizing blood sugar, reducing insulin resistance, providing alternative brain fuel, reducing inflammation, and eliminating sugar’s collagen-destroying effects — these are exactly what a perimenopausal body needs.
It doesn’t fix everything. But it handles a remarkable amount of the underlying metabolic chaos that makes this transition so hard for so many of us. Add targeted nutritional support, prioritize sleep, manage stress, move your body in ways that respect your connective tissue, and advocate loudly for yourself with your medical team.
We are zebrastrong. And we are not doing this alone. 🦓💜
Are you navigating perimenopause alongside EDS, PCOS, or POTS? I would genuinely love to hear your experience — what’s helped, what hasn’t, and what you wish more people talked about. Drop it in the comments. 💙
💰 Transparency note: This post contains affiliate links. If you purchase through my links I may earn a small commission at no extra cost to you.
⚠️ Disclaimer: This post is for informational purposes only and does not constitute medical advice. Perimenopause, HRT, and hormonal management decisions — especially for those with EDS, PCOS, or POTS — should be made in consultation with a qualified, informed healthcare provider. The research cited reflects current published science in an evolving field.
Photo by Anastasia Leonova on Unsplash
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