Perimenopause: WTF is happening to me?
Perimenopause can feel like your body suddenly changed the rules without sending you the updated handbook. Mood swings, brain fog, sleep problems, weird bleeding, libido changes. And yes, you can still be having perfectly regular periods while all of this is happening.
So… WTF is actually going on?
In this episode of Labia Logic, Dr. Ashley Fuller and Dr. Meredith McClure are joined by Women’s Health Nurse Practitioner Dr. Jaclyn Piasta to talk all about the hormonal chaos of perimenopause. They talk about why perimenopause cannot always be confirmed with a single hormone test but is still a clinical diagnosis. They also cover why symptoms can change from month to month, and how treatment may include birth control pills, IUDs, menopausal hormone therapy, vaginal estrogen, or a mix-and-match approach depending on what your body is doing.
The topics of painful sex, vaginal and urinary symptoms, libido, testosterone, mood changes, bleeding, and the very real mental load of midlife all come up too.
Here’s the hot take: perimenopause is not one-size-fits-all, treatment may need to evolve as your hormones do, and “normal labs” or regular periods do not automatically mean your symptoms should be dismissed.
Consider this your permission slip to ask better questions, explore your options, and expect care that actually listens to what your body is telling you.
Links
About Our Guest
Dr. Jackie Piasta is a Doctor of Nursing Practice, Women's Health Nurse Practitioner and a nationally recognized expert in perimenopause and menopause care, with a career spanning 16 years in women’s health. She is the founder of Monarch Health, a specialty midlife women’s health practice, and Monarch Health Clinician Academy, a CME-accredited training program that has educated hundreds of clinicians in evidence-based midlife and menopause care.
She serves on the Medical Advisory Committee for the National Menopause Foundation and contributes to national professional organizations, including The Menopause Society, the National Association of Nurse Practitioners in Women’s Health, and the International Society for the Study of Women’s Sexual Health. She speaks nationally on women’s health topics and most recently chaired NPWH’s annual Virtual Menopause Summit. She is also adjunct faculty at Vanderbilt University School of Nursing, where she lectures on menopause care for women’s health nurse practitioner students.
Dr. Piasta was awarded the Excellence in Leadership and Innovation Award from Frontier Nursing University in recognition of her contributions to menopause education and clinical leadership. In 2025, she was inducted into the inaugural Fellow class of the National Association of Nurse Practitioners in Women’s Health. Her work bridges advanced clinical practice, clinician education, and national advocacy.
More about the hosts of Labia Logic
Dr. Ashley Fuller is a Sexual Medicine Gynecologist and Vulvar Specialist in Seattle, WA.
Dr. Meredith McClure is a Menopause Specialist, Sexual Medicine Gynecologist, and Vulvar Specialist in Dallas, TX.
www.meredithmccluremd.com
Labia Logic – The Clinical Course – Meredith McClure MD
Follow the show on Instagram @labia_logic
This episode was produced by Audiotocracy Podcast Production.
