Let's Talk About Perimenopause

Why are my periods like a murder scene?

WE HIT THE USA TODAY BESTSELLER LIST AT #22 ON WEEK ONE.

This is because of all of you and I am so grateful. THANK YOU to everyone for buying and sharing and reviewing and doing all of the things for Everyone is Lying to You, truly the book of the summer.

If you haven’t gotten it yet grab a copy! YOU WILL LOVE IT.

Sorry for being a little quiet this week. I was trying to conserve my energy for week two of book tour (ie the week I am also with my kids which makes it actually exhausting). But being in Milwaukee with them was awesome. My 95 year old father in law got to come to our sold out book event with Boswell’s at the cutest tea cafe bar nextdoor called Serenitea. At the last minute, after a glass of champagne at the Milwaukee Bastille Day celebration (yes that’s a thing) I asked Nick Aster to be my convo partner and he was awesome. We had to give screens to the feral kids but everything worked out great.

And then the next day we rented this cool retro electric boat and cruised along the Milwaukee River.

I am going to start doing city specific guides to my five fave things to do with kids and I will have Milwaukee, SF, DC and NYC soon.

At the end of the week I had two Jersey events and I took a break in the middle to visit my good friend Colleen at her place down the shore. Col was my very first boss 20 years ago and catching up with her is the absolute best. It is also the absolute best that she still likes me so much despite what a little shit I must have been when I started working at the NY Daily News so many years ago.

So right now I am getting work done on the beach and snacking on these gems which I argue are the absolute best beach snack.

Now onto perimenopause.

The other day I heard perimenopause referred to as Cougar Puberty and I have never felt more seen. Because that’s what this is. My entire internal system is shifting in new and unexpected ways that the medical establishment has no prepared me for.

If you’ve whispered the word perimenopause near your phone in the past week, you’ve probably been served an ad for an estrogen patch, a protein powder that made someone want to have sex with their husband again, or a thirty-day hormone reset for a couple grand.

I hate this content and I also love that we are at least trying to do SOMETHING.

No one ever really explained to us what the hell perimenopause is so we’re figuring it out in real time.

I have questions. And if you’re a woman in your thirties or forties, I bet you do too. Questions like: Is this just stress? Or am I dying? Is this my hangover or low cortisol or both. Will I ever be able to lose belly chub again? What is happening to my vagina? Why is my period a gushing waterfall for two days and then….nothing.

I brought Dr. Kim Einhorn, a board-certified OB-GYN and the founder of the Menopause Collective, to answer everything on Under the Influence.

We talked about murder-scene style periods, hormone therapy, what to ask your doctor, and why so many of our GPs are totally unequipped to deal with any of this. Here are the top questions I had and Kim’s answers along with a reading guide.

Jo Piazza: Are we actually talking about perimenopause more than ever—or is my phone just spying on me?

Dr. Kim Einhorn: You hit the nail on the head. You're 44, so yes, it's definitely becoming part of your algorithm. If you say "perimenopause" one time near your phone, your feed becomes a flood of menopause content. But it's not just that. Gen X and millennial women are thinking differently about their health. We're not brushing this under the rug anymore. It's like a grassroots effort—patients pushing doctors to have the conversation.

Jo: So what exactly is perimenopause?

Dr. Kim: Let me start with menopause: that’s the point when you’ve gone 12 full months without a period. Every day after that, you're officially in menopause. Perimenopause is the time leading up to that final period when you start noticing symptoms or changes to your cycle. It could be shorter cycles, longer ones, skipped periods, or heavy bleeding. Early perimenopause might mean your period comes seven days earlier than usual. Later on, you might skip 60 days entirely.

Jo: So even if your cycle is still regular, you could be in perimenopause?

Dr. Kim: Absolutely. There’s a big study called SWAN—Study of Women’s Health Across the Nation—that showed symptoms can start six to eight years before menopause, even while you’re still getting your period. Women in their mid-thirties might start experiencing hot flashes, worse PMS, mood swings, fatigue, sleep issues, joint pain... and it all gets brushed off because they’re still menstruating. But those symptoms are real and part of perimenopause.

Jo: OK, let’s talk about the murder scene periods. I’ve started having this massive two-day whoosh period out of nowhere.

Dr. Kim: That’s so common. I hear it all the time. First two days are super heavy—what many women call the “murder scene”—followed by a quick taper off. It’s your hormones fluctuating, your ovaries producing less estrogen, and that impacts your whole cycle.

Jo: I had it happen during a book event and had to sit in a chair until the crowd cleared out. Then I backed out of the bookstore like I’d committed a crime.

Dr. Kim: I hear stories like that constantly. And you're right. It’s shocking how unprepared we are for these changes.

Jo: So what should women in their twenties, thirties, and early forties be doing now to prepare?