Many women expect menopause to arrive with a clear, unmistakable signal, like a hot flash or a missed period. What they don’t expect is that the hormonal transition can quietly begin a full decade earlier, disrupting sleep, mood, memory, and metabolism long before anyone puts a name to it.
Dr. Sohita Torgalkar has spent her career at that exact gap: the space between what patients are experiencing and what they’ve been told to expect. A lifestyle medicine physician and board-certified menopause specialist at Mount Sinai Medical Center, she joined Summus for an “Inside Access” master class to give women and the employers who support them a real, medically grounded picture of what perimenopause and menopause actually look like.
Here are her key takeaways.
When does menopause start? Earlier than you think
The most common assumption about menopause is that it’s a later-life event, but the data tells a different story.
“There are now studies showing that women can start experiencing symptoms even seven to 10 years before they actually go through menopause,” Dr. Torgalkar says. That means a woman in her late 30s noticing changes in her periods, disrupted sleep, or unexpected mood swings may already be in the early stages of perimenopause, and have no idea.
The early signs of menopause and perimenopause are often attributed to stress, burnout, or anxiety rather than hormones. The most commonly recognized symptoms — hot flashes, night sweats, low libido — tend to get the most attention, but Dr. Torgalkar notes that changes in menstrual cycles are usually the first indicator that something is shifting.
For employers, this timeline has major implications. Women may be managing the cognitive and physical effects of hormonal changes during some of their highest-output professional years, all without a diagnosis or support.
Perimenopause symptoms: Why it feels like chaos
“Pre-menopause, your hormones are very regular, very predictable. But when you’re going through the perimenopausal period, your hormones are all over the place. I just love this graph because everybody’s chaos of perimenopause is different, but it’s exactly that: It’s chaos.”
The irregular, unpredictable nature of perimenopause symptoms isn’t a personal failing or a sign that something is uniquely wrong, but a physiological reality. Unlike the steady hormonal rhythm of reproductive years, the perimenopausal transition involves erratic fluctuations with no predictable pattern. This is why it’s so disorienting to women experiencing it.
Common perimenopause symptoms include hot flashes and night sweats, sleep disruption, mood changes and irritability, menstrual cycle changes, low libido, and significant cognitive effects.
Watch the Summus Inside Access session with Dr. Torgalkar.
Can menopause cause brain fog? Yes, but it’s temporary
Menopause brain fog and memory loss are among the most distressing and least-discussed symptoms of the transition. Women often wonder privately whether what they’re experiencing is an early sign of cognitive decline. Dr. Torgalkar’s message on this is clear and reassuring:
“When you’re having brain fog, many times it’s just about understanding that this is a symptom that is generally limited in duration. Women who are going through the transition should understand — this is really something I’m not going to experience forever. That brain fog and that memory loss is going to improve.”
Rather than immediately pursuing hormone therapy or supplements, Dr. Torgalkar recommends focusing on the lifestyle factors most directly within your control:
- Sleep. Hormonal disruption and sleep disruption are deeply intertwined during perimenopause, and poor sleep is itself a driver of cognitive symptoms. Protecting sleep quality, including limiting alcohol and managing night sweats where possible, is one of the most effective tools available for clearing brain fog, a 2024 study found.
- Nutrition. Blood sugar stability matters more than most women realize. A breakfast built around protein and plants versus refined carbohydrates helps prevent the mid-morning energy and focus crashes that can mimic or worsen cognitive fog throughout the day.
- Movement. Regular physical activity supports circulation, mood, and cognitive function. Movement is one of the few interventions with consistent evidence across multiple menopause symptoms simultaneously. Even moderate daily movement makes a difference.
- Stress. Chronic stress elevates cortisol, which compounds the hormonal volatility of perimenopause and further impairs memory and concentration. For Dr. Torgalkar, stress management isn’t a soft recommendation, it’s a physiological lever.
The cognitive symptoms of menopause brain fog are real, but they’re also temporary. For women who are otherwise feeling well and not seeking hormone therapy, the evidence supports trusting the transition while tending carefully to these fundamentals.
Menopause weight gain: What’s actually happening — and what to do about it
Menopause weight gain, especially in the abdominal area, is one of the most searched and least well-explained aspects of this transition. Dr. Torgalkar links it directly to the drop in estrogen.
“Because of that lack of estrogen, you are now at a higher risk of depositing weight especially in your abdominal area. And that type of weight can be dangerous because you’re getting deposition of fat around your liver called visceral fat.” Unlike subcutaneous fat (the kind you can pinch), visceral fat has been shown to drive metabolic dysfunction and inflammation.
Nutrition can help with perimenopause and menopause weight gain
The nutritional antidote, Dr. Torgalkar says, is simpler than most people expect. Starting at age 30, the body loses up to 8% of its muscle mass per decade, a process that accelerates during menopause. Protein becomes essential to counteract that decline.
“Protein is super important during this transition because the aging process ultimately leads to a decline in muscle mass. In order to offset that loss, you need to supply your body with amino acids, the building blocks to build and maintain and repair muscle.”
Her framework for how to stop menopause weight gain via nutrition is memorably simple: plants and protein, every meal. Skip the pastries and refined carbohydrates that spike blood sugar. Prioritize lean protein and vegetables first, and the hunger and energy crashes that follow a processed-carb breakfast tend to disappear with them.
Does GLP-1 help with menopause weight? A doctor’s honest take
“Does GLP-1 help with menopause symptoms?” is a question flooding doctors’ inboxes right now.
Dr. Torgalkar’s answer: It depends. (Sorry.) But the framing matters enormously.
“If you find that through the menopausal transition you really are just gaining weight that you are unable to manage despite nutritional changes and exercise changes, GLP-1 support could be reasonable,” she says. “But I don’t necessarily advocate a GLP-1 for patients who gain five or 10 pounds for aesthetic purposes. I don’t think it’s a great thing to go on those medicines for that reason if you don’t have another illness or issue related to weight.”
The key distinction is between visceral fat accumulation posing a genuine metabolic risk — where GLP-1s may be clinically appropriate — and cosmetic weight management, where the risk-benefit calculation can look very different. As with any medication, she emphasizes, there are real side effects to weigh carefully with a physician.
Alcohol and menopause: Why it hits differently now
Even women who’ve had a glass of wine with dinner for decades report having more trouble processing alcohol during menopause, and Dr. Torgalkar explains why.
“In menopausal women, you’re metabolizing alcohol differently, and not as well. You’re not tolerating it as well,” she says. This isn’t about willpower or tolerance in the colloquial sense. It’s a physiological shift in how the body processes alcohol as estrogen levels decline.
The connection to sleep is particularly important. Alcohol and menopause are a problematic pairing partly because alcohol disrupts sleep architecture at precisely the stage of life when sleep is already under threat from night sweats and hormonal changes. “I know for a lot of women, they can’t sleep. So if you have that drink, you have to consciously say, ‘I’m going to have this drink, I’m going to enjoy it, but I know it might affect my sleep tonight.’”
Her overall recommendation: Drink as little as possible. But she also doesn’t moralize: If a glass of wine at Friday night dinner is important to someone’s quality of life, that’s a different conversation than a nightly habit that’s quietly wrecking sleep and amplifying brain fog.
Natural remedies for perimenopause: What works
Women searching for natural remedies for menopause and perimenopause will find no shortage of supplements, adaptogens, and wellness products claiming to ease the transition. Dr. Torgalkar’s guidance here is grounded in lifestyle medicine rather than any particular product.
She advocates prioritizing sleep, building protein into every meal, reducing alcohol, moving your body to protect muscle mass, and managing stress. While these may feel like basic recommendations, they address the underlying mechanisms driving many of the most common perimenopause symptoms.
Her broader philosophy comes back to a metaphor she uses for preventive medicine generally: “There was this running faucet and I was just trying to mop up the water on the floor instead of turning the faucet off. I want to see patients from the beginning where we can talk about preventive measures.”
Perimenopause, she says, is exactly the moment to address the lifestyle foundations that will determine health outcomes in the decades that follow.
What this means for women’s health at work
For HR and benefits leaders, the data here is a call to action. Women between the ages of 40 and 55 represent one of the most experienced, senior cohorts in most organizations. The symptoms of perimenopause and menopause, from cognitive effects and sleep disruption to fatigue and weight gain, don’t stay at home. They show up in meetings, in focus, in productivity, and ultimately in retention.
Connecting employees to specialists like Dr. Torgalkar, who can give them a clear picture of what’s happening and what to do about it, is one of the highest-leverage investments a benefits team can make in women’s health.
