From Night Sweats to Brain Fog: How to Navigate Perimenopause

Perimenopause is having a moment, but for many women, it can still feel confusing, unpredictable, and difficult to navigate. In this episode of Health Matters, host Courtney Allison speaks with Dr. Cassandra Simmons, chief of obstetrics and gynecology at NewYork-Presbyterian and Columbia, about what’s really happening during this transitional phase. Dr. Simmons explains that perimenopause is driven by fluctuating levels of estrogen, progesterone, and testosterone, which can begin as early as a woman’s 30s and last for several years. These hormonal shifts can lead to a wide range of symptoms—from hot flashes and night sweats to brain fog, mood changes, joint pain, and sleep disruption. The conversation focuses on vasomotor symptoms like night sweats and why they can significantly impact energy, sleep quality, and daily functioning. Dr. Simmons also discusses the emotional and cognitive effects of perimenopause, including the common feeling of “just not yourself.” Finally, Dr. Simmons outlines treatment options in three categories: holistic approaches such as supplements and lifestyle changes, non-hormonal prescription therapies, and hormone replacement therapy. She emphasizes individualized care, the importance of understanding the whole patient, and how modern hormone therapy has evolved to be safer and more tailored than in the past.   Chapters 00:00 – What Is Perimenopause? How hormone changes drive symptoms and why timing varies for every woman 03:15 – Hormones and Symptoms Explained The role of estrogen, progesterone, and testosterone in sleep, energy, and mood 07:45 – Why Night Sweats Disrupt Daily Life Understanding vasomotor symptoms and their impact on sleep and function 12:00 – Treatment Options and Lifestyle Support From supplements and therapy to hormone replacement and exercise     Key Topics Covered Perimenopause definition Hormone fluctuations (estrogen, progesterone, testosterone) Night sweats and hot flashes Brain fog and cognitive symptoms Sleep disruption and fatigue Emotional and mood changes Weight, metabolism, and muscle mass Bone health and estrogen decline Holistic supplements and nutrition Hormone replacement therapy (HRT) Non-hormonal treatment options Lifestyle strategies for symptom management   Takeaway message: Perimenopause can affect nearly every part of the body, but understanding what’s happening hormonally is the first step toward feeling better. With a combination of lifestyle changes, supportive therapies, and personalized care—including hormone treatment when appropriate—women can manage symptoms and maintain their health and well-being through this transition.   Doctor Bios Dr. Cassandra Simmons is the chief of general obstetrics and gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center. In this role, Dr. Simmons directs clinical operations for the division of General Ob/Gyn, with the goal to deliver the highest quality of care to patients. She also sees patients at NewYork-Presbyterian The One in Westchester. Before joining the faculty at Columbia, Dr. Simmons practiced as an Ob/Gyn in many states across the country, including California, Georgia, New Jersey, and the New York Metropolitan Area. This diverse breadth of professional experience has given her an idea of what Ob/Gyn care could, and should, look like for patients. Informed by these experiences, Dr. Simmons emphasizes the importance of building trusting patient-provider relationships and improving processes that support continuity of care. In her clinical and administrative roles, Dr. Simmons is passionate about addressing the myriad determinants of health that can shape outcomes for women and their families. Specifically, Dr. Simmons is focused on the accessibility of preventative care as a means for mitigating health disparities among vulnerable populations. Outside of her work, Dr. Simmons is a proud mother of three children.