Perimenopause doesn’t begin with a single hot flash. It often starts with sleep changes, anxiety, brain fog, stubborn weight gain, and subtle shifts in skin and hair—long before periods stop. In this physician-led guide, Dr. Tulsi Kotecha explains how to recognize perimenopause, why standard testing can miss it, and how Refine Her supports women with a thoughtful, whole-body approach to hormones, wellness, and skin longevity.