Why Perimenopause Can Strike As Early As Your Mid-30s

Balance hormones when signs of the “Change” come too early.

Bloating, brain fog, depression, dizziness, fatigue, insomnia, loss of libido, menstrual irregularities, migraines, thinning hair, swollen ankles and/or feet, vaginal dryness, water retention, and weight gain are common symptoms among menopausal women. But while they don’t recognize the cause, all too many women start to experience these complaints—signs of perimenopause—starting in their mid-30s.

“It’s not unlike a bad case of premenstrual syndrome,” explains Gloria Bachmann, MD, professor and chief of obstetrics, gynecology, and reproductive sciences at Robert Wood Johnson School of Medicine. But because reproductive aging is a progressive rather than a discrete change, perimenopause is difficult to recognize.

“When they first start to appear, perimenopausal symptoms may seem unrelated,” says Nancy Lee Teaff, MD, a reproductive endocrinologist in Charlotte, NC, “and women often treat each problem individually, not seeing the connection until years later.”

“Skipped periods and hot flashes are almost automatically attributed to menopause, ” she adds, “but if your first symptom happens to be insomnia, you may spend hours in a therapist’s office before it becomes apparent that the problem is primarily hormonal.”

“Along with migraine headaches, dizziness is one of the most common complaints of perimenopause,” write UC San Diego scientists in Medical Hypotheses. While researchers conclude “recognition of the steroid influences on migraine genesis will lead to improved treatment,” most physicians still don’t connect the dots.

“I would say that 50% of women in perimenopause have been misdiagnosed,” says menopause specialist Helene B. Leonetti, MD. “Usually they’ve been given Prozac or put through a $10,000 cardiac workup.”

The Change Before the Change
When I wrote the New York Times bestseller, Before the Change, fifteen years ago, few people were even aware of perimenopause. Women like me were wondering, “What on earth is happening to my body?” After many nights without solid sleep, it’s no wonder we were exhausted.

One of my clients, Liz, complained of “No energy…I’m tired all the time,” she told me. “My whole body is breaking down, falling to pieces. My mind, too.” In addition, she gained 15 pounds in less than two years. “That’s fat. But if you’d seen me about 10 days ago,” she added, “I looked like I was 30 pounds overweight because of water retention. Then it went away” later in her monthly cycle.

Another client, Dianne, complained of other symptoms. “I couldn’t explain why I didn’t want sex anymore,” she said. Her doctor assured her that she didn’t have a hormone problem, nor signs of any medical disorder, and suggested an emotional or psychological cause, while Dianne was certain her lack of libido “was for a physical reason.”

“I wasn’t going to see a shrink,” Dianne told me, her eyes blazing at the thought. In fact, she seemed surprised when I dropped the subject of sex and started asking her about unrelated symptoms. While she hadn’t gained weight and didn’t have headaches, she also felt sluggish, especially in the morning.

Estrogen Dominance
While Liz and Dianne had very different symptoms, they both lacked energy and vitality—and were beginning to experience menstrual irregularities! Much like myself and other clients in perimenopause, they shared some of the many signs of estrogen dominance—ranging from bloating and fatigue to diminished sex drive and weight gain—increasinly common from the mid-30s on.

In a normal menstrual cycle, your estrogen levels are high for a week or so after your period—peaking around the 12th day, beginning to drop just before you ovulate. After ovulation, the hormone progesterone increases, stimulating the build up of the uterine lining. If the ovum (egg) has not been fertilized in this cycle, both estrogen and progesterone levels drop sharply. If the egg is fertilized, progesterone remains high during pregnancy.

During the subtle hormonal changes of perimenopause, this natural balance gets thrown out of whack. If you don’t ovulate, for instance, the ovaries don’t secrete enough progesterone to counteract the effects of estrogen—and estrogen dominance occurs.

Estrogen stimulates both breast cell and uterine lining growth, increasing the risk of cancer. This hormone also adds to body fat and promotes water retention. Estrogen-dominant women tend to be depressed, suffer headaches, experience slow thyroid function, lower libido, and blood sugar imbalances. By contrast, progesterone stabilizes both breast cell and uterine lining growth, helps burn fat as fuel, and is a natural antidepressant and diuretic. This hormone also enhances sex drive and supports thyroid function, while stabilizing blood sugar.

As women approach menopause, hormonal imbalance not only increases but also raises their risk for cardiovascular disease. Besides its ability to counteract the unwanted effects of estrogen dominance, progesterone has been credited with helping to prevent heart disease and cancer. Among women in their 30s and 40s, this hormone also protects against osteoporosis.

By menopause around the age of 50, progesterone levels have declined 12 times the decline in estrogen—only exacerbating estrogen dominance. Interestingly, men have higher levels of the female hormone progesterone than some postmenopausal women!

Balance Hormones Safely
That’s too bad, because progesterone boosts energy levels, probably by helping thyroid hormones work better. Another of my clients, Jackie, is a case in point.

At 44, she came to my office, complaining of chronic, constant fatigue and asking for an energy boosting diet. While her doctor had suspected hypothyroidism (slow thyroid function), Jackie’s test results were normal.

During our consultation, I discovered that Jackie was using estrogen patches—something she neglected to mention to her doctor since a friend (not the doctor) had given her these prescription patches.

Easily applied with its pump dispenser to the abdomen, chest, face, inner arms/thighs, or neck, this progesterone body cream helps revive vitality, spark sex drive, and enhance metabolism. One full press of the pump dispenses the recommended 20 mg of natural progesterone from wild yam.

Perimenopausal women can apply it once or twice a day, starting on the 7th day after menstrual flow begins and continuing until the 27th day. Menopausal women can apply it once or twice daily for 25 days, followed by a five-day break. 

Before the Change, Taking Charge of Your Perimenopause
Hot Times: How to Eat Well, Live Healthy, and Feel Sexy During the Change