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

March 26, 2013
Ann Louise Gittleman, PhD, CNS

Ann Louise Gittleman, PhD, CNS

Award-winning nutritionist and New York Times bestselling author.

Balance hormones when perimenopause strikesBalance 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. I convinced Jackie to throw out her patches and rebalance her hormones with daily applications of ProgestaKey, a natural topical progesterone body cream.

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. You can read more about ProgestaKey including additional benefits and true stories and reviews from women at unikeyhealth.com.

Hormone Testing
To fully evaluate your body’s hormone levels and obtain a complete assessment, consider an at-home Salivary Hormone Test. You’ll collect a saliva sample in the privacy of your own home, send it to a licensed medical lab and receive the complete report along with a personal letter of recommendations from yours truly. You can learn more about Salivary Hormone Testing online; for specific questions, contact UNI KEY’s Testing Coordinator at 800-888-4353.

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

Related Articles and Podcasts

Ann Louise Gittleman, PhD, CNS, is an award-winning New York Times bestselling author of more than thirty books including The Fat Flush Plan series and her latest book, Radical Metabolism. She’s been rewriting the rules of nutrition for more than 40 years and is internationally recognized as a pioneer in the field of diet, detox and women’s health issues. 

For a FREE daily dose of tips and strategies for maintaining healthy weight, conquering insomnia, and much more…check out my Radical Health Tips.

I’d like to meet and greet you on my Facebook groups, so won’t you check us out at the Radical Metabolism RevolutionFat Flush Nation, or my Inner Circle!


  1. Casey

    this is the biggest bunch of crap i have ever heard. i almost always agree with Anne’s posts, but not this one. she is on the ‘progesterone bandwagon’ and will not get off. to FULLY inform yourself, please read Dr. Vliet’s book, ‘Screaming To Be Heard’ or any book by Suzanne Somers. sorry to hear the woman threw out her estrogen patches on your advice. i bet she will be wishing she didn’t in time. my cardiologist makes sure i am on mine, estrogen has MUCH benefit to the heart. your posts are completely unbalanced about women’s hormones. it’s a crying shame.

    • Laura

      Yikes, Casey. Apparently your hormone regime has left you bitter and angry. Or were you just badly raised?

  2. Sierra

    I’ve had amazing success with balancing my hormones by following Ann Louise’s recommendations. My energy level has dramatically improved, and the moodiness and discomfort of PMS has been alleviated as well.

  3. Patrick Moore

    I am a great fan of Anne Louise. A few comments to add. We are facing an epidemic of Vitamin D deficiency across the USA. This is our master hormone that influences so many genes and biological pathways in our body. Start by getting your D level in the 50ng/ml -85ng/ml lab level and good results will follow. Stay off cholesterol-lowering drugs if you are a woman – they interfere with hormone production. Consider learning about Pregnenolone, the “grandma” of hormones that intelligently regulate estrogen/progesterone/testosterone/cortisol/dhea/aldosterone and many others. A healthy cholesterol level in women will help women live longer and diminish cardio risks, according to the largest study ever conducted, the Norway Hunt-2 study, a study the drug company’s would prefer you not know about. Patrick Moore, N.D.

  4. liz

    Dr. Moore, you bring up some excellent points. Our overall health affects our hormones. Another one I would add is having adrenal glands that are functioning well. This can contribute to steroid hormone balance too.

  5. Patrick Moore

    Liz, I couldn’t agree with you more. Depleted adrenals will affect hormone balance and we live in a non-stop, stress-filled environment. Lots of Vitamin C and B-vitamins can help.

  6. Marina

    Dr. ALG’s book Before The Change put me on the path to greater wisdom and health many years ago. I came upon this book during my own peri menopause and finally came to understand why I felt “off” with various seemingly unrelated symtoms — while being found healthy with normal bloodwork during my annual physicals. In this book, Dr. ALG provides clear guidance on diet, vitamins, minerals, herbs and progesterone cream. Becoming naturally balanced starting in peri menopause supports a smooth transition to and thru menopause. With Dr. ALG’s guidance, I have also learned of adrenal fatigue and how to remedy it. When it comes to health, nutritionists like Dr. ALG and naturopathic physicians are my most trusted guides. I appreciate the input of Dr. Moore above.
    With puberty coming at an earlier age than ever, I welcome your guidance in keeping our young girls and teens

  7. Marina

    (Cont). …healthy in a world of toxins and xenoestrogens. Thank you!

  8. Tammy

    Dr. Moore is right.
    This person Casey, I dont think Dr.Loise was stating that estrogen was bad in fact it is good but in America we have known estrogen dominance because of people eating hormone induced chicken and beef and cooking in plastics that are known to cause estrogen dominance. I never felt right for years and did have my estrogen and progesterone levels checked and I was way high in estrogen, I cut out allot of foods and cooking in plastics as much as I can possibly do according to my life style and I did see a significant difference in how I felt! Even though I still have a higher estrogen level it has come down and I am not in brain fog or overly emotional! I am supplementing with a progesterone plant based pill mid cycle and my erratic periods are normal again.I am also supplementing with GLA which helps the pms and cramps! If your progesterone is low and you supplement you will feel a difference!

  9. Marlene

    I already use a progesterone cream but still feel like I need to have my hormone levels retested. Is it necessary to stop using the cream for a period of time prior to having my hormone levels tested?

    • Sierra

      Yes, Marlene, give yourself at least 24 hours. If you are hoping to get a baseline reading that doesn’t include any HRT influence, you should abstain from the cream for at least 2 weeks.

  10. Administrator

    We have read all your comments and need to make the point that this blog was adapted from “Before the Change” which is devoted to perimenopause. At perimenopause, progesterone levels are the key whereas at menopause both estrogen and progesterone come into play. Most of the case histories detailed above were tested via blood tests or salivary hormone testing, which demonstrated that progesterone-rather than estrogen-was the hormone of choice.

  11. Midgy

    Hi, I read on Dr Mercola’s website that progesterone cream should be applied vaginally because it will stop working after a couple months because it gets stored in your fat. Is Progestakey safe to use vaginally?

    • Sierra

      The Progesta-Key is not designed to be used internally, so topical skin application should be the only method of supplementation.



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