Early Signs of Perimenopause: What Most People Aren't Looking For
If I could pick one period of a woman's life that I wish got more attention, the time that I think many women are thinking least about their health, it would be the early to mid 30s.
Because for many women, this is when early signs of perimenopause can begin. Yes, that young!
And precisely because it CAN be that early, and the early to mid 30s are also usually a time of much personal and professional growth, it's easy to brush some subtle signs and symptoms under the rug.
Plus, our medical community is simply not looking for perimenopause. They aren't educated on it (except for a stellar few), they can't really bill for it, women's health is vastly underresearched, so it's still not well understood, and western medicine is mostly set up to treat disease, not to be proactive and think ahead to optimize health.
Thus, many women look back at their 30s and see the absolute shitstorm of hormonal issues they were having that went almost entirely unrecognized and untreated (except for maybe a birth control pill).
A Perimenopause Story
Woman in her early 30s, very stressful job, a lot of international travel, tough locations, minimal healthy food or access to exercise. She'd been on the birth control pill since she was 18, but she was reading more and more about how perhaps that wasn't ideal and she came off of it. Now, she'd originally gone on the pill because of crippling menstrual cramps, but since the pill "mostly" handled the cramps, no one thought to dig any further.
She came off the pill, and a few months later, in a location far from home, middle of nowhere in a country at war, her period came back with a vengeance. Horrible cramps, vomiting, she ended up in the ER of a very sub-standard hospital where she was offered a painkiller injection and the platitude that, "you're a woman, it's supposed to hurt" from a male doctor.
These volatile periods continued, she never knew whether a month would be manageable or horrible. It was stressful and hard to plan for.
Also during this period of time, she'd been starting to sleep more lightly at night, waking up with every little sound and sometimes with no disturbance at all. It was infuriating and would start a spiral of anger, furious at being awake, stressed about being tired the next day, rinse and repeat.
She also found herself becoming more and more anxious and emotionally volatile. She chalked it up to the lack of sleep, but she was having real trouble managing her emotions and her relationship was suffering. Some nights she would lie awake with everything running through her head like a freight train.
Now, this woman was 35. She was climbing the ladder in her career, she was developing a new relationship, she didn't have a ton of extra brain power left over to try and put all the health pieces together.
Then, toward her late 30s, she started having pain in one of her knees. She thought she had injured it, worked around it, but it continued. And then the other knee would hurt, and then they would feel ok, and then both would hurt. And this continued... for years. There were times she could barely walk down the stairs in the morning.
I could go on, but this woman was me. I look back at my 30s and I see the storm of hormonal changes happening, starting probably when I was 33 or 34. The sleep, the anxiety, the crazy periods. The joint pain is what pushed me into action, I went gluten free and started hormones and I am a new person since that time.
Early perimenopause can be really tricky if you don't know what you're looking for. But let me explain to you what's happening.
What's Actually Happening: Progesterone
Usually, in my experience, progesterone is the first hormone to start to wobble. As we move toward "advanced maternal age" (35), we are entering a period where our bodies are ovulating less predictably. There are months we may not ovulate, and without ovulation, the body is not producing adequate progesterone. But this doesn't happen every month, and can be shrugged off as a fluke or a stressful period or may even pass unrecognized.
Plus, periods CAN remain normal and on a regular schedule, and you may only have symptoms like the ones listed below. This is still perimenopause!
Progesterone is a calming hormone for most women, it gets turned into (among other things) allopregnenolone, a calming hormone for the brain, as this hormone acts on GABA receptors. Progesterone can also be turned into cortisol and even testosterone and then estradiol. It does a lot of work!
Many women are taught that progesterone protects the uterus, and is important for fertility, but progesterone does much more than that and is arguably more important in the brain than anywhere else.
Progesterone also has effects on gut motility, the immune system, diuresis, bone health, breast health, and even our basal body temperature.
So your constipation, fluid retention, heat tolerance changes, and breast tenderness can ALSO be early signs of perimenopause. If you are experiencing these signs of perimenopause, I would love to connect with you. Check out my Very Peri Coaching Package where we will troubleshoot your current symptoms, focus on strategies that can help you feel better, and so much more!
Perimenopause Starts Earlier Than You Think
Let's take a step back here and reassess what we've talked about.
Whether you're 38 or 48, if you're still cycling, you're likely in perimenopause. Remember, perimenopausal symptoms can start up to 10 or more years before the end of the period. For me I'd guess it was about 13 years before the end. 13 years is a long time to be miserable and I can't tell you how thankful I am that I learned about hormones and pushed to get on them.
Early perimenopause can start in the early 30s, or even before. I hate to put firm numbers on things, because I know women who have gone through spontaneous early menopause in their late 20s and I know cycling women in their 20s who are on progesterone now.
What you want to look for are the symptoms. You do NOT need a blood test to confirm your hormone levels, you do NOT need a Dutch test to confirm your hormone levels (although in certain circumstances both can be useful, but they are not required for treatment).
If you are having symptoms of early perimenopause, anything I've listed today, but especially anything that feels emotional, mental, or sleep-related, as those do seem to be the most common, consider trying some low-dose progesterone.
You can start it in the second half of your cycle only (after day 12-14) when your progesterone should naturally start to rise. Eventually you may want to take it all month long, as your natural progesterone levels drop. Pay attention to your body, and you will know.
One big caveat here- if you are trying to get pregnant, actively, this information may not apply to you. Although I also know women undergoing fertility treatment who are using progesterone as part of their treatment this is a specific product and dosage, not the same as treating perimenopausal symptoms.
Our Types of Progesterone Support
Lastly, let's go over our types of progesterone support.
Progestin pills - this is not progesterone, anything with a progestin is a synthetic, should be used for birth control only, they will not provide the brain and sleep benefits of real progesterone, they can worsen androgenic side effects in the body (acne, hair growth, oiliness), they can flatten libido and increase clot risk, depending on which generation of pill you are taking and the type of progestin. Birth control pills are awesome, we should protect them 100%, but we should also be aware when to use it (preventing pregnancy when no other method is available) and when it is no longer useful for us.
Hormonal IUD - these are usually progestin based and used for birth control, but can also be used for very heavy periods, will generally not provide the systemic brain and sleep benefits but can be used in conjunction with systemic progesterone capsules. If you are a woman with super heavy periods, still wanting contraception, and having other hormonal symptoms, you CAN do an IUD with supportive bio-identical progesterone capsule (below) at the same time.
Bio-identical micronized oral progesterone - this is the progesterone capsule that most women in perimenopause and menopause take. Regularly available doses start at 100mg and go up, some women go to 400mg or higher. This is systemic, it will give you the brain and sleep benefits, the bone benefits, etc...
Progesterone pellets - these are implanted in your glute and replaced every 4 or so months. Most practitioners do not recommend these as you cannot control the dosage, your body just absorbs at the rate it absorbs them, they are expensive, not covered by insurance and who wants to have their butt cheek sliced open every few months? There are better options.
Progesterone cream - controversial, progesterone cream applied to the skin daily can be poorly absorbed. Because progesterone is highly fat soluble, it tends to get clogged up in the skin layer/fat layer and doesn't always pass into the systemic circulation as well. If you need progesterone for uterine protection (and most of us do) as well as everything else, you need robust systemic circulation. However, for anyone who is progesterone sensitive (see below), this can be a better option because of the poorer absorption.
When You're "Progesterone Sensitive"
Lastly, lastly- it has to be said. Because we are all individuals and unique in our bodies and biochemistry, we have to acknowledge that some women are what can be called "progesterone sensitive". Due to the way their brains process progesterone, the allopregnenolone component can actually make them feel worse when more progesterone is introduced. Mood changes and sleep issues are usually the most predominant symptoms but bloating, heart palpitations, flushing, achiness, dizziness, tinnitus and other symptoms can also indicate that your body uses progesterone a bit differently.
In this case, it often helps to change the type of progesterone support you are using. Oral capsules are the most allopregnenolone/brain involved, so switching here to a form of progesterone that is absorbed through the skin (the cream) might actually be the right move. Or using vaginal only progesterone, which would provide the uterine benefits and allow you to stay on estrogen if you needed it, while not aggravating the brain component.
The Bottom Line
Hormonal health is complex and has no "one" answer. Understanding a bit of the nuance when you go in to talk to your practitioner is key. Also, paying attention to your body and knowing what your signs and symptoms are. Just because Judy down the block had hot flashes and night sweats doesn't mean you will. Everyone is different. Understand your own symptoms, keep a list, explain how things are affecting your quality of life. Early perimenopause is too busy a time to be bogged down with hormonal issues, so let's stay on top of it!
Want Help Understanding Your Next Steps?
Join my perimenopause coaching program! We will do 7 weeks of calls, spread out as you need them, that will go over your specific situation, come up with common sense lifestyle strategies to help combat them, discuss HRT for your specific situation, and you will walk away understanding EXACTLY what you need to do to make perimenopause a blip on the radar instead of an iceberg that takes you down. Food, exercise, stress, sleep and even supplements and toxins in the home, we go over it ALL.
Frequently Asked Questions
At what age can perimenopause symptoms actually start?
Early perimenopause can start in the early 30s, or even before. Perimenopause can start up to 10 or more years before the end of the period - it doesn't have to mean irregular cycles or classic symptoms right away.
What is usually the first hormone to start to wobble?
Progesterone is usually the first hormone to start to wobble. As we move toward "advanced maternal age" (35), our bodies are ovulating less predictably, and without ovulation, the body is not producing adequate progesterone.
Can I be in perimenopause even if my periods are still normal?
Yes - periods CAN remain normal and on a regular schedule and you may only have symptoms like anxiety, poor sleep, joint pain, constipation, fluid retention, heat tolerance changes, or breast tenderness. This is still perimenopause.
Do I need a blood test or Dutch test to confirm perimenopause?
You do NOT need a blood test to confirm your hormone levels, you do NOT need a Dutch test to confirm your hormone levels, although in certain circumstances both can be useful - they are just not required for treatment.
What symptoms are most common and worth paying attention to?
Anything that feels emotional, mental or sleep related seems to be the most common. Constipation, fluid retention, heat tolerance changes, and breast tenderness can also be early signs.
When in my cycle should I take progesterone?
You can start it in the second half of your cycle only, after day 12-14, when your progesterone should naturally start to rise. Eventually you may want to take it all month long as your natural progesterone levels drop.
What's the difference between a progestin and real progesterone?
Anything with a progestin is a synthetic and should be used for birth control only - it will not provide the brain and sleep benefits of real progesterone, and can worsen androgenic side effects like acne, hair growth, and oiliness, plus flatten libido and increase clot risk.
What if progesterone makes me feel worse instead of better?
Some women are "progesterone sensitive" - due to the way their brains process progesterone, the allopregnenolone component can make them feel worse with mood changes, sleep issues, bloating, palpitations, flushing, achiness, dizziness, or tinnitus. Switching to a cream or vaginal-only form often helps.
Should I avoid progesterone if I'm trying to get pregnant?
If you are trying to get pregnant, actively, this information may not apply to you - although women undergoing fertility treatment sometimes use progesterone as part of their treatment.
Weight loss medications have changed the landscape of health and weight management. GLP-1 medications are helping people lose weight, reduce inflammation, and, in many cases, decrease reliance on other medications. For many, they feel like a long-awaited solution.
But for many, this solution isn’t the full story. New research shows that 50-80% of people report gaining back between 25 and 60% of the lost weight within two years of stopping medication. What does that tell us? For many, supportive lifestyle pieces were likely missing.
Lasting success requires a plan. Many people are never taught the lifestyle strategies needed to preserve muscle, support metabolism, and nourish their body while appetite is suppressed. Muscle loss during weight loss is one of the biggest predictors of regain—and it can be prevented.
The GLP-1 Companion is about setting you up for long-term success. Together, we’ll focus on how to eat and move in a way that supports fat loss while protecting muscle, energy, and overall health. No gimmicks, no fads—just science-based guidance, common sense, and consistent support.
I’ll be with you every step of the way. We’ll tailor our calls to your goals, your body, and your lifestyle, so you leave this program confident in how to care for yourself both on and beyond your GLP-1 medication.
Program Details
Length
5 weeks
Meetings & Ongoing Support
Coaching Calls:
Five 60-minute one-on-one calls
Total Calls: 5 (5 total hours)
Email Support:
Weekly email support for questions and guidance throughout the program
Additional Support:
Additional consultation hours available at $175/hour
Areas of Focus
We’ll focus on the foundational habits that support sustainable weight loss and long-term metabolic health, including:
How weight loss occurs in the body
Fat loss vs. muscle loss—and why it matters
The role of movement and exercise while on GLP-1 medications
Protein, carbohydrates, and fats: how to balance them with reduced appetite
Practical strategies for managing decreased hunger cues while meeting nutritional needs
Investment
$1,075
We plan ahead to optimize outcomes—weddings, vacations, and job interviews. Why wouldn’t we plan to optimize our health before pregnancy? Don’t wait until you’re nauseous and exhausted to realize you need a strategy to eat better, sleep more, and stress less. Pregnancy can be an immense drain on the body, especially one that begins the journey stressed, undernourished, underslept, and exposed to a high level of environmental toxins.
Fertility Foundations is about controlling what we can control. Together, we’ll reduce lifestyle factors that may hold you back from feeling your best and do the work in advance so your body is prepared, resilient, and supported when pregnancy occurs.
This program is ideal for anyone on a fertility journey and is most effective if we have at least 3–6 months before you’d like conception to occur—but it’s also a powerful starting point if you’re earlier in the planning phase. Every change we make together supports your health, the health of your partner, and the health of your future child (and any children already in your home).
I’ll be with you every step of the way. We’ll identify the supports you need, tailor our calls to your priorities and unique situation, and adjust as life or plans shift. Entering pregnancy with a nourished, rested, and less inflamed body can make a meaningful difference in how you feel during pregnancy itself.
This program is not testing-dependent, though functional medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the baseline program cost.
Program Details
Length
3.5 months
Meetings & Ongoing Support
Initial Setup Call:
One 60-minute onboarding sessionOngoing Calls:
Two calls per month for the first three months (45–60 minutes each)
One final call in month four (45–60 minutes)
Total Calls: 8
Email Support:
Weekly email support, as needed, for questions and ongoing guidance
Areas of Focus
We’ll focus on preparing your body—and your home—for pregnancy by improving nutrition and lifestyle factors that support fertility and a healthy conception or implantation. Topics may include:
Nutrition, optimized for fertility
Exercise
Stress management
Sleep
Environmental toxins
Supplements
Cycle regulation, if needed
Investment
$1,7000
Some of us may have a new friend in our lives. She’s… unpredictable. A bit chaotic. It doesn’t seem like she’s leaving anytime soon, and we need to figure out how to deal with her.
Meet Peri.
All jokes aside, perimenopause is often described as a time of hormonal chaos—and for many women, that’s exactly what it feels like. In today’s world of full-time jobs, aging parents, kids, school schedules, activities, and running a household, feeling “off” can sneak up on you. Perimenopause can begin 10 or more years before menopause, which is wildly inconvenient, considering these are often the years when women have the least amount of time to stop and figure out what the h*ll is going on.
Let me help.
Spend a little time with me each month, and together we’ll make sense of what’s happening in your body, reduce the overwhelm, and create a plan that actually fits your life.
If you’re in your 30s and suspect you’re just entering perimenopause, we’ll troubleshoot current symptoms, make sure the foundational lifestyle pieces are in place, and prepare you for what’s coming. If you’re in your 40s or 50s and right in the thick of it, we’ll evaluate what’s going on now, troubleshoot symptoms, refer out when appropriate, and focus on the strategies you need right now to feel better.
Areas of Focus
Our work together may include:
Understanding your current symptoms
Understanding the hormonal shifts occurring
Knowing what’s happening now and how things may change over time
Optimizing nutrition
Appropriate and effective exercise for this stage of life
Sleep hygiene
Hormone Replacement Therapy (HRT) education and discussion
Stress management strategies
How to minimize toxins
How to optimize supplements
This program is not testing-dependent. Functional Medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the baseline program cost.
Program Details
Duration
3 months
Meetings & Support
Introductory Call:
One 60-minute onboarding sessionOngoing Calls:
Two calls per month for three months (45–60 minutes each)
Total Calls: 7
Email Support:
Weekly email support, as needed, for questions and ongoing guidance
Investment
$1,525
Would you rather do this with a friend? Check out the Add a Friend program instead!
This is the same Very Peri program—just designed for two people instead of one.
Do you have a friend who’s at the same stage of life? Move through the Very Peri coaching experience together and share the journey. You’ll receive the same education, guidance, and support as the one-person program, with the added benefit of a built-in accountability partner who truly gets it.
The topics, framework, and core content are exactly the same as the individual Very Peri program. The difference is that this option is structured to support two participants at once, with individual onboarding and expanded communication support for both people.
You’ll move through the same discussions, education, and practical guidance—together—while still receiving individualized support within the shared sessions.
How the Two-Person Program Works
Both participants attend all coaching calls together
You must be available at the same time (you may join from separate locations)
Coaching is tailored to each individual within the shared sessions
You’ll gain insight into your own perimenopause experience and learn through your friend’s perspective
What We’ll Cover
(Same as the One-Person Very Peri Program)
Understanding current symptoms
Understanding the hormonal process occurring
What’s happening now—and how things may change going forward
Optimizing nutrition
Appropriate and effective exercise for this stage of life
Sleep hygiene
Hormone Replacement Therapy (HRT) education and discussion
Stress management strategies
How to minimize toxins
How to optimize supplements
This program is not testing-dependent. Functional Medicine testing can be added at standard rates if we decide it would be helpful. Testing is not included in the base program cost.
Program Details
Duration
3 months
Meetings & Support
Introductory Calls:
Two 60-minute onboarding sessions (one per participant)Ongoing Calls:
Two shared calls per month for three months (45–60 minutes each)
Total Calls: 8
Email Support:
Up to two emails per week, as needed, for questions and ongoing support
(Emails may be submitted jointly or individually)
Investment
$2,000 total
($1,000 per person)