Perimenopause: 1 Word, 34 Symptoms

Did you know there are over 34 symptoms of perimenopause and menopause? 

Yet, despite how common this transition is, so many women feel unprepared, unsupported, and unheard. 

As part of our ongoing commitment to women’s well-being this Menstrual March, we’re opening up the conversation on perimenopause and menopause — shedding light on the real experiences, challenges, and changes that come with this powerful life stage. Through real stories and expert insights, we’re here to help you navigate this transition with knowledge and confidence.

What we discovered:

In a recent global survey of 222 JSHealth community members, 9 out of 10 women said they felt inadequately prepared for perimenopause. Almost half shared that menopause remains a taboo topic and is not discussed openly in social circles, leaving many to navigate it alone, feeling confused and isolated. 

From sleep disturbances and brain fog to a host of unexpected symptoms, the reality of menopause extends far beyond hot flashes.

The most common symptoms reported to us include:

Sleep disturbance - 82%
Fatigue - 73%
Weight Gain - 70%
Brain Fog - 68%
Memory Problems - 67%
Anxiety - 66%
Irritability - 64%
Bloating - 64%
Low libido - 64
Hot flashes - 56%

We asked our community, what has been the most challenging?

Here’s what some of the women shared: 

• “GP just put me on antidepressants, which didn’t agree with me and my body, it just made me feel worse. I felt very lonely, like no one could help me. It’s a frustrating cycle.” - Peggy, 51 years. 
• “My doctor didn’t connect the heart palpitations and hip pain to perimenopause. I experienced symptoms that are less commonly talked about or known.” - Odette, 53 years. 
• “I started perimenopause young at 41 from a hysterectomy. Not enough people talk about peri and menopause, there’s a lack of understanding.” - Rahel, 55 years. 
• “The symptoms can affect work life, home life, and relationships. A lot of workplaces don’t understand or acknowledge this stage and how it impacts team members. GPs only recently have been mandated to train in peri/menopause and how to manage it.” - Emma, 54 years.

Expert Advice from Lara Briden

So, where do we go from here? To empower and educate, we’re revisiting one of our favorite conversations with trusted expert, naturopath Lara Briden (AKA ‘The Period Revolutionary’). With decades of experience, she shares her essential insights on navigating perimenopause and menopause with knowledge and the right support.

What is happening during perimenopause and menopause?

First, some definitions. Perimenopause is the two to ten years before menopause. It is the time of greatest symptoms, but it is temporary. Menopause is the life phase that begins one year after the final period. It is usually the time of almost no symptoms.

The normal age for menopause (periods stopping) is anywhere from 45 to 55, and the normal age for perimenopause is up to ten years before that — as young as 35! That’s why perimenopause is not about aging. Instead, it’s about the recalibration of the entire hormonal system and the support you may need during that temporary process.

What are the phases of perimenopause?

Phase 1 of a normal perimenopause is when periods are still regular but symptoms are starting. This phase can last 2-5 years and is usually a time of high estrogen and low progesterone.

Phase 2 is the early menopause transition when cycle length starts to vary by more than 7 days. Cycle length means counting from day 1 of the bleed to day 1 of the next bleed. Estrogen is still high but fluctuating more widely with some real low points — leading to both high estrogen symptoms like irritable mood and breast pain AND estrogen withdrawal symptoms like migraines and night sweats. The timing from the onset of irregular cycles till the first skipped period is 2-3 years.

Phase 3 is when cycle length starts to vary more dramatically, with up to 60 days between periods. Estrogen is getting lower now but still fluctuating up to some high points.

Finally, phase 4 or late perimenopause is the waiting room — or the time between what you think might be the final period and achieving menopause 12 months later. Phase 4 is a time of lower estrogen.

What is actually happening in the body during this time?

Perimenopause is essentially a second puberty, so it’s a time of hormonal change. If we look at hormones across the lifespan, estrogen is low in childhood and then high and fluctuating during the teen years, especially in comparison to progesterone.

Estrogen then goes up, not down, in the perimenopause years, and women in their 40s can have up to 3x more estrogen than they did in their 30s.

Progesterone, on the other hand, is low in the teen years until regular cycles become established, and then becomes low again in perimenopause.

So, the combination of high estrogen and low progesterone occurs in both first and second puberty, with progesterone being slowly gained in first puberty and slowly lost in second puberty.

Progesterone makes periods lighter, so low progesterone paired with high estrogen is why heavy periods can occur in teenagers and then again in women’s forties.

Eventually, with second puberty, women lose most — not all — ovarian estrogen and arrive at the stable low estrogen of menopause that is normal — not a deficiency — and is similar to childhood levels.

What are the main symptoms women going through perimenopause may experience?

The 9 possible symptoms of perimenopause include:

Heavier periods Worsened period pain Shorter (at first) menstrual cycles (< 26 days) Painful, lumpy breasts Difficulty sleeping, including mid-sleep waking Premenstrual night sweats New or increased premenstrual mood swings New or markedly increased migraine headaches Weight gain without changes in exercise or eating

Can you share some tips on how to manage these symptoms?

There are lots of ways to feel better, including body-identical hormonal therapy (both progesterone and estrogen). Other strategies include outdoor exercise (what researchers call “green exercise”), reducing alcohol, and taking nutritional supplements such as magnesium. In a paper called “Magnesium in the gynecological practice: a literature review,” researchers conclude that magnesium is an effective treatment for menopause and perimenopause because it helps to “normalize the action of hormones on the central nervous system.” It works well in combination with the amino acid taurine, which helps to calm the brain and prevent hot flashes.

Stress impairs the brain’s ability to recalibrate and rewire during the perimenopause transition, so practicing stress relief techniques is also important.

Which nutrients and herbs can support those going through perimenopause?

It very much depends on the symptom(s), but supplements discussed in my perimenopause book Hormone Repair Manual include:

• Magnesium
• Taurine
• Zinc
• B-complex
• Vitamin B6
• Iodine
• Ashwagandha
• Vitex 
• Inositol

For more on any of the topics, there is lots of free information available on Lara Briden’s blog, as well as in her 2 incredible books. Head to www.larabriden.com.

In honor of menopause

Remember, while it may be overwhelming at times, menopause can be regarded as an advantageous evolutionary process that is a profound time during a woman’s journey. Armed with the right tools and education, this is a phase of life to be celebrated and an invitation to deepen self-care and body kindness. 

From the first-hand stories we collected from our community, it’s clear there’s a positive shift happening — one where women are embracing this stage with greater self-awareness and compassion.

• “I've learned to really appreciate my body even more and just love her the way that she is, bumps and lumps and all.” - Peggy, 51 years
• “I think embracing the symptoms rather than pushing against them is really important. Now I really have to slow down and find moments of calm.” - Odette, 53 years
• “Our hormones are running around and we have to be kind to ourselves and know that it is a normal thing.” - Rahel, 55 years 
• “Education [so people understand] what you're going through is really important for us to be able to cope with everyday life. I think that is happening now, which is really refreshing.” - Emma, 54 years

Let’s keep the conversation going and empower one another at all stages of womanhood. For free personalized wellness and product advice, reach out to our dedicated Nourish Hub team.

Remember this is general advice only and is not intended to diagnose, treat or cure. Please always consult a health professional for guidance.