Three Essential Truths I Wish Every Woman Knew Before Menopause
So many times I’ve seen women caught off guard by perimenopause, struggling with symptoms they don't recognize or understand, feeling dismissed by healthcare providers, and being left confused about what they should or could be doing to feel better.
As a naturopathic doctor focused on perimenopause and menopause, I believe every woman deserves to make informed choices about her body and her care. The first step of this is understanding how to set yourself up as well as possible for this significant hormonal shift, and how to recognize when your hormones might be changing. So let’s talk about three things I want all women in their 30’s and 40’s to know:
Truth #1: Perimenopause Can Begin Much Earlier Than You Think
If you expect to start thinking about menopause in your 50s, you're likely missing the boat entirely. The reality is that approximately 20% of women will go into perimenopause by age 40. Even more striking, research shows that about 40% of women between ages 36-40 report experiencing perimenopausal symptoms. That means that nearly half of women in their late 30’s are already experiencing symptoms of hormonal shifts (as a reminder women can continue to conceive all the way through perimenopause).
This early onset isn't a sign of premature aging or poor health—it's simply the natural variation in human biology. Some women begin this transition in their early thirties, while others don't experience it until their late forties or early fifties. Your genetics (have you spoken to your mother about how or when she experienced menopause?), stress levels, lifestyle factors, ethnicity, and overall health all play a role in timing.
Why does this matter? Because recognizing perimenopause early gives you more time to prepare, adjust your health strategies, and address symptoms before they significantly impact your quality of life. It also means you can make more informed decisions about contraception, family planning, and long-term health protection during this extended transition period, which can last anywhere from two to twelve years.
Truth #2: Hot Flashes Aren't Usually Your First Signal
Ask most people about menopause symptoms, and hot flashes top the list. While these vasomotor symptoms certainly affect many women, they're often not the first signal that your hormonal levels are shifting.
In my practice, I regularly see women experiencing the below symptoms of perimenopause years before their first hot flash ever appears:
Sleep disruption is often the earliest and most persistent complaint. You might find yourself waking at 3 AM with a racing mind, unable to fall back asleep despite feeling exhausted. This isn't just stress—it's often declining progesterone affecting your sleep architecture.
Anxiety and mood changes can appear seemingly out of nowhere (can we talk about rage?!). Women who've never experienced anxiety suddenly find themselves feeling on edge, overwhelmed by previously manageable situations, or experiencing panic attacks. The fluctuating estrogen levels during perimenopause directly impact neurotransmitters like serotonin and GABA and without the calming support of progesterone the body’s ability to mitigate that fight-or-flight response drops significantly.
Heart palpitations can be frightening when they first occur. Many women have rushed to the ER thinking they're having a heart attack, only to receive a clean bill of cardiac health. These palpitations are often hormone-related and tend to coincide with other perimenopausal symptoms.
Joint pain and stiffness frequently develop, particularly in the hands, knees, and hips. Women often attribute this to aging or overuse, but estrogen plays a crucial role in maintaining joint health and managing inflammation. For some women, frozen shoulder can mark the onset of perimenopause so pay attention to those pain signals from your body.
Brain fog and memory issues can be particularly distressing for high-achieving women who pride themselves on mental sharpness. Estrogen supports cognitive function, so its fluctuation during perimenopause can temporarily affect memory, concentration, and mental clarity. If you’re experiencing this please know that these symptoms will not last forever and they are not an indicator that you’re at a higher risk for dementia, even though it often feels like it.
These symptoms can begin years before hot flashes appear, and they're often dismissed—by both women and their healthcare providers—as stress, aging, or other conditions. Recognizing them as potential signs of hormonal transition is crucial for getting appropriate investigation and support.
Truth #3: Your Critical Window for Bone and Muscle Health is Now
Here's perhaps the most important message I can share: the time to act on bone and muscle health is now, not after you’re menopausal.
During the late stages of perimenopause and the first five years after your final menstrual period, you lose bone density at an accelerated rate—up to 20% in the first five to seven years post-menopause. This rapid loss occurs because estrogen, which helps maintain bone density by regulating the balance between bone breakdown and formation, declines precipitously during this period.
Similarly, maintaining muscle mass becomes increasingly challenging as estrogen levels drop. Estrogen supports muscle protein synthesis and helps maintain muscle quality. Without adequate estrogen, your body becomes less efficient at building and maintaining muscle tissue, even with the same exercise routine that previously kept you strong.
What does this mean for you?
Start strength training now. Resistance exercise is non-negotiable. Weight-bearing activities and resistance training not only help maintain muscle mass but also stimulate bone formation. If you've never lifted weights, now is the time to start. If you already exercise, consider increasing the intensity or frequency of your strength training.
Prioritize protein intake. Your protein needs increase during perimenopause and menopause. Aim for at least 1.1-1.2 grams of protein per kilogram of body weight daily, spread throughout the day to optimize muscle protein synthesis.
Consider your bone health comprehensively. This includes maintaining adequate vitamin D levels and appropriate calcium intake, in addition to weight-bearing exercise.
Evaluate menopausal hormone therapy (MHT) timing. If you're considering MHT, the "window of opportunity" hypothesis suggests that starting treatment closer to menopause onset (either before or after) may provide greater benefits for bone and cardiovascular health. However, this decision should be individualized based on your health history, risk factors, and personal preferences. MHT is not for everyone and understanding the risks, benefits, cost, and possible duration of treatment are all critical for helping you decide what’s right.
Get a baseline established. I don’t want you to wait until you have osteoporosis to confirm this, I want to know what your bone density is as you’re entering menopause so we can evaluate how high your risk for developing osteoporosis is during these most critical years of bone density loss.
Your Health, Your Choice
Every woman's menopausal journey is unique. Some will benefit tremendously from hormone replacement therapy, while others will find significant relief through herbal medicine, acupuncture, lifestyle modifications, and mind-body approaches. Some will choose a combination of treatments, adjusting their approach as their needs change.
What matters most is that you're informed about your options and empowered to make decisions that align with your values, health status, and life circumstances. No healthcare provider—myself included—should dictate how you navigate this transition. Our role is to provide you with accurate information, support your choices, and help you optimize your health throughout this process.
The menopausal transition, while challenging, also represents an opportunity to reassess your health priorities, strengthen your body, and potentially experience a renewed sense of vitality and purpose. With knowledge, preparation, and the right support, you can not only survive this transition but thrive through it and beyond.
Ready to make a change?
If you're searching for more guidance and understanding around how you can move through perimenopause with naturopathic medicine, you can book a complimentary consult with me or learn more about my practice here.
Be well,
Dr. Hayhlee Clarence, ND