1 hr 1 minEarly Perimenopause Signs Women Over 40 Should Know
With Dr. Jolene Brighten
Guest on the show
Dr. Jolene Brighten
Dr. Jolene Brighten is a board-certified naturopathic endocrinologist, certified menopause specialist, sex counselor, founder of Dr. Brighten Essentials and best-selling author of Beyond the Pill and Is This Normal?
Episodes with Dr. Jolene Brighten
1 hr 1 minWhat Jolene talks about
Ep. 279: Early Perimenopause Signs Women Over 40 Should Know
Most women expect perimenopause to start with hot flashes or irregular periods. Dr. Jolene Brighten, naturopathic endocrinologist and author of Beyond the Pill and Is This Normal?, explains why she sees it differently. In her view, the first hormone to decline is progesterone, which can show up as worse PMS, irritability and waking at 4 or 5 a.m. in the days before your period, sometimes starting in your mid-thirties. She walks Nikkiey Stott through what she does about it: stress inventories, vagus nerve practices, cutting out the people who drain you, and testing that actually looks at cortisol, testosterone, DHT and estrogen metabolites.
From there they get into what women are rarely told: how chronic stress can show up as being wired and tired, constant illness, brain fog and faster aging, the common hormonal and nutritional drivers of hair thinning, and why Dr. Brighten believes perimenopause and menopause are not something you just have to ride out. She shares her view on the HRT and breast cancer fear, and why she says HRT alone is not enough without nutrition and lifestyle.
You also get her simple daily food structure (30 grams of protein per meal, 25 grams of fiber per day, under 25 grams of added sugar), why cooked cruciferous vegetables and cooled potatoes earn a spot on your plate, what drives libido and mood changes in perimenopause, and what to know about staying on hormonal birth control in your forties. Her closing advice: question everything, including her, and always ask whether it is true for you.
- Dr. Brighten explains that progesterone is the first hormone to decline in perimenopause, so worsening PMS, irritability and waking early in the days before your period can show up long before hot flashes or irregular cycles.
- Do a stress inventory: brain dump everything stressing you, offload what doesn't have to be you, and separate perceived stress from actual stress.
- Use humming, singing out loud and deep breathing to stimulate the vagus nerve and shift your body toward rest and digest.
- Structure your day around at least 30 grams of protein per meal, at least 25 grams of fiber per day, and less than 25 grams of added sugar.
- Build your plate as half fruits and vegetables, a palm-sized portion of protein and a portion of carbohydrates, and cook then cool potatoes to create resistant starch for gut health.
Questions Jolene helps answer
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Menopause & Perimenopause Weight Loss
What are the first signs of perimenopause?
According to guests on The WarriorBabe Show, the first signs usually aren't hot flashes or missed periods. Dr. Jolene Brighten says falling progesterone shows up first as worsening PMS, irritability, breast tenderness and waking at night before your period, sometimes from 35. Hatty McCafferty adds sleep disruption, skin changes, digestive shifts and fatigue.
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Common questions
What is the first sign of perimenopause?
Dr. Brighten says it is not hot flashes or irregular periods. Progesterone is the first hormone to decline, so worsening PMS, irritability, breast tenderness and waking at night or very early in the days before your period can be the earliest signs, sometimes from age 35.
How can I tell if my stress hormones are out of balance?
Dr. Brighten points to being wired and tired at bedtime, being constantly startled, waking with headaches or unrested after a full night's sleep, blood sugar crashes, and getting sick all the time. She says this can be tested with salivary or urinary cortisol, such as the DUTCH test, or with ACTH and 8 a.m. cortisol blood work.
Does hormone replacement therapy cause breast cancer?
Dr. Brighten's view is that the Women's Health Initiative used much older women, and that progestins and Premarin are more associated with cancer than the bioidentical hormones used today. She says smoking, alcohol and binge eating ultra-processed food are higher breast cancer risk factors than a small, balanced dose of estrogen with progesterone.
How much protein, fiber and sugar should women aim for to support hormones?
Dr. Brighten recommends at least 30 grams of protein at every meal, at least 25 grams of fiber across the day, and keeping added sugar, not fruit, under 25 grams.
Why does libido drop during perimenopause?
Dr. Brighten explains it is multifactorial: falling progesterone, swinging and then declining estrogen, histamine, pain with sex, mood changes, body image, insulin resistance and inflammation all play a role. She adds that stress and strained relationships matter too, so it is never just your hormones.
Should I stay on hormonal birth control in my 40s?
Dr. Brighten says birth control is great if you don't want a baby, but it is very poor hormone replacement therapy and carries risks like clotting, inflammation and possible nutrient depletion. If you stay on it, she recommends knowing the risks, eating the best diet you can and taking a quality multivitamin.