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  • March 30, 2021 5 min read

    by Dr. Jason Dave
    Doctor’s Note
    A new series featuring leading physicians who love plants as much as we do!

    Once we hit our thirties, our hormones seem like that just can’t take it anymore. Balance becomes elusive. Mood swings, pain, bloating and weight gain become normal. We become less resilient to stress and more readily give into cravings. 

    Many women are unaware that there is a stage right before menopause – called perimenopause – that share many classic menopause symptoms (such as hot flashes and decreased libido), but may also manifest as worsening premenstrual syndrome (PMS), heavy periods, difficulty sleeping and weight gain. The word "peri" is derived from the Greek word meaning "around" or “near.” Perimenopause is the transition your body goes through leading up to menopause, which is also referred to as a “menopause transition.” 

    To help you understand the bigger picture of what’s going on with your body, let’s take a closer look at the similarities and differences between perimenopause and menopause.     

    What happens during perimenopause?

    Perimenopause is the gradual transition into menopause. For most women, it usually starts around mid-to-late 40s. Some women can also experience the onset of perimenopause even earlier- in their 30s! The average length a woman experiences perimenopause is around 4 years. Some women may only experience this stage for a few months, while others will be in this transition phase for more than 4 years. When and how long a woman will experience perimenopause is determined by a variety ofgenetic, lifestyle and environmental factors.

    In perimenopause, the ovaries gradually produce fewer sex hormones (estrogen, progesterone and testosterone). Estrogen levels during perimenopause usually fluctuate up and down more sporadically than they do in a typical 28-day cycle, causing a disruption in the menstrual cycle- this is usually the first sign a woman will experience that they are in perimenopause. For example, menstrual cycles that normally last for 28 days can come as early as day 21 or as late as day 35 with the onset of perimenopause. Some women can also experience months without a period, and then have heavier than normal periods when they do have them. 

    The drop in estrogen levels is accelerated in the last 1 to 2 years of perimenopause. Estrogen levels will then continue to decline further until a woman’s ovaries cease the release of eggs. When this occurs, many women may experience full onset of menopause symptoms.  

    Progesterone levels, which also help regulate a woman’s cycle, also are also in decline during this stage. This can lead to irregular or heavy bleeding, which is a common complaint of perimenopausal women. Low progesterone can also contribute to insomnia, memory and concentration issues, and breast tenderness. 

    It is important to remember that women still have menstrual cycles during this time and conceiving a child may still be possible. The intensity and type of symptoms a woman will experience in this stage can vary greatly- for some it might be very intense, and others might not notice anything at all. 

    Some common perimenopause symptoms include:

    • Shorter or longer menstrual cycles
    • Irregular periods (including missing periods, or lighter or heavier periods)
    • Worsening of PMS 
    • Night sweats and hot flashes
    • Insomnia
    • Vaginal dryness, leading to painful intercourse
    • Breast tenderness
    • Mood-related changes, including anxiety and depression

    What happens during menopause?

    Menopause occurs right after perimenopause, and is a normal part of aging and marks the end of a woman’s reproductive years. It is diagnosed when a woman no longer has a menstrual period for12 consecutive months. In other words, your period has “officially ended.” Menopause generally occurs as women enter their late 40s to early 50s, with the average age of onset being 51 years old. During this stage, a woman’s ovaries have stopped releasing eggs and producing most of their estrogen, progesterone and testosterone. 



    Menopausal women not only continue to experience the same symptoms they had when they were in perimenopause, but continued new changes to the body can also cause symptoms such as:

    • Occasional racing heartbeat or palpitations
    • Weight gain
    • Difficulty with concentration, thinking and memory
    • Hair thinning or growth of facial hair
    • Unexplained joint and muscle aches
    • Loss of muscle mass and bone, leading to increased risk of fractures

    Women who are in menopause are also at a higher risk for osteoporosis (a disorder where there is significant bone loss), cardiovascular disease and urinary incontinence. This is due to the lack of estrogen production- which once helped protect and support a woman’s bones, heart, and other important bodily functions. With age and estrogen decline, it becomes easier for bones to fracture. 

    Whether you are in perimenopause or menopause, it is a good idea to work with a physician (preferably one who is trained in nutrition or functional medicine) during this phase in your life so he or she can continue to provide you with regular bone density screenings, mammograms, routine blood lab testing, and monitor your overall health. Certain tips can help address the symptoms that often accompany declining hormone levels, such as:

    Lifestyle modification tips:

    • Weight loss or maintenance if needed- consider regularjuice cleanses to stay on track
    • Regular exercise 
    • Add in more fiber than you think-Pineapple Chia Cleanse is a fantastic way to get things moving through your digestive system, which slows during menopause. Consider two servings a day.  
    • Switch to a plant-based diet that includes plenty of cruciferous and leafy green vegetables: 

    If you’re finding it hard to incorporate a plant-based diet, not to worry! Our deliciousOrganic Pressed Greens contains organic kale, spinach, broccoli and other superfoods that have been shown to significantly reduce overall menopausal symptoms in women. In addition, the cruciferous and leafy green vegetables contain plenty of highly-absorbable calcium to help support bone health during menopause.  

    • Avoid spicy foods, alcohol, caffeine and other dietary triggers that can worsen hot flashes
    • Try mindfulness-based practices (yoga, meditation, etc.) 

    Supplements and Medications to Consider (should be taken only under the supervision of your physician):

    • Black cohosh for hot flashes 
    • Evening primrose oil 
    • Antidepressant medication
    • Increase your calcium, vitamin K2, and vitamin D intake to prevent bone loss
    • Hormone replacement therapy

    Next week, Dr. Cassidy Miller will tell you how to eat, what to eat and when to eat during peri-menopause and menopause! Stay tuned and stay healthy.

    By Dr. Jason Dave


    Doctor’s Note

    A new series featuring leading physicians who love plants as much as we do!

    For more SMART lifestyle tips like this, visit our other blogs at and follow us on Instagram or like us on Facebook. You can also visit our shop to stock up on our delicious juices.


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