Dr. Jackie Piasta: Why Perimenopause Can Start at 36

Perimenopause isn't just a buzzword it's the missing vocabulary that finally explains why your body feels like it's betraying you in your late 30s and 40s.

This conversation with Dr. Jackie Piasta explored why perimenopause has become such a powerful word for women finally finding answers to years of unexplained symptoms. We discussed the complex hormonal orchestra that begins breaking down in the late 30s and early 40s, creating a cascade of physical and emotional changes that often leave women feeling like they're "not themselves."

The physiology behind perimenopause involves the ovaries becoming less responsive to brain signals, leading to missed ovulations and progesterone deficiency. This creates what's often called "estrogen dominance" though we prefer the term "progesterone deficiency" to avoid vilifying estrogen. The result is unpredictable cycles, mood changes, brain fog, sleep disruption, and metabolic shifts.

A major revelation emerged around hormone testing it's largely unhelpful during active perimenopause with regular cycles, since hormones fluctuate daily. However, testing can provide validation for women experiencing significant cycle disruptions, even if it doesn't change treatment plans. The key is understanding when testing makes sense versus when it's a waste of money.

The conversation highlighted how perimenopause accelerates metabolic dysfunction, with cholesterol, blood sugar, and liver enzymes often rising for the first time. Dr. Piasta introduced the "red wine sign" when alcohol tolerance suddenly disappears as an early warning that metabolic changes are happening throughout the body.

Treatment approaches vary based on individual needs, considering contraception requirements, cycle regulation, and symptom management. Both birth control pills and menopausal hormone therapy have roles in perimenopause care, often used together with IUDs providing contraception while hormones address symptoms. The goal is having more tools in the toolbox, not fewer.

Highlights:

• Why perimenopause is a "power word," not just medical jargon.

• When to test hormones (and when not to waste your money).

• Metabolic changes that accelerate during perimenopause.

• Birth control pills vs. menopausal hormone therapy approaches.

• When your body stops processing alcohol.

• Weight gain and metabolic dysfunction solutions.

• Treatment strategies for the "sandwich generation".