Am I in Perimenopause? 10 Signs Your Hormones Are Shifting

Perimenopause symptoms can be confusing, overwhelming, and easy to dismiss. Here’s how to recognize them.

perimenopause symptoms naturopath

By Dr. Maria Wong, ND | Women’s Health & Hormone Focussed | Mississauga & Virtual (Ontario-wide)

If you’ve been Googling perimenopause symptoms in Ontario, you’re not alone – and you’re probably not imagining things. You’re not quite yourself lately. Maybe you’re waking up at 3am for no obvious reason. Your mood shifts faster than it used to. You feel warmer than everyone else in the room. Your periods – once predictable – have become a guessing game.

You might be wondering: is this perimenopause? Or is it just stress? Thyroid? Getting older?

The honest answer: it could be any of these. But if you’re a woman in your late 30s or 40s and these changes are new, perimenopause is worth understanding – because recognizing it early gives you far more options than waiting until symptoms become overwhelming.

As a naturopathic doctor with a focus in women’s hormonal health, I see patients navigating this transition every week. Here’s what I want you to know.

What causes perimenopause symptoms?

Perimenopause is the hormonal transition leading up to menopause – the point when you’ve gone 12 consecutive months without a period. It typically begins in a woman’s mid-to-late 40s, but can start as early as the mid-30s.

During perimenopause, estrogen and progesterone levels don’t decline in a neat, steady line. They fluctuate – sometimes dramatically – and it’s these fluctuations, not just the decline itself, that cause many of the symptoms women find most disruptive.

Perimenopause can last anywhere from a few months to over a decade. That wide range is part of why it can be so confusing to recognize.

10 perimenopause symptoms to watch out for

1. Your periods have become unpredictable

This is often the earliest and most reliable sign. Cycles that were like clockwork start arriving earlier or later than expected. You might skip a month, then have two cycles close together. Flow can become heavier, lighter, shorter, or longer – sometimes all in the same year.

What’s happening: declining progesterone in the second half of your cycle is often the first hormonal shift to occur, disrupting the timing and quality of ovulation.

2. Sleep has become elusive

You fall asleep fine but wake between 2am and 4am, mind racing, unable to get back to sleep. Or you sleep through but wake exhausted. Night sweats – sudden heat and dampness that disrupt sleep – are common even before classic daytime hot flashes appear.

What’s happening: progesterone has a calming, sleep-promoting effect. As levels decline, sleep architecture changes – particularly the deep, restorative stages. Estrogen fluctuations also affect temperature regulation, contributing to night sweats.

3. Your mood feels less stable

Irritability that feels disproportionate to the situation. Anxiety that appears out of nowhere. A low-level sadness or flatness that doesn’t quite lift. Many women describe feeling emotionally “off” in a way that’s hard to articulate – and are often told it’s just stress.

What’s happening: estrogen has a significant influence on serotonin, dopamine, and GABA – neurotransmitters that regulate mood and anxiety. As estrogen fluctuates, so does the stability of these systems. This is not a mental health problem. It’s a hormonal one.

4. Brain fog and memory lapses

Forgetting words mid-sentence. Walking into a room and having no idea why. Struggling to focus in meetings that never used to bother you. Many women are alarmed by these cognitive changes – some fear early dementia. In most cases, it’s hormones.

What’s happening: estrogen plays an important role in memory consolidation and verbal fluency. Its decline affects cognitive performance, often transiently. Research suggests that for many women, cognitive symptoms improve once hormone levels stabilize post-menopause.

5. Hot flashes or sudden warmth

Sudden waves of heat through the chest, neck, and face – sometimes followed by chills or sweating. These can last 30 seconds or several minutes, and may happen a few times a day or much more frequently. Not everyone experiences dramatic hot flashes; some women notice only mild warmth or flushing.

What’s happening: estrogen helps regulate the hypothalamus, the brain’s thermostat. As levels decline and fluctuate, the thermostat becomes more sensitive – triggering the heat response more easily.

6. Changes in your cycle length or flow

Heavier periods with more clotting than before. Or the opposite – light spotting where there used to be a full flow. Cycles shortening to 21 or 22 days. Premenstrual symptoms becoming more intense than they were in your 30s.

What’s happening: anovulatory cycles (cycles where no egg is released) become more frequent during perimenopause. Without ovulation, progesterone isn’t produced in the second half of the cycle, leading to estrogen dominance – which often causes heavier, more symptomatic periods.

7. Vaginal dryness or discomfort

Dryness, irritation, or discomfort during sex. Changes in vaginal tissue that make intercourse uncomfortable for the first time. Increased susceptibility to urinary tract infections. These symptoms are common and treatable – yet many women don’t mention them to their healthcare providers because they’re embarrassed or assume they’re inevitable.

They’re not inevitable. There are effective options, and this is worth discussing openly.

8. Weight changes – especially around the midsection

Weight gain that seems to concentrate around the abdomen despite no significant changes in diet or exercise. A feeling that your metabolism has simply slowed down. Difficulty losing weight using approaches that worked before.

What’s happening: estrogen influences where fat is stored. As levels decline, fat redistribution from the hips and thighs to the abdomen is common. Cortisol sensitivity also changes, making stress-related weight gain more pronounced.

9. Low libido or changes in sexual desire

A reduction in interest in sex that feels different from simply being tired or stressed. Changes in arousal or physical sensation. This is one of the most common perimenopausal symptoms and one of the least talked about – in large part because women are often told to just expect it as they age.

Hormones – particularly testosterone (yes, women produce testosterone too) and estrogen – play a direct role in libido. Addressing the hormonal component can make a meaningful difference.

10. Fatigue that sleep doesn’t fix

A bone-deep tiredness that persists even on days when you’ve slept reasonably well. Energy crashes in the afternoon. Feeling depleted by things that used to be manageable. This kind of fatigue has a hormonal component – but it can also be compounded by poor sleep, thyroid changes (which are common in perimenopause), and adrenal stress.

Ruling out thyroid dysfunction is important here – hypothyroidism and perimenopause share several symptoms and frequently co-occur.

What to do when perimenopause symptoms appear

The first step is getting clarity. Many of these symptoms are genuinely caused by perimenopause – but some can have other contributors, including thyroid issues, nutritional deficiencies, sleep disorders, or adrenal dysfunction. A thorough assessment matters.

As a naturopathic doctor in Ontario, my approach to perimenopause symptoms starts with understanding the full picture: a detailed health history, the right lab testing (which may include blood hormone panels or comprehensive urine hormone testing like the DUTCH test or Mira hormone monitor), and an honest conversation about your goals, concerns, and what you’re willing to consider.

From there, treatment options range from foundational lifestyle and nutritional strategies, to targeted supplementation and herbal medicine or acupuncture, to bioidentical hormone replacement therapy (BHRT) for women whose symptoms are significantly affecting quality of life.

There is no single right approach. What works depends on your individual hormonal picture, your health history, your values, and your symptoms. What I can tell you is that you don’t have to white-knuckle your way through this transition. There are options, and the earlier you understand what’s happening, the more of them you have.

Note: Bioidentical hormones for perimenopause symptoms in Ontario

One question I hear often: can a naturopath in Ontario actually prescribe hormones for perimenopause symptoms? The answer is yes – naturopathic doctors who have completed the additional prescribing examination are licensed to prescribe bioidentical hormones, including topical estrogen and progesterone.

Bioidentical hormones are structurally identical to the hormones your body produces naturally. They differ from conventional synthetic hormone therapy in their molecular structure, and many women – and practitioners – prefer them for that reason. BHRT is not appropriate for everyone, and it’s not something I prescribe without proper assessment and monitoring. But for the right candidate, it can be genuinely life-changing.

If you’re curious about whether BHRT might be relevant for you, that’s a conversation worth having.

Ready to get some answers?

I see patients for perimenopause symptoms in-person in Mississauga and virtually for anyone in Ontario. If several of the signs above resonated with you and you’d like to understand what’s actually going on with your hormones, I’d encourage you to book a consultation.

I also offer a free 15-minute meet and greet for new patients in Ontario who want to learn more about my approach to perimenopause symptoms before committing to a full visit. It’s a no-pressure conversation – and often, it’s the first time someone has felt genuinely heard about what they’ve been experiencing.

Book your appointment here – in-person (Mississauga) or virtual (anywhere in Ontario).

About Dr. Maria Wong, ND

Dr. Maria Wong is a naturopathic doctor practicing in Mississauga, Ontario, with a focus in women’s hormonal health – including perimenopause symptoms, PCOS, endometriosis, fertility, and PMS. She sees patients in-person in Mississauga and virtually for patients across Ontario. She is licensed by the College of Naturopaths of Ontario and has prescribing authority for bioidentical hormone therapy.

The PMS Paradox and the 50 Shades of Chocolate

(How To Have Your Brownie and Eat It Too)

It’s that “time of the month” again …

…and you’re craving chocolate. But you’re already feeling a little bloated from your hormones going crazy… is this just nature’s idea of a cruel joke? You’ve been sticking to your new year’s resolutions (see January’s post) and losing weight with help from your favourite naturopath. So why do women crave chocolate during that time of the month? Doesn’t chocolate just make you gain more weight?

The 50 Shades of Chocolate

Actually, nature is smarter than we think. Craving chocolate certainly might not help you from a weight loss or PMS perspective, but that’s only because it’s full of sugar (Approximately 1-2 teaspoons of sugar in each snack sized mini bar…and about 14 teaspoons in a full sized chocolate bar!!!… but more on that in a future post). Cacao (not cocoa) is the pure form of chocolate, with no sugar added to it, and has many health benefits. Specifically, it is a great source of magnesium, which helps to alleviate PMS symptoms such as water retention, pain and anxiety (Read: bye bye bloating, cramps and mood swings!). For even more ways to improve mood, see our February post on “Beating the February blues.”

Nutrient of the Month

Magnesium

So can we really incorporate chocolate into a healthy diet? Well, that will depend on the current shade of chocolate that you’re consuming. It’s a bit paradoxical because if you’re having a lot of milk chocolate, that will actually be counterproductive and increase PMS symptoms. But, the darker you go, the more magnesium your chocolate will have, and the more benefits you will get from your chocolate.

YOUR 21 DAY CHALLENGE

Go one shade darker. 

*100% pure cacao can taste like dirt if you go cold turkey. But if you go gradually, you won’t notice the change so much! So this month, just focus on going one shade darker. If you’re at 50% try 60%. If you’re at 70%, try 80%. If you’re already at 90%, bravo and try going that extra step to pure cacao!

Are you feeling the effects of PMS? 

For Additional Support Please speak to your Naturopathic Doctor.

Disclaimer: Information is for educational purposes only. It is not meant as medical advice and any treatment decisions should be made with the knowledge or consent of your healthcare professional.

No time to make breakfast?

Have no fear! “Quick Cook” Steel Cut Oats is here!

My 7-minute protein and fibre packed breakfast this morning

So I know we’re all busy, and there is never enough time in the day. However, having a healthy, protein packed breakfast is super important to having a good start to the day! I just discovered these “Quick Cook” Steel Cut Oats, which takes all the time out of making them! So, if we can all just spend 7 minutes (literally, that’s all the time I spent making this) of our time to make a hearty breakfast, we’ll be more focussed and energetic, and all around just better people 🙂

So here’s everything you need:

Ingredients

1/2 cup Quick Cook Steel Cut Oats
3/4 cup Unsweetened Almond Milk (Just water will work as well)
1 tbsp Hemp Hearts
1 tbsp Chia Seeds
2 tsp Cacao nibs
1/4 cup Organic Toasted Coconut Slices
Optional: 1/4 cup of fruit 

Recipe

  1. Using a small pot, combine Quick Cook Steel Cut Oats and Unsweetened Almond Milk (for a creamier taste)
  2. Bring to a boil, and reduce heat to a simmer
  3. Simmer for 5-7 minutes until cooked through
  4. Remove from heat and add in Hemp Heart, Chia Seeds, Cacao Nibs and Coconut Slices (Optional: fruit to sweetened it up a bit!)

And voila! You have a protein packed, full of fibre breakfast! Note: I eat a lot for breakfast, so this might be equivalent to 2 portions for some people.

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Shovelling Causing You Back Pain?

Are you sick of shovelling? It’s February… commonly known as the worst month of the year so I don’t blame you. We’ve already gone over 3 Tips on How to Make Shovelling Fun in a previous post. But, shovelling is still tough work. And back pain can be inevitable even with the best of technique. So today I will talk about what we can do about it!

Discover the Benefits of Electroacupuncture

WHAT IS ELECTRO-ACUPUNCTURE?

Electro-acupuncture refers to the application of a gentle pulsating current to specific acupuncture points on the body. No current is actually transmitted through the body and is only enough to gently stimulate the acupuncture needle. When these specific points are activated/stimulated, chronic pain/illnesses can be alleviated. Low frequency electro-acupuncture is also associated with the release of endorphins which provides an extended period of pain relief, better tissue healing and wound repair. Perfect for those sore muscles and back pain after shovelling on a day like today.

DOES IT HURT?

Electro-acupuncture is very gentle. You will feel a slight pulsating/buzzing sensation (not a shock!). The intensity and frequency is also adjusted to your tolerance.

WHAT CONDITIONS DOES IT TREAT?

Electro-acupuncture is used for many conditions, but some of the common conditions that it can be used to help treat include:

Sciatica Back Pain
Knee Pain Tennis elbow
Muscle Spasm Nerve pain/neuralgia
Arthritis Bone fractures

HOW MANY SESSIONS ARE REQUIRED?

This depends on the individual, but typically acute injuries require 8-12 sessions. Chronic issues will require approx. 1-2 sessions/week over several months with monthly maintenance thereafter.

HAVE MORE QUESTIONS? Contact Dr. Maria or schedule a free 15 minute consultation to how acupuncture can benefit you!

For even more benefit, schedule a massage together with your acupuncture session at the Health in Hands Massage Therapy and Wellness Clinic!

Dr. Maria mississauga naturopath enjoying sun on a -35 degree day

Combating The Winter Blues

People enjoying the snow and socializing to avoid seasonal affective disorder

Are you feeling sad? Unusually fatigued? Not motivated to do much? It’s not uncommon to feel the blues by this time of year. The days have been short, overcast and cold, which can impact the best of us.

But could it be more than just a seasonal slump? Seasonal Affective Disorder (SAD), which may also be known as the “winter blues”, is a type of major depressive disorder that occurs during the same season each year, most often in the winter.

Signs and symptoms of SAD may include:

  • Feeling depressed most of the day, nearly every day
  • Losing interest in activities you usually enjoy
  • Sleeping too much or too little
  • Changes to your appetite or weight
  • Having low energy
  • Feeling easily irritated
  • Difficulties with concentrating or making decisions

It is not known exactly what causes SAD, but changes to our sleep-wake cycle, neurotransmitter levels and vitamin D may be implicated.

Here are 6 Tips to help Combat the Winter Blues:

Get a good night’s sleep: with longer periods of darkness, our natural sleep-wake rhythms may be disrupted, so it is important to maintain routines. Go to bed and wake up at the same times, make sure your bedroom is dark, quiet and comfortable. Avoid screens within 30-60 minutes of bedtime and avoid oversleeping. If you have difficulties with falling or staying asleep, talk to your ND for support.

Exercise: regular exercise is a great stress buster and can help improve your mood. Go for a walk, try a new exercise class, hit the slopes, yoga, anything that will get you active for 30 min per day. Make it consistent by doing something you enjoy, or make it social – go with a friend or the whole family.

Socialize: we have just come out of the holiday season, likely full of seeing friends and family. Why does that have to stop just because the holidays are over? So call a friend, hang out with your family, have lunch with a coworker, organize a game night, etc anything that keeps you from being isolated.

Mood foods: consume foods that are high in vitamin B6, tryptophan and tyrosine, nutrients that are needed to make serotonin and dopamine, your feel good hormones. These foods may include: fish (also rich in omega-3’s and vitamin D, which are good for your mood – bonus!), poultry, dairy, eggs, legumes, nuts, avocado. A variety of fruits and vegetables also have an array of nutrients like vitamin C, magnesium and folic acid, to support mood and energy.

Get outside: it may seem like the last thing that you want to do, but being in nature can help to lift your mood, so bundle up and get some fresh air! This is especially helpful if you can get out earlier in the day, when the sun is highest in the sky.

See the light: 30 min of light therapy can be helpful in improving symptoms of SAD when used regularly (always read and follow the manufacturer’s instructions). Don’t have an artificial bright light? Make your space lighter by opening curtains, working closer to a window (especially in the morning), cleaning your windows and removing any furniture that may be blocking them or hanging mirrors to reflect the light around the room.

Could your symptoms be due to an imbalance? Talk to your ND about:

Naturopathic lab testing in Mississauga

Vitamin D testing: living in the northern hemisphere, we are exposed to less sunshine throughout the year which can impact our body’s natural ability to synthesize vitamin D. Low levels can impact our mood and may be implicated in seasonal changes.

Other nutrient and hormone testing: nutrient and hormone imbalances can also affect our mood, so talk to your ND about screening for any tests that would be appropriate for you.

For additional support, please contact me or book an appointment to discuss the optimal treatment plan that is tailored to your needs!

Recipe of the month:

Mood boosting colourful recipe for seasonal affective disorder - One pan salmon with rainbow veggies

Your 21 Day Challenge: Get outside for at least 5 minutes every day for the next 21 days

My21Days.What will you make of them?

More information coming soon.

In Health,

Dr. Maria

3 ways to make shovelling fun.

Ok… so maybe not THAT fun. Especially after today with this crazy snowstorm. I can attest to that after shovelling twice already. It’s back breaking activity. Buut.. as I was shovelling today, I actually really got into it. Came back in the house looking like a snowman, but had a giant grin on my face. Crazy right? So how did I do it?

  1. Look at it like it’s a workout
    • The only way I was getting off of my comfy couch and out from under warm blankets was because I knew that I would be getting a serious workout from doing it…. and it also meant I didn’t have to go to the gym later (insert guilty smile here). C’mon just because I’m a naturopath, doesn’t mean I want to head out in blizzards either. Even if it means an awesome session at the climbing gym.
    • Pro tip: get some music going, and it’ll feel just like a workout. Get those endorphins going! (Just make sure you bundle up.. shorts and a t-shirt won’t cut it here)
  2. Do it with a friend
    • Whether it’s a partner, housemate or just calling over a buddy… make it a social activity! 2 shovels are waay better than one. They say misery loves company… but why can’t you just want company to make a hard task easier? Nobody said 3 feet of snow had to be misery…
  3. Make it a race
    • Time yourself! It’ll feel more like a challenge, and it’ll get your adrenaline going a little bit.
    • If you’re doing it with a friend, see who can finish their side faster
    • Note: Just watch your back and shoulders. No need to injure yourself either

When you’re done, reward yourself to a nice soak in the tub with some epsom salts to relax the muscles. And maybe a nice glass of wine… ;

For more monthly free fun tips, recipes and more; subscribe to my newsletter below. For a limited time, you will receive 5 delicious smoothie recipes for FREE when you subscribe.

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In health,

Your Friendly Mississauga Naturopath

Get A Head Start On 2019

NEW SERVICE: CUSTOM MEAL PLANS

Beginning in 2019, I am adding customized meal planning (tailored to your health concerns) to my list of services provided. What does this include?

  • Customized weekly meal plan (1 week given per visit)
  • Grocery list
  • Delicious recipes with pictures
  • Nutrition Facts
sample-meal-plan-clinic-copy-1

Who Can Benefit From This?

Everyone! Whether you have a specific health concern (eg. hormone imbalances, high cholesterol), want to lose a couple of pounds (eg. paleo, keto diets) or you just want some meal ideas, I can create a specific meal plan for you!

Meal Plans for Specific Health Concerns Such As…

  • High Blood Pressure
  • Auto-Immune
  • High Cholesterol
  • Hormone Imbalance
  • Diabetes
  • IBS
  • Thyroid Health
  • Weight Loss
  • … and more

Meal Plans For Specific Health Goals Such As…

  • Anti-Inflammatory Diet
  • Food Sensitivities
  • Keto
  • Gut Healing
  • Paleo
  • 21-Day Cleanse
  • Summer Shape Up
  • … and more

What to Expect:

We will first meet to discuss your health goals, lifestyle and food/diet preferences. At the second visit, I will then prepare a diet plan for you to try out for a couple weeks. At each subsequent visit, we will discuss your feedback on the meal plan, and I will give you a new plan with new recipes.

What-to-Expect

To get your customized meal plan, click here to book now!

NEW: Monthly Newsletter Subscription

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In health,

Dr. Maria
Naturopathic Doctor (Meadowvale, Mississauga) 

Top 5 Natural Flu Prevention Tips

Coughing? Sneezing? Know someone who is having cold/flu symptoms?

Flu season is definitely upon us. Even though it doesn’t generally peak until those cold winter months (December-February), everywhere I go I’m already hearing those dreaded coughs and sneezes. As a naturopath, I am certainly not immune (no pun intended) to these little buggers either. In fact, just yesterday I felt a bit of a sore throat and headache coming on. So how can we protect ourselves this flu season?

To vaccinate or not to vaccinate… 

The CDC states that “the single best way to protect against the flu is to get vaccinated each year.” This blog post is not intended to be a long discussion on the efficacy of the flu shot, or whether you should get the flu shot or not. (For the record, I am not anti-vaccines. I am, however, pro educated decisions). Whether you choose to get the flu shot or not, there are still other ways to enhance your immune system. The flu shot may protect you against the 3 or 4 strains of viruses deemed to be most common in that season. However, the flu shot does not protect you against those strains if they have mutated, or all of the hundreds of other strains that are not covered, and any non-flu viruses that cause influenza-like illnesses. So, if we can’t protect ourselves against all of those other potential hitters, it makes sense to me to strengthen our body’s defense system.

How do I stay flu-free this season? 

OK, so we all know about rest, fluids and washing your hands. I’m not here to preach about things that we all know already. Nothing is more annoying than going to your doctor’s office, and them telling you just to get some rest and drink water. I mean, we all know that already right? So I’ve created a short checklist of 5 items that I think are important, but may be missed in the general population. You can check out the brief checklist in my previous post, but I will be writing a longer post on each item over the next couple weeks, so stay tuned! These are by no means the ONLY ways to protect yourselves, and you should always consult your friendly Naturopathic Doctor for more specific and tailored approaches to your immune system.

I can’t wait. I need to see a Naturopath now.. 

If you want to get immune ready now, I am currently running my annual flu clinic at my Mississauga (Meadowvale) clinic . The initial immune consultation consists of a wellness assessment, a zinc tally test, individually tailored flu flighting tips as well as a free immune booster!. The cost of the consultation and treatment is only $40 and is covered by your extended health benefits. Click here to book online now. Or click here to contact me for any further questions.

Stay tuned for more… 

In Health,

Dr. Maria