Is This Perimenopause? The 34 Symptoms & Counting (Ep 1)

You're not going crazy. You're not broken. And no — it's not "just stress."

Somewhere in your 40s or 50s your body starts doing things no one warned you about — the broken sleep, the rage out of nowhere, the anxiety, the brain fog, the aching joints — and none of it makes sense. So you ask for help. And too often you're turned away. Told you're too young. Too stressed. That your bloods are "normal." You leave more defeated than when you walked in, quietly wondering if you're imagining the whole thing.

You're not. And you're not alone.

What the Peri? is for the woman navigating perimenopause or menopause — or lying awake wondering if this is it — who's done being confused and just needs someone to make it all make sense. I'm Kirsten Cooke: 30 years in health and fitness, and I've lived every one of these symptoms myself. This isn't a lecture from someone who read the research. It's the conversation I wish someone had sat me down and had with me years ago.

In this episode: 
→ My personal perimenopause journey — and why this podcast exists 
→ The statistics that prove this is a systemic failure, not a personal one 
→ What perimenopause actually is — and why it's different from menopause 
→ All 34 recognised symptoms — plus the extras that don't always make the list 
→ Why these symptoms happen, at a hormonal level 
→ What to do this week: starting your symptom diary

DOES ANY OF THIS SOUND FAMILIAR? Hot flushes & night sweats · broken sleep · brain fog & memory lapses · anxiety, low mood & unfamiliar rage · joint pain & stiffness · weight that won't shift · low libido · thinning hair · heart palpitations · burning mouth · a changed sense of smell · easy bruising… and many more. If you're nodding along — this episode is for you.

Not sure if this is you? → Download your FREE Guide: www.kirstencookecoaching.com/free-guide

Ready for real support? → Work with me: kirstencookecoaching.com/apply

RESOURCES
Track your symptoms with the free Balance app by Dr Louise Newson: drlouisenewson.co.uk

REFERENCES
– Australian female suicide rates by age group: AIHW / ABS Causes of Death 2023 — aihw.gov.au
– UK divorce & menopause: Office for National Statistics; Stowe Family Law Survey 2022
– USA divorce rates over 50: Bowling Green State University, 2022
– 39% of menopausal women offered antidepressants first-line: Newson Health Survey — drlouisenewson.co.uk
– Newson Health survey of 5,744 women: drlouisenewson.co.uk
– Menopause research underfunding: Nature, 2023
– Female-specific conditions receive ~1% of biopharma R&D: McKinsey Health Institute
– Santoro N et al. (2021), The menopausal transition — Journal of Clinical Endocrinology & Metabolism

If anything in this episode hit close to home, please reach out for support. In Australia, Lifeline is available 24/7 on 13 11 14.

The change you didn't ask for. The conversations you need.

Work with Kirsten: https://www.kirstencookecoaching.com
Say hi: @kirstencookecoaching on Instagram and Facebook

Transcript

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I thought I was losing my mind. I genuinely thought something was very wrong with me. And every time I asked for help, I was brushed off, dismissed, and gaslit. The exhaustion, the anxiety, the joint pain, the brain fog, nobody ever put them together, and no one suggested perimenopause. 30 years as a personal trainer and nutrition coach, and I still felt confused and completely on my own. And if you're feeling that too, you're not imagining it, and you are not alone. Welcome to What the Perry. I'm your host Kirsten Cook, personal trainer, menopause coach, and a woman living it right alongside you. This is the podcast for women navigating perimenopause and menopause. The change you didn't ask for, but the conversations you need. Let's get into it. Eight years ago, I birthed twins. They were baby number three and four. I was 40 years old, and although I loved being a mum, I started having an array of health issues, which I just put down to new mum exhaustion, or my busy life of four kids, running a business and a household. All the things that make for this super busy life that most of us have now grown accustomed to. I suffered bone-crusigue, significant hair loss, chronic joint pain, horrible sleepless nights, and out-of-the-blue anxiety, which was totally new for me. Frequently during the night I'd wake up drenched, change my shirt, turn the pillow over to the cold side, and lay there in the dark with my heart pounding, my brain racing with a thousand anxious thoughts, and the feeling that I had absolutely no idea what was happening to my body. What I figured was just new mum exhaustion, I now know turned out to be the start of my perimenopause journey. And here's the wild part. I'm a personal trainer and nutrition coach. I've been working in health and fitness for nearly 30 years. I have four children, I run a business, I've spent my career helping hundreds of women understand and care for their bodies. I thought I knew bodies, and I thought I knew my own body. I had absolutely no idea what was happening to me. Over the last several years, I can't tell you how many doctors and specialists I've seen. Women's GPs, doctors who call themselves women's hormone specialists, only to find out they're not a specialist at all, but maybe intended a one-day seminar on the topic, rheumatologists, pain specialists, functional medicine practitioners, physios, chiros, naturopaths, you name it, I've spent thousands and thousands of dollars. Every single one of them told me something different. Some of their treatments helped a little, some made my symptoms worse. And through all of it, through the confusion and the conflicting advice, and the appointments that just left me more lost than when I walked in, I kept searching for someone who could just make it make sense. But here's the thing I really want you to hear. The first place a woman goes when she does not feel like herself, when her body seems to have turned against her, is her GP, her trusted family doctor, the person she's known for years. I've sat in the chair across from numerous doctors and described what I was experiencing. The rage, the despair, the brain fog, the joint pain, the loss of libido, the weight that would not shift no matter what I did, the complete loss of my sense of self, only to be told that I'm too young to be in perimenopause. I've been told that my feelings of sadness and anxiety were depression or just stress and maybe I should try an antidepressant. Or, and this one still makes me furious, that because I have periods, I could not possibly be in perimenopause. And on the other end, I've been prescribed HRT with very little information, a free license to increase the dose as I see fit with no monitoring and no blood work. And then when I felt worse and was reacting to the medication, I was told that my body's reaction was very unusual and that they'd never seen that before. Each doctor I've seen has contradicted the other in terms of their recommendations, and I've been left feeling more confused than ever. I've been brushed off, dismissed, or gaslit more times than I can count. I have that experience and I hear a version of it every single day. Because here is what I do outside of this podcast. I talk to women constantly, in my coaching practice, in the Pilates studio, in my friendship group, in my community. Women who know something is deeply wrong with their bodies but cannot name it. Women who have been to their GP and come home feeling worse than when they left, dismissed, minimized, told it's all in their heads, told they're too young, handed a prescription for an antidepressant, and then sent on their way. And what I see in those conversations every single day is women who feel like they're losing their minds, their bodies, their relationships, their sense of self. Women who do not recognize themselves anymore. Women who are desperately trying to find someone who will just take them seriously. That was me. For years, that was absolutely me. I want to share some numbers with you, because I think when we are in the middle of something as isolating and confusing as perimenopause, it helps to know that this is not a personal failing. This is a systemic one. The average Australian GP receives fewer than three hours of menopause training throughout their entire medical degree. Three hours to manage a transition that will affect every single woman on the planet, that can last up to a decade, and that touches every system in the body. Three hours. Now they don't know what they don't know, and yet when a woman does not feel like herself, when her body is behaving in ways she cannot explain, where does she go first? She goes to her GP, the person she trusts most with her health. And all too often she walks away from that appointment feeling more dismissed, more confused, and more alone than when she walked in. Here is what that looks like in practice. A survey conducted by Dr. Louise Newsen's clinic, Newson Health, showed that antidepressants are the first line of treatment offered to over 39% of women who present to their doctor with perimenopausal symptoms. Not hormones, not a hormonal assessment, antidepressants. For a condition that is biological in origin, hormonal in nature, and in most cases would respond far better to addressing the hormone changes driving it. In that same survey of nearly 6,000 women, 84% reported feeling anxious or stressed since becoming perimenopausal or menopausal. 79% felt more overwhelmed. 72% felt low or tearful. And yet the most common medical response to those women is a prescription for an antidepressant and maybe a referral to therapy. Not a conversation about their hormones, not an investigation into what is actually driving those symptoms. And here's where it gets even harder to hear. In Australia, the Australian Bureau of Statistics states that women aged 50 to 54 have the highest age-specific suicide rate of any female age group. Let that sit for a moment. The age group that most closely aligns with perimenopause and menopause has the highest suicide rate of any female age group in Australia. And the connection to untreated and unacknowledged hormonal suffering is not coincidental. In the UK, over 60% of divorces are initiated by women, with the peak age for women filing for divorce sitting squarely in the perimenopausal and menopausal years. In the USA, divorce among adults over 50 has nearly doubled since 1990, coinciding precisely with the transition years. The perimenopausal and menopausal years are the period in life with the highest number of divorces initiated by women. Relationships ending, families fracturing, careers abandoned, and in too many cases, a woman who was never told that what she was experiencing had a name, an explanation, and a treatment. Menopause affects over one billion women globally, and yet female-specific conditions like menopause receive only 1% of biopharmaceutical research and development spending. One percent of one billion women's health. That is the value that medical research has historically placed on understanding what happens to half the world's population as they move through midlife. Women's health has been underfunded and understudied worldwide for generations. The research gap is real. The training gap is real. The dismissal gap, the gap between what women are experiencing and what they're being told, is catastrophically heartbreakingly real. And awareness is growing, the conversation has started. Social media has done something genuinely remarkable in the past few years. It's given women a platform to say out loud what they have been suffering in silence. And for the first time, millions of women are hearing their own experiences reflected back at them and realizing that this is not in my head, this is real, and there is help. But the confusion is still enormous. The misinformation is still everywhere, and the gap between what women are experiencing and what they're being told by the first medical professional they trust, their GP, is still vast. This is why this podcast exists. Welcome to What the Perry, the podcast for women who are in perimenopause or menopause, or who suspect they might be, and who are done being confused, dismissed, or left to figure it out alone. I'm your host, Kirsten Cook. I'm 49 years old, I'm a certified personal trainer and menopause coach, and I've been working in health and fitness for nearly 30 years. I'm a business owner, a wife, a mum of four, including eight-year-old twins, which is its own extraordinary kind of chaos. And I've been in perimenopause for several years. Not quietly, not gracefully, in the thick of it, with devastating symptoms that have impacted my work, my relationships, my sense of who I am, and my ability to function at the level I had spent three decades building toward. I'm not a doctor, I'm not a menopause specialist or a medical professional, and I want to be completely upfront about that. What I am is someone who sits at a very specific and I believe very useful intersection. I have nearly 30 years of evidence-based knowledge about the human body, muscle, bone, nutrition, hormones, recovery, and performance. I have personal first-hand experience of what it feels like when that body that you thought you understood turns into something completely unrecognizable. And I have a burning, relentless drive to understand what is happening, to read the research, to ask the hard questions, and to find the answers that I and so many women around me have been denied. I also speak to women every single day who are living exactly what I lived, and their stories are as important as mine. This podcast is not coming from a doctor who has studied menopause from the outside. It's coming from a woman who has experienced it from the inside, who has felt the complete loss of identity, the despair, the physical symptoms that made her unrecognizable to herself, and who has fought her way back to information, to understanding, and to finally starting to feel like herself again. My goal with What the Perry is to break down perimenopause and menopause into simple, honest, understandable terms, to share my journey and the journeys of the women around me, to give you the information your GP should have given you, to help you understand what is happening to your body, what to look for, and what you can actually do about it. And to go beyond perimenopause, into menopause, post-menopause, and everything else that matters to women's health in midlife and beyond. Every episode will be grounded in real science, and I'll do my best to reference studies in the show notes so you can read the research yourself. Of equal importance, every episode will be honest and based on my experience and the experiences of hundreds of women in my circle, because what you need right now is not more confusion. You need someone who will just tell you the truth and who will make you feel seen, heard, and understood. The tagline of this show is the change you didn't ask for, the conversations you need. And that is exactly what we are going to have, starting right now. Let's start at the very beginning, because I find that most women come into this conversation with assumptions that turn out not to be true, including me. First, perimenopause is not menopause. I know that sounds obvious, but I've spoken to hundreds of women who use the words interchangeably. They are completely different things. Menopause is a single day. It is the day that marks 12 full months since your last period. That's it. That is the clinical definition. Everything before that day, the transition, the hormonal chaos, the symptoms, that is perimenopause. And everything after it is postmenopause. So when most of us talk about going through menopause, what we're actually experiencing is perimenopause. And perimenopause can last anywhere from four to ten years. Some women have it for as little as a year, some women are in it for up to 14. The average is around seven years. Seven years? That's not a blip, that is a significant life-altering chapter. Perimenopause typically begins in the early to mid-40s, though it can start in the late 30s. In Australia, the average age of reaching menopause, that 12-month mark, is around 51 to 52. What drives it is three hormones estrogen, progesterone, and testosterone. In perimenopause, these hormones do not just decline, they fluctuate wildly. They spike and crash in unpredictable patterns. And that erratic fluctuation, more than the decline itself, is what drives the chaos so many women experience. Which brings me to the part of this episode that I believe is going to genuinely stop some of you in your tracks. Most women know about hot flashes, some know about night sweats, a handful have heard about mood changes. Here is what most women don't know. The medical community formally recognizes 34 symptoms associated with perimenopause and menopause. 34. And some experts and clinics list up to 40. One OBGYN I encountered in my research suggested there may be as many as 500 ways the body expresses this hormonal shift. 500. I'm going to walk you through the recognized 34 today, and then I'm going to add the extras. The ones that do not make every list but women experience constantly and that leave them feeling the most confused and the most alone. Because nobody connected those symptoms to their hormones either. Listen with curiosity, not alarm. I want you to start joining some dots. Vasomoto symptoms. The most well known, hot flashes. Night sweats, chills, heart palpitations, yes, palpitations can be hormonal. A racing heart, a mistbeat, a fluttering, all can be perimenopause. Always worth getting checked, but very commonly hormonal. Sleep. Difficulty falling asleep, waking in the middle of the night, often between 2 and 4 a.m. And laying there unable to go back to sleep. Waking drenched. Vivid or disturbing dreams. Feeling exhausted despite being in bed for eight hours. I spent years functioning on four or five hours of broken sleep. The impact on my body, my mood, my patience as a mother. I will dedicate a whole episode to this because it deserves it. Neurological and cognitive. Brain fog. Memory lapses, forgetting words mid-sentence, walking into rooms and having no idea why. Difficulty concentrating, headaches, dizziness. I had brain fogs so severe I would forget my clients' names mid-session. I was worried I was developing early dementia. I was not. It was hormones. There is a whole episode on this too because I know how terrifying it feels and I want to give it the attention it deserves. Psychological and emotional. This is the category that blindsides women the most. Anxiety, low mood, depression, irritability, not just a bit snappy, but rage that feels completely disproportionate and sometimes terrifying. Panic attacks. A loss of the feeling of being yourself. And here's the critical thing. The perimenopause transition is statistically the highest risk window in a woman's life for first onset depression. Not because something is wrong with her mentally, but because estrogen regulates serotonin and dopamine, the brain's own mood chemicals. When estrogen fluctuates, mood follows. And yet, as we discussed, the most common medical response is an antidepressant, not a hormonal assessment. Musculoskeletal, joint pain, particularly in the hips, knees, and hands, muscle aches, morning stiffness, frozen shoulder, which is significantly more common in perimenopausal women and almost never identified as hormonal. Reduced grip strength. I spent years thinking my joint pain was from decades of high impact training. It was partly that, and it was absolutely perimenopause. Urogenital and pelvic vaginal dryness, painful sex, urinary urgency, more frequent UTIs, bladder leaking with impact, coughing, sneezing, jumping, pelvic floor changes. These symptoms have a clinical name. And unlike hot flashes, they tend to get worse over time without treatment. We're going to go there in this podcast fully. No topic is off limits here. Sexual function, low or absent libido, painful intercourse, changes in arousal and orgasm. These are real physiological hormonal symptoms, not a reflection of your relationship or your desirability. I will say that as many times as it takes. Metabolic and body composition. Weight gain, particularly around the abdomen, bloating, a complete sense that your metabolism has changed, because it has. Slower recovery from exercise, changes in how your body responds to food. I know this one intimately. As a trainer of nearly 30 years, I was doing everything right and watching my body composition change in ways I had never seen before. The episode on this is going to be one of the most important ones I record. Skin, hair, and nails, thinning or increased shedding of hair, new or worsening facial hair, skin becoming thinner, drier, more prone to wrinkling, adult acne, brittle nails, all driven by shifting estrogen and androgen levels. All real, all manageable. The rest of the 34. Tinnitus, ringing in the ears, electric shock sensations often felt just before a hot flash. Altered sense of taste or smell. Dry eyes, worsening allergies, gum problems, breast tenderness or changes. Now the extras, the ones that don't make the standard list, but that women bring to me constantly. Often with a kind of desperate relief when I tell them that yes, this too can be perimenopause. Burning mouth syndrome, a burning sensation on the tongue or the roof of your mouth or the inside of your lips, sometimes accompanied by a metallic taste. This is a real recognized phenomenon associated with perimenopause, and I can tell you that the hundreds of women I've spoken to who experienced this, almost none have had a doctor connect it to their hormones. Altered sense of smell. Sense that you used to love suddenly becoming overwhelming or unpleasant. Things you could smell easily becoming harder to detect. Estrogen receptors are present in the part of the brain that process smell, which is why this makes complete physiological sense even though nobody is talking about it. Easy bruising and slower wound healing. As estrogen declines, skin becomes thinner and more fragile. Women notice bruising from impacts that would never have marked them before. Cuts taking longer to heal, completely hormonal, rarely discussed. Increased body odor, change in the way sweat smells, sometimes significantly, driven by both hormonal changes and the increase in sweating from hot flashes. Another symptom that leaves women feeling bewildered and embarrassed, and that nobody ever attributes to their hormones. Nausea, particularly in early menopause when estrogen is fluctuating most dramatically. Women attribute This is to stress, a stomach barg or anxiety. It's frequently hormonal. Gum problems and dental changes. Estrogen plays a role in bone density throughout the body, including the jaw. Gum sensitivity, recession, and in some cases loosening of teeth. Dentists are not connecting this to hormones. GPs are not connecting this to hormones, but it is. And changes to the character of periods before they stop. Not just irregular periods, but periods that are heavier, lighter, shorter, longer, or completely different in texture and timing. Spotting between periods, brown discharge, these changes are almost always hormonally driven. They are not normal aging, they're perimenopause. Between the standard 34 and the additional symptoms, we're potentially talking about 40 or more distinct ways that this hormonal transition can express itself in your body. Forty ways. Which is why it is so completely understandable that women spend years, sometimes decades, not knowing what is happening to them. When you have joint pain and anxiety and brain fog and burning mouth and you smell differently, and your period has changed character and you are exhausted and you do not recognize yourself. The idea that this is all connected to one hormonal transition is not something that occurs to most people, including most doctors. Until now, this is what we are here for. Here's the thing that changed everything for me when I finally understood it. Estrogen receptors exist throughout your entire body, not just in your reproductive system. In your brain, your heart, your bones, your skin, your gut, your joints, your bladder, your eyes, your ears, your nose, and your mouth. Which means that when estrogen starts fluctuating and declining, every single system in your body that has an estrogen receptor is affected. Every single one. That is why the symptom list is so long and so varied. It's not that 40 unrelated things are going wrong simultaneously, it's that one hormonal shift is rippling through every system in your body that was relying on that hormone to function well. And this is also why so many doctors miss it. Because when a woman comes in with joint pain and anxiety and poor sleep and brain fog and burning mouth and tinnitus, the medical training response is to refer to three different specialists, not to say this is one hormonal event expressing itself in multiple ways. I want to say one more thing about progesterone because it doesn't get enough air time. Progesterone, your calming, sleep-promoting hormone, often declines before estrogen does. It drops as ovulation becomes less regular. So for many women, the very first sign of perimonopause is not hot flashes, they're worsening PMS, disruptive sleep, increasing anxiety, and a feeling that their emotional regulation has gone slightly offline. If that sounds familiar, if you've noticed that in the years before any obvious symptoms started, that something just felt a bit off, that may well have been the earlier signs of progesterone shifting. It was for me. I just didn't know it at the time. Right, so here's what I want you to do with everything you've just heard. Step one, start a symptom diary. This week, today if you can. When you walk into a GP appointment and say you think you might be in perimenopause, the most powerful thing you can bring is a written record. The Balance app developed by Dr. Louise Newsom is free, it's excellent, and it generates a report you can literally hand to your doctor. The link is in the show notes. Step 2. Rule out the mimics. Several conditions produce symptoms that look identical to perimenopause. Thyroid dysfunction, iron deficiency, anemia, vitamin D deficiency are all most common. Get a comprehensive blood test. Non-negotiables are a full blood count, iron studies, thyroid panel, and vitamin D. If you don't know what to ask for, there's a whole episode coming on this. Step 3. Find the right doctor. Not all GPs are created equal when it comes to this. The Australasian Menopause Society has a directory of accredited menopause practitioners in Australia at menopause.org.au. Ask specifically whether your GP has additional training in perimenopause. If they do not, consider seeking out someone who does. You deserve a practitioner who has the knowledge to actually help you. I know how hard that search can be. We'll do a whole episode on navigating the system. Before these episodes include guests and getting more into people's personal stories, while we work through this education series on perimenopause and menopause, I want to point you to the research behind today's content. During this education series, everything I share in this podcast is backed by evidence, and I'll always link the studies in the show notes so you can read them for yourself or take them to your doctor. Here is where I want to leave you today. If you heard yourself somewhere in those symptoms, if something clicked or if you felt the specific relief of finally having a word for something that you've been carrying, I want you to know you are not going crazy. You are not weak, you're not being dramatic, you are not imagining it, and you are absolutely not alone. What you are experiencing is a profound biological transition that has been underfunded, understudied, and underacknowledged in medicine for generations. You have not been failed because you are not worthy of care. You've been failed because the system has not yet caught up with the reality of what women go through. This is changing slowly, and conversations like this one, imperfect, honest, coming from a woman who has lived it rather than studied it from the outside, are part of how it changes. Your action for this week? Start your symptom diary. Everything, even the things that seem completely unrelated to hormones. You're building your evidence base and you're going to need it. Next week we go deep on something that is the foundation of everything else we will discuss. Understanding how your hormones actually work. Estrogen, progesterone, and testosterone. What they do when they're functioning well, and what happens when they're not, and what tests to ask for. It's the episode I wish I had at the very beginning of all of my own personal chaotic journey. If today's episode helped you in any way, please share it. Send it to the woman you know who is lying awake at 3 a.m. wondering if she's losing her mind. Feel free to subscribe and leave a review, which is the best way for a brand new show like What the Perry to make a genuine and significant difference in finding the women who need it. I'm so glad you're here. Everything I've mentioned today is referenced in the show notes, along with all the links. And you can find me at Kirstencookcoaching.com. Just a reminder, though, this is education, not medical advice. So take these conversations to a practitioner who will actually listen to you. Thank you so much for being here and for listening to the What the Perry podcast. The change you didn't ask for, the conversations you need to do.