Dr. Michelle Sands: 99 Signs of Perimenopause

Dr. Michelle Sands isn’t just reshaping the conversation around women’s health, she’s rewriting the blueprint entirely. With a background that bridges conventional medicine and functional, hormone-focused care, Dr. Sands has become a sought-after voice for women looking to feel powerful, balanced, and fully at home in their bodies. Her approach goes beyond quick fixes, diving into the root causes of fatigue, hormonal imbalance, and burnout that so many women silently navigate. I had the chance to speak with her to learn more about her perspective on modern wellness, the evolution of hormone health, and what it truly means for women to thrive at every stage of life.

STEPHANIE SHEHAN: We all know about hot flashes and mood swings, but you mention there are actually 99 signs of perimenopause. What are the top five "invisible" symptoms that women (and their doctors) almost always overlook?

Dr. Michelle Sands: Most women are taught to look for hot flashes, night sweats, and mood swings. That’s the surface-level version of perimenopause. The reality is this transition impacts nearly every system in the body, neurological, metabolic, cardiovascular, and musculoskeletal, which is why symptoms show up in ways most people don’t expect. The top five “invisible” symptoms I see overlooked most often are:

1. Heart palpitations: Sudden racing, pounding, or irregular heartbeats that feel alarming enough to send women to the ER. Estrogen and progesterone both regulate the autonomic nervous system and vascular tone. When they fluctuate, the nervous system becomes more reactive, and the heart often reflects that instability first.

2. Insulin resistance and unexplained weight gain: Women are eating the same, training the same, and suddenly gaining weight, especially around the midsection. Estrogen plays a critical role in insulin sensitivity and glucose metabolism. As it declines or fluctuates, the body becomes less efficient at managing blood sugar, which drives fat storage, cravings, and energy crashes.

3. Joint pain and stiffness: Women often feel like they’ve aged overnight. Estrogen supports collagen, joint lubrication, and has anti-inflammatory effects. When levels drop, joints can feel dry, inflamed, and achy, often misdiagnosed as early arthritis.

4. Brain fog and cognitive changes: Difficulty finding words, forgetfulness, and loss of mental sharpness. Estrogen supports brain metabolism, blood flow, and neurotransmitter activity. When it becomes unstable, cognitive performance takes a hit. This is not a loss of intelligence; it’s a hormonal shift affecting brain function.

5. Accelerated bone loss: Most women think bone loss happens later, but it can begin in perimenopause. Estrogen is essential for maintaining bone density. When it declines, bone breakdown can outpace formation, silently and without symptoms, until damage is already done.

The problem is not that women aren’t experiencing symptoms; it’s that the medical system isn’t connecting the dots.

SS: Why are so many women over 35 being told they have anxiety or dental problems when the root cause is actually hormonal, and how can they better advocate for themselves in a doctor's office?

Dr. Sands: Because hormone-related symptoms are still misunderstood, understudied, under-taught, and often dismissed.  In other words, women were largely left out of studies because of their “complex cycle,” and doctors only get 1-3 hours of menopause training.  A woman walks in describing anxiety, insomnia, heart palpitations, sensory changes, brain fog, and cycle irregularity. Instead of being viewed as a hormonal pattern, each symptom is isolated. She’s labeled anxious, referred out, or given medication to suppress the symptom rather than investigate the cause.

Women can advocate for themselves by tracking patterns across sleep, mood, cycles, energy, and symptoms.  And, by using direct language: “I want to evaluate perimenopause as a root cause.”  Advocating means asking better questions: “How are you ruling out hormonal fluctuation?”  Lastly, be willing to seek a second opinion if dismissed. Women know when something has shifted. That intuition should be taken seriously.

SS: We’ve been conditioned to expect "hot" flashes, yet you highlight "cold flashes" as a symptom. How does the body’s internal thermostat get so hijacked during perimenopause?

Dr. Sands: The body’s thermostat is regulated by the hypothalamus, and estrogen helps keep that system stable. When estrogen fluctuates, the hypothalamus becomes more reactive. Small changes in body temperature get misinterpreted as major events, triggering exaggerated responses. Sometimes that response is heat: vasodilation, sweating, or flushing. Other times it’s the opposite: vasoconstriction, chills, or shivering. That’s why some women swing between feeling overheated and freezing. It’s not that the thermostat is broken; it’s that it’s become hypersensitive and poorly regulated due to hormonal instability.

SS: For the woman who is currently experiencing these "ghost symptoms" and feels like she’s "going crazy," what are three immediate lifestyle or hormonal shifts she can make to find relief?

Dr. Sands: She’s not going crazy. She’s under-supported hormonally. Three immediate shifts that can create a fast impact are:

Stabilize blood sugar: Blood sugar swings trigger adrenaline, and adrenaline mimics anxiety, palpitations, and sleep disruption.  Be sure to eat protein-forward meals, stop skipping meals, reduce reliance on caffeine, and build balanced meals. This alone can dramatically calm symptoms.

Support progesterone and the nervous system: Progesterone is calming and often declines early. Low progesterone can mean anxiety, poor sleep, reactivity, and overstimulation. Support may include targeted hormone support and foundational habits such as magnesium, sleep consistency, breathwork, and strength training without overtraining.

Reduce endocrine disruptors and inflammation:  Many women are trying to fix hormones while exposing themselves to compounds that disrupt them. It is important to remove synthetic fragrances, reduce plastic exposure, clean up personal care products, limit alcohol during symptom flares, and prioritize sleep. The goal is to reduce noise so the body can recalibrate.

SS: As the co-founder of Glow Natural Wellness, what is the most common misconception you see women holding about "natural" hormone support, and how does your approach help them reclaim their vitality without relying solely on a prescription pad?  

Dr. Sands: The biggest misconception is that “natural” means weak or ineffective. A properly designed holistic approach is not passive; it’s precise. Women often think their only options are to suffer through symptoms or rely entirely on prescriptions. That’s a false choice. A comprehensive approach looks at hormones, metabolism, stress, nutrition, environmental toxins, and nervous system health. Sometimes that includes lifestyle changes. Sometimes supplementation. Sometimes bioidentical hormones. The goal is not ideology, it’s restoring function.

At Glow, we focus on clean, toxin-free support because it makes no sense to try to balance hormones with products that disrupt them. Women don’t just want symptom relief; they want energy, clarity, strength, confidence, and drive. That’s what we’re restoring.

SS: What does your own daily wellness routine actually look like?

Dr. Sands: 

• Morning sunlight and hydration

• Protein - 160 grams a day

• Strength training

• Daily movement beyond workouts

• Nervous system regulation - meditation, breathwork, time in nature

• Clean inputs (food, products, environment)

• Protecting sleep

Simple, consistent, and effective.

SS: What do you believe the most underrated supplement is?

Dr. Sands: Magnesium. It supports sleep, stress, muscle function, and metabolic health, and most women are deficient.

SS: What is the one test every woman should run annually?

Dr. Sands: Fasting insulin. It reveals metabolic dysfunction long before glucose markers do.

SS: Tell me the biggest hormone myth in one sentence?

Dr. Sands: Estrogen is dangerous. In reality, properly used estrogen, especially bioidentical and appropriately delivered, is associated with protective effects on the brain, bones, cardiovascular system, and overall longevity.

SS: What is your current wellness obsession?

Dr. Sands: Building muscle. It’s one of the most powerful tools for metabolic health, hormone balance, and aging well.

SS: What is one habit you think delivers the highest ROI for women over 35?

Dr. Sands: Strength training.

SS: What is a popular wellness trend you think is overhyped right now?

Dr. Sands: Extended fasting for women who are already hormonally stressed.

Follow Dr. Sands:  IG: @drmichellesands   YouTube: @fixhormones   glownaturalwellness.com