Perimenopause

Everything we should have been told about perimenopause a long time ago.

I always heard a lot about menopause. After years of battling endometriosis, I sometimes felt like declining estrogen levels during this time would be my only salvation.

What I had no idea no idea about was perimenopause and it’s potential to wreak havoc during what is often the most demanding time in a person’s life.

Perimenopause literally means “around menopause” and refers to the transition time between your fertile years and menopause.

Menopause is technically only the 12 consecutive months without a cycle at the end of perimenopause.

For some stupid reason, most of us are never told what to expect during this time. We are unaware that this might be what’s behind our collection of new and worsening symptoms and we receive no guidance on how to navigate through this period in our lives.

Here’s the low-down…

Perimenopause generally begins between the ages of 40 to 44 but can start earlier for a variety of reasons and can last up to 10 years.

Reasons why menopause or perimenopause may come early:

• Chemotherapy or radiation
• Surgery that removes ovaries
• Surgery that removes the uterus
• Family history
• Starting menses before 11
• Chromosomal Abnormalities
• Autoimmune diseases – R.A., Crohn’s, Thyroid disease
• Smoking
• ME/CFS
• HIV/AIDS
• Infections like mumps
• Endometriosis – 30% more likely

If you are reading this you are probably all too familiar with the impacts that hormonal imbalances and fluctuations can have on your physical, emotional, and mental well-being.

We’ve learned this in puberty, from our monthly periods, maybe from pregnancy and post-pregnancy and now here we are at perimenopause – why do all these things start with a P?

Perimenopause is not just your body adjusting to the decrease in estrogen associated with actual menopause. 

Nope, instead, this is a roller coaster ride of hormonal swings that can ebb and flow throughout a number of years. So, you will go from a drop in hormones to a surge, and all during a time when we are probably juggling more than we ever have before (such as demanding careers, kids, and aging parents…) Some have described it as reverse puberty.

What to expect and how to identify perimenopause:

Periods can become heavier with more or larger blood clots, our cycles can get longer or shorter or oscillate between both. Any reproductive issues we had earlier can often get worse or see a resurgence at this time. 

The risk of uterine fibroids is actually at its highest during perimenopause.

The following is a list of the most common symptoms:

• Anxiety, depression, rage and anger, lower self-esteem
• Lack of attention span, worsening ADHD symptoms
• Forgetfulness, cognitive impairment
• Hot flashes or night sweats
• Weight gain, especially around the midsection
• Fatigue
• Vaginal and bladder issues, infections, pressure on the bladder
• Insomnia
• Heart palpitations
• Muscle and joint aches
• Dry or itchy skin
• Low libido
• Vaginal dryness and pain during sex
• Hair loss or changes in hair growth
• Less able to tolerate/recover from alcohol intake
• More sensitive to caffeine
• Migraines and headaches
• Breast tenderness
• Clumsiness and lack of coordination (yep, even your depth perception and spatial awareness are affected)
• Dry eyes
• Things that used to work (exercise, dieting, self-care), no longer do.
• Things you used to be able to get away with (staying up late, drinking), you no longer can.

Here is just a little taste of the hormonal dynamics going on at this time:

Your body produces estrogen in your ovaries, but also in your fat cells (and a little bit in your adrenal glands). When the production of estrogen slows down in your ovaries, your body tries to compensate by holding on to and/or increasing fat. 

Also, estrogen acts as a counter-regulatory hormone to cortisol. So, the less estrogen, the fewer checks and balances on cortisol. High cortisol can contribute to a multitude of issues including increased inflammation, insulin resistance, anxiety, and oh, that extra weight around the midsection.

According to the Mayo Clinic, the average woman gains 11-18 lbs during this time – fun.

When your ovaries do not produce as much estrogen, and you don’t ovulate periodically throughout this time, your body doesn’t get the usual dose of progesterone released by the corpus luteum during ovulation.

Low progesterone can cause anxiety, depression, anger, insomnia, heart palpitations, and headaches or migraines, amongst many other symptoms.

Testosterone can also dip during this time lowering sex drive and causing fatigue, a lack of concentration, muscle weakness, and thinning hair.

There’s the perimenopause doom and gloom. Now, here’s what we can do about it…

The good news is that armed with the awareness of what’s happening and some strategies geared toward this new reality we can navigate and thrive through this phase of our lives.

All the things that have always been important before are even more important and now allow for very little wiggle room without repercussions. So, sleep, stress management, quality food in your diet, good gut health, and good liver function all need to be top on your priority list.

• Managing cortisol is now paramount. Keeping cortisol in check will help you weather hormonal swings, lower inflammation, improve gut and immune health, improve sleep, and help with maintaining or losing weight.
• Adding cortisol-lowering activities like meditation, yoga, breathing exercises, relaxing walks, or even some time to soak in the tub. Whatever works for you. Even if you start with 5 minutes once or twice a day, it can have a significant impact.
• Limiting high-intensity or endurance exercise as these raise cortisol the most and for longer periods of time. If or when you do this kind of exercise, commit to putting an equal amount of time and effort into cortisol-lowering activities both before and after these workouts.
• If you don’t get a good night’s sleep skip the workout and go for a walk before bed instead to ensure adequate sleep the following night.
• Prioritize weight-bearing activities to increase and maintain muscle mass and increase insulin sensitivity. Weight-bearing exercise has been found to improve insulin sensitivity more than cardio only or even combined exercise.
• Nutritional insufficiencies are never good, but cutting too many calories will raise cortisol even more and lower your metabolism.
• If prioritizing yourself isn’t something you’ve mastered at this point, now is the time. It is not only in your best interest but will enable you to show up as your best self for loved ones and inspire them to do the same.
• Your gut health and liver function play crucial roles in hormone production and metabolism. Beginning here will be the most effective route in supporting healthy hormone balance.
• Thyroid function is often impacted during times of hormonal fluctuations, so it is a good idea to check in if you haven’t run a full panel in a while. Simplifying things a bit, thyroid function is most often also improved by improving liver and gut health.

Supplementation and Hormone Replacement Therapy

There are a number of nutritional and herbal supplements that can be very helpful in alleviating symptoms throughout this phase of life but which one’s work for each individual will differ depending on each individual’s symptoms and chemistry.

Bio-identical hormone replacement can be life-changing for many women. Not all women will be candidates and many may not wish to pursue this route either way. However, there is a lot of misunderstanding regarding this topic. 

There is no right answer to whether or not to pursue this route, but the decision should be made from a position of being fully informed of the research, and potential risks and benefits.

More to come on this soon!

If it is a route you do decide to pursue, optimizing liver and gut health before starting and committing to regular testing and qualified oversight throughout treatment is a must.

Tracking your symptoms is a necessary step to enabling a practitioner to find the best options for you whether you decide to utilize HRT, supplements, or both.  

***This is just a broad overview, every person that goes through perimenopause will have a unique experience. Try not to get overwhelmed with all the information and grab the lowest-hanging fruit first.

Don’t go it alone!

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