Your Perimenopause Survival Guide
If you own a pair of ovaries, you will most likely transition into a new hormonal stage called perimenopause (AKA “second puberty”- a term I love) in your mid-to-late thirties and it will continue until you reach menopause (1 year after your final period) around the average age of 52. And as you may know, it can come with some challenges.
During perimenopause you may experience symptoms such as changes in your menstrual cycle, mood changes (more feelings of depression, anxiety, weepiness, or anger), weight gain, brain fog, problems sleeping, more sweating at night, less desire for sex or vaginal discomfort, breast pain, headaches, or joint pain…just to name a few things.
Why does this happen? The first thing that occurs is our progesterone levels begin to lower, which can create some changes in our menstrual cycle, mess with our quality of sleep, and possibly increase our agitation or anxiety. Also with less progesterone in our cycles, we can feel more fatigued and start to gain some weight.
A little later, estrogen levels become erratic, some months we will have higher levels of estrogen than ever before, but the overall trend is a decline in estrogen. This is when our weight gain tends to become more noticeable, we can have worsened PMS, more mood disturbances, possibly joint pain, and hot flashes (oh what fun).
Progesterone and estrogen are often not the only hormones affected. Our thyroid tends to become more strained during this time, our blood sugar regulation can become less stable, and our testosterone levels may also dip or peak.
In this 12-15 year period, we are going through significant physical, psychological, and metabolic changes, making this a critical time to care for your physical and mental health. Intelligently caring for yourself during this time can prevent major adverse health outcomes, and help you blossom— instead of wilt. Almost no one will go through this period completely symptom-free, but you can mitigate many unwanted struggles and set yourself up for a healthy body and psyche now and in your next stages of life.
What I want women to know is that this does not have to feel like punishment, it can feel like liberation. In her book Perimenopause Power, Maisie Hill wrote, “Perimenopause is a baptism of fire that forces you to face yourself, your history, and your future”. You can cower to this right of passage, or you can approach it like a shield maiden in the battle for your best life.
Why this is harder than it should be
The truth is, the perimenopause period is much harder than it should be thanks to problems in our food industries, environmental pollutants, trauma, and the patriarchy. Our modern-day lifestyles leave us tired and wired, underslept, overworked, undernourished yet overfed. All of these factors make the road to menopause much rockier. With all that we are expected to get done on a daily basis, we are, no doubt, all doing the best we can, and doing an incredible job of it! While we can’t make these problems go away overnight, you can inform yourself and make little choices every day that will add up and create a life of wellness.
Something else important you should know
When in the mid to late stages of perimenopause, natural “hormonal balance” is not always possible to achieve. Your brain and ovaries are doing the work they are meant to do–essentially retiring parts of your reproductive system–and this will inevitably cause symptoms and periods of imbalance. However, there is much you can do to make this transition as smooth as possible. Achieving that requires healthy lifestyle choices, good gut health, efficient detoxification pathways, utilizing stress-reducing principles and support from supplements, herbal medicine, and even possibly hormone replacement therapy. This is not a time in life where we can get away with what we did in our early 20s, but we will be much better off caring for ourselves in the way we were always meant to.
What you can do:
Learn how to care for your stress
In your life there are stressors, and then there is the stress that your mind and body take on because of those stressors.
While you can’t get rid of every stressor in your life (unless, maybe, you happen to win the lotto, leave your family, and move into a 5-star resort for a few years), you can learn how to take care of your stress in a way that it doesn’t harm your physical health.
Stress makes every part of the perimenopause experience worse, and, unfortunately, losing our normal exposure to our sex hormones worsens our resilience to stress. It’s a double-edged sword.
Stress poorly managed will make our blood sugar less stable, adversely affect our sex hormone production, increase inflammation and therefore “inflammaging”, contribute to poor sleep, and make us feel more anxious, agitated, and depressed.
The best ways to manage it will be unique to you, but learning how to regulate your nervous system and manage your mind around your stressors are two tools I use and the ways my clients often find success.
Also, find the things that help you turn off your “stress brain”, and incorporate them into your weekly routine such as taking walks in nature, prioritizing some pleasurable exercise, listening to guided meditations, getting regular acupuncture or massages, or making time for masturbation Other things to work on could be; untangling people-pleasing or trauma wounds, learning how to say no, and being okay with doing a little less.
Support your metabolic health
and mitigate unwanted weight gain
Weight gain, especially in your abdomen and torso (bra strap region) is a common complaint of women during their perimenopausal years. The reason weight gain is common during this time is, of course, multifactored. Declining and changing hormones, muscle loss, stress, and more sedentary lifestyles are the main contributors to the weight gain annoyance.
Issues with weight management are not just about vanity, middle weight gain is associated with increased cardiovascular health risk and metabolic diseases such as high blood pressure and diabetes.
Estrogen is a key hormone in weight management. Estrogen is closely involved in our energy metabolism, our feelings of hunger and satiety, and our blood sugar control. It has been shown that both low levels of estrogen and abnormally high levels of estrogen are associated with insulin resistance and weight gain. It is common that in our perimenopause years, our estrogen can swing from abnormally high levels to low as our body is processing the change in our brain and ovaries.
As mentioned above, a higher incidence of insulin resistance happens during the perimenopausal and menopausal years, contributing to many unwanted symptoms, including weight gain. Insulin resistance happens when high blood sugar causes our pancreas to secrete high levels of insulin into our bloodstream to remove the sugar from our blood and into our tissues. Eventually, high levels of insulin in our bloodstream overwhelm our receptor sites for insulin and they start to shut down, leaving our tissues unable to metabolize glucose, creating chronically high levels of blood sugar. This leads to weight gain (especially in the middle) and chronic inflammation.
The keys to supporting your metabolic health, and improving your insulin sensitivity are mostly through (surprise, surprise) diet and exercise. However, it’s probably not what you are thinking. We have learned that the old days of calorie restriction and cardio can actually make things worse, and that is probably why nothing is working no matter how much you seem to be trying.
Here is what you can do that actually works:
-Lift weights or do some other resistance exercise that builds muscle
-Get plenty of protein, fiber, and micronutrients in your diet
-Prioritize sleep and relaxation
-Reduce stress with relaxation techniques, time in nature, doing less, regulating your nervous system, etc.
-Get the right lab work done with your practitioner to look at your sex hormones, thyroid hormones, fasting insulin, and inflammatory markers so you understand what is going on for you
- Use herbal medicine and supplements to help regulate estrogen and progesterone levels, and/or consider bioidentical hormone replacement therapy
Utilize supplements and use them wisely
There are many great supplements and botanicals that can be of great support in perimenopause. I highly recommend working with an herbalist or qualified healthcare practitioner to find out which ones fit your body, your needs, and your health goals. If that’s not an option for you, really take your time to do your research and have some patience. Otherwise, you might find yourself frustratingly throwing your money at products with good marketing teams that won’t necessarily be the right fit for you and miss the mark.
Below you can find a list of some of the supplements and herbs I recommend most often to my perimenopause clients, but I certainly do not recommend all of these to everyone.
You want to understand what support suits you best and what you’re trying to target that will move the needle toward a much better experience of your health. For example, for some, it’s sleep support, for others stress relief and adrenal support, it could be improving insulin sensitivity, or helping with estrogen elimination, improving mitochondrial function or, supporting progesterone production. This is why an individualized approach is important during perimenopause.
Magnesium
Vitamin D
Myoinsoitol
Omega-3s
Adaptogens such as Ashwagandha or Maca
Vitex (also known as Chaste Tree Berry)
Personalized Chinese medicine blends
Melatonin
N-Acetyl Cystine
COQ10
Zinc
A high-quality multivitamin
Build your knowledge and advocate for yourself at your doctor’s office
Most doctors go through med school receiving very little training and knowledge about menopause and perimenopause and therefore are not equipped to care for you in the way that you deserve. The tools they typically have for perimenopause symptoms are birth control pills or depression medications, so don’t be surprised if that’s what you are offered. Neither of those drugs can support the root cause and come with unwanted side effects.
note: the use of antidepressants in perimenopause can be very useful and helpful for some people, but should not be the only support offered or given
However, when you educate yourself about your hormones and perimenopause, you can have the right conversations with your doctors that are necessary for getting what you want out of your appointments. If you know why you want your blood sugar markers and sex hormones tested, doctors are more likely to be responsive to these requests.
Prioritize sleep
Good sleep can feel harder to come by in your 40s thanks to the hormonal changes that take place, but the irony is that sleep is still one of the best medicines for creating great hormone health.
Sleep deprivation can lower your testosterone levels, worsen your weight gain, affect your sex life and ability to climax, worsen your mood, and age your body and brain faster.
Your natural melatonin levels decline as you age, which is one of the reasons why sleeping well becomes more difficult. And, it just so happens that your ovaries need a lot of melatonin to eradicate oxidative stress and rejuvenate in order to keep making helpful hormones. That is why I recommend supporting your natural melatonin production as much as you can to slow down the aging process and support your best hormone balance. This requires daytime sun exposure and nighttime dark exposure, reducing your screen time at night, avoiding alcohol before bed, getting rid of LED lights, and using an eye mask to sleep.
Keep your sex life juicy–if you want to
Loss of sex drive and vaginal dryness are common complaints in the mid-to-late stages of perimenopause. Estrogen is the hormone that keeps things flexible and juicy down there and as it starts to decline, sex can become less comfortable or desirable. Decreased levels of estrogen cause thinning, drying and even shrinking of the tissues of the vagina. However, this does not have to be a death sentence for your sex life!
The loss of libido can be complicated; this can come from hormone imbalances, sleep deprivation, stress, or your thoughts about yourself or your partner, so a holistic approach is often necessary to get back to feeling excited about sex again.
There is also plenty that can be done to keep your vagina feeling juicy. Number one is to “use it or lose it”: create regular opportunities for increased blood flow to your sex organs through masturbation or foreplay with a partner. Secondarily, you can use an estrogen and DHEA-based topical or suppository. These formulations often contain a combination of estriol (the primary estrogen in pregnancy) and DHEA and can rehydrate the tissues and rebuild nerve fibers leading to increased pleasure and sensation.
Consider Hormone Replacement Therapy (HRT)
Unfortunately, no matter how terrific your self-care is, some of your hormones are never coming back. Although hormone replacement therapy might not be right for everybody, for many using bioidentical hormones to replace some of what gets lost is a big game changer in surviving the menopause transition well.
There are unhelpful myths and conflicting messages about HRT inside and outside of the healthcare system. But you should know they are (mostly) very safe when used correctly! Up-to-date studies have proven the safety and efficacy of HRT, showing that the risks are small. Just make sure to work with a doctor who is savvy with HRT.
I know all of this can feel like a lot to navigate. This is exactly why I created Root Care Program. The Root Care Program is a 6-month, 1:1 coaching container with me to help you discover what’s going on for you, what you need to reach your goals, and how to execute the changes needed to thrive. I want you to have your best life and cultivate the health you need to enjoy it. You can get started by filling out the application here.
Resources:
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Labarta E, de Los Santos MJ, Escribá MJ, Pellicer A, Herraiz S. Mitochondria as a tool for oocyte rejuvenation. Fertil Steril. 2019 Feb;111(2):219-226. doi: 10.1016/j.fertnstert.2018.10.036. Epub 2019 Jan 2. PMID: 30611551.
May-Panloup P, Boucret L, Chao de la Barca JM, Desquiret-Dumas V, Ferré-L'Hotellier V, Morinière C, Descamps P, Procaccio V, Reynier P. Ovarian ageing: the role of mitochondria in oocytes and follicles. Hum Reprod Update. 2016 Nov;22(6):725-743. doi: 10.1093/humupd/dmw028. Epub 2016 Aug 25. PMID: 27562289.
Prior JC. Progesterone for treatment of symptomatic menopausal women. Climacteric. 2018 Aug;21(4):358-365. doi: 10.1080/13697137.2018.1472567. Epub 2018 Jul 2. PMID: 29962247.
Prior JC, Hitchcock CL. The endocrinology of perimenopause: need for a paradigm shift. Front Biosci (Schol Ed). 2011 Jan 1;3(2):474-86. doi: 10.2741/s166. PMID: 21196391.
Süss H, Willi J, Grub J, Ehlert U. Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study. Psychoneuroendocrinology. 2021 May;127:105177. doi: 10.1016/j.psyneuen.2021.105177. Epub 2021 Feb 26. PMID: 33676150.
Vigil, P., Meléndez, J., Petkovic, G., & Del Río, J. P. (2022). The importance of estradiol for body weight regulation in women. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.951186
Books
The Hormone Repair Manual Lara Briden
Estrogen’s Storm Season Jerlynn Prior
The Complete Guide to POI and Early Menopause Dr. Hannah Short and Dr. Mindy Leonhardt
Perimenopause Power Maisie Hill
