Periods in Perspective: Peaceful Passage into Perimenopause
When you first get your period, you learn that one day, far in the future, it will come to an end and you will no longer have regular menstrual cycles. However, less often discussed is what happens between those two phases. Before your body enters menopause, the menstruation-free era marked by the thirteenth consecutive month without a period, it goes through the transition of perimenopause. Translating to “around menopause”, perimenopause can last for as little as two years, or as long as ten years. While it usually starts sometime in your forties, it can also begin as early as your late thirties, depending on a variety of factors like genetics, family, medical, and menstrual history, surgery, fertility treatments, medication use, nutrition, organ function, stress levels, and lifestyle.
How Will I Know?
According to endocrinologist Dr. Jerilynn Prior, you’re likely perimenopausal if you’re experiencing any three of the following:
- new changes in flow: heavier or longer
- menstrual cycles that are shorter in length than normal
- maintenance insomnia where you fall asleep but wake up in the middle of the night
- night sweats which are most likely worse before your period
- new or more pronounced mood swings before your period
- weight gain without changes in your nutrition or exercise regimen
- sore, swollen, or lumpy breasts that you haven’t previously experienced
- increased menstrual cramps
- new-onset or increased migraine headaches
As your body prepares for menopause, your hormones begin shifting around, but instead of a nice smooth decline in estrogen levels, perimenopausal hormonal changes are often more akin to a rollercoaster. For some, the transition might be a smooth and seamless ride, while for others the excitement never stops: a rollercoaster ride with loop-de-loops and plenty of twists and turns! For most, however, the transition will settle somewhere in between.
Common secondary symptoms typically associated with estrogen changes like hot flashes, fluid retention, fatigue, vaginal dryness, incontinence, and changes in appetite, memory, and body composition may be further exacerbated by naturally declining progesterone levels.
Along with hormonal changes, your body’s natural reaction to chronological aging is also taking place, and with it comes a host of other issues that can bring total frustration. Loss of lean muscle mass, a decrease in metabolism, and weight changes are quite common, with weight gain around the midsection being a common complaint. To further complicate matters, perimenopause typically takes place during a time in our lives that is already filled with the busyness and stress of work, family obligations, and personal growth, adding further complexity to this already-trying transition.
Unfortunately, there are no magical solutions to fix all your perimenopausal symptoms in one fell swoop; however, there are strategies that support your physiology, life, and wellbeing as a whole that will help this transition. Visiting your healthcare provider and coming up with a holistic treatment plan to best suit your specific situation is highly recommended as you start to notice changes.
Medical treatments for perimenopause are personalized as they can vary greatly depending on individual situation. From over-the-counter medications like ibuprofen to prescribed anti-depressants, many doctors are quick to offer solutions that offer temporary or superficial relief, but don’t necessarily address the underlying changes that are occurring. Other more invasive procedures that may be offered in the case of severe symptoms include dilation and curettage (D&C) whereby part of your uterine lining is removed, endometrial ablation, and hysterectomy, with or without removal of your ovaries. Hormone therapy, IUDs, and oral contraceptives are commonly used as well.
One of the most common practices is hormone replacement therapy (HRT), where one or more sex hormones, most typically estrogen or a combination of estrogen and progesterone, are prescribed to help alleviate some of the symptoms associated with perimenopause. Despite conflicting information and fear about HRT use, it can actually be quite safe and very effective for certain individuals. Appropriate testing like bloodwork and ultrasounds are a critical part of safe and effective use of HRT, as are dosages that are dependent on the individual’s unique symptomatology, history, bloodwork, and assessment. While there is some concern of increased risk of clots and cancer when not administered appropriately, properly prescribed HRT can help with hot flashes, vaginal changes, energy, body composition, mood, sleep, skin, and more.
Whether or not your healthcare provider prescribes HRT, natural and complementary therapies can be very effective both directly and indirectly at supporting your journey through perimenopause. Remember: your sex hormones interact with the rest of your systems as well, making digestion and liver, immune, adrenal, and thyroid functioning key components of healthy perimenopause! Taking a holistic approach to perimenopause can help make the transition easier. This means focusing on areas that are good for you as a whole: the foods you eat, the supplements and herbs you include, adjunctive therapies like acupuncture, and your lifestyle can all work together to complement this time of change.
Food for Mood
Incorporate adequate protein, eat the rainbow (especially cruciferous veggies and leafy greens like kale and arugula), add in various sources of fibre like ground flax seeds, get adequate healthy fats and carbs, choose more nutrient-dense whole grains over refined grains, and opt for antioxidant-rich fruits like wild blueberries, blackberries, and pomegranate.
Abstain to Gain
Both alcohol and caffeine can exacerbate perimenopausal symptoms and impair the metabolism of your hormones. Cutting back on alcoholic and caffeinated beverages is a strategy that can help reduce perimenopausal symptoms like hot flashes and support healthy hormone metabolism.
Complement with Supplements
Key vitamins and minerals like vitamin B6, magnesium, and zinc support healthy hormone metabolism, while antioxidants and other plant compounds like resveratrol, phytoestrogens, and curcumin can be helpful to support mood and hormones. And for a more peaceful and less-symptomatic perimenopause, consider incorporating herbs such as black cohosh, wild yam, rhubarb, and chaste tree under the guidance of a well-versed practitioner.
Have Your Sights Set on Mindset!
Especially weight-bearing exercise, is a must for perimenopausal women to preserve lean muscle mass and support bone and cardiovascular health. Start slow and consider getting professional instruction or join a class for guidance and accountability.
Rest can be elusive during this time because of night sweats and insomnia, but both are critical to healthy hormones and overall wellbeing. Bring this up with your healthcare provider so you can address it sooner rather than later. Acupuncture, herbs, and natural supplements can also be extremely helpful here.
This is an often-overlooked aspect of perimenopause care plans. Make a list of activities that bring you pleasure and peace and incorporate these into a regular routine.
Sharing Your Insights
Whether through journaling or speaking to a therapist or coach, can be an empowering way to support you through this transition. Chatting with friends or joining forums and community groups can also be extremely beneficial during this (and any other!) time. Too many women go through perimenopause feeling lonely, overwhelmed, and unsupported, and sharing your experience may help others as well.
No matter what phase of your menstrual journey you are in, you don’t have to suffer in silence! Be proactive and talk to your healthcare provider so together you can come up with a holistic plan that works best for you and your specific situation.