Perimenopause can start as early as 35, but typically in the 40s, we start seeing these changes. Perimenopause refers to the transition period leading up to menopause. Perimenopause typically begins several years before menopause, when a woman's ovaries start producing less estrogen, which can result in irregular menstrual cycles, hot flashes, night sweats, and other symptoms. The duration of perimenopause can vary, but it usually lasts about four years on average. Once a woman has gone 12 months without a period, she is considered to have reached menopause.
From a hormonal perspective, what happens during this time is that the ovaries start producing less progesterone. The balance between progesterone and estrogen gets thrown off as estrogen is on a rollercoaster ride, going up and down wildly. Eventually, estrogen will decline as well as we enter menopause. But many women experience estrogen dominance as progesterone starts to decline.
The adrenal glands can make progesterone to pick up the ovaries' slack during this time. However, this can add additional stress to the HPA axis. The adrenal glands also produce cortisol, aldosterone, and adrenaline, among other hormones. The adrenals affect energy levels, our sleep/wake cycle, our blood pressure, and our ability to do things we need to do daily. If the adrenals are overtaxed, and from all the stress our bodies are under in the modern world, they will have trouble producing progesterone, and we can develop symptoms of adrenal deficiency.
The most common symptoms include:
Night sweats
Hot flashes
Low libido
Disrupted sleep
Joint and muscle aches
Anxiety, depression, and/or irritability
Heavy or irregular periods
What can you do to feel better?
Protect your body from added stress (get your body get into rest and digest mode by calming the parasympathetic nervous system):
Practice self-care, and make sure to schedule yourself some downtime
Supplement with magnesium, L-theanine, and the amino acid taurine— nutrients that can relax the nervous system, relieve hot flashes and improve sleep
Take extra time to recover from workouts, and don't go hard six days a week. Recovery time is equally important at this time in your life.
Focus on intensity over volume- ditch the moderate to high-intensity cardio sessions.
Practice breathwork and/or daily mindfulness.
Prevent estrogen from spiking too high:
By reducing alcohol
Supporting a healthy gut microbiome by eating probiotic-rich foods, cruciferous vegetables, and a diet high in nutrient-dense fiber-rich foods
Choose whole foods 80-90% of the time:
Skip processed foods. This is only adding to hormonal chaos
Avoid sugar and opt for fiber-rich, nutrient-dense foods
Get your leafy greens, non-starchy vegetables, and fruits- aim for 5-9 serving per day
Lean, clean protein should be part of every meal- eggs, yogurt, cottage cheese, chicken breast, fish, and turkey
Other great options: unrefined grains, beans, healthy fats like avocado and olive oil
Manage your blood sugar balance:
Carbs are healthy and essential for hormone products. Just make sure to combine them with fat and/or protein for blood sugar balance.
Choose whole foods over processed carbs- oats, sweet potatoes, brown rice, fruits, and veggies should make up the majority of your carbohydrate consumption. Limit consumption of pasta, processed bread, and cracker.
Supplement with bioidentical or body-identical hormones:
See an integrative medicine doctor who can help test your hormone levels and write prescriptions.
Supplementing with progesterone can ease your symptoms and balance out the high levels of estrogen seen in perimenopause. Progesterone also stabilizes the HPA (adrenal) axis and supports thyroid function.
Testosterone improves stamina and energy levels, both physically and mentally – and often improves libido and the ability to orgasm. Testosterone treatment usually has no side effects as it is given to replace the testosterone you are missing.
If estrogen is low, estrogen HRT can help with sleep disturbances, night sweats, and hot flashes.
Summary
Lift weights (as heavy as you can with good form and no pain)- building muscle will help support your hormones and set you up to protect your bones in menopause once estrogen disappears.
Eat a diet rich in vegetables and fruits with plenty of high-quality protein (eggs, fish, chicken, lean cuts of beef, yogurt)- this will support your hormones (made of protein) and help you to build lean muscle, which helps keep you slim and supports strong bones.
Go for walks, especially in nature. Walking is beneficial for both physical and mental health, helps with blood flow, and calms the nervous system. It's also a great way to regulate blood sugar which can get dysregulated during perimenopause and menopause. Aim for 7,000-10,000 steps daily.
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