There is a mysterious time in a woman's life that spans between 7 and 10 years that not many people know about. This time period is something that almost every woman will go through, and yet it isn't very studied or understood. Perimenopause can begin as early as age 35 and continue until menopause.
An indicator of perimenopause will be a very small change in your monthly cycle. It can be just a day or two shorter than usual for a few months, and then the fluctuations and changes begin. Many women go to their doctor and can only describe themselves as "not feeling right" or "something is wrong with me", and when they get checked out, they're told there's nothing physically wrong with them. This is a sign that you have entered the beginning stages of perimenopause.
In perimenopause, first progesterone falters. This can give symptoms like not sleeping through the night, anxiety, and periods getting closer together. Then estrogen falters, and we experience more wrinkles, night sweats, low libido. A feeling of disinterest in life is actually a good indicator that you are going through perimenopause.
The symptoms of perimenopause are vast and differ for every woman. They include hot flashes, cold flashes, night sweats, excessive sweating, clammy feeling, weight gain, cholesterol level changes, heart palpitations, mood swings, sleep disruptions, headaches, hair loss, tinnitus, vertigo, frozen shoulder, joint pain, inflammation, headaches, irregular or skipped periods, itchy skin, rosacea, skin plaques, hormonal acne, decreased strength and muscle mass, bone loss, weakened fingernails, changes in the teeth health and gut health, brain fog, exhaustion, depression and anxiety, lack of focus, poor concentration, dizziness, constipation, incontinence, lack of or diminished sex drive, sore breasts, worsening allergies, change in body odor, and these are just a few of the stated symptoms that have recently been acknowledged. All of this from your hormone levels dropping.
The female system that has worked liked a well created timepiece is now stuttering. During your teenage years, your hormones ramp up. Your adrenals, pituitary glands, hypothalamus (HPA axis) along with your gonads (ovaries in women; testes in men), your thyroid, and your gut microbiome all do this amazing dance that cause us to develop the procreation system of the body. For a girl, this begins with the growth of breasts, and then the menses begin about a year after her breast buds show.
During perimenopause this dance winds down, estrogen and progesterone levels fluctuate, testosterone levels drop, in fact, all the hormones are thrown into chaos. Estrobolome has a hard time getting rid of excess estrogen, especially the xenoestrogens that our bodies are accumulating, and estrogen dominance ushers in other heath conditions. Cortisol and thyroid are so out of whack that weight gain occurs. Adrenals mess up, insulin levels go haywire, and your ability to regulate stress falters. And this disorder continues until your ovulation has completely stopped.
Menopause is marked as "one year" of not having a cycle. This means you haven't had a period for an entire 12-months, and therefore you are considered to have gone through menopause. The rest of your life you are in PostMenopause.
Menopause and perimenopause study only get about .03% of the funding for research. The majority of funding is spent on fertility issues. This leaves a lot of women completely ignored in a sensitive time of their lives.
There was a study done by the WHI (Women's Health Initiative) which was really was only searching for one answer- was hormone replacement therapy beneficial for cardiovascular disease. This study shouted only one result- hormone replacement therapy can cause cancer. This outcome was very constricted as far as the facts that were presented. First, the average age of the participants was 63 years old- these women were well into their menopause years. Next, they didn't look at the overall health of the participants. Many of them were already in poor health because of their age.
There were two different groups of women who were included in this study- women who still had a uterus and women who had a hysterectomy. Half of the women who had a uterus were given both estrogen and a synthetic progesterone. Half of the women who had a hysterectomy were given only estrogen. Half of both groups were given a placebo.
Women who have a uterus need progesterone along with estrogen because of endometrial cancer risks. The progesterone keeps the effects of the estrogen in check. Women without a uterus don't have this risk, and so they only need to be given estrogen.
The group of women on both estrogen and synthetic progesterone showed a slight increased risk in their chance for breast cancer. The numbers went from 4 women to 5 women out of 1,000 had a higher risk of getting breast cancer. Therefore, estrogen was blamed as the proponent that caused this increase since estrogen can feed breast cancer cells. Nothing was said about the synthetic progesterone.
The group of women who only took estrogen, however, saw a decrease in the risk of getting breast cancer. Estrogen doesn't cause cancer. But the mindset regarding estrogen replacement therapy was never questioned or changed. According to a leading researcher for the WHI project, “good science became corrupted and eventually caused substantial and ongoing harm to women for whom proper and useful therapy was either terminated or never began.”
Some people say that HRT can cause blot clots, but this risk can be bypassed by taking a form of estrogen that isn't oral and therefore doesn't go through the liver.
Women who can find a doctor who listens can find help. Bioidentical hormone replacement therapy is not something to be feared or shied away from. Estrogen, Progesterone, and Testosterone replacement therapy have been shown to enhance the quality of life for many women. Women who start hormone therapy in perimenopause actually see benefits in almost every area of their health- bone, mind, skin, mood, and more.
Note, that a woman has more testosterone in their body than any other hormone. It's just that men have such a higher rate than women that it's looked at as a male hormone.
What to look out for with HRT are more intense headaches, vaginal bleeding (apart from period), or rashes. This is where you start asking if HRT is right for you.
Seeing as how nearly every woman will go through this, what can we do to help besides hormone replacement therapy?
The first thing that I would recommend is for you to get a hormone panel done in your twenties. If you have to pick one day, do it around day 21 or 22 of your cycle, and when you aren't pregnant or breastfeeding or on birth control. This will give your doctor a benchmark for what is normal for your body.
Dr. Sara Gottfried prefers urinary hormone levels and salivary cortisol levels to get the best information. "Sex hormones that I commonly test include estrogen (estradiol), progesterone (tested on day 21 of your menstrual cycle), cortisol (the stress hormone), and testosterone. Additionally, I like to measure the ratio of testosterone to estradiol. For peak estradiol, check on day 12 of your cycle. If your cycles are very irregular, test day 21-22 after a period."
Micronutrients play a huge roll in your hormone production, along with a lot of other functions in the body. Adding in Magnesium and Baja salt can help with your nutrition. If you have trouble with digestion, add in a digestive enzyme.
Exercise is so important. Strength training is great to help with bone density. Also adding in pilates and yoga help with flexibility and balance issues. It can also be great for your stress levels.
Grounding is a wonderful way to help your stress levels. Plus, it gives you a chance to get sunshine and fresh air.
Add in creatine to your supplement routine. This helps with your bones and muscles.
Get plenty of protein. Most women need at least 70 grams daily.
Eat good fats- avocado, coconut oil, bone broth, eggs, butter, nut and seeds.
Avoid foods that cause inflammation, like added sugars and artificial flavors, and enriched flours. Eat food and not food-like-products.
Intermittent fasting will also help. The recommended fasting is 16 hours of fasting, followed by an 8-hour eating window. Work up to this timeframe slowly by increasing the time 15 minutes until you can achieve 16-hours without feeling like you're starving! Remember, fasting is not for people with diabetes or hypoglycemia or other health disorders that can be affected by long periods without food.
There are a few supplements that can help during this time.
Over time, consistently high cortisol is linked high blood pressure, prediabetes and diabetes, increased belly fat, brain changes such as atrophy of the hippocampus (where memory is synthesized), depression, suicide, insomnia, and poor wound healing.
To help with cortisol:
Eat dark chocolate! Just a couple square with little sugar. You could even eat a couple cacao beans daily.
Phosphatidylserine (PS) is another supplement that is a chemical that is important for many functions in the human body, especially in the brain where it protects brain cells and supports memory and cognitive functions.
Rhodiola Rosea can help with anxiety, fatigue, and depression. Some studies have shown that it may inhibit the growth of lung, bladder, gastric, and colon cancer cells.
Fish oil helps both your heart and your brain. Along with Omega 3's it also contains Vitamins A and D. It also helps your skin health and reduces inflammation.
Taking a little time for yourself daily to destress is also important. Take a bath. Breathe. Whatever you need to do for about 15 to 20 minutes to let yourself relax.
To help your thyroid:
Take Vitamin D plus Vitamin K daily. Most people are chronically deficient in Vitamin D, and this is needed for so many actions in the body.
Add a daily multivitamin with methylated B vitamins. This is very important, especially if you have the MTHFR genetic mutation.
Add 1/4 tsp of Baja Gold Salt to one of your meals. This will provide the trace minerals your thyroid needs for regulation.
You can try the yoga pose Shoulder Stand to help with the blood flow to the thyroid.
To help with estrogen regulation:
Get at least 25 grams of fiber daily. This will keep your gut microbiome healthy which helps get excess estrogen and other toxins out of the body.
DIM helps with getting rid of excess estrogen.
Adding Beets to your diet to help detoxify the liver is another great way to support your estrogen.
To help with low progesterone:
Taking 150 IU of natural Vitamin E can increase progesterone levels.
Using ProGest cream, about a pea sized amount at nighttime for the last 7 to 10 days of your cycle, can also help with upping your progesterone, which helps with PMS, menopause symptoms, and osteoporosis. Progesterone and thyroid hormone help regulate metabolism and normalize the pituitary gland.
For the adrenals:
An adrenal complex can help to support the endocrine system.
Adding in Greens can also help provide the nutrients the adrenals need. They provide magnesium and also help with cortisol levels, which can ease the job of the adrenals.
Some people find that they must cut out caffeine because it further stresses the endocrine system and doesn't allow it time to recover.
Other supplements shown to help with hormones are:
Vitex, or chasteberry, helps with progesterone levels, as well as helping to balance the HPA axis. And it supports progesterone.
Maca helps with libido and energy and can help to balance hormones and decrease hot flashes.
Dr. Anna's Wild Yam Cream is a topical way to help your body balance hormones. Many women claim that it helps with mood, sleep, and bone health. It can be used by both men and women to help your body balance its own hormones, whether something is too high or too low.
Evening Primrose Oil and essential fatty acids to help with skin and joint health.
SAM-e is an amino acid that’s found in foods like egg whites, wild-caught fish, oats and sesame seeds. Your body needs it to make certain chemicals and is an energy-producing compound that acts as a source of fuel within our cells. It acts on a number of important molecules including hormones, neurotransmitters, fatty acids, DNA, proteins, and cell membranes. In the United States, SAM-e is marketed as a supplement to enhance mood, brain and neural function, joint mobility, and liver detoxification. WARNING, people who have schizophrenia or bipolar disorder should avoid SAM-e supplementation as it could make the manic symptoms worse!
As with all supplements, begin with low dose. If it doesn't make you feel right (if you become agitated or have any physical reactions), it may not be for you. If you have any health issues or are taking prescription medication, talk with your doctor first.
Some good resources for women going through Perimenopause are:
