Perimenopause can be a confusing time for many women. The scientific explanation of perimenopause sounds so simple: a gradual slowing down of reproductive hormones until menopause. But, did you know that perimenopause can last up to 12 years and it is often called “puberty in reverse” because of the dramatic hormone shifts involved?
Many women in their late 30s through their 40s don’t realize they are actually IN perimenopause – the symptoms can be sneaky and often less obvious than the classic menopause symptoms of missed periods and hot flashes.
In my experience as a naturopathic doctor specializing in hormone balance, women have come to me not only for relief of their symptoms but also to understand what is happening in their bodies, why it’s happening and what to expect for the future as they reach menopause and beyond.
I have found that addressing the earliest symptoms of hormone shifts associated with perimenopause not only improves energy levels, mood, and sleep quality but also eases patients’ worries about the transition ahead. Working with an integrative or naturopathic doctor to get to the root of your symptoms and exploring functional lab hormone testing to design a plan for your unique needs is always recommended.
In the meantime, let’s explore How Perimenopause can Sneak up on You what to do about it…
Problem #1: The after dinner “food baby”
Do you look 8 months pregnant or that you’re trying to smuggle a beach ball under your shirt after dinner?
Our digestive system begins to gradually slow down and lose some of its power around age 40, in perfect time for perimenopause. This leaves us more vulnerable to bloating soon after eating because of lower stomach acid and to bloating hours after eating because of slower intestinal motility. (Effects of aging and gastritis on gastric acid and pepsin secretion in humans: a prospective study)
A common hormone pattern seen in perimenopause – lowering levels of progesterone and normal/elevated levels of estrogen – slows your intestines down even further leaving you more likely to develop gas and bloating. (Role of estrogen and stress on the brain-gut axis)
Pro Tip #1: Reduce Raw and Let go of the Leggings
Raw vegetables are more difficult to digest and because of their high fiber content. They spend more time in transit down our lengthy intestinal tract – being fermented by our happy intestinal microbes – thus, creating more gas and bloating. Try to limit raw vegetables to one cup per day and incorporate more steamed and roasted vegetables into your routine.
Tight clothing such as yoga pants, leggings and sports bras apply pressure on your gut, which can physically impede the digestion process and make you feel more bloated than you really are! (Effects of skin pressure by clothing on digestion and orocecal transit time of food/) When not at the gym or yoga studio, ditch the leggings and opt for looser clothing.
Problem #2: The Floodgates have Opened
Heavier menstrual bleeding and/or having blood flow for many more days of the month – sometimes even two full periods in the same month – is the most common reason for women to visit their OB/GYN in their 40s (besides routine exams). Most women think of perimenopause/menopause to be a time of missed periods or not having periods at all and are surprised to hear that the changes in their periods are a sign of perimenopause. (Abnormal uterine bleeding in perimenopause)
Your body is a miraculous machine and your menstrual cycle is one of those miracles. Each month after ovulation your brain sends hormone signals to your uterus to build up a fertile lining – it will be needed if you become pregnant. This process involves creating a multitude of new blood vessels each month and if you are not pregnant, during your period you will shed the new blood vessels before you start a new cycle. In perimenopause, those hormone signals can be wacky and vary a lot from month to month. This can cause too many blood vessels, too much time for the blood vessels to mature or leakier blood vessels – all leading to a very heavy and/or longer periods.
Pro Tip #2: Go to the Dark Side
Hormones aside, one of the most effective ways to manage menstrual bleeding is to increase your intake of darkly colored fruits. The deep, rich pigments found in blackberries, wild blueberries, pomegranate and concord grape juice help you create stronger (i.e less leaky) blood vessels and fewer new blood vessels as well as help manage the inflammation that can make your cramps and blood clots worse.(Therapeutic Approaches of Resveratrol on Endometriosis via Anti-Inflammatoryand Anti-Angiogenic Pathways)
Visit the dark side daily and rotate your choices throughout the year to add variety – frozen wild blueberries in the Spring, fresh organic blackberries in the Summer, pomegranate in the Autumn and elderberry syrup in the Winter is the plan I routinely recommend to my patients.
Concord grape juice and herbal teas containing blueberry, pomegranate and hibiscus are also a worthy, economical way to visit the dark side. (Disruption of Angiogenesis by Anthocyanin-Rich Extracts of Hibiscus sabdariffae)
Problem #3: Supersonic Senses when you are Supposed to be Sleeping
Do you suddenly find yourself waking up multiple times a night because of a slight noise, a gentle shift of the blankets, a change of airflow in the room, even a change of smell in the room? You’re not alone. Sleep issues occur on 40-60% of women in perimenopause and menopause. Sleep in Women Across the Life Span
Even for women that have never had trouble sleeping, perimenopause can be a challenge. Hormones, particularly progesterone, play a role in our sleep-wake cycle, impacting how deep we sleep and how long we sleep. Progesterone normally drops a few days before your period begins and this can cause many women to experience insomnia as part of their PMS. During the perimenopause years, progesterone levels are gradually reducing and can also be erratic month to month – causing you to “sleep lighter” – being pulled out of sleep more easily by small disturbances in your environment. Sleep in Women Across the Life Span
Pro Tip # 3: Support Your Progesterone
Most people think of melatonin when thinking about sleep remedies. However, even low doses of melatonin can make matters worse, making you wake up between 1-3 am fully alert if it is not the correct remedy for your sleep issues. Staying asleep throughout the night is often the crux of the matter for perimenopausal women and in my over 15 yrs of practice, I have found the lesser known sleep remedies of magnesium, glycine and phosphatidylserine to do the trick to support progesterone levels and improve sleep.*
Magnesium is the miracle relaxing mineral that also plays a role in making progesterone. Sore muscles, neck tension and small muscle twitching (such as in your eyelids or upper lip) can be signs that your magnesium intake is lacking and supplementing may help you. Magnesium glycinate is a well-absorbed and well- tolerated form of this miraculous mineral.
The amino acid,Glycine, helps keep your body cool overnight so it is a helpful remedy for women waking up because of mild night sweats. Glycine supplementation has been shown to increase progesterone levels in animal studies and theoretically could improve sleep quality and duration. (Effects of changes in the concentration of systemic progesterone on ions, amino acids and energy substrates in cattle oviduct and uterine fluid and blood)
Phosphatidylserine is my favorite remedy to dispense to women under chronic stress and may have cortisol (stress hormone) imbalances, keeping them in a “fight or flight” state overnight. The adrenal glands not only produce adrenaline to fuel our stress but also can be a reservoir or back-up system for estrogen, testosterone and progesterone. As these hormone levels dip and dive during the perimenopause years, our adrenal glands can come into play and pick up the slack – that is, if our adrenal glands are healthy and not overtaxed by chronic stress. Supporting a healthy adrenaline – cortisol cycle with nighttime phosphatidylserine is a holistic way to support not only stress recovery but progesterone levels as well. (A lecithin phosphatidylserine and phosphatidic acid complex (PAS) reduces symptoms of the premenstrual syndrome (PMS): Results of a randomized, placebo-controlled, double-blind clinical trial58/)
*Always consult your physician before beginning an herbal or supplement regimen.