Navigating Perimenopause

Author: Caren Wigmore ND

Not much is said about Perimenopause – the gradual change (or not so gradual for some) from a regular cycle to cessation of them.  The symptoms might be mild or significant – on the mild side it often starts off like this:  a patient will tell me:  “I’m just not losing weight as easily as I used to”  when we talk about sleep that is usually a bit disrupted, cholesterol and blood pressure might be going up when we test – even though it has been stable for years.

If we dig a little deeper, I find if ever there was a demographic carrying a load that is unrecognised its usually a Perimenopausal woman.  It is no wonder so many Perimenopausal women end up in my rooms feeling overwhelmed, experiencing anxiety they have never had before, not sleeping, and feeling like things are unravelling.  You are not alone and there are good reasons behind it.   A woman in her early 40’s to mid 50’s is often elbow deep into their careers, if you have kids, they are usually in their early teens or older and she finally has the space and time to get back to what it was she was doing pre-kids with gusto.   You may have a little more wisdom & maturity, but this age group is often at their peak of carrying loads:  caring for aging parents, supporting and navigating teenagers through school and life (you know the saying:  little kids = little problems; big kids= bigger problems) all the while careers and workloads may be at their peak.  Often not having a moment to stop and think “how am I going?” 

With so much to juggle at this time of one’s life it is not surprising that depression rates in woman are at their highest between the ages of 45-54yrs:  especially when you consider hormones play a huge role in influencing neurotransmitters and also act as an anti-anxiety.

By your early 40’s something is starting to shift in your body:  over the next 2-12 years a process called perimenopause is slowly taking place: leading to the final period and cessation of your menstrual cycle and fertility.  It’s a bit like a second puberty.  For some it can feel like choppy waters but there is a sequence to it: it starts with low progesterone and temporary high estrogen and concludes with low estrogen and significant changes to insulin metabolism.  Lara Biden, a Canadian Naturopathic Doctor labels it “a critically sensitive window for health”:  a time when small health problems if not address can be amplified into more permanent health problems later in life.  The great news is that it is also a window of opportunity where a few small changes can have significant and lasting beneficial health impacts for later.  Not all symptoms are temporary, but many are: so remembering that “this too shall pass”.

It’s been referred to as “the grand finale” of our hormonal cycle – for some it happens without many symptoms and over a couple of years and for others it can be quite the wild ride.  The hormonal fluctuations can become quite erratic and feel chaotic. Night sweats may come and go, swollen tender breast like you’ve never had before – these are often triggered by levels of oestrogen dropping suddenly and shooting back up to levels higher than in our 20’s!

4-6 years is the average for most women, perimenopause can be as short as a year or last for more than 10yrs:  at the end of which is Menopause by which time all the work is done.

So what is going on?  Our ovaries and reproductive system are slowly winding down.  The changes to our menstrual cycle is often the first clue something is shifting.  Periods may become irregular, spaced further apart, heavier, lighter, or even have a different pattern each month. 

So what is “normal”

• your cycle will change – it could get longer or shorter and skip months
• Your flow will vary from light to heavy and become less predictable
• Vaginal lubrication and elasticity changes – this due to reduced oestrogen levels
• Fertility decreases

What is not normal and when to seek help:

• Bleeding lasting more than 7 days
• Bleeding between periods
• Cycle length less than 21 days
• Excessive heavy periods may need further support

Although these symptoms are considered normal in perimenopause there is much that can be done to subdue them:

• hot flushes
• night sweats
• problems with sleep
• breast tenderness
• exhaustion
• trouble concentrating
• irregular period
• vaginal dryness
• loss of libido
• migraines
• increased PMS
• mood changes: feeling more teary, irritable, or increased anxiety
• weight gain despite no change to diet or exercise – this is due to the shift in hormones slowing a woman’s metabolism

Active women have fewer and less distressing perimenopausal symptoms:  so walk, dance, ride, Pilates, netball or tennis your way through these years to get the best outcome.  Aim to be active most days for 30-45 min of moderate intensity.

The goal is to get through as smoothly as possible, a tailored approach will be made depending on your symptoms and experience:  diet, lifestyle, nutritional or herbal supplements may be engaged but as you move deeper into the menopause your health should stabilize and you could find you no longer need the supplements you once did and the shift changes from hormonal balancing to supporting bones, heart and brain health.

What can you do about it?  Eat healthily:  aim to half full your lunch and dinner plate with a variety of vegetables, a palm-sized piece of protein of your choice and make sure your grains are wholegrains for the added nutrition in the germ and fibre.

Hot flush can be triggered by:  alcohol, caffeine and high glycaemic index foods: steer clear of sugary foods, be physically active, don’t smoke, limit alcohol (less is definitely better in this phase of life) and take care of your emotional health.

A couple of side notes:  it is still possible to ovulate so you can still become pregnant although the chances of this as low as 2-3% for those 45-49yrs.

Pelvic floor muscles are affected by the drop in hormones, so even if you got through childbirth with a strong pelvic floor things could change with the hormonal shift – engage a pelvic floor physiotherapist if you need to. 

Interesting the Japanese word for menopause is konenki which means “renewal years” or energy.

Japanese see this period as a time of change, renewal and for women to share their wisdom and lived experiences. This second spring is a time of honour and respect. What do you envisage for your konenki/second spring?

There is so much one can do to ensure a smooth transition through to menopause.  Remember a little bit every day is much more effective than big sporadic bursts of effort.  

My approach is to understand what perimenopause symptoms are most distressing for you, assess through a combination of blood tests/ urinary test and salivary tests as necessary how certain other biochemical markers are holding up and support you through this natural phase of life so that you come through it well and can move onto enjoy your second spring.

Book an appointment today so that we can help you navigate perimenopause as easily as possible