Let’s Talk Perimenopause

Thankfully women and the health profession are talking about perimenopause more frequently now. In years gone by, menopause was a hush-hush subject, even amongst other women. And perimenopause got barely a mention at all. Now, women are rightfully demanding more attention be paid to the often debilitating symptoms they experience and they are seeking options for relief, whether it be medical or natural health approaches, or a combination of both.

The average age for menopause (defined as 12 months after the final period) is 51 years in Australia but it commonly occurs within the ages of 45-55 years. Some women of course will experience menopause earlier or later than this for various reasons.

The hormonal symptoms of that transition into menopause can last from one to ten years and severity varies hugely amongst women. Some will barely know it’s happening whilst others will be profoundly impacted. Some women can start to experience symptoms in their late 30’s. For the majority, they will likely start to notice changes to their cycle in their 40’s and corresponding physical and mental symptoms. It can be difficult to ascertain whether perimenopause is to blame since a lot of the symptoms can be attributed to other causes. 

Some of the signs that may indicate you are in perimenopause include:

• Heavier or lighter periods 
• More painful periods 
• Irregular cycle 
• Anovulatory cycles
• Fatigue
• Headaches and migraines 
• Cognition issues like brain fog
• Irritability
• Anxiety
• Depression
• Difficulty sleeping
• Alcohol intolerance
• Hives and rashes
• Vertigo
• Body aches and pains 

As you can see, it’s quite a combination of symptoms! And that is by no means an exhaustive list. In the past, middle-aged women were frequently dismissed as being “hysterical” or “crazy” when complaining about things such as irritability, depression, anxiety, pain and so on, when in fact, it is likely that many were struggling with the resultant effects of hormonal changes.  

What is actually happening during perimenopause? In simple terms, we are dealing with a gradual decline in progesterone and wildly fluctuating oestrogen levels. This explains why the symptoms are changeable and wide-reaching. The lower progesterone and swinging oestrogen can bring the migraines or headaches, anxiety, heavy, painful and irregular periods and disturbed sleep among other things. As we move closer to menopause, oestrogen declines and eventually reaches a permanently low state. Progesterone, our “calming” hormone, progressively decreases until we lose it almost entirely with menopause. This new hormonal state may manifest with hot flushes and night sweats, weight gain, achy joints, brain fog and vaginal dryness. Additionally, testosterone levels decline as we age (yes, women have testosterone too!) and this can impact libido, energy and muscle strength and mass. 

Why is it that some women sail through the menopausal transition unscathed whilst others go through hell? There are a myriad of factors that can influence your experience, including:

• Stress – high stress is associated with worse vasomotor symptoms 
• History of hormonal dyresgulation such as oestrogen dominance
• Genetics – however keep in mind that lifestyle and diet determine whether genes are expressed or not
• Metabolic health – being insulin resistant increases risk of weight gain, type 2 diabetes and development of fibroids
• Nutrient deficiencies – for example, being deficient in iodine can worsen cyclic breast pain and iron deficiency impacts thyroid function and fatigue levels
• Thyroid dysfunction – an underactive thyroid has overlapping symptoms to perimenopause & it affects the menstrual cycle
• Systemic inflammation is associated with worse somatic menopausal symptoms
• Alcohol consumption – alcohol causes histamine release and this can trigger headaches, gut issues and sleep disturbances
• Exposure to endocrine-disrupting chemicals (xenoestrogens) such as BPA, pesticides, PCBs, parabens etc  interrupts oestrogen signalling pathways 

It is important to think of menopause as the natural transition that it is and not focus on negative aspects. It signifies a move into a new chapter of life that many women can find free-ing and transformative. At the same time, we need to have access to, and guidance on how to soften the hormonal effects and alleviate troublesome symptoms. 

From a naturopathic perspective, we need to recognise what stage of perimenopause a woman is at and assess their full health picture. Testing can be important to determine aspects such as thyroid function, fasting blood glucose and insulin and nutrient deficiencies. Assessing cardiovascular health and bone health is also vital since loss of oestrogen in menopause increases the risk of osteoporosis and cardiovascular events such as stroke. 

It depends on the patient’s symptoms and overall health and the stage of perimenopause/ menopause that they are in as to what we need to focus on and how we prioritise aspects to their treatment. Some of the specific treatment approaches that I may incorporate into a patient’s treatment protocol could include:

• Herbs like sage and Black cohosh in herbal formulas along with supplementation of magnesium, taurine, vitamin B6 and zinc for hot flushes
• Chaste tree and zinc to support progesterone production for as long as possible
• Dairy free diet to reduce heavy and painful periods
• Magnesium for metabolic health, nervous system calming and supporting sleep
• Phyto-estrogenic foods such as ground flaxseed and organic soy products like tempeh, edamame and miso to help modulate oestrogen (avoid soy if you have an underactive thyroid)
• Liver-loving foods like turmeric, onions, broccoli, beetroot and herbs like St Mary’s Thistle to aid the liver in excreting excess hormones, and metabolising fats & cholesterol properly
• Collagen for bone and joint health, skin elasticity and a healthy gut lining 

The increased dialogue and research around menopause means that we now have more knowledge and access to ways we can support this hormonal transition and mitigate symptoms and health risks as much as possible. And many women now combine a naturopathic approach with medical intervention such as hormonal replacement therapy. It’s all about finding what works for you. Seeking guidance from a naturopath can help to set you up for a smoother ride into the menopausal sunset!