The roller coaster of perimenopause

The Roller Coaster of Perimenopause

A friend of mine in her 40s recently went to her doctor because of concerns about irregular menstrual cycles, mood changes and other symptoms that seem to change on a monthly basis. Her doctor told her that she is likely in perimenopause. She called me in a panic. "But I'm not ready!" she said. "I want OFF this roller coaster!"

Menopause signals the end of menstrual cycles. It is a moment in time and you will only know you've completed menopause after 12 months of no periods. If you've had a hysterectomy you may experience a sudden, dramatic and uncomfortable menopausal transition. 

It is common for women to experience changes in their menstrual cycle in the years before menopause.  This may mean shorter or longer periods or heavier bleeding. There may also be new symptoms that appear related to the cycle like problems with sleep, mood, cognition and migraines. There may be hot flashes, night sweats, vaginal dryness and problems with urination. These symptoms can come and go and women in perimenopause can feel like they are indeed on a rollercoaster from month to month. 

The average age of menopause is 51 in the U.S. and perimenopausal changes classically appear in women in their late 40s. But I commonly see more subtle changes in women in their early 40s and sometimes even in the late 30s. The hormonal shifts can be jarring and unpredictable. 

So is there a way to make the ride leading to menopause a smoother one? 

Perhaps the biggest opportunity for women during this time is learning how to nourish themselves and making the space for self-care. Many women are still heavily involved in parenting their children and caring for aging parents. Career pressures may be ramping up. I see woman after woman who appear to be holding the weight of the world on their shoulders. The result? Stress is high. Sleep is not good. Because of limited time, nutrition and exercise suffers. The body switches into survival mode, just trying to make it through each day without falling apart. As a result, the body will actually put less of a priority on making hormones as it focuses on more essential functions.

From a treatment standpoint, self-care techniques, sleep, movement and adrenal support are absolutely critical. 

When it comes to hormone support in perimenopause, natural progesterone, DHEA, pregnenolone, and thyroid hormone can all be helpful tools. Estrogen therapy is not typically appropriate in perimenopause because it can cause an estrogen excess situation and cause symptoms like breast tenderness, heavy bleeding and abdominal bloating. 

There are many herbs, nutrients and functional foods that can be very supportive during perimenopause and the menopausal transition. The choice of which ones to use depends on each woman's unique symptom and hormone picture and any other health challenges that they may be facing. Acupuncture can also be EXTREMELY helpful here. 

Perimenopause can bring irregular cycles and unpredictable symptoms but there are definitely ways to smooth out the journey!