If you’re in your early 40s you might be surprised to hear that you could be experiencing perimenopause. But yes, the hormonal changes that lead us towards the end of our reproductive years will begin around the age of 42.
The photos we see in the media about menopause show much older women. However the following photo is more realistic for a woman experiencing perimenopause.
I am passionate about helping you to understand the changes that are occurring in perimenopause and what they means for you in terms of symptoms and natural treatment options. Perimenopause can be a time that your body lets you know you need to start paying attention!
Perimenopause can creep up on you. In our early 40s we are so busy with career and family and having a busy social life that we often have little time to pay attention to our health. Perimenopause symptoms can be easy to ignore at first.
I have noticed that many women will allow their perimenopause symptoms to become extremely bad (e.g. anxiety, flooding or insomnia), often to the point that they struggle to go to work each day, before deciding there is something definitely wrong.
From working with many women in my clinic I can appreciate that education, emotional understanding and early intervention are the keys to managing these hormonal changes most easily.
The information I’ve presented here is for any woman wondering about natural, non-medical options for a healthy, happy perimenopause.
—– Natural perimenopause —–
If you’re not taking hormonal contraceptives then you will experience perimenopause for 7 to 10 years from around the age of 42.
The health choices you make through perimenopause are entirely up to you and based on your own circumstances. Not everyone will choose to use non-hormonal methods of contraception. Many women will choose to stay on the oral contraceptive pill or have an intrauterine device such as the Merina implanted, and that’s OK.
Hormonal contraceptives provide you with a chemical equivalent of estrogen and progesterone (depending on the brand) and can be masking the fact that you’re in perimenopause. If you’re able to come off the contraceptive pill in your early 40s I would encourage you to do so and consider alternative forms of contraception, should you need that.
According to Dr. Jerilynn C. Prior, the Scientific Director of the Centre for Menstrual Cycle and Ovulation Research, the longer you can experience regular menstrual cycles with ovulation, the better for prevention of breast cancer, osteoporosis, dementia, stroke and heart disease. Natural cycles with ovulation promote muscle gain, insulin sensitivity and long term bone health.
The topic of perimenopause is close to my heart because I at 53 years of age, I’ve been managing my changing menstrual cycle for over 10 years, mostly with dietary and lifestyle changes and with occasional herbal medicines and supplements. The diet changes have become part of an ongoing healthy lifestyle, however the herbs and supplements are needed when major hormone fluctuations or stressful events enter the picture. More about this in later sections.
Perimenopause is a critical window in a woman’s life. If not transitioned in a healthy way in your 40s, this decade can leave you vulnerable for menopause symptoms, autoimmune conditions, and higher risk factors for heart disease, cancer and dementia.
— Myths about Perimenopause —
There are many horror stories about perimenopause floating around. Happily the vast majority of women will transition to menopause with only minor challenges and often feel more energetic and fulfilled on the other side.
Myth 1: You have no control over your perimenopause symptoms
There is a lot of misplaced fear associated with perimenopause and menopause. The important thing is to educate yourself. Once you fully understand what stage of perimenopause you’re in, and what symptoms are completely normal, it’s easier to know how to manage what you’re experiencing with diet changes, changes to the way you exercise, or by taking supplements if you need them.
Myth 2: You need medication to suppress the symptoms
The symptoms of perimenopause are changeable and not permanent. Think carefully before agreeing to a hormonal medication, an anti-depressant, or a surgical intervention such as a hysterectomy to solve a temporary hormonal challenge.
Some women are misdiagnosed and medicated for conditions such as fibromyalgia during perimenopause. If you are experiencing any new type of symptom in your 40s such as aches and pains or fatigue, make sure to ask your doctor if perimenopause could be an alternative diagnosis.
Myth 3: Your vagina will dry up and you won’t enjoy sex any more
I have met many women who don’t find this aspect an issue at all. For those who are worried, then remember that prevention is the key to maintaining the integrity of the tissue in your vagina. This can be done with supplements and diet changes which I will talk more about in the sections below.
– The hormones involved in perimenopause –
A hormone is another word for a messenger. All our hormones work together to send messages through the blood stream to other organs or cells. The messenger provides feedback about what’s happening in other parts of the body and tells the organ or cell what they should be doing.
An example of a hormone is insulin which is made by cells in the pancreas. When we eat carbohydrates they break down to become glucose in the blood stream. Insulin is then released into the blood to instruct our cells to take the glucose out of the blood and inside cells for energy production.
There are a few hormones that are important in perimenopause, I want to focus on four of them:
Progesterone is made in the ovaries by the corpus luteum, which is formed in the ovary after ovulation. The role of progesterone in the menstrual cycle is to prepare the body for pregnancy in the event that the egg is fertilised.
Progesterone prevents heavy bleeding by thinning the lining of the uterus. It calms the brain and helps us to sleep and feel emotionally balanced.
Once you stop ovulating in perimenopause, you will stop producing progesterone.
Estrogen is an umbrella term for three types of estrogen: estradiol, estrone and estriol. These hormones are made in our ovaries, adrenal glands and fat tissue. Estrogens bind to receptors on our cells called estrogen receptors, which are located in most tissue throughout the body.
Estradiol is most famous for it’s role in the menstrual cycle stimulating eggs and ovulation and thickening the uterine lining before a period. Estradiol triggers the release of serotonin, supporting healthy mood and sleep.
Estrogen is also important in bone health, muscle mass and cardiovascular health throughout our life. Once you have achieved menopause, you will maintain low levels of estrone for the rest of your life.
Estrogen fluctuations (both high estrogen and low estrogen) cause a wide range of symptoms in perimenopause which are explained in a later section.
Cortisol is a steroid hormone produced by the adrenal glands which sit on top of each of our kidneys. When cortisol is released into the bloodstream it acts on many parts of the body to help us respond appropriately to stress or danger.
When the adrenal glands and stress hormones are in balance, you will make cortisol and adrenaline only when it is needed. For women over 40, the adrenal glands are often making chronically higher levels of cortisol due to the daily stress of coping with a too busy lifestyle.
High cortisol levels can contribute to low mood, insomnia, low energy levels, low libido, insulin resistance, weight gain and reduced muscle mass. All of these symptoms can be associated with perimenopause, but can be worsened by high cortisol. More about this later.
Insulin as I explained earlier, is necessary for blood glucose management and energy production. Insulin resistance is when the cells in the body resist the message of insulin to take glucose from the blood stream and into the cells. If you have insulin resistance, you will have more fat cells and lower energy levels.
Other effects of insulin resistance can be poor memory, hot flushes, fibroids, heavier periods, skipped periods, and increased risk of breast cancer, osteoporosis, heart disease, cholesterol and dementia.
The reason insulin resistance becomes critical in perimenopause is due to declining estrogen levels. As estrogen levels drop, insulin resistance can increase. Insulin resistance can be responsible for some of the perimenopause symptoms such as fatigue, brain fog, memory loss, facial hair and hot flushes.
Of the above hormones, insulin resistance is the only one that we can accurately test for in perimenopause.
Typical stages and symptoms of perimenopause
Perimenopause follows a pattern and can be broken into early perimenopause and late perimenopause. It is easy for me to pick which stage of perimenopause you’re experiencing, based solely on your symptoms. Blood tests aren’t needed or even useful in perimenopause because the hormones fluctuate daily. It’s the overall pattern of symptoms that tells us which type of support will work best as you move through perimenopause.
Early perimenopause is a time when progesterone levels are starting to drop. You might notice that your periods are slightly closer together by even 1 or 2 days. This drop in progesterone causes a relatively high amount of estrogen, due to the fact that the effects of estrogen are no longer being balanced by progesterone. You might experience both the symptoms of low progesterone and high estrogen.
The typical symptoms of early perimenopause include insomnia, anxiety, breast pain, worse PMS symptoms, night sweats, extremely heavy periods, clots, flooding, fibroids, migraines, worse endometriosis. You might not suspect that this is related to perimenopause because the length of your cycle might still be completely regular.
If you have heavy periods you might find that your iron levels are dropping and this can actually drive heavier bleeding. Women in the early stages of perimenopause often respond best to herbs and supplements to support progesterone levels. See the sections below to learn more.
As you enter the later stages of perimenopause you might start to skip periods because ovulation isn’t occurring. This is the stage where estrogen has joined progesterone in decline.
Periods are usually lighter and further apart. Late perimenopause is when night sweats and hot flushes often start to occur. Women in late perimenopause will benefits from herbs and supplements to support both progesterone and estrogen levels. You can read about these in the sections below.
At this stage you may find that one treatment doesn’t work all the time. If you start to suspect that the treatment is making your symptoms worse, then you are likely to be experiencing another cycle of rising estrogen (heavy periods, headaches) or declining estrogen (hot flushes, night sweats). These fluctuations can be happening even after a hysterectomy, or when your period has stopped.
Menopause is the day that your period stops. It’s the permanent cessation of menstruation. You can’t be absolutely sure that you’e in menopause until you haven’t had a period for 12 months. It’s best to continue with birth control until the full twelve months have elapsed (unless you’re over 55, when contraception is no longer needed).
If you’ve transitioned naturally into menopause, then you can expect that menopausal hot flushes and night sweats might continue on and off for a year or two, because your hormones are still cycling. These can be managed naturally with the suggestions in the later sections.
Vaginal dryness is sometimes a feature of menopause and I strongly advise women to start supporting their vaginal health in early perimenopause. The reduction in estrogen means that pH balance in the vagina changes, making you more susceptible to dryness, urinary tract infections and sexually transmitted infections.
Are you experiencing perimenopause or could it be something else?
Whenever I work with women over 40 I like to keep in mind that the symptoms you are experiencing may not be perimenopause and might be caused (or worsened) by another factor or condition.
For women younger than about 42, I will always suspect stress or thyroid conditions before perimenopause.
I have worked with several clients who have consulted with me for perimenopause problems and it turns out that stress was the main factor causing their symptoms. In these cases, when we support the nervous system with calming and supportive herbal remedies, the menstrual cycle can become regular again.
Indicators that your period changes could be stress related are hair loss, anxiety, brain fog, emotional issues, younger than 40, juggling a too busy lifestyle, or that many of your symptoms don’t follow a cyclical pattern.
2. Thyroid conditions
Thyroid conditions are common during your 40s and early 50s. Many of the symptoms of thyroid disease overlap with those of perimenopause including weight gain, depression, insomnia, joint pain and anxiety. Whenever I work with women in their 40s and 50s I like to make sure that their doctor has done all the tests necessary to rule out hypo or hyperthyroidism, or autoimmune thyroid disease.
One of the things that might make me suspect the involvement of a thyroid condition is blood tests that show elevated cholesterol levels, as this is not a symptom of early perimenopause.
3. Perimenopause complicating an existing condition
Perimenopause can also complicate the treatment for an existing thyroid condition, mental health, or any other autoimmune condition. If you are already taking medication for another condition, you might find that your dose needs to be monitored or adjusted more frequently during the transition to menopause. This is something you should discuss with your doctor.
The role of lifestyle factors in perimenopause symptoms
Lifestyle plays such a huge role in the way you might experience perimenopause that I want to mention this first. As progesterone and estrogen decline, their absence has a major impact on the brain, which literally needs to rewire to accomodate the differences in hormonal input.
The brain changes can cause the most worrying problems for many women, such as brain fog, memory loss, anxiety, depression. It’s essential to understand the process that’s happening to your brain and allow yourself space and rest to let your body adapt and adjust in a healthy way. These perimenopause symptoms are only temporary and will pass if you look after yourself.
Here are a few lifestyle tips for everyday health during perimenopause:
~ Make time for yourself. Your emotional and spiritual health is paramount.
~ Educate yourself about the changes to expect in perimenopause to reduce the worry of the unknown.
~ Prioritise sleep. Everything feels better when you’ve slept well.
~ Exercise in a way that is fun for you and maintains your muscle mass.
~ Pay attention to your symptoms to know what stage of perimenopause you’re in.
~ Know when to rest. If you’re tired or emotional, make time for a break, even if it’s just a few minutes of slow deep breathing.
~ Prioritise fresh, home cooked food (see dietary tips below).
~ Being organised is the key to managing your health and looking after all your other responsibilities.
~ Don’t snack – snacking increases insulin resistance and puts stress on your digestive system.
~ Invest time in developing a strong support network. Girlfriends are a lifeline in perimenopause and can help you if you need a break, or encourage your exercise goals.
~ Learn to be comfortable in your own skin. The emotions that come with feeling older can be surprising and confronting.
~ Seek help when you need it. Don’t wait until your symptoms are so bad you need medication.
The importance of food choices in perimenopause
Have you noticed that the foods you ate in your 20s and 30s aren’t agreeing with you anymore? In perimenopause you may find your body holds onto weight more easily, or you might discover that foods give you reflux, migraines or bowel changes.
There are 5 key areas that I address when it comes to food choices to support women in perimenopause:
Carbs are not the enemy, however processed carbs can be, because they are more readily converted into glucose in your body. As estrogen levels decline in late perimenopause we can develop insulin resistance, making it important to watch the types of carbohydrates that we’re consuming.
In a nutshell, bread, pasta, cakes and muffins should make way for unprocessed carbohydrates such as white beans, and whole grains including oats and rice. This is a practice that will serve you well not just in your 40s, but into your healthy older years.
I advise women not to try to restrict their food intake because this can cause hormonal changes that make you crave carbohydrates and retain fat. Instead I recommend a sensible and sustainable approach of consuming 3 satisfying meals a day to maintain a healthy metabolism through perimenopause.
Women need more protein in perimenopause and after menopause. I recommend that you eat some protein at every meal for these reasons:
protein assists with maintaining muscle mass
protein assists with blood glucose regulation and feeling full between meals
protein is needed for repair of cells in the digestive system and immune system
If you have trouble digesting protein then I recommend that you see a naturopath to help you with protein digestion.
Protein is found in red meat, chicken, almonds and other nuts, fish, cheese, eggs, tofu, chickpeas, quinoa and lentils.
3. Histamine foods
Histamine foods can play a huge role in the symptoms of perimenopause. You’ve probably already noticed that wine can affect you more than it used to. The good news is that this is often a temporary problem during the transition to menopause.
Fluctuating estrogen levels are the reason for the increase in your reaction to foods with histamines. Histamine can drive a wide range of symptoms such as migraines, anxiety, itching, hot flushes, night sweats, insomnia, heart palpitations and reflux.
I consider perimenopause to be a time of temporary histamine intolerance and I have found that many women can find relief from cutting back on these foods. Histamine intolerance is one of the key things I work with in clinic. Read more about this here.
I’m sorry to say that many of the foods that contain histamine are otherwise very healthy an/or delicious such as ripe bananas, avocado, nuts, eggplant, miso, bone broth, wine, sauerkraut and kombucha.
4. Phytoestrogen foods
Foods that contain phytoestrogens can be an excellent choice, especially in the early stage of perimenopause because they can have an anti-estrogen effect by binding to estrogen receptors. Phytoestrogens can help to lighten heavy periods and improve estrogen metabolism.
Phytoestrogens in plants such as soy beans, flaxseed, fennel, sage, legumes and grains bind to estrogen receptors on our cells and can have a hormone balancing effect. The more often you eat phytoestrogen containing foods in a day, the greater the anti-estrogen effect will be.
Your gut microbiome is important in perimenopause because it influences so many different parts of your health. This is another whole topic in itself, which I can only cover in a small section here.
Studies on the microbiome and it’s health effects have astounding results. Our microbiome influences our immune function, mood, energy, histamine reactions, estrogen metabolism and insulin resistance. All these parts of our health are affected in perimenopause as we’ve already identified.
So it makes sense to do whatever we can to support healthy gut bacteria in perimenopause and this is quite easy if you enjoy vegetables, nuts, seeds and legumes, because the fibres from these foods are fuel for healthy gut bacteria.
To improve your microbiome I recommend eating at least 7 different vegetables every day and ensuring a wide variety of at least 40 types of vegetables throughout the year, season by season. If you struggle to eat vegetables, you might like to read my blog how to eat more plants.
Herbal medicine for perimenopause
When I think about the herbal medicines that I might use for a women in perimenopause there are about 30 that come to mind. It’s wonderful as a herbalist to have such wide ranging choices and it allows me to tailor each formula to an individual, and change the formula as perimenopause progresses and the symptoms evolve.
– Supplements for perimenopause –
I aim to support women to get as many of the nutrients they need in perimenopause with food. I spend a lot of time with clients discussing food and providing recipes and simple shopping and cooking ideas to see you through perimenopause. As a mum of 3, I have learnt how to make changes to family meals that are well received by the rest of the family.
Some situations require supplements because it’s hard to get enough of the nutrients from food, especially if you are a vegetarian
Emotional support during perimenopause
Flower essences for emotional support
As our hormones change in perimenopause, our brain rewires to accomodate the changes in hormones. This can have a troubling effect on our emotions and some women can swing from calm to angry in minutes. This is normal in perimenopause, you haven’t had a personality change and the emotional rollercoaster won’t last forever.
As hormones change in perimenopause no longer experience the same levels of oxytoxin, a hormone that helps us to bond with our babies and care for our children and partners. Women often just don’t feel the need to care for others as we did in our 30s and 40s. Many women in their late 40s and early 50s start to rethink the way they live their lives and this can bring many benefits. Initially however the emotional changes can be hard.
I work with flower essences to support women to shift any negative emotions they have about ageing and experiencing menopause. Working in this way can be a game changer for some women. I use Australian Bush Flower Essences in my clinic, however there are many other wonderful flower essences to try.
Mental health and perimenopause
Perimenopause is a typical time for women to be prescribed anti-depressants. Your lifetime risk of anxiety and depression increases with perimenopause and then reduces again after menopause.
The brain changes and emotions you feel are natural and can be helped by supporting progesterone and estrogen levels naturally. For some women, seeing a therapist is also of immense support.
Menopause and old age have been emotionally linked together for way too long. We are all ageing, this is a biological process that we can’t change, however we can affect the way we age with our lifestyle and dietary choices.
Perimenopause isn’t a result of ageing, it’s part of our hormonal lifecycle in the same way puberty is a natural transition. Menopause is a natural reproductive process that allows us to take a rest from menstruation and child bearing after many years of periods.
Actions to take for a gentle transition to menopause
Well done! You’ve made it all the way to the end of this guide! I just want to leave you with a bit of a summary and a few points to remember so you can take action for a happier perimenopause:
1. Remember that perimenopause has a pattern and by understanding what stage you are in, you can decide what type of support you might need.
2. Try to accept or even embrace the changes and freedom that comes with menopause. Emotional acceptance is one of the keys to a smooth transition.
3. Try to set boundaries and reduce the number of things you say ‘yes’ to. Stress is the number one thing that can make perimenopause symptoms worse.
4. Be discerning about health advice. Stay clear of generic diet advice, particularly advice that might be helpful for men or younger women. Question your doctor about any diagnosis or recommended medication when you’re over 40 to check that the symptoms you’re experiencing aren’t perimenopause related.
5. Find a herbalist that you like and trust. You may not need herbal medicines to help you with perimenopause, but in my experience, most women can benefit from a gentle herbal remedy at least once or twice during perimenopause to manage the symptoms of fluctuating hormones.
If you would like to talk to someone about transitioning through perimenopause naturally, please enquire about a consultation with me. I would be delighted to help you experience a natural perimenopause.