Perimenopause is a 10-13-year time frame between when your cycles are normal and menopause – when they stop completely around age 45-55 – for one year. This is where the ovaries make less estrogen and have fewer eggs to release, which means there might be cycles where ovulation doesn’t occur at all (anovulation), skewing the ratio of estrogen to progesterone. It can start as early as the mid-30s but symptoms are more commonly experienced by the majority of women in their ‘40s. Every woman eventually goes through this phase of declining hormones but the majority don’t even know what the term means or don’t understand the full scope of this reproductive rite of passage (aka 2nd puberty). Once you start noticing changes such as irregular periods (mid-cycle spotting, heavier or lighter than normal), irregular cycle length (either shorter or longer), moodiness (short temper or even rage is common), shifts in memory (brain fog is common), stubborn weight, anxiety (often one of the first signs), depression, low libido, insomnia, night sweats, or hot flashes – you might be perimenopausal.
Perimenopause and menopause are not interchangeable terms and once women understand the distinction, they are better prepared for the rollercoaster ride that declining levels of estrogen and progesterone can be. One major problem with perimenopause is that it isn’t easy to explain because it is a complex process and no two women experience it the same. And to make it more confusing, perimenopause symptoms can come and go, so it’s no surprise that a woman might not recognize the symptoms she’s experiencing as perimenopausal symptoms. For example, she might chalk up the extra anxiety she feels or the sleepless nights to plain old general life stress – but what is really happening is that hormonal fluctuations are having a disruptive effect on the hypothalamic-pituitary-adrenal (HPA) axis – which is responsible for the stress response. And as stress hormones become imbalanced, women may experience mood swings, increased anxiety, depressive symptoms, and feel extra irritable or ragey.
Another problem is that perimenopause isn’t part of the curriculum of any traditional medical school – which is why many physicians only offer up antidepressants or hormonal birth control when their perimenopausal patients come in with their wide-ranging symptoms. They also might offer synthetic (created from pregnant horse urine) hormone replacement therapy (HRT) when symptoms become intolerable.
What to know about Hormone Replacement Therapy
You may have heard of the controversy highlighting an increase in breast cancer occurred after taking conventional HRT – a misinterpretation of a 2002 study called the Women’s Health Initiative – however the occurrence of breast cancer deaths was not significantly increased in the treatment group relative to the placebo group. It is very important to remember that most studies have involved pharmaceutical hormones (because that’s where the money is) that are not identical on a molecular level to what the human body produces. While a giant study hasn’t been performed since, the proof is in the pudding when women are feeling loads better after being treated with hormone replacement therapy.
From a functional nutrition perspective, bioidentical hormone replacement therapy makes the most sense since the term “bioidentical” – when used in regard to estrogen and progesterone and other important hormones – simply means that molecule for molecule they are absolutely “identical” to hormones produced by the human body. Bioidentical hormone replacement therapy (BHRT) can reduce perimenopausal symptoms and “rebalance” the erratic hormone levels experienced in this phase. Studies have also shown that use of BHRT can reduce a woman’s risk of developing heart disease, osteoporosis, memory loss and even cancer. Many women also report that they sleep better, are less depressed and prone to anxiety, as progesterone in particular can have a marked calming and mood-stabilizing effect – bioidentical progesterone is an excellent place to start if you have these symptoms during perimenopause (consult with your practitioner first).
The bottom line is that you’re not imagining any of your symptoms — women’s hormones do some really weird stuff in their late 30s and 40s and you might even feel a subtle shift in identity as a result. I don’t want you to think you’re going to have to start sticking your head in the freezer to stop a hot flash or that you’re old now…just know that your body is changing and there are natural ways you can optimize perimenopause and probably feel better than you’ve ever felt before. The key to handling erratic and declining hormones is to understand what your options are. And the reality is you won’t hear these things from your conventional doctor, but lifestyle, stress, sleep, and modern life all impact whether your experience with perimenopause will be rocky and chaotic, or smooth and easy.
Knowledge is empowering
To enter this phase of life with confidence, it’s a good idea to track your cycle and symptoms. You can use an app or just log in your journal. Take notice of what symptoms are and when they occur. Log start and end dates of each period and any spotting that occurs. This information is key to learning about what your hormones are up to and relaying that information to your healthcare practitioner. As for hormone-level testing, this is best done BEFORE symptoms are extreme to get a “blueprint” of sorts. In my practice I offer a few different functional labs (DUTCH Complete, Extended Female Hormone Panel, Perimenopause Panel) that can give us insight of which I’ll use as a guide when making diet, lifestyle, and targeted supplementation recommendations that may include bioidenticals.
Perimenopause is a natural phase of life that doesn't have to be feared or misunderstood. Be gentle with yourself and try to understand what's happening to your body to make the journey more manageable. The more you know, the easier it will be to navigate perimenopause and embrace this new phase of life with confidence, resilience, and grace.