Menopause & perimenopause

Perimenopause — what to expect and how to feel the way you want

by Marcy Holmes, NP, Certified Menopause Clinician

• Why hormonal imbalance in perimenopause causes symptoms
• Relieving perimenopause symptoms — naturally

During a daily e-mail exchange between sisters, a 43-year-old friend of mine shared that she had been talking with her healthcare provider about perimenopause. Just seconds later, her (slightly) younger sister shot back a response — “Isn’t it too early to be thinking about this?!”

But after months of exhaustion, crazy mood swings, creeping weight gain and just not feeling like herself, my friend was relieved to learn that these are actually symptoms of perimenopause.

Whether you call it pre-menopause or perimenopause, the lead-up to the midlife transition can be a scary time, one that’s different from woman to woman. Your changing hormones can set off any number of symptoms which often vary wildly in severity and frequency. This unpredictability can be shocking and unsettling, especially if you think you’re too young for perimenopause.

Understanding what’s happening in your body is a critically important step that will ultimately lead you to the right solution for feeling your best in perimenopause — and beyond.

What is perimenopause?

Perimenopause is defined as the natural transition period preceding menopause that is often symptomatic of hormonal imbalance and fluctuations. In many ways it is the flip side of puberty, beginning as early as our mid 30’s or as late as our 50’s for some. Most often it starts during our mid to late 40’s, leading to menopause at an average age of 51 in the US.

And like in puberty, perimenopause is when our hormones fluctuate far more than they do during less “eventful” years.

What’s not normal is for the fluctuations to become so extreme or erratic that they make your life miserable. That’s not perimenopause — that’s hormonal imbalance!

Why does hormonal imbalance in perimenopause cause symptoms?

In perimenopause, hormonal imbalance results when our sex hormone levels fluctuate too widely or too quickly, outside the range that your body can manage. (See chart above.) There are also changes in the cycling and ratios between estrogen, progesterone, testosterone, DHEA, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

Fortunately, our bodies have back-up systems to compensate for these changes. But the cumulative effects of poor diet, chronic stress, lack of sleep, too little exercise, and environmental toxins often undermine our bodies, and then our sex hormones get pushed out-of-sync. Once this happens, the problem tends to escalate over time, unless you offer your body the kind of support it needs to restore hormonal balance.

With imbalance, you may experience symptoms, such as irritability, irregular periods, weight gain, menstrual migraines, fatigue, poor sleep, and a whole lot more. I’d also like to point out that these symptoms might appear before you notice anything different about your periods — though the problems are certainly compounded when they start to coincide with erratic periods.

When does perimenopause start (and how do you know)?

There actually isn’t a precise time for perimenopause because it’s really more of a progression than a series of specific events. You might start to notice symptoms as early as 10–15 years before your period completely stops. Or just a few months or years before you’re “officially” in menopause — that is, when you’ve gone a full 12 months without periods.

When women ask me how they can be sure they’re in perimenopause, I suggest they let their symptoms tell them. Are you experiencing symptoms that may be affecting your life, but in a way you can manage? Then you may well be experiencing perimenopause.

If in contrast, your symptoms are so frequent or severe they’re affecting your ability to enjoy life or relationships, you’re most likely suffering from hormonal imbalance. Somewhere in between? You could still feel a whole lot better given a little more support!

Who will have more severe hormonal imbalance in perimenopause?

Women carrying extra burdens tend to have more extreme hormonal imbalance. And in my experience, the greatest burdens to your health relate to chronic stress and emotional issues. If we describe our life as a journey, I think perimenopause is like standing at the baggage claim. Chronic stress and unresolved emotions are like baggage that we need to handle now, or it just keeps on circling around.

For example, we know chronic stress can amplify the effects of changing sex hormone and neurotransmitter levels in perimenopause and menopause, as well as the ratios between these hormones, resulting in more dramatic symptoms.

Also high on the list of burdens are spotty nutrition, inadequate sleep, and sedentary lifestyle. These factors can escalate symptoms in perimenopause because they reduce your body’s natural ability to detoxify and maintain balance. In today’s fast-paced, disconnected, eat-and-run world, it’s not a surprise that younger and younger women are experiencing perimenopausal-type symptoms of hormonal imbalance because of these factors.

Finally, our clinical experience is that women who already have intense PMS — itself a sign of hormonal and neurotransmitter imbalance — may be more predisposed to hormonal imbalance in perimenopause.

How can I relieve my symptoms?

Perimenopause and menopause share many of the most common symptoms. I’ve found that the most effective approach to relief covers the foundation of women’s health: a deliberate diet, enjoyable exercise, rest and relaxation, herbs and nutrients targeted to hormonal balance, and solid emotional support. I’ve seen this combination make all the difference with my patients. And it’s what we’ve been practicing at the Women to Women clinic for more than 25 years!

At Women to Women, we start with a pharmaceutical-grade multivitamin-mineral complex like our Essential Nutrients to provide the key levels of micronutrients your body requires — but which are often lacking in our diets. Such targeted nutritional support may be enough to begin healing your hormonal pathways. If not, we recommend gentle phytotherapy as your second step (our Herbal Equilibrium is specially formulated for women transitioning through perimenopause). Medicinal herbs support the body’s ability to restore hormonal balance by mimicking hormonal actions at a molecular level. They also interact with your body’s tissues to facilitate natural hormone regulation.

Most women find that adding high-quality nutrients and phytotherapy is enough. Others need more support to reach ideal symptom relief. This can mean adding more essential fatty acids, or amino acids like 5-HTP, or complementary therapies like acupuncture or chiropractic, just to name a few possibilities. Different women have different needs, so you may want to work with a practitioner to decide which added therapies would help you.

From denial to transformation

I understand that perimenopause can be difficult for women at first. Some women wonder if they’ve waited too long to have children. Others see it as the “beginning of the end” in our youth-obsessed culture. But you don’t have to accept anything short of optimal health and balance for yourself! One woman told me she was “in denial” for years before finding relief for her physical issues — and, ultimately, peace of mind about her place in the world.

Wherever you may be on your journey through perimenopause, the symptoms you feel will ultimately influence your actions and reactions. I encourage you to choose not to let your symptoms define you during this stage of your life.

Know that you do have the power to help yourself during this time. And we are always here to help. For many women, it is a wonderful time of growth and transformation!

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Last Modified Date: 07/02/2012
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician