Menopause & perimenopause
Symptoms of hormonal imbalance in perimenopause
Some of the most common symptoms include:
- Hot flashes
- Depressed mood
- Weight gain
- Fuzzy thinking
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Perimenopause — what to expect and how to feel the way you want
by Marcy Holmes, NP, Certified Menopause Clinician
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.
Our perimenopause symptom solution
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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
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.
It’s normal to change
This diagram illustrates normal variation in sex hormones across a woman’s lifespan.
Our bodies manage changing levels of hormones throughout our lifetime. However,
when changes are most dramatic — such as during pregnancy or perimenopause — our
bodies may need extra support to stay in 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
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!
Feeling good in perimenopause
“I can’t believe how wonderful I feel. I also found a new doctor and told her about
the supplements I was taking and she approved. I recommend your website to all my
— Ellen Personal Program Member.
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
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