Menopause & perimenopause

Perimenopause — the beginning of hormonal change

by Marcelle Pick, OB/GYN NP

• What are the symptoms of perimenopause?
• How hormonal imbalance develops in perimenopause
• How long does perimenopause last?
• What you can do to relieve your symptoms

Up until recently, conventional medicine has had little to offer women suffering from symptoms of hormonal change. Until a woman was deemed officially in menopause and could be prescribed synthetic hormone therapy, she was often told her symptoms were all in her head. Even today, women struggling with hormonal imbalance are frequently sent home with a prescription for antidepressants, rather than being offered real solutions for a very real condition.

In integrative medical circles, there has long been recognition that a transitional period exists before menopause that is different for each woman, when fluctuating hormones can cause her serious distress. Thankfully, conventional medicine has caught up, and we now have an official name for this passage in medical textbooks: perimenopause. By definition, this is the transitional period of time that precedes menopause, as in “pre-menopause,” that is often symptomatic of hormonal imbalances and fluctuations in a woman’s body.

What are the symptoms of perimenopause?

Symptoms of perimenopause can begin as early as 10–15 years before menses completely stop. Women in their mid to late 30’s, 40’s, and early 50’s may transition in and out of a perimenopausal state many times before they finally enter menopause. If you are currently experiencing such symptoms of hormonal imbalance as irregular periods, heavy bleeding, hot flashes, sleep disruption, headaches, dry eyes, vaginal changes, hair loss, weight gain, loss of libido or extreme emotional distress, it may come as a relief to know that these are all common signs of perimenopause.

Along with the more obvious changes listed above, many of my perimenopausal patients find short-term memory impairment or a lack of focus to be very irksome. These cognitive effects of hormonal imbalance are frequently overlooked in mainstream discussions about perimenopause. Yet fuzzy thinking and difficulty with multitasking can definitely be traced to your physical state, as can increased anxiety, fatigue, depression and drastic mood swings. These symptoms are signals being thrown up by your body, to make you stop in your tracks and take notice. New mothers often remark upon the brain fog that comes over them, affording them only the attention span to focus on their new baby. A similar phenomenon occurs with the hormonal fluctuations leading up to menopause — except that now the miasma of your hormones is telling you to stop and pay attention to yourself!

It may be reassuring to remember that a woman’s body, mind, and spirit are always in flux, always changing — especially in the years that surround puberty and perimenopause. Just as you can be “pubescent” as you enter womanhood, you can be “perimenopausal” as you advance into the second half of your life. But these two words are simply labels, not a rigid definition of who you are, what your body is capable of, or who you are going to be.

Hormonal imbalance in perimenopause

During perimenopause, the ratio of estrogen to progesterone in the body is frequently in a state of flux. This can manifest, along with other symptoms, as irregular periods or very heavy (and maybe even frightening) bleeding. In our culture, many women tend to be operating with an internal hormonal balance tipped toward the estrogen side of the scale. This tilt is often the result of a diet high in refined carbs and low in quality protein, a lack of essential nutrients and fats, and chronic exposure to environmental toxins and artificial hormones such as endocrine disruptors. Prolonged emotional and physical stress, which I define as anything that works against your state of balance, will also upset the hormonal applecart. In today’s fast-paced, disconnected, eat-and-run world, it is no surprise to me that younger and younger women are coming in to my practice with symptoms of hormonal imbalance and perimenopause.

In some cases, women in perimenopause may have low levels of progesterone in comparison to their estrogen levels. In other cases, the progesterone level is fine, but estrogen levels are high. Another pattern we are seeing more frequently is where all three of the key sex hormones — estrogen, progesterone and testosterone — are low. What’s most important to recognize is that each woman needs to be evaluated as an individual, ideally by a medical practitioner conversant in integrative or alternative medicine. More often than in the past I now find conventional doctors willing to discuss the reality of perimenopause, but natural, long-lasting solutions are still hard to come by. Most conventional practitioners have limited faith in their patients’ ability to adopt healthier lifestyle and eating habits. My response is that I know and have seen that they can. And I will tell you this: no woman needs to suffer with symptoms of hormonal balance, at perimenopause, menopause, or after menopause. You can feel better, and you can start right now.

How long does perimenopause last?

Being in perimenopause does not necessarily mean that you will follow an immediate or direct path into menopause. Some women persist for years in this transitional state, whereas others sail through in a matter of months. What seems to influence the severity of symptoms most is the weight of other burdens that a woman’s body has been carrying over the years. Poor nutrition, chronic stress, and a lack of regular exercise are three major amplifiers, because they each play a significant role in the body’s ability to detoxify and maintain homeostasis. Lifestyle choices such as smoking or drinking to excess are likewise compounding factors.

Another hidden element of perimenopause is fear. Many women are terrified by the prospect of losing their biological fertility, just when stress and low testosterone may be zapping their libido. Our youth-obsessed culture can be extremely hard on aging women, but I have witnessed the dynamic transformation that regularly takes place in my patients. The joys of life after menopause are limitless — especially when you’ve learned to address the symptoms leading up to it!

What you can do to relieve your symptoms

After more than 20 years of helping women with their premenopausal issues, I understand firsthand women’s frustration with the way healthcare is often delivered. With public health research suggesting that for the first time in history, our children’s life expectancy may be shorter than our own, the time is ripe to make some changes in the way we care for ourselves — changes that aren’t oriented toward drugs. I’ve found that a combination approach, one that takes into account all four corners of a woman’s foundation of health, provides the most relief. That’s why I created the Personal Program, to give women the basic tools necessary to navigate the confusing waters of perimenopause: optimal nutrition, hormonal balance, mindful exercise habits, and emotional support.

By taking our Essential Nutrients and using our Herbal Equilibrium as directed, Members have taken the initial steps toward healing their bodies and restoring their natural hormonal balance. Frequently they then find the energy and will to make lifestyle and dietary changes that dramatically improve their quality of life. Many write to us to describe their transformation. I encourage you to read these women’s stories for yourself, and to learn more about your health in our health topics section.

Wherever you may be on your journey through perimenopause, the symptoms you feel will ultimately influence your actions and reactions. So take our hormonal profile and learn for yourself what proactive steps might be most beneficial to you. Know that you do have the power to help yourself during this time, and that we are always here to help.

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References & further reading on perimenopause

 

Last Modified: 09/02/2010
Principal Author: Marcelle Pick, OB/GYN NP