As women move into perimenopause, they begin to experience irregular or heavy periods, mood swings and/or depressed feelings, mysterious weight gain, lower libido and even adult acne. The way these symptoms present is very specific to perimenopause and normalizing your hormonal activity now will help your body calm the confusing endocrine changes that are the signature of perimenopause.

Hormone replacement therapy for perimenopause symptoms?

I occasionally recommend bioidentical hormones (bioHRT) for severe perimenopause symptoms such as insomnia, hot flashes and menstrual migraines. Often I choose progesterone alone to balance out surging estrogen levels. That's because research has shown that treatment with estrogen can cause heavier flow, worsening mood swings, and more breast tenderness, and does not seem to kindle sexual desire. If you’re like many women, you can find lasting, natural relief by rebalancing your hormones with one of our Hormonal Health Packages.

What happens to your hormones in perimenopause?

As your hormone production begins to shift, anytime between ages 35-50, you will feel it as symptoms. Inside, your metabolism is slowing, your moods spike and plunge erratically, and you feel more stressed more often, and less resilient. Sex becomes a take-it-or-leave it activity. Many women feel these effects but are unaware that that they are actually the symptoms of perimenopause, mostly because they’re still menstruating.

As noted in the British Medical Journal, “The paradox of perimenopause is that estrogen levels soar and become erratic before they eventually settle into the low, stable levels of menopause. That’s why the onset of perimenopause is really based on characteristic changes (symptoms) that likely result from these hormonal changes in women with regular flow. ”

There are at least three hormonal changes in perimenopause, starting with a rise in estrogen levels. Then, progesterone levels drop and the luteal phase (last part) of your menstrual cycle gets shorter. You don’t ovulate as often (anovulation) though you still have periods. The third and final stage leads to real hormonal imbalance as progesterone drops, and levels of your primary sex hormone, estradiol, become higher. That’s why perimenopause symptoms tend to get worse if left unaddressed.

Women’s Health Network solutions for five perimenopause symptoms

Dr. Sharon Stills

1. Irregular or heavy periods are hallmarks of perimenopause, but dealing with them is very stressful. You may have normal periods for a while and then have months when your flow is so heavy you can't leave the house, sit in a meeting, or go on a trip. Your period may last three to four days or two weeks. You may skip an entire month or spot between periods. Your period could come every 28 days — or every 45 days.

Heavy periods are especially difficult, sometimes leading to iron-deficient anemia. Researchers say these occur when there is not enough progesterone to balance the effect of estrogen, leading to a thicker uterine lining that is shed as heavy periods. Abnormally heavy menstrual cycles in perimenopause involve wildly fluctuating hormone levels and months in which you may not ovulate, which is associated with inconsistent periods. If your period changes to seven days or more in length, and that lasts a while, you’re likely in early perimenopause. If you go 60 days or more between periods, you're likely in late perimenopause.

Address irregular or heavy periods by: balancing your hormones with an approach that involves gentle herbal coaxing to affect your levels of estrogen, testosterone and progesterone. Keep track of all menstrual occurrences on a calendar to chart your progress through perimenopause. Pay close attention to your food choices, using our healthy eating guidelines as a foundation, and maintain or even increase your exercise frequency.

Key tip: ramp up your intake of calcium and vitamin D because calcium deficiency contributes to heavy and/or irregular periods and vitamin D lets your body absorb and use the calcium. Supplement with 1000-1200mg of calcium per day and between 2000-4000 IU of vitamin D.

2. Mood swings and depressed feelings often appear at the onset of perimenopause, sometimes for the first time in a woman’s life. For many, this is due to higher levels (up to 34% higher than younger women, and 16% higher than menopausal women) of a specific brain protein, monoamine oxidase A (MAO-A), in perimenopausal women. MAO-A breaks down serotonin, norepinephrine and dopamine — the very same brain chemicals that help maintain normal mood. That’s why high levels of MAO-A are strongly linked to mood swings, crying and depression.

“I'm what is known as perimenopausal."Peri” — some of you may know — is a Latin prefix meaning 'SHUT YOUR FLIPPIN' PIE HOLE’.”

Celia Rivenbark
author and humorist

During perimenopause, you may feel super-sensitive to things that never fazed you before, or shun activities you used to enjoy. Some women feel “blah” or reclusive, with very low energy. You may be more impatient at home and less willing to accommodate others. These feelings can make perimenopause an isolating time in your life.

Address mood swings and depressed feelings by: building a new emotional safe zone, especially if this is the first time you’ve felt depressed. It’s crucially important to recognize and acknowledge how you feel, and it’s also time to put yourself first, even if you’ve never done it before. Tending to your physical needs can help satisfy many of your emotional requirements as well. Avoid “drug effect” foods like sugar, alcohol, fried foods, and caffeine if you are sensitive to it.

Key tip: Get more rest by going to bed earlier. Your body will get the cue to relax which helps stabilize your mood. If you need help getting to sleep, try natural melatonin.

Dr. Sharon Stills

3. Perimenopausal weight gain — some women call this “instant” weight gain because it seems to happen overnight with no explanation. A combination of factors conspires to make your body accumulate extra pounds in perimenopause but the research clearly points to three main issues, starting with declining hormones, especially estrogen and progesterone. These hormonal shifts can send gained weight directly to your abdomen instead of your hips and thighs.

The next culprit is the muscle loss that is common as women get older. Since muscle burns more calories than fat, losing muscle slows metabolism. When this happens, your go-to weight loss methods won’t work anymore and you’ll pack on the pounds. And finally, when you’re less active physically, as many women become in perimenopause, it allows extra weight to take hold. If you exercise less but eat the same amount, your body won’t burn calories at the same rate, creating an imbalance that leads to weight gain.

Address perimenopausal weight gain by removing just 200 to 400 calories a day by either lowering your total food intake OR exercising a little bit more. Either option will make up for the hormone shifts that shut down the weight loss process in perimenopause. You can cut 200-400 calories simply by eating more fruits, vegetables, legumes and whole grains in place of other foods. These choices provide vitamins, minerals, and other nutrients while naturally lowering your caloric intake and filling you up. Your weight-loss rate will always be tied to your ability to take care of yourself so focus on your overall health and wellbeing — not the weight. This in itself can help restart the weight loss process.

Key tip: Get help for cravings by enjoying specialized protein shakes at snack time, or try a dose of L-glutamine, up to 1000mg, when you eat lunch.

4. Adult acne is another disturbing and unexpected symptom that you may experience for the first time in perimenopause. It’s caused by oil, or sebum, clogging your pores which attracts bacteria and causes inflammation. An imbalance in both “male” hormones and estrogen during perimenopause can cause breakouts as can hormone surges around your period, which tend to intensify in perimenopause. Being stressed and eating hormone-enhanced meat and dairy foods are both associated with skin changes like acne. You can still get acne in perimenopause if your hormones are at normal levels but your hormonal situation will continue to affect the way your skin protects and regenerates itself. And perimenopausal pimples may pop up on dry, sensitive skin that’s tougher to take care of.

Dr. Sharon Stills

Address perimenopausal adult acne by: using Ayurvedic techniques, starting with stress reduction, and strengthening the digestion by avoiding crunchy fried foods, cold drinks, alcohol, coffee and frozen desserts. Stoke digestive fires by consuming soft cooked foods and room-temperature drinks and water. Take a probiotic, because newer research shows that probiotics inhibit the growth of bad gut bacteria that can fuel acne and inflammation. Avoid cleansers, like Cetaphil or Aquanil which contain sodium lauryl sulfate that destroys the natural protective barrier on the skin. For dry skin with acne, mix avocado pulp with olive oil, apply for a few minutes, then rinse. If you have oily skin with acne, use a mixture of cucumber juice and raw organic milk.

Key tip: Spot-treat a breakout with a paste made from turmeric, which is naturally antibiotic and antibacterial. Use ¼ teaspoon of turmeric powder with a little water and carefully apply it to blemishes with a cotton swab.

5. Lower libido is a subtle and gradual effect of the physical changes in perimenopause that can lead to having no interest at all in sex by the time you’re in menopause. The real reason you care less and less about sex is likely to be physical, not emotional. The longer you wait to take action, the more difficult it becomes to restore your libido and if you are in a relationship, this can have dire consequences.

Here’s what happens: Before menopause, sex drive peaks just before and after you ovulate. In perimenopause, estrogen and testosterone dip and you experience fewer of these high-libido days, with less blood flow to the vagina. Your interest in sex begins to decline though you may not even notice it happening. Perimenopause is often a stressful time for women and that can put the brakes on sex drive. Other perimenopause symptoms — depressed feelings, heavy periods, weight gain — worsen low libido and can make it tougher to become aroused when you do want to have sex.

Address lower libido in perimenopause by: Enjoying more foreplay, and trying other kinds of sex, such as erotic massage and oral sex. Definitely take steps to recover hormonal balance as it is directly tied to your sex drive. Many women say that sex during perimenopause is the most satisfying sex they’ve EVER had, but please note, you have to want it first.

Key tip: Don’t wait for the 'urge' to have sex to propel you into the bedroom. Instead be proactive and plan for it regularly either alone, or by having regular date nights with your partner.

Working with your body during perimenopause

Experiencing any of these five telltale perimenopause symptoms can make you feel like a stranger in your own body but addressing the physical needs of your body will allow you to feel better, and look better too. When you respect your own perimenopause timeline, it will help you glide through each phase if you balance your hormones naturally.