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
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
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
eating guidelines as a foundation, and maintain or even increase your exercise
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 others
— 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’.”
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
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.
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.
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
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
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