After about age 35, women move into the life phase known as perimenopause, which marks the start of the body’s slow and gradual menopausal transition towards eventually achieving menopause. Menopause is reached after a woman has gone 12 consecutive months without having a period, and the journey to that point can be a rocky one, this is perimenopause.
In simple terms, perimenopause is characterised by changes in the behaviour of oestrogen along with a decline in progesterone (you can read my perimenopause 101 blog here to learn more).
Understanding Perimenopause
What is Perimenopause?
Perimenopause is the natural phase of womanhood where your hormones are starting to shift and change as your body starts its slow and gradual transition towards eventually going 12 consecutive months without a period, also known as menopause.
Your body moves into this phase from mid to late 30s and it’s common to start noticing perimenopause symptoms or changes relating to it from early to mid 40s.
Perimenopause occurs typically in a woman’s 40s, but it can begin as early as the mid-30s for some, marking the onset of irregular menstrual cycles and hormonal fluctuations.
Common Perimenopausal Symptoms
Perimenopause is often accompanied by a range of symptoms that are physical, emotional, and cognitive, including:
- Mood changes: Mood swings, anxiety, and depression.
- Sleep disturbances: Difficulty sleeping or insomnia.
- Heavier periods: Sometimes with clotting and flooding
- Breast Pain: This can be in the lead up to your period and or for the entire luteal phase
- Irregular periods: Changes in menstrual cycle length, frequency, and heaviness.
- Hot flushes: Sudden feelings of heat, often accompanied by sweating and flushing.
- Night sweats: Hot flashes that occur during sleep.
- Vaginal dryness: Decreased estrogen levels can cause vaginal dryness and discomfort.
- Weight gain: Many women experience weight gain during perimenopause, particularly around the midsection.
These symptoms can vary in intensity and frequency, making each woman’s experience of perimenopause unique. Understanding these changes can help in managing them more effectively.
It’s Not Only About Oestrogen and Progesterone: Understanding Perimenopause Symptoms
Perimenopause isn’t only an imbalance between oestrogen and progesterone. It’s a phase in a woman’s life when many other hormones and systems are being disrupted, which is causing various metabolic shifts that affect her physically, mentally, and emotionally. It’s a WHOLE body systems shift and so we need to take a WHOLE body systems approach when looking to support the body through it. Alongside making nutrition and lifestyle changes, hormone therapy can be an effective way to manage some of these hormonal changes and alleviate symptoms.
Not only is oestrogen erratic (and higher) and progesterone declining, we also have more cortisol, less stable blood sugar, more insulin, less muscle mass, and less thyroid hormone. Furthermore, digestion can be disrupted and there can even be some immune dysregulation and more inflammatory processes at play.
This all starts to bring symptoms that you likely didn’t have to deal with 10, 5, 2 and even 1 years ago. You might notice that you’re reacting differently to certain things in your 40s such as your exercise, late nights, certain foods, alcohol, and stress.
Sound familiar?
Address Your Health and Lifestyle: Perimenopause Support
The more areas of our health and aspects of our lifestyle that need attention (e.g., stress, sleep, gut, work, finances, relationships, alcohol consumption), the more symptoms we will feel.
In your 20s and first half of your 30s your hormones were way more resilient than they are in your 40s. In your 20s and 30s they were less likely to be knocked off balance by factors such as how you exercised, late nights, alcohol, watching TV until late, certain foods/eating styles, and stress.
In perimenopause it’s a different story. Here your other hormones are less resilient and they really do start reacting to your nutrition and lifestyle choices.
This is good news as it means making positive changes to your nutrition and lifestyle habits can make a BIG difference to your experience of perimenopause by significantly minimising and even eliminating some or all of your symptoms! Adopting a perimenopause diet can help manage symptoms and improve overall health during this transitional phase.
The Shifts in Oestrogen and Progesterone’s Impact ALL Body Systems: Hormone Balance in Perimenopause
In your 40s, oestrogen gets erratic (sharp highs followed by sharp drops) and you don’t manage to ovulate as many months as you did before. This results in no progesterone being made in those months. This leaves oestrogen alone to dominate your entire cycle instead of being balanced out by it’s partner hormone.
This new hormonal landscape picture comes with consequences. In the early part of perimenopause (late 30s to mid 40s), oestrogen is actually higher than ever before, sometimes even by 3-fold!
Oestrogen only actually starts its decline in the later part of 40s (sometimes mid 40s but more commonly later).
Whether a person is in the higher or declining oestrogen stage, it’s always erratically fluctuating. It’s actually progesterone that we start to lose first, not oestrogen. Hormone replacement therapy can be considered to manage these hormonal shifts and alleviate symptoms.
The Impact of Oestrogens Erratic Fluctuations
The sharp drops: Insulin resistant cells, brain fog, dip in mood, migraines, hot flushes, weight gain, anxiety, irritability.
The high points: Heavy periods, clots, breast pain, mood swings, headaches, histamine reactions, weight gain.
Here are some things to address to support oestrogen balance
1) Taper the oestrogen rollercoaster and higher oestrogen levels
by supporting the detoxification processes in your liver responsible for clearing out used oestrogen. This keeps things as balanced as possible.
There is a specific enzyme called COMT (Catechol-O-methyltransferase), which needs to be working well for this detox process to work efficiently. There are also a couple of important pathways called glucuronidation and methylation that are crucial here.
Click here to read my blog on how to support oestrogen detoxification.
These hormonal fluctuations can also lead to changes in blood pressure levels, which can be managed through lifestyle and dietary adjustments.
2) Care for your gut microbiome
This is the collection of bacteria that live in your gut. An unhealthy balance of bacteria here increases the chances of used oestrogen being sent BACK into your body for circulation and the more more symptoms of ‘unopposed’ oestrogen. Less than once daily bowel movements can also increase oestrogen in circulation. Read my blog on the gut and oestrogen clearance here.
3) Reduce your exposure to/intake of ‘endocrine-disrupting chemicals’
Also known as xenoestrogens, such as plastics, pesticides, and chemicals found in commercial body and hair care, perfumes, and household cleaning products and detergents.
They contain chemicals that ‘look like’ oestrogen and once inside the body they take the place of real oestrogen inside the cells, causing hormone havoc and increasing your total load of oestrogen.
- Filter your water
- Use glass, ceramic or stainless steel for cooking, heating, storing and drinking
- Switch to cleaner skincare brands such as Green People, Antipodes, Sukin, Ren, Neal’s Yard and Tropic and cleaner household cleaning and detergent brands such as Bio-D, Method and Attitude.
The Impact of Declining Progesterone
Progesterone gradually starts declining from your mid or late 30s but the decline is more significant around mid 40s.
You only make progesterone when you ovulate and ovulation becomes harder and harder to achieve the further through your 40s you go.
In the earlier part of perimenopause you might start having the occasional cycle where you didn’t manage to ovulate, which might not be so impactful.
But as you move through your 40s, non-ovulatory cycles become more and more likely, leaving you progesterone deficient more months than not.
The decline in progesterone can also increase the risk of cardiovascular disease, making it important to monitor heart health during this phase.
Symptoms you might start to notice as a result of not making progesterone include:
- Trouble falling and or staying asleep at night, disrupted sleep
- Anxiety that’s particularly heightened, increased feelings of stress
- Lowered immunity (even autoimmunity in some cases)
- Shorter menstrual cycles, spotting between periods, heavier periods including clotting and flooding
- Irritability and low mood
- Breast pain
- Fatigue (brain and body), headaches
- Water retention/all over bloating
- Changes in cognition or memory
The good news is you CAN support your body to ovulate (so that you make progesterone) more months than it would have done without the intervention.
Here are some things to address to support progesterone levels:
1) Stress is one of the biggest reasons why we might not ovulate some months and it HAS to be the first thing to address
Look at areas where you can make changes that can help to reduce your life load, and then start to nourish and support your nervous system DAILY to cope better with the inevitable stressors of modern life.
Simple daily restorative habits such as deep breathing exercises and meditation (even 3-5 minutes a day has been shown to be impactful), mindful walks through nature/green spaces, yoga (even 5-10 minutes), more laughter and joy, and talking and somatic therapies are all powerful ways to do this.
2) Support insulin sensitivity (read my blog on this here)
because insulin resistance can cause irregular ovulation or even block it completely. This is all about supporting good blood sugar regulation via your diet, sleep, stress, exercise, alcohol etc.
3) NOURISH your body
The ovulatory process is energy, calorie and nutrient-expensive. This ISN’T a time to be low calorie or low fat, or to be eating one meal a day or “OMAD” – please no!!
You must be well nourished. Eat ENOUGH food/calories coming from a variety of quality protein sources, healthy fats, colourful veg and complex/slow-release carbohydrates.
This will allow you to get adequate macronutrients and also the key micronutrients needed for ovulation to occur successfully such as all of the B-vitamins, coQ10, vitamin D, iodine, magnesium, selenium, zinc. You also need adequate cholesterol to make progesterone after ovulation so don’t avoid cholesterol foods!
4) Support your thyroid health
An under-active thyroid gland robs your ovaries of the cellular energy they need to ovulate and elevates prolactin, a hormone that suppresses ovulation.
Check your thyroid health markers by way of a FULL thyroid panel that includes not just TSH and T4 PLUS Free T4, Free T3, Total T4, Total T3, Reverse T3, and thyroid antibodies (TG and TPO).
Your doctor will likely only test for T4 and TSH so for a full thyroid panel you can go via FunctionalDX or Genova Diagnostics labs, which are practitioner-led only so you would need to be working with someone like myself or similar. Or, you can go it alone and order a Thyroid Panel with Medichecks, (which doesn’t include the marker for Reverse T3).
What about when ovulation just becomes too hard for the body to achieve regardless of making these changes? Managing menopausal symptoms
This is when you might want to speak to your doctor about taking body identical (NOT a progestin) progesterone.
In the earlier stages of perimenopause the answer is likely not to use both progesterone AND oestrogen HRT because remember I said that in the earlier years oestrogen is still high and sometimes MUCH higher than it ever was.
Certain lifestyle factors can make perimenopause symptoms worse, so it’s important to manage these effectively.
NOTE: The “progesterone” found in the hormonal IUD or oral contraceptive/hormonal medication is NOT progesterone in it’s natural, body identical form, rather it’s in the form of progestin which is an synthetic form with a different molecular structure to progesterone and so it doesn’t different (not so helpful) things in the body.
I hope you can see how important it is to support the body on a holistic level rather than simply look to fix one hormone or system.
A 360° approach is needed as per my diagram below.
Nutrition and Lifestyle Changes
A Healthy, Balanced Diet for Perimenopause:
A well-balanced diet is essential for managing perimenopausal symptoms and supporting overall health. A healthy diet for perimenopause should include:
Omega-3 fatty acids: Found in fatty fish, flaxseeds, and chia seeds, these healthy fats support heart health and reduce inflammation.
Plenty of fruits and vegetables: Rich in antioxidants, fiber, and essential vitamins and minerals.
Whole grains: Brown rice, whole wheat bread, quinoa, and oats provide sustained energy and fiber.
Lean protein: Include sources like poultry, fish, beans, and lentils to support muscle mass and bone health.
Healthy fats: Nuts, seeds, avocados, and olive oil provide essential fatty acids and support heart health.
Calcium-rich foods: Dairy products, leafy greens, and fortified plant-based milk support bone health.
