Just when you’re feeling like you’ve mastered your hormones in your 30s and things are going smoothly, your 40s can throw you a hormonal curveball!
If you’ve moved into your 40s and you’re feeling more tired or fatigued, you’ve got worse PMS symptoms, heavier periods, irregular periods, mood swings, sleep issues, brain fog, anxiety, headaches, hot flushes, night sweats, vaginal dryness.
Rest assured you are not alone! These are some of the typical perimenopausal symptoms we can start to experience, often thought of as the start of menopause symptoms.
You might be thinking, “ am I in perimenopause and what is it exactly?”
Well, you’re in the right place! I’m Francesca, your perimenopause nutritionist. The purpose of this blog is to help you understand exactly what perimenopause is, what’s actually happening to your body, typical perimenopause symptoms, when perimenopause starts, and what you can do to support yourself.
PERIMENOPAUSE 101
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.
Perimenopause is NOT menopause.
It’s everything BEFORE menopause.
A “menopausal” woman is a woman who has already reached menopause (1 day) and is now in postmenopause.
A woman in her 40s who’s still having periods but experiencing perimenopausal symptoms is not “menopausal”, rather she is moving through PERImenopause. Menopause symptoms are actually perimenopause symptoms.
WHAT’S ACTUALLY CHANGING FROM LATE 30S?
As you move past your mid 30s, the communication between the brain and ovaries starts to change.
The brain to ovary communication is what has governed your menstrual cycles since your first ever period as a teen. In your 20s and earlier 30s their communication was fairly robust, but as you move past about 35, the brain and ovaries stop communicating with each other as well or clearly.
This soon starts to result in changes in output of progesterone and oestrogen.
Early menopause can occur due to factors such as family history, medical conditions, and certain lifestyle choices, and it is important to differentiate it from perimenopause and premature menopause.
It Starts With A Decline In Progesterone
In the initial stages of perimenopause, progesterone levels start to decline. This occurs because ovulation starts to occur less during your monthly menstrual cycle. Ovulation is HOW you make progesterone. Changes to oestrogen actually come a little later on.
It’s important to note here that your menstrual cycle can remain regular and ‘normal’ to you, however you are not managing to ovulate as much as before. Also known as “anovulatory” or “non-ovulatory” cycles.
At first it may just be the odd cycle here and there where you don’t manage to ovulate but the further you progress through your 40s, the more non-ovulatory cycles you may have and therefore for more progesterone declines.
Consequences of Low Progesterone
Declining progesterone soon starts to create symptoms related to the nervous system and stress. This is because progesterone is a calming, nervous system supportive hormone.
Symptom we can start to experience related to this inlcude:
- Insomnia or disrupted sleep. For example trouble falling asleep and or staying asleep through the night
- Heightened anxiety or increased feelings or stress / less resilience to stress
- Mood swings and irritability
Other symptoms of low progesterone include:
- Shorter menstrual cycles
- Heavier menstrual flow, perhaps with flooding and clotting
- Sore breasts or swollen breasts
- Fatigue or low energy
- Cyclical headaches, usually a few days before your period
- Difficulty concentrating or poor memory
- Water retention or bloating
For some women it may be helpful to discuss (body identical) hormone therapy for progesterone in their 40s, even early 40s, if such symptoms are troubling.
It is also important to address nutrition and lifestyle factors that support the body to ovulate as well.
Then Comes Changes To Oestrogen
The next characteristic of perimenopause is erratic fluctuations in oestrogen AND higher levels than we saw in our previous decades.
This new oestrogen rollercoaster can see levels of oestrogen rising 3 times higher than ever before then crashing down to really low levels, over and over again throughout the month, often leading to hot flushes.
Couple this with the decline in progesterone levels, and you’ve got the perfect stage set for perimenopausal symptoms, such as heavy periods, breast pain, foggy head or cognition issues, low mood, anxiety, irritability, sleep issues, longer or shorter cycles, headaches, migraines, weight gain, loss of libido, hot flushes, and night sweats.
Diagram showing decline in progesterone, high and erratic nature of oestrogen in early stages of perimenopause, and lower and erratic oestrogen in the later stages of perimenopause.
Perimenopausal Symptoms Resulting From The Oestrogen Rollercoaster
The HIGHS = heavy periods, painful periods, breast pain, headaches, bloating, mood swings.
The DROPS = hot flushes, night sweats, headaches, migraines, low mood, flat mood, low energy and fatigue, low libido, little zest for life, joint aches and pains, vaginal dryness.
Symptoms Resulting From Declining Progesterone
Less stress resiliency, trouble falling asleep and or staying asleep, anxiety, and irritability are the most common symptoms of low progesterone.
Unopposed Oestrogen
Another situation that arises during perimenopause is something known as “unopposed oestrogen” or “oestrogen dominance”. This is a situation that occurs when oestrogen is not balanced out or “opposed” by its partner hormone progesterone.
Progesterone in the calming yin to oestrogens wonderful yang. As progesterone levels are on the decline (due to less and less ovulatory cycles) oestrogen is not only high and erratic but it’s also left unopposed.
Symptoms of Perimenopause Resulting From Unopposed Oestrogen
Heavy periods, painful periods, breast pain, headaches, bloating, mood swings, and new or worse PMS.
When you consider that we move into perimenopause from mid to late 30s and that the average age of reaching menopause is 51 (give or take), I hope you can see that perimenopause is a lengthy, transitional phase.
These stormy waters are eventually followed by a calm after the storm, menopause (1 day). After that 1 day, you are in postmenopause / postmenopausal forever more.
Progesterone hormone therapy (body or bio identical) can be a potential support to relieve symptoms of low progesterone and should be discussed with a doctor to tailor the treatment plan based on individual symptoms and health conditions.
That being said, let’s look at a more detailed breakdown of the various stages from start to finish, with the “finish” being finally achieving / reaching menopause.
THE STAGES OF PERIMENOPAUSE
Very Early Stages of Perimenopause: 38 – Early 40s
Here you may experience subtle changes related to nervous system and mood as progesterone is dropping, such as:
- Very mild changes in mood
- Very subtle changes in things like confidence, sociability, outgoing nature etc.
- Fleeting anxiousness
- No change to menstrual cycles
Early Perimenopause: Early – Mid 40s
Here, progesterone is dropping even more while oestrogen remains high / gets higher, you may experience:
- Menstrual cycle has started to change. Usually shorter in length by 5 or so days
- Flow is heavier, often with flooding or clotting
Mid To Late Perimenopause: Mid To Late 40s
Here, oestrogen levels are fluctuating more wildly AND spiking up to 2-3 times higher than they were before perimenopause. This results in neurological symptoms such as:
- Hot flushes
- Night sweats
- Vaginal dryness
- Brain fog
- Irregular periods as the cycle length gets longer, as ovulation occurs less and less. Cycle lengths can be 60 days plus
Late Perimenopause To approaching Final Menstruation: The Graduation To Menopause
- Oestrogen is now consistently lower
- The turbulent fluctuations are over
- You are almost at the 12 month mark of having had no period
- You’ve reached the 12 month mark (one year following your final period) and you have moved into the most stable hormonal phase
HOW TO SUPPORT YOUR BODY FOR A MUCH SMOOTHER RIDE
Leverage Nutrition And Lifestyle Habits
You have the power to minimise your symptoms or make them go away completely! As long as you know what your body needs in order to support against the rocky hormonal ride of your 40s.
Isn’t that great?!
Perimenopause does not need to be a phase to dread or hate. After all, it’s a natural phase of our amazing womanhood, and we owe it to ourselves to know what’s happening and know how to support ourselves.
I cannot emphasise enough how impactful nutrition and lifestyle habits are on your entire perimenopause experience.
They can improve the severity or intensity of symptoms 10-fold if you know how to leverage them.
You can leverage nutrition and lifestyle habits to:
- Calm the oestrogen rollercoaster as much as possible and shelter your body and nervous system from sharp highs and lows.
- Support your body to ovulate more months than it would have done without intervention (so you can make progesterone more often and minimise its decline).
In my blog called “How To Get Rid of Perimenopause Symptoms” I’ve outlined what constitutes a healthy diet and some of the most helpful habits to start to implement for a much smoother ride. Head here to read it.
Identify And Address Pre-Existing Health Imbalances
Any pre-existing hormonal imbalances or health niggles can set the stage for a more rocky perimenopause, amplifying symptoms. Cancer treatment, such as chemotherapy or pelvic radiation received during childhood, can also influence the timing of perimenopause, leading to earlier onset of symptoms.
The severity of many perimenopause symptoms are a direct consequence of imbalances in hormones such as cortisol and insulin, gut and digestive health issues, hormone metabolism and detoxification issues, nutrient deficiencies, xenoestrogens, and toxins.
This decade (and a bit!) provides a window of opportunity for you to start to address various areas of your health and to really start to focus on your nutrition and lifestyle habits. This is a time to really start to optimise and safeguard your health!
For A Smoother Perimenopause Experience And Graduation Into Menopause You Need:
- A healthy diet that supports good blood sugar regulation, optimal protein intake, and healthy fats
- Good sleep and healthy circadian rhythms
- Good stress management/nervous system support
- Efficient liver detoxification processes, particularly for healthy metabolism and clearance of used hormones
- A healthy gut and good digestion
- Healthy muscle mass
- To identify and address any potential autoimmunity, chronic infections such as mould toxicity, pathogenic gut bacteria or parasites, viruses, or chemical burdens
- To identify and address any nutrient deficiencies such as iron, B12, folate, and vitamin D
- To identify and address any thyroid issues such as under or overactive thyroid hormone production or Hashimoto’s (thyroid autoimmunity)
- Blood work information for markers such as cholesterol, triglycerides, HbA1C, fasting glucose, as well as immune, kidney, and liver markers.
- To understand and address conditions that can lead to premature menopause, such as certain medical conditions or procedures.
One Size Doesn’t Fit All
Sometimes a person simply needs to increase their protein intake with all their meals and they already start to feel so much better. Then they have the energy and inclination to start working on improving their sleep.
Once they’re getting better sleep they want to dig a little deeper and address other areas such as their stress load, their gut and digestive health, and so on.
For some we can stop here, for others we need to go further.
For some women, discussing hormone therapy with their doctor may be beneficial.
Here’s To An Empowered Perimenopause!
I hope this blog has provided you with some positive and empowering insight into this truly impressive transitional biological phase and the signs and symptoms of perimenopause.
You can appreciate now that the menopause transition is a long one! If you’d like my help and support as you navigate these stormy waters, click here to learn more about how we can work together.
