This post may help you understand what perimenopause is and when to expect it as well as offer you some tools to get through it with ease. In our late 30s or early 40s we may start wondering why we're experiencing changes in our body like never before. We may be moody, anxious, have irregular periods, or have hot flashes. These are all common symptoms of perimenopause.
WHAT IS PERIMENOPAUSE? Perimenopause is the time leading up to menopause when symptoms begin to appear. It is also called the menopausal transition. During this time, the estrogen level in your body rises and falls unevenly. Your menstrual cycles may get longer or shorter and bleeding can be light or very heavy. You may also begin having menstrual cycles in which your ovaries don’t release an egg!
These “anovulatory cycles” occur when the body skips ovulation (doesn’t release an egg) – bleeding often still occurs, so you may not even notice! Officially, Perimenopause lasts until you have gone a complete twelve consecutive months without a menstrual period. After that, you’re considered to be in menopause. WHAT ARE THE SYMPTOMS OF PERIMENOPAUSE? There are many symptoms of perimenopause - physical, psychological, and emotional. Some symptoms are common with other conditions as well, so it’s a good idea to check in with your physician and pinpoint the cause – perimenopause or other!
➢ Joint pain ➢ Digestive changes ➢ Bloating ➢ Bone loss ➢ New allergies ➢ Brittle nails ➢ Dry skin ➢ Vaginal dryness ➢ Cyclical breast pain ➢ Incontinence ➢ Hair loss ➢ Itchy skin ➢ Headaches ➢ Weight gain around the abdomen ➢ Heart palpitations ➢ Hot flashes ➢ Night sweats ➢ Irregular periods ➢ Memory lapses ➢ Poor concentration ➢ Sleep disorders ➢ Fatigue ➢ Loss of libido ➢ Mood swings ➢ Depression ➢ Anxiety ➢ Forgetfulness ➢ Loss of confidence ➢ Panic disorder ➢ Irritability
HOW DO YOU KNOW YOU ARE IN PERIMENOPAUSE?
If you’re between the age of 30-50, you may experience symptoms of perimenopause. This phase can last from a few months up to around ten years before menopause. Not all women have the same symptoms or experience perimenopause in the same way, so it’s hard to say there are specific things that will happen for you to know that you are absolutely in perimenopause. Although, there are a few symptoms that are common across the board for women in the perimenopausal phase, including irregular periods, insomnia, hot flashes, irritability, mood swings, fatigue, breast tenderness, and weight changes.
TESTING
No single test can determine if you’ve entered perimenopause. There are other things to consider, including age, menstrual history, and the symptoms or body changes you’re experiencing.
The thing to know is that testing only reflects your hormone levels on the day of testing. Hormones shift during your cycle and can be impacted by hormonal birth control, hormone replacement therapy and some meds. Some supplements, such as biotin(B7), can also interfere with hormone tests such as TSH, FSH, LH, T4, T3, Estradiol, Testosterone, and Cortisol.
The following home testing kits are also available:
· Everlywell Perimenopause Test
· myLAB Box Perimenopause Test
· DUTCH tests
If you’re working with a practitioner, these labs may be helpful:
· Follicle-stimulating hormone
· Luteinizing hormone
· Estradiol
· Testosterone
This information is in no way intended to be and/or replace the advice of a qualified medical professional. Please talk with your physician about any questions or concerns you have about testing options and/or the best timing for testing.
ADRENALS AND PERIMENOPAUSE
When hormone production drops in the ovaries, the adrenal glands take over. At the same time, the adrenals continue producing testosterone, cortisol, and adrenaline, which give us the opportunity to deal with the ongoing stressors of the day. The severity of symptoms experienced during perimenopause like hot flashes, trouble sleeping, and mood swings are influenced by the production of those hormones by the adrenals.
Often, symptoms of perimenopause can look like adrenal fatigue symptoms. If you find yourself constantly stressed and have fatigue, trouble sleeping, weight gain, moodiness, or mental fogginess, there is a chance that you could actually be experiencing adrenal fatigue instead of thinking you’re in the perimenopause stage of life. This is where the DUTCH test can come in very handy – but, you have to find a practitioner who can interpret it.
If you’re a 50-year-old woman with very little stress who suddenly starts having hot flashes, feeling anxious, and experiencing trouble sleeping, most likely you’re entering perimenopause, whereas if you’re 25 years old with a stressful job and you start feeling fatigued, anxious, etc. you may want to check your adrenal health.
HORMONE BASICS
Estrogen
The female body makes three major types of estrogen.
1. Estradiol (E2) is the most abundant form of estrogen in women of childbearing years. E2 is important for maintaining regular menstrual cycles and for overall health.
2. Estriol (E3) is only detected in significant quantities during pregnancy because it is produced by the placenta.
3. Estrone (E1) is the main estrogen produced after menopause.
Estrogen not only plays a critical role in regulating menstruation and reproduction, but is also key for neurological processes, bone growth, cholesterol levels, urinary tract, heart and blood vessels, skin, hair, mucous membranes, and pelvic muscles.
Estrogen tests are used to detect imbalance. The levels of each type of estrogen in conjunction with information about your cycle can aid in the diagnosing conditions associated with an imbalance.
Progesterone
Progesterone is important in preparing the body for pregnancy. Each menstrual cycle, after the egg is released, the corpus luteum releases progesterone and progesterone levels dramatically increase.
This hormone prepares the lining of the uterus for fertilized eggs to attach and prevents the uterine lining from shedding if an egg is fertilized. If the egg is not fertilized, progesterone levels decrease and the lining sheds. This shedding is what causes menstrual bleeding.
During pregnancy, progesterone levels should remain high so the placenta grows and the fetus is nourished.
In perimenopause, progesterone tests help your doctor assess ovulatory function.
Testosterone
Testosterone may be thought of as a male hormone, but women need testosterone for bone strength, cognitive performance, and a healthy sex drive. Women with inadequate levels of testosterone experience low libido and are at higher risk of osteoporosis.
Too much testosterone in women can cause the development of excess body hair, facial hair, and acne; PCOS and a higher risk of infertility can also result.
Follicle-stimulating And Luteinizing hormones
Follicle-stimulating hormone (FSH) is released by the pituitary gland. FSH stimulates the follicles in your ovaries to mature. The pituitary gland then releases luteinizing Hormone (LH), which is responsible for ovulation. Only one follicle will “ripen” and become mature during each cycle.
Tests for FSH and LH are used to check fertility and to predict when a woman will naturally enter menopause.
Cortisol
Cortisol is a stress hormone. It is released by the adrenal glands and it impacts digestion and hunger, sleeping and waking, blood pressure, insulin, immunity and inflammatory response, as well as our response to stress.
A cortisol test is used to check cortisol levels and to diagnose disorders of the adrenal glands.
Because stress can play such a big part in sex hormone production, checking cortisol can help your practitioner get a more well-rounded picture of your health and hormone status.
Thyroid Hormones
Because so many symptoms of perimenopause overlap thyroid imbalance, it can be a good idea to check thyroid hormone levels.
The three main thyroid hormone to test are TSH, free T3, and free T4.
TSH is a hormone made by the pituitary gland that stimulates the thyroid to make hormones. If the pituitary gland is producing abnormally high levels of TSH, it may mean that your thyroid gland is not making enough hormones. On it’s own, TSH does not tell us about the health of the thyroid.
T4 is the main hormone produced by the thyroid. It is inactive until conversion in the liver to T3.
By testing TSH, free T3 and free T4, your practitioner can assess if your thyroid is producing enough hormone and if your body is converting T4 to the active/usable form (T3).
rT3 is another useful test. This measures the amount of reverse T3 which is an inactive form of T3. The body converts T3 to rT3 when it notes an excess of T3. Sometimes this conversion can happen in error or in excess. rT3 binds to the same receptors as T3, so too much of this hormone can prevent T3 from getting into your cells. This can be a helpful piece of information if your thyroid labs otherwise look normal but you’re experiencing symptoms of being hypothyroid.
FOODS FOR PERIMENOPAUSE
Certain foods are recommended during perimenopause as they can help balance your hormone levels, even while your body is going through these changes. It doesn’t mean they will stop perimenopause from happening, but they may help this phase be more comfortable and easier to manage the symptoms.
Calcium and Vitamin D-rich foods. Calcium can be found in foods like kale, turnips, seaweed, milk, and collards. Vitamin D can be found in cod liver oil, tuna, yogurt, eggs, and salmon.
Vegetables, especially leafy greens like kale, Swiss chard, collard greens, arugula, and bok choy. Vegetable intake is important for weight loss during perimenopause as it’s normal to gain some extra weight due to hormonal changes.
· Cruciferous and sulfur-rich vegetables such as brussels sprouts, kale, spinach, and asparagus help the body make Diindolylmethane. Diindolylmethane, or DIM for short, helps in the balancing of the body’s hormones by aiding in the breakdown of estrogen. The breakdown of excess estrogen is a necessity if the end goal is overall hormonal balance in the body.
High fiber foods including lentils, black beans, peas, broccoli, raspberries, pears, and oatmeal. Fiber will help with your digestive health and weight control, and it will help you feel full longer.
Berries are full of fiber and packed with antioxidants. They contain less sugar than most fruits, helping curb your sugar cravings.
Protein helps you feel longer, making it less likely to snack between meals. Protein reduces hunger, helps curb cravings, and also protects muscle mass. Healthy proteins include eggs, lean meats, fish, nuts and seeds, tofu, tempeh, edamame, and soy milk. When consuming tofu, always make sure you are leaning toward organic brands.
Legumes are also high in protein and fiber, which will help you feel full, which is very helpful when battling perimenopause weight gain. They can help stabilize blood sugar levels and decrease mood swings. Legumes to include in your diet include peas, beans, and lentils.
Phytoestrogen-rich foods: Phytoestrogens found in whole foods. They do not cause estrogen excess like xenoestrogens in the environment do. Studies show isoflavones may act as antiestrogens protecting women from stronger estrogens such as estradiol. Phytoestrogens appear to down-regulate the activity of some estrogen receptors prominent in breast and uterine tissue. This is one possible action behind their projected anticancer effects. Flax seeds and other seeds, legumes, grains, and vegetables such as yams, carrots, and apples have phytoestrogens.
Probiotic-rich foods or Cultured foods help keep the gut microbiome thriving. Research is emerging demonstrating a connection between the gut microbiome and hormone balance. Researchers now believe that certain microbes in the gut secrete and modulate hormones to such an extent that the gut microbiota should be classified as part of the endocrine system!
To cultivate a robust gut microbiome, incorporate cultured foods such as cultured vegetables, sauerkraut, beet kvass, sugar-free non-dairy yogurt, kombucha and water kefir.
Another easy way to strengthen your microbiome is to FEED it! One of my favorite tips is to make a Microbiome Mash. This mash is a mix of as many varieties of veggies as possible to feed gut bacteria. The easiest way to do this is to take various vegetables and greens and pulse in a food processor until everything is pretty small (and more easily digestible). Begin by adding 1-2 tablespoons of your microbiome mash to your meals daily – depending on the variety of veg and greens you choose, you may enjoy sautéing your mash a little and adding to cooked foods or try a small amount in a smoothie!
Watch this video for more on how to create a Microbiome Veggie Mash - https://www.youtube.com/watch?v=ImHQAvY6Wu8&t=19s
Seeds are the perfect hormone food. Seeds have ligands that bind excess hormones so they can be removed from the body. As well, they are high in omega-3 fats which help with hormone production. A super combo! I love hemp, chia, and flax to keep my hormones in check.
Wild-caught, low-mercury seafood. Seafood supports healthy iodine levels, vitamin D levels, testosterone levels, and much more! Choose low mercury seafood like shrimp, scallops, clams, oysters, salmon, and sardines. Fatty fish is known to decrease inflammation, reduce night sweats, improve mood, and help with depression. Some fatty fish include salmon, sardines, and tuna.
Zinc-rich foods help boost testosterone and support immune function. Testosterone levels decline as we move toward menopause. Studies have shown that a decrease in testosterone is a common reason for reduced libido in perimenopausal women. Foods that are high in magnesium, such as hemp seeds, spinach, and figs, increase testosterone. Maple syrup, cocoa powder, and any chocolate product that is at least 40% cocoa, sunflower seeds, pine nuts, pumpkin, most nuts and most cuts of beef and lamb generally have 4 mg zinc per 100 gram serving. 2-3 servings daily with your meals can meet your need for zinc.
FOODS TO AVOID DURING PERIMENOPAUSE
There are also some foods to make sure you avoid during perimenopause. For good health, it’s best to avoid these things in general!
· Packaged and processed foods with more than 4 grams of sugar per serving.
· Refined carbs in things like cookies, cakes, fast foods, pasta, and bagels.
· Highly processed foods such as deli meats, potato chips, and microwave meals (they contain high amounts of sodium and sugar, leading to bloating and water retention).
· Stimulants and foods that promote imbalance: alcohol, caffeine, salt, fried foods, fatty cuts of beef, and pastries.
SUPERFOODS FOR PERIMENOPAUSE
I've listed great foods for perimenopause, but how about superfoods? Superfoods make it into this category because they are nutrient dense and typically have qualities that are more beneficial per bite than other foods.
Below are some special superfoods recommended while in perimenopause:
● Reishi: supports the endocrine and immune systems as well as supports a healthy stress response (Harmonic Arts makes a great 5 blend mushroom supplement you can add to your daily coffee!)
● Chaga: an adaptogen that helps manage stress and supports the immune system
● Bee pollen: provides an energy boost, reduces the amount of stress the body is under in a safe and natural manner, and may help manage irritability, depression, immune deficiency, and anxiety
● Coconut oil: this medium-chain fat has antibacterial and antifungal properties. It can help support healthy brain and gut function and is an alternative moisturizer and lubricant (do not use with latex condoms).
Sea vegetables provide much-needed iodine for the thyroid gland, breast tissue, and energy production. You can add kelp sprinkles to food, add spirulina to smoothies or take chlorella tablets. If you have any issues with sodium, you may need to lower your sea veggie intake.
Perimenopause is a normal, natural, empowering time of life but it can feel confusing and frustrating if your body is out of balance and you don’t have the information and support needed.
Starting with the information I've just provided you can take action:
✓ Eating better
✓ Assessing your vitamin levels
✓ Assessing your hormone levels
✓ Supplementing if necessary
✓ Having a conversation with your doctor or trusted practitioner
You can also get deeper support through health coaching and community. My passion is helping women regain balance regardless of their age and stage. You deserve to feel great and I’d love to help you get there.
If you'd like to know more and go into 12 different topics on nutrition, fitness, behavior and more then please check out my Prosper in Perimenopause program - an incredible 12 Week Group Coaching online program that kicks off in 2024!
It's the Prosper in Perimenopause plan SO MANY women have been waiting for.
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If you need more immediate support to deal with frustrating, crazing making perimenopause challenges, book a discovery call with me HERE to discuss if this might be the next step for you.
If you'd like a copy of my "The Perimenopause Plan" in PDF format which also comes with breakfast, lunch, snack, dinner and a desert recipe, please download it here:
Coach Julie xx