What’s Happening In Perimenopause?

Written by Dr. Hannah Webb, BSc, ND

The transition to menopause is a powerful stage in a woman’s life on many levels. Her hormones are changing, which changes her body, her mental state, and her role in life. Or, not! Some women go through menopause with great ease, while for others it is a challenging period with hot flashes, night sweats, irregular periods, heavy bleeding, irritability and anxiety, difficulty sleeping, and vaginal dryness.

First, a few definitions: a woman is considered to be menopausal after 12 months without a period. The average age that this occurs is 51. Perimenopause is the symptomatic period that leads up to menopause, and typically lasts 1-5 years.

As a woman ages, her ovaries become less responsive to the stimulating hormones that normally cause follicle development and ovulation. With no ovulation, the follicle doesn’t develop into its corpus luteum stage causing a drastic decline in progesterone production. This sets up the hormonal milieu of perimenopause – high levels of estrogen and low levels of progesterone. With wild swings up and down as the body attempts to normalize.

One of the most important messages I like to communicate to women in perimenopause is that they have options. Hormone replacement therapy is an option many know about, with important pros and cons to consider. However in between taking hormone replacement and doing nothing at all, there is a spectrum of other strategies to consider.

One way to alleviate perimenopausal symptoms is to address high estrogen levels. This can be done through dietary changes and herbal medicines which encourage estrogen processing and excretion. Another strategy is to support progesterone levels, either with herbs or hormones. In the world of hormones, there is conventional therapy (synthetic analogues to progesterone and estrogen), and bioidentical hormones (which have the same chemical makeup as the hormones produced by your own body).

Supporting your adrenal glands can help ease the perimenopausal transition, because when the ovaries stop producing estrogen and progesterone the adrenals start to take over. They produce a relatively very small amount, but enough that they help balance the rapidly swinging levels of sex hormones. If however, your adrenals are already under-functioning because of years of chronic stress, they will not as effectively be able to respond.

Other considerations I work on with my patients during this period include supporting healthy sleep and establishing consistent routines with exercise, both of which can help alleviate symptoms. It is also important to address bone health because bone density declines significantly during this period. Supporting your body with the vitamins and minerals needed to build healthy bone helps to prevent osteoporosis.

Every women will have a unique way of supporting her body and mind through perimenopause, depending on her particular symptoms as well as her beliefs and values. Book an appointment with Dr. Webb if you would like to discuss your options, clarify your questions, and get a personalized treatment plan for your menopause transition.