Many health topics go in trends, where the conversation is all about keto, then intermittent fasting, and the benefits of grounding or eating salt. All of this is cool; knowledge is power. Where I really think the conversation about Perimenopause is coming from is twofold. The first piece of this discussion comes from the fact that women often do not understand the natural processes of their bodies ("nobody told me..."), and their physicians often understand the disruption of daily life even less ("there, there, you are just a woman... now here's an antidepressant" - huge appreciation for practitioners that dig deeper but this is not as often the reality). The second, is that it's quite likely that the symptomatic experience of the years leading into menopause has actually worsened, and I'll explain why in a moment.
Women of any age will commonly attribute their health concerns to "hormones" when really what they mean is reproductive hormone balance. To be precise, hormones actually encompass a whole range of messenger chemicals like thyroid hormones, cortisol and insulin, as well, and they have a relationship with one another. With a shift in recognition of the feminine, we are finally beginning to see greater attention going towards women's health concerns. It's truly unbelievable the lack of research on endometriosis, or harmful ingredients in tampons (just completed for the first time this year). Better late than never, I guess.
(Men, please keep reading too - I'm sure you have a woman in your life that could use some hormonal compassion, plus some recognition for the awesomeness of a body that produces life).
Peri vs Menopause
So, while we have heard about Menopause, the real action is in Perimenopause. Menopause is the moment that a woman has not had a period for one full year. It marks the transition into the non-reproductive years, where fertility is replaced by powerful wisdom (and no longer tolerating any bullshit - if you know you know).
Perimenopause is like puberty in reverse. It's the time when some women experience the symptoms we commonly attribute to menopause like hot flashes, anxiety and insomnia. The thing that many people don't realize is that this phase can last 5-10 years (or more)! It's not uncommon to see the first whispers of hormone change at 37 years old, and this time frame is shifting earlier and earlier (my last webinar said 35). Many times I will have patients say, "why didn't anyone tell me this?!" Truly though, I think we don't have the knowledge, vocabulary, or the sense that others might be going through the same thing, in order to put words to or describe how we feel. Women are great at powering through and taking care of everyone else, and being distracted by the responsibilities of the day to day, so they can 'suffer' in silence or not really be sure what is causing their symptoms - there are too many possibilities to even count.
The way that I view Perimenopause, I've borrowed partially from the work of Dr Christiane Northrup (she has a great book called "The Wisdom of Menopause"), is that it is a stormy time for women because they are often raising older kids or teens, caring for parents (the sandwich generation), at a time of high responsibility and commitment in their careers and don't have a lot of opportunity for self care and reflection. So, when stress, anxiety, lack of movement, and years of bad habits start to catch up in your 40s, there is also a drop in estrogen and progesterone making everything that much more pronounced.
There are actually hundreds of documented symptoms that can be attributed to perimenopause, from anger to joint pain to to alcohol/caffeine intolerance to digestive changes, and here's why: hormone messengers impact more than just the reproductive organs. Changing estrogen levels can shift the gut microbiome. Lower progesterone impacts the GABAergic pathways (GABA is super calming). And on and on it goes. So, when someone says, "I think it's my hormones", they are probably right on some level.
One of the first changes often noticed by women is from the decline in progesterone levels. As ovulation (release of the egg) gets less consistent, the corpus luteum isn't developed to maintain progesterone production. This can show up as changes to the length of the cycle, anxiety and insomnia especially in the days or weeks before a period. This is also why women can show signs of estrogen dominance, not because estrogen levels are high (although they could be) but because progesterone is dropping lower in comparison.
Hormones are Complicated
In reality, I am oversimplifying a very complex process for your better understanding. Other parts of the body like the adrenal glands can also produce these hormones, and I believe this is actually one of the reasons why stress, which puts extra demand on the adrenals, has such an impact on this hormonal transition because we just don't have anything left to give. Other considerations are that hormones are actually made in the mitochondria of the cells, so mitochondrial health is especially important to good hormonal health. Additionally, hormones are made from cholesterol, so the quality of fats we eat and the medications we take can be another piece to the puzzle. Finally, I'll mention that liver and digestive function is another key player, since the liver metabolizes (breaks down) hormones and they are removed via the gut.
Is your brain hurting yet? I'm guessing you get the point! LOL
How do we help this important time?
There are so many possibilities! At the symptomatic level, please know that you do not need to "just live with it". There are multiple ways to help sleep, joint pain, bloating, hot flashes and all the rest. Beyond the symptoms, it's great if we can look deeper into digestive health, liver burden, stress relief, thyroid and mitochondrial function.
Here are the big 3 that you can start any time:
- Eat more protein - to maintain muscle mass, metabolism, mood and blood sugar regulation
- Build muscle - for bone protection, blood sugar, inflammation and longevity
- Prioritize sleep - lower cortisol, improve repair, cognitive & immune function
Imbalances in the body become highlighted at this time of life. What used to work for you no longer does anymore. Super fun times (for everyone in the house) as women get reacquainted with themselves! If it's a spouse/partner/friend/sibling that's struggling then please encourage them to seek support, and certainly do that for yourself too.
This is such a big topic - If you'd like to learn more, I'm thinking about running a course for a deeper dive on perimenopause education, resources, and tools/action steps to support and transform your journey - let me know if you're interested here :)
Have a beautiful day,
Dr Christa
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