What is Perimenopause?

Perimenopause is the transitional phase leading up to menopause, typically beginning in a woman's 40s but sometimes starting earlier. It is characterised by hormonal fluctuations, often referred to as a hormonal rollercoaster, that can cause a variety of symptoms, including irregular menstrual cycles, hot flashes, night sweats, mood swings, and changes in sleep patterns. This period, which can last several years and marks the gradual end of a woman's reproductive years as the ovaries produce less estrogen. Understanding perimenopause is crucial for managing its symptoms and maintaining overall health and well-being during this significant life stage.

What are the signs of perimenopause?

• Most women find that they have put on extra weight and it is harder to shift especially around our waist.
• Our thyroid may become more sluggish - hypothyroid, thyroiditis or Hashimoto's Disease (autoimmune thyroiditis).
• Autoimmune conditions may develop due to a lot of changes happening;
• Cardiovascular issues - these are common in women over forty and can present as so many other conditions so its really important to seek medical advice if you experience any cardiovascular issues.
• Hot flashes and night sweats.
• Trouble getting back to sleep or trouble falling asleep.
• Changes to our periods – some months are heavier with flooding and/or clots especially on day one or day two of our cycle. After the flood we can experience a much lighter or pretty much non existent period for the next few days.
• Our cycle can become more frequent or longer. Some women can have a lighter cycle or start to miss a period here and there.
• Mood swings - PMS symptoms but worse! Anxiety and depression can flare up or be more frequent.
• Loss of libido - you just don't have any mojo left.
• Vaginal issues - (this does affect libido too) - hormonal fluctuations and changes to our vaginal microbiome can cause - vaginal dryness, painful intercourse, vaginitis, vaginosis, bacterial vaginitis, candida infections, higher risk of urinary tract infections, incontinence issues and prolapses. 

Changes in our mood

Perimenopausal women who have never had mental health issues, may experience symptoms of anxiety and depression during those months or even years before actual menopause. During this period, for those women with a history of anxiety or depression your symptoms may get worse. A summarised version of what is happening at this time is listed below:-

• Symptoms of depression and anxiety differ by menopausal status in midlife women;
• Perimenopause is associated with increased risk of greater symptoms of depression;
• Post menopause is associated with increased risk of greater symptoms of anxiety and;
• Women without a history of anxiety or depression may be at risk of experiencing them during perimenopause and post menopause.

So why does this happen?

Our hormones oestrogen and progesterone are behaving like crazy teenagers! This is why perimenopause is referred to as our second puberty due to the hormonal fluctuations that most of us experienced during our early teenage years.

The common misconception is that oestrogen is rapidly declining in our forties but in fact it is fluctuating wildly just like a rollercoaster! Oestrogen soars to levels that can be twice as high from what you had you were younger—only to crash down again to almost nothing and then does it all over again next month. Oh the Joy!

• High oestrogen levels - this causes breast pain, heavy periods, fluid retention and irritable moods. These symptoms can affect many women throughout their reproductive years and can be what some women consider 'normal' but its not and should not be left untreated.
• Low oestrogen levels - can cause depression, hot flashes, night sweats along with vaginal dryness. Vaginal tissues become thinner causing irritation (vaginitis or vaginosis), resulting in painful intercourse and other issues as I have mentioned above.
• Hot flashes - are the result of the rollercoaster of high to low oestrogen levels and can be more prevalent just before menstruation.

In your forties, you may find you don’t cope as well with stress. This happens because losing progesterone during perimenopause can destabilise our HPA axis (Hypothalamus, pituitary, adrenal axis) known as the stress response system. This destabilisation can affect our sleep, mood, body temperature, hormones, cardiovascular system, nervous system and reproductive system.

The recalibration of the nervous system is why perimenopause is associated with an increased risk of anxiety, depression and insomnia.

Progesterone is not just a reproductive hormone as it is also a brain hormone and a nervous system hormone. Lower levels of progesterone can affect our adrenal glands leading to adrenal dysregulation (adrenal fatigue or burnout).

Whilst oestrogen is on a rollercoaster ride, progesterone is slowly decreasing although it counterbalances oestrogen – like yin and yang!

• Progesterone calms your nervous system, while oestrogen stimulates it;
• Progesterone boosts your thyroid, while oestrogen suppresses it;
• Progesterone thins your uterine lining, while oestrogen thickens it and finally;
• Progesterone prevents breast cancer, while oestrogen promotes it.

Changes in our digestive health

Being perimenopausal our digestive problems can be triggered by a variety of factors but the most common cause is hormonal imbalances.

As perimenopause progresses, our bodies begin to wind down and our reproductive hormones (oestrogen and progesterone) decrease. These sex hormones have been found to regulate and influence the gastrointestinal tract. As such, when levels begin to fluctuate, this negatively affects healthy digestive functioning.

In addition to hormone imbalances, perimenopausal digestive issues can be triggered by other factors, including:-

• Stress especially chronic stress. I have noticed more ladies coming into clinic with IBS or SIBO symptoms due to the stress and uncertaintly of last year and what this year has to offer.
• A poor dietary choices - starting our day off with a couple of coffees for breakfast (save our coffee for morning tea) instead of a healthy breakfast, too many takeaway meals, highly processed packaged foods, sugary or salty snacks. Many of these foods contain too many carbohydrates (the bad ones) and bad fats along with poor protein content. We need to find a healthy alternative with good carbohydrates, good protein and good fats. 
• Sluggish Liver - a under performing liver (fatty liver or sluggish liver) contributes to a build up of toxins that lead to weight gain. A sluggish liver also inhibits glucose metabolism and causes insulin resistance. This is why we have abdominal fat (fat being stored in our adipose tissue causing fat, bloated tummies) and can't seem to lose that weight during our forties and fifties. This can lead to metabolic syndrome (pre-diabetes) or if left untreated or undiagnosed can be the reason why perimenopausal ladies are suffering from Type 2 Diabetes. 
• Medications - birth control (especially if its being used to regulate your periods or acne), anti depressants, antibiotics, painkillers and any medications that stop our digestive system from working properly - such as, PPIs, antacids, cholesterol medications, reflux medications etc. These are okay as a quick fix but should not be used long term.
• Excessive consumption of alcohol - unfortunately this is a common problem at the moment and the stress of last year with lock down, home schooling or working from home has lead to an increase in alcohol consumption. I'm not anti-alcohol as I do have a gin and tonic on the weekend but we really need to have at least three alcohol free days per week (preferably in a row). Being alcohol free all week and then bingeing on the weekend it not a good idea either. Alcohol is another form of sugar and it leads to weight gain (especially around our tummies) and is really bad for our gut lining and digestive health - this includes our livers (this wonderful organ works way too hard when processing alcohol.)
• Lack of exercise - choose the type of exercise that you love. Lack of exercise causes weight gain, mood dysfunction along with some people suffering from constipation. Yes this is a form of self care and finding the type of exercise that you will enjoy is important. What is the point of exercising when you are doing something that you don't like? I love walking and doing yoga. I used to love aerobics but haven't done this in such a long time as I just don't enjoy it anymore. Some of my clients love crossfit or F45 - I'm in awe of these ladies but it just isn't something I could commit to at this stage. I like to work with my clients to find something that they will enjoy and are passionate about.

Over the past couple of years my SIBO (small intestinal bacterial overgrowth) had come back - the symptoms started slowly with bloating after certain meals, and abdominal discomfort which ultimately lead to changes in bowel habits last year. I was fortunate to be able to take the time last year to heal my SIBO and now I am SIBO free. I do think that chronic stress and being perimenopausal has contributed to this flare up as it had been a busy couple of years in clinic and then 2020 hit big time!

Dietary Changes for Perimenopause

There has been a lot of research done on what diet is 'perfect' for the perimenopausal lady. Here are some of the more popular ones:-

• The Mediterranean diet is a popular one and achieves great results. You can do either plant based or include fresh seafood and organic meats into this diet.
• Keto is another one that has some positive feedback but it is very restrictive. I like to incorporate foods from all the food groups for my clients.
• Plant based diets - this is great but you really need to have optimal digestive health as a lot of ladies experience bloating and abdominal discomfort due to the increase in legumes (these can cause a lot of wind and bloating if not cooked/prepared correctly).
• Cutting back on alcohol is essential as that extra glass of wine can stop us from having a good nights sleep. Are you waking up at 3:00 am after having a few extra wines that night?  Are you finding it hard to get back to sleep? You could try clear spirits (vodka or gin) with soda water and lime - this is basically sugar free so it doesn't seem to affect our sleep as much as the fermented alcoholic drinks (wine or beer.)

How can Naturopathy help support you during this transition?

Naturopathy can support you in many different ways. Perimenopause can be supported naturally so that you can transition into a healthy menopause and post menopause. It is important to work on all systems within your body as there is so much going especially with the connection between hormones, gut health, mental health and our vaginal microbiome. 

There are herbal medicines that work in synergy along with nutritional supplements to support our bodies during this time. There is no one size fits all approach as we are all different and have our own unique issues with this important life transition.

Diet and lifestyle wise I incorporate my Repair, Re-balance and Restore Wellness Program into my treatment plan for my clients. This program works with foods and products that are compatible with you. This is a six month program where I support you on a monthly basis and I provide you with fortnightly recipes that are tailored for you depending on your results. I also recommend exercise that is specific for you and incorporating the types that you like to do.

If you're needing support and guidance throughout this transition please reach out to me and book your appointment

Book your appointment 

Yours in health and wellness,

Katrina xxx