Perimenopause vs. Menopause
While many women are familiar with symptoms that occur with menopause, it’s often confusing when the body starts to change years before menopause. This is called perimenopause. It refers to the 10 years or so before menopause. This could occur in your 30’s or 40’s and leave you with symptoms such as hot flashes, mood swings, irregular periods and difficulty sleeping. Actual menopause may still be years away!
Hormones quiet down after menopause when the ovaries no longer respond to stimulation from the pituitary gland. This means the ovaries reduce excretion of estrogen and progesterone. It’s a time of low estrogen. Perimenopause, on the other hand, is an estrogen roller coaster (both high and low levels) (1).
Symptoms of perimenopause can include (2):
- Unexplained weight gain
- Increased heaviness or flow of cycle
- Cycles less than 25 days long
- Tender, lumpy or swollen breasts
- Disrupted sleep
- Night sweats
- Menstrual cramps
- Unexplained headaches/migraines
- Onset of mood swings
These symptoms drive women crazy! The response from a provider might be, “this is just part of being a woman,” or you might be offered the pill, estrogen or an antidepressant. What you need to be mindful of is starting estrogen or hormone replacement therapy while in perimenopause. Estrogen levels will be all over the place. And adding more could be a problem (especially if you don’t detoxify it well, or correctly). Some women breeze through perimenopause with no major symptoms, while others get hit pretty hard.
Symptoms of high estrogen include (in relation to progesterone):
- Heavy periods
- Fluid retention or that “puffiness” feeling
- Increased irritability
- Breast pain
- Increased insulin resistance
- Increased histamine symptoms
- Weepiness or mood instability
Symptoms of low estrogen include:
- Low mood
- Hot flashes
- Night sweats
- Heart palpitations
- Poor recovery from exercise
As estrogen levels fluctuate, perimenopausal women can experience all, or none, of these symptoms. Okay, so what about progesterone? Progesterone, like estrogen, is also released by the ovaries, but it has a different exit strategy than estrogen. Progesterone slowly declines through perimenopause, which is unfortunate because it would ease the symptoms of estrogen highs and lows (2-3).
Fortunately, there are some strategies to make the journey to menopause easier. They include things we should be doing throughout our lifetime, but often don’t due to lack of education. Implementing these strategies could save many young girls and adult women years of major PMS, hormonal issues and even infertility. So, if you have daughters or young women in your life, keep these things in mind to help them towards a healthy hormonal path!
Strategies to make perimenopause easier:
- Reduce inflammation (hello 131 Method)
- Support estrogen metabolism
- Support progesterone production
- Pay attention to, and decrease stress
You know this one by now! If you’re applying what you’re learning in The 131 Method, you’re reducing your inflammation. Your hormones talk to your entire body via receptors on various tissues. If you’re inflamed, that inflammation will disrupt the communication between your hormones and the tissues. Inflammation will reduce progesterone production and slows estrogen metabolism (the opposite combination of what we want).
Support estrogen metabolism
Ways to help support estrogen metabolism include: reducing alcohol intake, maintaining good gut health and gut bacteria, eating phytoestrogens (more on this below), address underlying insulin resistance, exercise and avoiding dairy from cows. There are various nutrients or supplements that help too, but this article is focused on food and lifestyle habits which need to be done first. Supplementation is only meant to supplement a healthy foundation.
Phytoestrogens are a group of naturally occurring plant nutrients that are structurally similar to estrogen (4). These foods bind to estrogen receptors and act like anti-estrogens, which can be beneficial during times of high estrogen. Food sources of phytoestrogens include: flaxseed, soy (whole food and organic), nuts, whole grains, legumes and berries. The right dose really comes down to the individual. In the right amount, phytoestrogens can be a wonderful addition to support women’s hormones (both peri and postmenopausal) (1).
Support progesterone production
As mentioned above, progesterone levels slowly decline throughout perimenopause. That’s natural! What you can impact is how drastic or quickly this happens. One of the biggest factors here is stress! This means all types of stress…emotional, physical and chemical. In summary, reduce inflammation, avoid chronic cardio (long strenuous workouts), take a vacation and breathe!
In addition to reducing inflammation and stress, you can support progesterone production by ensuring your body has enough of the raw materials it needs to build this important hormone. Key nutrients for progesterone production include: Vitamin C, magnesium, zinc and B-6. Don’t be afraid to include plenty of healthy fats as well – the body uses these fats to build essential hormones.
Pay attention to, and decrease stress
Without getting into detail, your stress response changes when progesterone declines. The relationship between progesterone and the HPA Axis is why many women experience mood shifts, depression and anxiety during perimenopause. The nervous system is also going through changes, so self-care, self-love and rest, are essential here.
Menopause & fasting
A quick word on fasting. For women post-menopause, or men post-andropause (yes, this is a less dramatic male version of menopause) or even those who simply have low hormone production, it may take longer to get into ketosis. It’s completely possible, but trust the process a bit longer. It may take days or weeks, depending on the person.
It may be helpful to do blood ketone testing to ensure you reach ketosis during a fast. If you’re not reaching ketosis, but continue to eat low carb, high fat, you may not feel well and you’re not going to get the same benefits. In this case, consider adjusting macronutrients with slightly higher carbs and review the recommendations below. This is a situation where one may benefit from using exogenous ketones for a short period of time. Think of it as a bridge to support the process of getting to ketosis. But allow your body to do the rest once you’re there.
Summary of what to do:
- Eat an anti-inflammatory diet
- If elevated estrogen symptoms are present, increase phytoestrogen foods
- Assess your stress levels
- Get quality sleep
- If necessary, work with an Integrative or Functional Medicine Healthcare Provider.
- If necessary, get some lab work done. Examples include:
- Fasting insulin
- Fasting glucose
- Consider the impact of various medications on your hormonal system and speak with your provider if you have questions or concerns.
- Bridin, Laura. “Period Repair Manual. Natural Treatment for Better Hormones and Better Periods.” 2017.