Perimenopause

The average age of menopause, when the ovaries cease to produce estrogen and progesterone, is

• 50.5 to 51.4 years in North America
• 50.1 to 52.8 in Europe
• 42.1 to 49.5 in Asia

Biological changes

During perimenopause a number of changes occur:

• Progesterone levels steadily decline due to fewer ovulatory cycles (the ovaries produce progesterone after they release eggs).
• The number of ovarian oocytes (eggs) decreases from 1 to 2 million at birth until they are depleted at menopause.
• Menstrual cycles shorten or become irregular.
• Follicle stimulating hormone (FSH) increases.

These changes are accompanied by a decrease in estrogen and all sex hormones, contributing to a variety of uncomfortable symptoms.

After menopause, smaller amounts of progesterone, estrogen, and testosterone are secreted from the adrenal glands (the stress-managing glands on top of the kidneys), and new fat cells are deposited around the abdomen.

It’s normal

Perimenopause is a normal part of aging, and all women go through it. Changes in perimenopause are marked by a wide range of symptoms, and the experience is different for each woman. Hot flashes, irregular periods, abdominal weight gain, and mood swings are in the normal sphere of changes contributed to by hormone fluctuations.

Other common changes include

• acne
• anxiety
• vaginal dryness
• night sweats
• low libido
• insomnia
• decreased bone density

When to see your health care practitioner

Some changes require a visit to your health care practitioner for further investigation. Follow up with any new changes or concerns, including

• continuous heavy menstrual bleeding
• bleeding between periods
• pain or bleeding with intercourse
• new breast lumps
• discharge from the nipples
• significant mood alterations
• changes in bowel function

While perimenopause is not a medical problem or disease, women often choose to support themselves with nutrition, stress management, herbs, vitamins, and exercise.

Maintain good nutrition

Whole, unprocessed food choices offer the greatest support for minimizing perimenopausal symptoms and supporting health. There are a variety of supportive foods for women, and the following suggestions are helpful for women of any age.

Calcium

Calcium sources are an important addition during perimenopause as bone density declines. Dark green leafy vegetables such as kale, broccoli, and spinach are excellent sources of calcium, as are bone-in canned salmon, sesame seeds, and almonds. Cow, sheep, and goat milk dairy products are also good calcium sources.

Soluble fibre

Fibre is an important addition to the diet as it binds cholesterol and toxins and plays a role in estrogen metabolism. Ground flaxseed, legumes, green leafy vegetables, steel-cut oats, and chia seeds are all excellent sources of soluble fibre.

Antioxidant-rich foods

Oxidative stress contributes to imbalances in the body, especially during perimenopause. Foods high in antioxidants and phytoestrogens may be helpful in reducing hot flashes. Try to consume an average of five servings of brightly coloured antioxidant-rich foods daily, such as blueberries, red and purple grapes, carrots, yams, red berries, and green leafy vegetables.

Supplements and herbs

For women who wish to support their body’s health during perimenopause, herbal and nutraceutical supplementation provide another option. Choosing good quality products is important to receive optimal benefits from any supplement. For a safe, personalized recommendation, or if you’re taking any other herbs, supplements, or medications, it’s best to consult a naturopathic doctor or health care practitioner.

Hot flashes

The exact cause of hot flashes is unknown, but they appear to be related to a decrease in estrogen. They may be reduced with black cohosh (Cimicifuga racemosa) and evening primrose oil (Oenothera biennis).

Waning libido

This common concern may be improved by tribulus leaf (Tribulus terrestris). Other herbs that indirectly improve women’s libido by supporting adrenal function are licorice root (Glycyrrhiza glabra) and ashwagandha (Withania somnifera).

Vaginal dryness

The distressing, uncomfortable symptom of vaginal dryness can be aided by vaginal vitamin E and hyaluronic acid suppositories. Vitamin E is soothing and healing to the vaginal tissue, and hyaluronic acid is a gel-like, water-holding substance.

Anxiety

Some women may require mood support to decrease depressive symptoms and anxiety. St. John’s wort (Hypericum perforatum) may help regulate serotonin levels to enhance mood and reduce anxiety.

Sleep

Sleep often becomes more elusive and disrupted during perimenopause. Melatonin is a safe, supportive antioxidant to help with sleep. Gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, and L-theanine, an extract from green tea, are also calming, non-addictive sleep supports that may decrease anxiety.

Bone density

Ask your health care practitioner about supplementing with calcium, vitamin D3, and magnesium to assist in bone health. Many perimenopausal women also have concerns with muscle cramping, which can be alleviated by absorbable forms of calcium and magnesium.

Exercise and lifestyle

Regular, moderate exercise helps to improve sleep, increase sexual satisfaction, balance mood, aid in stress management, and minimize fat deposits around the abdomen.

The Canadian Physical Activity Guidelines recommend getting 150 minutes of moderate- to vigorous-intensity aerobic activity each week, plus perform bone- and muscle-strengthening activities on at least two days of the week.

To improve perimenopausal symptoms, try

• yoga
• resistance exercise
• walking
• hiking
• bike riding
• swimming
• meditation