Menopause Monologues Part 2

It felt like an out-of-body experience the first time my perimenopause switch flipped. I went from Stable Able to Attila the Hun instantly. I wish I knew then what I know now about how lifestyle modifications can take perimenopause from practically unbearable to positively manageable. 

I invented my colleague and friend Dr. Stefania Tiveron back for Part 2 of the Menopause Monologues. She’s going to teach us how to add a moveable dimmer switch to help navigate the highs and lows of perimenopause.

Take it away Stefania!

What Perimenopause is…

The term ‘perimenopause’ is most often used to describe the time (2-10 years) leading up to menopause. For most people, this transition usually begins sometime in the ’40s and lasts about 4 years. 

Perimenopause starts with changes in the menstrual cycle and ends 12 months after the final menstrual period. During this time, hormone levels fluctuate. This is a highly symptomatic time because of the variable nature of estrogen, as well as declining progesterone levels.

What’s happening inside your body during perimenopause and what hormones are involved…

There are two hormone factors at play during the perimenopause stage—low progesterone combined with high and fluctuating estrogen

The symptoms as a result of these two factors are varied, unpredictable, and often go unrecognized as perimenopausal symptoms, making it a frustrating and confusing time for many women. 

Typically, the onset of perimenopause is marked by changes in the menstrual cycle and in the duration or amount of menstrual flow. In other words, menstrual cycle irregularities like skipped periods, shorter cycles, irregular bleeding (including heavier and more painful periods) are common in the early stage of perimenopause.

The CliffsNotes Version of Perimenopause

  • Occurs between the ages of 39-55 years old, and can begin at 35 years of age.
  • For most people, perimenopause usually begins sometime in the 40s and lasts about 4 years. Average age of onset is 47.5.
  • Several biological changes are associated with perimenopause: increased levels of FSH in the body, variable estrogen levels, and declining progesterone levels. 
  • Hormones are more varied month to month compared to menopause. 
  • Menopause is a time of low estrogen, whereas perimenopause is a time of variable estrogen levels. At times, you can have more estrogen than you ever had before. This causes irregular cycles, skipped cycles, anovulation, hormonal swings, and menopause type symptoms.
  • It is a highly symptomatic time.

What are the adverse effects of Perimenopause?

Ann here again—this is that part where I wish I knew then, what I know now. Many of these perimenopause symptoms can be managed by healthy lifestyle practices, like whole food nutrition, hydration, self-care, rest, movement and the timing and type of exercise you perform.

Here are some of the typical symptoms of both perimenopause and menopause.

  • menstrual irregularities 

  • hot flashes 

  • vaginal dryness and thinning 

  • skin changes

  • fatigue

  • decreased libido 

  • mood swings 

  • depression 

  • changes in memory and cognition

  • sleep disturbance

  • hair loss on the head 

  • hair growth and acne on the face 

  • heart palpitations

  • nausea 

  • headaches

  • urinary tract infections 

  • joint pains 
  • early stages of osteoporosis and 
  • early stages of heart disease 

These changes can be mild, moderate or severe. Similar to any other life stage transition (puberty for example), women will experience the menopausal transition differently. 

How to offset the effects of perimenopause? 

There are tons of ways to curb the cruddy feelings that one experiences during perimenopause. I like to focus on 5 critical areas of consideration—screening, self-care, nutrition, supplements, and lifestyle.

Nutritional & Supplemental Considerations

Food packed to the brim with nutrients can help your brain recalibrate to changes in hormone levels. 

This can improve symptoms related to premenstrual mood syndrome-like migraines, hot flashes, and poor sleep. By the way, many of these symptoms (especially mood) should improve in menopause once your hormones stabilize.

Estrogen plays a massive role in brain function because of its actions on the mitochondria—the energy producing cells in your brain. As we age and estrogen levels decline, we no longer have the shield of estrogen to protect the brain from degeneration and age-related diseases.

Modify the composition of your diet. 

By making small tweaks to your daily diet you can work with your mitochondria to support cellular energy production in the brain. 

Say goodbye to brain fog and hello to a clear mind!

Here are a few more nutritional considerations you may want to experiment with, to find what works for you:

  • Protect the brain with a low carb/moderate-high fat diet. Shifting your diet towards a higher intake of healthy fats, and a lower intake of carbohydrates (especially refined sources) can help your brain use alternative fuels (like ketones) for energy. 

  • Improve insulin resistance, which can stabilize blood sugar levels and keep mood stable. You can do so by eating healthy whole foods, increasing your fiber intake, or even add some spices like cinnamon to your cooking. 

  • Reduce histamine. A low-histamine diet filled with fresh meat and fish, gluten-free grains, and hearty vegetables, can support your mood and reduce vasomotor symptoms.

  • Protect your bone health. Consider discussing supplements like Vitamine D3 + Vitamin K2 + Vitamin A with your HPC based on your risk factors. Progesterone therapy can also support bone health. 

  • Improve gut health to reduce chronic inflammation. Digestive problems are a significant source of chronic inflammation, which can make this transition harder. 

    • Here are a few quick ways to improve that gut health:

      • Eat vegetables and healthy starches

      • Avoid refined/processed food 

      • Avoid refined sugar

      • Ensure adequate stomach acid (think bitter foods)

Lifestyle Considerations

While estrogen is on a roller coaster and progesterone levels are steadily declining, your brain is recalibrating and trying to adapt to those hormonal highs and lows that come with perimenopause. 

Let me tell you, this stuff is not easy—remember puberty? There’s a reason that perimenopause is called second puberty. That’s why you need to consider a few lifestyle hacks that can make the whole experience a smooth one. Here’s a few…

Get your sleep in check. 

Work with your body and its natural circadian rhythms to get the proper amount of sleep every single night (6-8 hours roughly). Rise when the light comes out, sleep when it’s dark—the better quality of sleep you get the better those hormones will behave. 

Manage stress by scheduling time for relaxation and rest. 

The brain loves progesterone. Since progesterone levels are steadily declining during perimenopause, your stress-protective shield is weaker. Because of these changes, it is even more important that you prioritize rest and relaxation. 

Focus on modifiable lifestyle factors.

Sources of stress from lifestyle factors, such as smoking, junk food, lack of sleep, or chronic emotional stress can exacerbate perimenopausal symptoms such as low mood, insomnia, fatigue, reduced muscle mass, weight gain, low libido, impaired immune function, and insulin resistance. 

Focus on reducing or eliminating some of these factors so that you can optimize your body to take on the natural stresses of perimenopause with confidence. 

Combat stress with movement.

Most of us would agree that too much stress creates a state of chronic tension, which is not good for sleep, brain, or hormonal health. 

That being said, coping with stress can be challenging when you don’t feel well. Motivation can be low when symptoms are high. Attending to the modifiable lifestyle stressors like the ones above, i.e. junk food consumption is key. Adding movement to your routine takes it to another level!

By taking active steps (pun intended) through regular movement to improve the health and functioning of your stress response system, you can reduce the effects of stress on perimenopausal symptoms. In other words, a healthy and robust stress response system can be boosted through conducting regular activity and moving the body!

Here are a few things to try and improve stress through movement:

Movement and exercise reduce whole-body inflammation levels. Less inflammation means less stimulation to the stress-inducing part of the nervous system, which means fewer hot flashes and better mood. 

  • Yoga helps with hot flashes because of its relaxing effects on the brain. 

  • Try a breathing technique with long exhalations. Long exhales activate the vagus nerve and calm the stress response.

  • Nature or forest bathing/walking activates the “rest and relax” inducing part of the nervous system. This calms the brain for hours later and supports sleep. 

  • Don’t forget to simply do more of what you enjoy whether it’s walking, playing in the yard with your kids, or even doing a few squats while you wash the dishes.

Screening & Self-Care Considerations

Screening is self care! 

Most conventional doctors conduct basic screening tests but tend to leave out the extensive tests that can help identify the early stages of perimenopause or the natural progression of aging. Thus, taking time to get a variety of other tests done can help you understand where your body is currently at.  

For instance, some women experiencing perimenopause symptoms might get tested and find out that their symptoms are part of a larger issue at stake such as thyroid disease. This is not normally the case, but getting extensive screening (hormone testing) done can help you understand the symptoms you are experiencing and if they fall under the natural progression of perimenopause or if you need to address a specific part of your health. 

Perimenopause is an important season for your comprehensive health, diet, and lifestyle evaluation. Depending on your age, symptoms, family medical history, or other medical problems, selected tests, done by a licensed healthcare provider, can guide your therapeutic strategy moving forward.

Simply put, go beyond the annual check-up at your doc to ensure a clear understanding of your health and what stage of perimenopause you might be in. I encourage you to find a trusted practitioner to work with who can inform you about the spectrum of alternative and conventional treatment options.

Guess what, this season leads to a beautiful thing!

“Women need to know that perimenopause ends in a kinder and calmer phase of life called menopause.” – Professor Jerilynn C Prior

Ann here once more—I just wanted to jump in and encourage you that this quote is definitely ringing true for me. I’m finding menopause to be a beautiful season of womanhood. No more mood switches flipping on and off all the time. In fact, menopause came with a dimmer switch that I can control 0-100 one level at a time by adding some of these practices into my regular routine.

Add a few of them to your day-to-day and let me know how they work for you by commenting back or sharing it on Instagram with me!  

Thanks, Dr. Stefania for teaching us what’s actually going on inside our bodies and equipping us with lifestyle tools that are proven to move the perimenopause needle from practically unbearable to positively manageable!

If you have questions for her, leave them in the comments below, and we’ll be sure to respond with answers! If you want to learn more about Dr. Stefania, check out her website right here!

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