Your guide to perimenopause and how to get support
BY SASHA PARKIN, Registered Nutritional Therapist at Wild Nutrition
Did you know that:
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46% of audiences are unaware of what perimenopause is
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34% do not understand the difference between perimenopause and menopause
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Nine out of 10 women fail to link symptoms to perimenopause.
But with an estimated 40% of our lives spent between perimenopause and postmenopause, life’s simply too short to misunderstand this pivotal life stage. Knowledge is power and we’re to help make your transition as powerful as possible.
*Source: Menopause TLI (2020), Avon Worldwide.
In this blog, we cover the key need-to-know details on:
- What is perimenopause?
- What are your hormones doing?
- How to speak to your GP if you feel you need support
- Tests you may want to discuss with your GP
- What is HRT?
- Are there any natural alternatives to HRT?
What is perimenopause?
Perimenopause (peri = around) is the time in the lead-up to full menopause, it can last anywhere from six months to 10 years on average and is characterised by fluctuations in hormones and changes in a woman's menstrual cycle. These changes can lead to physical or mental symptoms. For many women, the first symptoms are mental; a lack of focus, a feeling of not being themselves and declining self-confidence.
There are over 34 commonly cited signs of perimenopause, however, it is a complex time in a woman's life and all women experience perimenopause differently. The important aspect to note is how you are feeling and how that is different (if applicable) from the months and years prior. While there are many possible changes around perimenopause, if you have noticed any that are impacting your life, it is always important to check these with your doctor to rule out any other underlying causes.
There are three ‘stages’ of perimenopause that you often see because it can span such a long time in a woman's life. In the first stage, we often see more neurological symptoms such as brain fog that may commonly be put down to other contributors, such as stress. Very few ‘hormone symptoms’ like cycle changes are experienced at this stage, even though these are often the indicators women look out for.
During the second stage, you may see more significant neurological, cognitive and cycle changes or the typically expected hormonal symptoms such as hot flushes. While in the last stage, there may be more symptoms simultaneously taking place, with periods becoming further and further apart. You may not have a period for several months at a time, but this final stage is taking you closer to menopause. You are not categorised as menopausal until you haven't had a period for 12 consecutive months in a row.
What are your hormones doing?
In perimenopause, hormones can vary day by day and cycle length can be highly changeable, making it difficult to know exactly where you are in your cycle (outside of your menstrual bleed) and get a good picture of hormone levels. It is common to see elevated levels of follicle-stimulating hormone (FSH) in perimenopause, but it can also be elevated for other reasons, such as medication or in conditions such as polycystic ovary syndrome. So, it is always worth exploring this with a doctor if you have carried out home testing via a private lab.
These are some of the common signs you may be in perimenopause:
Psychological, neurological and cognitive changes
Mood changes - neurotransmitters serotonin, dopamine and noradrenaline are increased/modulated by female hormones (oestrogen and progesterone), so the fluctuating levels can wreak havoc on these mood stabilisers that keep us feeling calm and content.
Tip: increase amino acid-rich proteins in your diet as these are building blocks for neurotransmitters. Tryptophan is especially key for dopamine, serotonin and melatonin production, so focus on foods such as chicken and turkey, eggs, salmon, cheese, tofu, nuts and seeds, bananas, and spinach.
Memory troubles - hormonal fluctuations can lead to increased brain fog and unclear thinking or forgetfulness. Our brain has oestrogen receptors which play a role in neuronal health, so low oestrogen can have a knock-on impact on the way our minds work, but it is important to say for most women this is short-term. While women are two times more at risk of dementia than men, this onset typically happens later in life.
Tip: ensure you are getting adequate B vitamins in your diet in the form of meat, fish, nuts and seeds and dark leafy greens as these help cognitive function.
Lack of confidence - this is something I hear time and time again in consultations and it is heartwrenching to hear how women at the top of their game with the most knowledge and wisdom feel imposter syndrome when it should be their time to thrive and feel powerful with a lifetime of experience behind them. This is no fault of their own but due to the hormonal shifts and the neurological symptoms that these can bring.
Tip: try positive daily affirmations to support self-confidence and go gently on yourself. Lean on your village: speak to friends and loved ones about how you are feeling, you are not alone and not the the only one experiencing this.
Changes in your sleep-waking cycle and energy - often initially caused by a decline in progesterone, our soothing hormone that plays a role in the production of melatonin (our sleep hormone). However, oestrogen plays a role too - if you are having pesky night sweats, it can make getting to sleep and staying asleep pretty difficult. In turn, poor sleep quality can have a knock-on effect on our energy throughout the day. That said, if you have a history of thyroid issues or persistent low energy is impacting your daily activities this warrants further investigation with your doctor.
Tip: avoiding blue light from electronic devices, increasing magnesium in your diet, slipping into a magnesium salt-infused bath and listening to a relaxing sleep podcast can all do wonders for better sleep. You can find more sleep tips in this blog post. It’s important to highlight that if you already do many of these and still have issues falling or staying asleep, it is sensible to investigate if hormones are to blame so that you can make an informed choice with your doctor on how to navigate this.
Typical ‘hormone’ symptoms
Cycle changes - these are often the first sign people expect to see, however, it is commonplace for women to experience other symptoms first and put cycle changes down to stress or lifestyle-related causes. Fluctuating hormones can result in shorter or longer cycles and lighter flows or menstrual flooding.
Tip: track your cycle, so that you know where you are and how anything is changing month-to-month.
Vasomotor symptoms such as hot flushes - triggered by a decline in oestrogen, the hypothalamus (which regulates body temperature) becomes more sensitive to temperature changes, resulting in the body getting intensely hot, sweating or feeling anxious.
Tip: increase phytoestrogens in the diet, such as organic tofu, edamame, flaxseed and chickpeas. Try to avoid foods that trigger hot flashes, such as alcohol and caffeine.
Genitourinary symptoms - hormone fluctuations can cause reduced libido and discomfort during sex due to reduced lubrication. There can also be an increase in infections including thrush and UTIs during these years due to the change in the vagina's PH from acidic to more alkaline, coinciding with a reduction in lactobacillus species within the vaginal microbiome. A change in the structure of the internal muscles due to reduced oestrogen and collagen is also commonplace, potentially leading to more pelvic floor symptoms.
Tip: stay well hydrated, take a probiotic specific to this life stage and work with a pelvic floor physio if you need more support.
Other common symptoms
Immune changes - perimenopause is categorised as an inflammatory life stage. This means that the immune system is affected and can become more inflamed, potentially resulting in increased susceptibility to picking up illnesses and taking longer to heal. Generally, women may also describe this as feeling like they are no longer as strong as they used to be. Tune in and listen to your body as perimenopause and menopause carry an increased risk of autoimmunity or autoimmune flares due to the reduction of oestrogen which is a protector of the immune system. If you feel something is off, speak with your doctor.
Tip: eat an abundance of colour daily: plants, fruits and vegetables contain an array of immune-supportive antioxidants that help the body respond to inflammation and infection.
Allergies and irritable skin - caused by the cumulative impact of fluctuating oestrogen potentially ramping up histamine production (histamine can be stimulated by excess oestrogen) and histamine dominance due to a reduced ability to process histamine during this life stage.
Tip: avoid histamine-heavy foods such as alcohol, fermented foods, tinned and smoked fish, cured meats, aged cheeses and fruits and vegetables high in histamine, such as citrus, tomatoes and aubergine. Everyone's response to these foods can present differently so before cutting any out, make sure you have reacted to the food in question.
Digestive changes - it is common to notice changes in digestion and an increase in digestive symptoms when hormones fluctuate due to their role in motility and gut health.
Tip: make fibre-rich foods a staple in your diet - good bacteria thrive from fibre and anything they don't need bulks out the stool to get things moving. Just be sure to stay hydrated to allow digestive mobility.
Joint pain - Oestrogen helps regulate inflammation so when it reduces, regulation is no longer managed as effectively which can lead to joint discomfort, redness and swelling. Oestrogen also plays a role in collagen production.
Tip: increase collagen-rich foods in your diet (meat and fish) and Vitamin C-rich foods to help with collagen synthesis. You can also look for a good-quality collagen supplement if you feel you need extra support.
Weight gain - over a lifetime insulin resistance becomes less effective and sensitivity can increase. This tends to coincide with when women commonly feel too self-conscious or time-poor to do the exercise they want to, so when these factors are coupled with potentially increased cortisol from the stress of this life stage, it creates the perfect storm for weight gain.
Tip: keep blood sugar balanced with a portion of protein, healthy fat and fibre with every meal and snack.
How to speak to your GP if you need support
If you are aged 45+ and you have symptoms, testing is not a requirement to be diagnosed with perimenopause under NICE guidelines, so it is more about how they can support you.If you are under 45 and have symptoms they may want to build a better picture and rule out any other conditions that can mimic the symptoms of perimenopause, such as thyroid disorders and chronic fatigue syndrome.
It is always helpful to arrive armed with data to make the most out of the 10 or so minutes you get with your doctor. So presenting a history of your last three cycles and any changes can be really helpful. You can use apps like Natural Cycles, Clue, Flo, or a trusty notebook to track your symptoms and when they occur in your cycle.
If you are feeling alone in your journey, you may also want to enquire about any local support groups available to you.
Tests you may want to discuss with your GP
Thyroid health - thyroid problems are more common in perimenopause in part due to hormonal fluctuations and many of the symptoms can be overlapping, so if you are concerned discuss the possibility of having markers tested.
Iron + Ferritin - if you are experiencing heavier menstrual cycles and displaying signs of low iron such as fatigue, shortness of breath or lightheadedness it is worth having your levels checked.
Hormones - FSH, oestrogen, progesterone and testosterone. However, as previously discussed, these can be tricky to assess due to fluctuations and knowing where you are in your cycle.
What is HRT?
Simply put: hormone replacement therapy (HRT) is the prescription of hormones (generally oestrogen and/or progesterone, and occasionally testosterone) to increase lowered hormone levels and in turn, reduce symptoms and increase quality of life in those finding perimenopause or menopause challenging. They can be synthetic (sometimes animal-sourced) or body-identical, derived from plants such as wild yam.There are many different forms of HRT, commonly seen applications include transdermal (via a cream, patch, gel or spray), oral via a tablet, and pessaries inserted into the vagina for a localised dose. It is important to mention that there is no one-size-fits-all approach to healthcare and HRT is not a panacea. One woman may be eager to start their HRT journey and another may be unable to, or not view it as part of their journey.
They are all great options and all have the potential to alleviate symptoms. However, diet and lifestyle play a crucial role in perimenopause, whether you take HRT or not, and it's important to be mindful of taking good care of yourself and implementing positive actions. An example of this would be someone taking HRT but having low Vitamin D and a very stressful home life - but the root cause cannot be fixed by HRT alone.
Are there any natural alternatives to HRT?
For those who do not want to, or cannot have HRT, there are other interventions that can be supportive during the perimenopausal years:Shatavari - translating to “who possesses a hundred husbands or acceptable to many” is a phytoestrogen and adaptogen. This means it can support during times of stress and by binding to oestrogen receptors, it potentially limits the symptoms of low oestrogen in the body, such as hot flashes and night sweats(¹).
Ashwagandha - used for thousands of years in the Ayurvedic medical system, ashwagandha is a powerful adaptogen which can have a profound impact on one's ability to manage stress and increase feelings of vitality (²). However, many don’t know its potential when managing common complaints during perimenopause such as memory (³), vasomotor symptoms (⁴) and sleep(⁵).
Saffron - Saffron has also been shown to improve stress resilience and mood by supporting serotonin pathways, making it a wonderful plant to consider as part of your wellness routine (⁶).
A final note: this blog post is not intended to cause worry or be seen as diagnostic. You know your body better than anyone else and will know if something doesn't feel quite right, or if you need a helping hand. Some women have very positive experiences and notice very few symptoms, but equally, this is not the majority so it's important to acknowledge that and arm yourself with information to put yourself in the best position to feel good.
All of the suggestions in this blog post are top-line and are only relevant if the particular symptoms apply to you. At Wild Nutrition, we love habit-stacking - combining small daily efforts as this approach has the biggest impact on health. Focusing on a wholefood Mediterranean diet rich in vegetables, nuts, seeds, olive oil and some good quality fish and meat also provides a solid foundation.
If you feel you need some advice on how best to support yourself during perimenopause or menopause, we’re here for you. Arrange your free 15-minute nutritional therapy consultation today.
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