The natural hormonal life cycle is influenced by many factors. Genetics, lifestyle, general health and nutrition contribute to the phasing of one stage to the next. Perimenopause represents the years prior to menstruation coming to a halt and menopause beginning. This can occur at a wide range of ages for women, from the mid-30’s into the early 50’s. Generally, the average age of onset is 40-44 years old. This transition signifies the decline in fertility and leads a woman closer to menopause.
Perimenopause can last for up to 10 years. Generally women may notice changes to their menstrual cycle patterns, flow, mood, body composition and sometimes sleep. Symptoms can be mild and not enough to consider treatment or can be severe. Many natural and prescriptive options exist to support these normal transitions of hormones but alleviate symptoms at the same time. Natural treatments involve the use of herbs, detoxifying protocols, diet and exercise while hormonal therapy can be used with bioidentical hormone applications.
Understanding Hormonal Changes During Perimenopause
A woman’s menstrual cycle is a complex balance of mainly estrogen and progesterone, however cortisol, thyroid, testosterone and insulin are important cofactors. Day 1 of a menstrual cycle is the first day of flow and this signals the beginning of the follicular phase. Estrogen is the dominant hormone and it promotes egg maturation in the ovary. Typically this phase ends in ovulation, or release of the egg providing a fertile window for getting pregnant. The next phase is the luteal phase, or progesterone-dominant phase. The uterine lining is built up to provide a protective landing site for a possible fertilized egg. If no pregnancy occurs in a cycle, hormone levels change again and initiate a menstrual flow, or a new Day 1.
During perimenopause, most commonly the hormone progesterone starts to have declining levels before estrogen drops. The luteal phase, or second half of the cycle, will see the most change in hormones and thus most symptoms occur leading up to the next flow. Some women can experience these changes a full 2 weeks prior to their next period and others only a few days. The drop in progesterone levels can result in shorter cycles, meaning less time between periods and often also causes heavier flow.
Both physical and emotional symptoms are common in perimenopause. It can be confusing at times when emotions do not match typical situations or why sleep patterns are suddenly disruptive. Physical symptoms can be uncomfortable and new or an increase of intensity in existing premenstrual symptoms. These are quite common during perimenopause.
Symptoms of Hormone Imbalance During Perimenopause
Common symptoms experienced during the perimenopausal phase include:
- Irregular or shortened cycle lengths
- Heavier flow or changes to length of flow
- Mood changes – anxiety, weepy, irritable and/or angry
- Sleep disruptions – waking in the night, light sleeping
- Stronger cramps, breast tenderness
- Weight gain
- Heat – night sweats and/or hot flashes
- Brain fog or difficulties concentrating
The severity of these symptoms can be a vast spectrum from very mild to severe. This spectrum can be explained often by the amount of disproportion between the hormones involved. Genetics often plays a role and women in a family can generally look to their mothers, sisters and aunts to get a preview of the genetic aspects of perimenopause.
Natural Methods to Balance Hormones During Perimenopause
Diet and Nutrition
A great place to start when looking to reduce perimenopausal symptoms is with nutrition. High carbohydrate diets – both sugar and starches can enhance some women’s perimenopausal symptoms. Sticking to a well proportioned diet that involves a substantial amount of non-starchy vegetables, protein and healthy fats is a wonderful way to improve overall health and hormonal imbalances. The Mediterranean diet is the most studied diet and the health benefits improve cardiovascular risks, diabetes and brain-health.
The Mediterranean diet includes sources of high quality omega 3s from fish and seafood as well as other healthy fats found in nuts, seeds and avocados which can be used by the body to make more hormones and to lower inflammation. Leafy green vegetables such as arugula, bok choy, swiss chard and kale are heavily loaded with vitamins and minerals. Each meal should ideally contain at least 1 green vegetable.
Avoidance of unhealthy foods can also make a difference with the degree of perimenopausal symptoms. Keeping processed foods, trans fats and excessive caffeine out of daily routines promotes overall healing and a healthier internal balance.
Exercise can increase hormone production! Studies have proved regular exercise of moderate intensity will increase thyroid and testosterone hormone secretion, and improve insulin and glucose balance. When these important regulator hormones are balanced, often estrogen and progesterone levels balance can improve.
Stress management techniques such as deep breathing, yoga and meditation will improve cortisol levels. Cortisol in excess can lead to midsection weight gain, fatigue, hair loss, insomnia and anxiety. Re-training the body takes time, but it is possible to lower and improve cortisol balance which will also improve thyroid and sex hormone levels.
Sleep is when the body heals and recovers. The lowest levels of cortisol should be produced at night when the brain and body are in the most relaxed state. Sleep can be thought of as a rebalancing state and allowing sufficient time and depth will improve hormone levels.
Herbal Remedies and Supplements
Herbs and supplements are often very helpful during perimenopause to decrease the intensity of symptoms and sometimes regulate cycle duration and flow. Common herbs used include:
- Chaste tree berry
- Black Cohosh
- Evening primrose oil
- Lemon balm
Depending on the symptoms, the appropriate herbs can be used. Consultation with a healthcare professional is advised before starting any new supplements as medications and supplements can interfere and herbs can have cautions just like prescriptions. Many times herbs are the perfect first option when beginning the perimenopause phase, herbs can help to re-balance the existing hormones produced. If hormones are too low, the best option may be to use bioidentical hormones. This can be determined through extensive testing prior to starting protocols.
Bioidentical hormone therapy (BHRT) is a safe and effective choice for perimenopause. If progesterone levels have declined too low, many herbs and supplements will not be capable of re-establishing a balance between estrogen and progesterone. Advanced testing is available for hormones which can help determine if BHRT is a safe and useful avenue to explore. In general, the most active form of estrogen (estradiol) is not prescribed until a woman has stopped menstruating.
Consulting with a healthcare professional who is skilled and experienced in BHRT is important. Using laboratory analysis and re-testing annually should be part of every BHRT protocol to ensure safety is at the forefront. Hormones are very safe when used and prescribed correctly.
Practical Tips for Hormonal Balance
Incorporating healthy routines involving exercise, nutrition, stress management and prioritizing sleep can be an excellent way to start addressing the natural change of hormones. Using an app to track menstrual cycles and associated symptoms can help to define patterns and changes. This information can be used when speaking to a Naturopathic physician and may help to determine the nature of hormone imbalance leading to specific testing.
Self-care means something different to each person. Massage therapy, spa days, exercise, naps, reading a great book or even just hanging out with close friends are some ways to lower stress levels and manage stress. Prioritizing yourself can be hard, give yourself patience and time. Seeking out a practitioner that understands the delicate balance of hormones and how you can benefit from the various modalities of treatment is important.
Natural and prescriptive methods for hormonal balance are available during perimenopause. This is not a phase of life to “suffer” through in order to get to the other side. Women can feel amazing as hormones naturally shift, it might take some changes to routines, diet and supplements but it is very possible. Finding an approach that works best is an individual journey, however naturopathic medicine can provide the support and foundation to take charge of your hormonal health during this wonderful time of transition.