Perimenopause, meaning ‘around menopause’, is the stage during which your body is preparing to enter menopause. Often referred to as the menopause transition, the production of estrogen and progesterone incrementally declines during perimenopause to prepare for the end of the reproductive stage of life.
Menopause is reached only when you have not menstruated for 12 consecutive months.
Below, we explain how declining hormone levels during perimenopause impact various aspects of the body. We also outline what you can do to manage your symptoms and improve your quality of life during this transitional phase.
What Causes Perimenopause Symptoms?
Once you hit puberty, estrogen and progesterone (and testosterone, to a lesser extent) naturally rise and fall to support your development, menstruation, reproduction, childbirth, and even breastfeeding.
During the mid to late 40s, (it can occur later or earlier for some), the ovaries start to produce less estrogen and progesterone as the end of the reproductive stage of life approaches.
Although declining progesterone can affect moods, sleep, and libido to a certain extent, estrogen is the main culprit beneath most perimenopause symptoms. While primarily known for supporting the female reproductive system, estrogen also passes through almost every organ, muscle, bone, and body tissue.
Therefore, when estrogen levels begin to diminish during perimenopause, it can impact the brain, heart, bones, muscles, joints, skin, and vaginal health.
This means, that along with irregular menstruation, lower estrogen levels can also cause brain fog, memory loss, anxiety, depression, hot flashes, loss of bone density, less muscle mass, slower metabolism, dry skin, vaginal dryness, and a weaker pelvic floor.
Why Do Perimenopause Symptoms Come and Go?
Although estrogen and progesterone levels are dropping during perimenopause, the decline tends to occur erratically rather than uniformly. This hormone fluctuation generally means that perimenopause symptoms arise and ease off randomly without any warning or recognizable pattern.
When women feel their symptoms in a more pronounced way, it can correlate with a further drop in estrogen levels.
Certain lifestyle factors, such as stress, excessive alcohol consumption, ultra-processed food, and smoking can also increase the intensity of perimenopause symptoms. Whereas, healthy life choices can ease the journey through perimenopause.
How to Manage Your Perimenopause Symptoms?
Recent research has largely debunked the risks previously linked to menopause hormone therapy (MHT), and it is now more widely recognized than ever as one of the most effective ways to treat perimenopause symptoms. However, the benefits and risks of MHT are dependent on receiving the right type of hormone therapy for you.
If you are considering hormone therapy to treat perimenopause symptoms, consider scheduling a consultation with a Menopause Coach or Gynecologist to understand what will suit you and your symptoms, your overall health, and your medical history. (Although helpful in other ways, local GPs are generally not equipped with the necessary updated research to do this.)
That being said, whether you choose MHT or the natural route through menopause, the following lifestyle changes have also been proven to help ease several perimenopause symptoms.
Eating The Right Food to Manage Perimenopause Symptoms
Nutrition is incredibly important throughout life but even more so during perimenopause to support the body under the impacts of declining estrogen. In addition to supporting your physical and mental well-being throughout the menopause transition, the right nutrients can also help with perimenopausal weight gain and hot flashes.
For instance:
· Foods rich in vitamin B6 can support hormone regulation
· Calcium keeps the bones strong as low estrogen levels lower bone density to prevent osteoporosis later in life
· Magnesium can improve sleep and help the absorption of calcium to keep the bones strong
· Protein and fiber boost muscle and bone health
· Phytoestrogens can help lower hot flashes
· Omega-3 fatty acids help boost the immune system, lower blood pressure, and support cardiovascular health to prevent heart disease later in life.
Nutritionists, dieticians, and menopause coaches understand that each woman experiences perimenopause differently in addition to favoring certain eating habits. It can, therefore, be helpful to schedule a consultation with either to create a nutritious eating plan that suits your tastes and can help manage your symptoms.
Reducing Hot Flashes & Night Sweats with Lifestyle Changes
Declining estrogen levels during perimenopause often affect the body's thermostat (hypothalamus) and renders it far more sensitive to internal temperature changes. This typically means that when the perimenopausal hypothalamus senses an increase in body temperature it will cool the body down.
This process is known to us as a ‘hot flash’ and typically causes a sudden feeling of heat in the chest, neck, and face. Red blotchy skin, upper body perspiration, an increased heartbeat, and a cooling sensation as the hot flash subsides are also common.
Hot flashes that occur during the night are known as ‘night sweats’ and they are often the cause of broken sleep during perimenopause, or that unexplained 3.30 am waking.
Although the most effective way of reducing hot flashes is through estrogen supplementation, the following lifestyle adjustments can help manage them too.
· Wear clothes from natural materials like cotton and hemp to keep the body cool
· Dress in layers that can be easily removed and put back on as body temperature changes
· Cotton or linen sheets will keep the body cooler at night than sheets made from synthetic materials
· Put a hand fan in your bag and use it anytime you feel a hot flash starting
· Drink cold water throughout the day to stay cool and hydrated
· Cut back on alcohol, smoking, and spicy food. All three can trigger and intensify hot flashes
Several Perimenopause Symptoms Are Eased by Maintaining a Healthy Weight
Although many women believe that perimenopause causes them to gain weight, this is not necessarily true. That said, hormone imbalances can contribute to the loss of muscle mass, slow the metabolism, and result in less physical activity due to a lack of energy. These changes often result in weight gain during perimenopause, particularly around the midsection.
Scientific evidence suggests weight gain can increase the severity of hot flashes, whereas maintaining a healthy weight has been found to reduce their intensity. When anxiety, brain fog, or mild depression arise as perimenopause symptoms, weight gain can also lower women’s confidence in their appearance and further affect their mental health.
Another important reason to maintain a healthy weight during perimenopause is to relieve extra pressure from the bones and joints. Low estrogen levels are known to reduce bone density and increase the risk of fractures and osteoporosis later in life.
Therefore, eating a well-balanced and nutritious diet not only helps reduce perimenopause symptoms but also speeds up menopause metabolism and keeps weight gain in check.
Along with a balanced diet, exercising 3-5 times a week for 20 minutes can help maintain a healthy body and mind during the menopause transition.
How Exercise Can Help Cognitive & Musculoskeletal Symptoms of Perimenopause
Extensive research has shown that regular exercise provides several benefits during perimenopause. In addition to maintaining a healthy weight, exercise helps improve cognitive and musculoskeletal symptoms in the following ways:
· Aerobic exercise like walking, dancing, biking, and swimming can boost your serotonin release to improve your energy levels, ease brain fog, and relieve anxiety or mild depression
· Aerobic exercise can also improve sleep, breathing, and cardiovascular health when practiced at least 3 times per week
· Strength training with Pilates, yoga, or weights can improve bone strength and muscle mass
· Back pain and joint aches can also be relieved by improving flexibility and balance through yoga or Pilates
How to Naturally Relieve Anxiety, Sadness, or Mild Depression During Perimenopause
You’re getting older, your body is changing, and your kids might be leaving home. On top of that, declining estrogen levels may be playing havoc with your moods, libido, and sleep patterns. All of these factors can enhance feelings of anxiety, sadness, depression, or pessimism during perimenopause and negatively affect your quality of life.
First of all, it helps to understand that these emotions, just like other perimenopause symptoms, will not last forever.
Being mindful that you are in a transitional phase of life can help you to find a more balanced outlook and release anxious, sad, or depressing thoughts. In fact, research has shown that women who have a positive mindset about menopause tend to experience less intense perimenopause symptoms than those with a negative outlook.
· Try starting your day with meditation to calm the mind and let go of whatever is not serving your happiness
· Get into the frame of mind where you can accept your body for what it is and everything it has done for you thus far in life
· Be open and welcoming of your elder years and wisdom rather than grieving your youth
· Meet regularly with friends going through the same phase of life. Sharing experiences can be beautifully therapeutic, remind you that you are not alone, and empower you to understand that perimenopause symptoms will not last forever
Conclusion
The list of perimenopause symptoms is wide-ranging and known to affect women in unique ways. Understanding why each symptom occurs and how to ease their intensity can greatly improve your quality of life and prevent more serious conditions like osteoporosis and heart disease later in life.
Irrespective of whether you decide to use MHT or treat your perimenopause symptoms naturally, the lifestyle changes outlined above can offer more ease, happiness, and positivity during perimenopause.
If you'd like more guidance on managing your perimenopause symptoms, reach out to me at coachcaboverde@gmail.com to arrange a face-to-face or online coaching session. As a Yoga Teacher, Menopause Coach, Female Health Writer, and middle-aged woman who has come through perimenopause naturally, I can help.
Namaste,
Karen
References
British Nutrition Foundation – Managing Menopause with Diet - https://www.nutrition.org.uk/nutrition-for/women/menopause/managing-menopause-symptoms-with-nutrition-and-diet/
National Library of Medicine - Physical Activity and Health During the Menopausal Transition - https://pmc.ncbi.nlm.nih.gov/articles/PMC3270074/
Mayo Clinic – Hot Flashes - https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790
Taylor and Francis Online Medical Journals – Understanding Weight Gain During Menopause - https://www.tandfonline.com/doi/full/10.3109/13697137.2012.707385
Balance Menopause - Pelvic floor health during the menopause Factsheet - https://www.balance-menopause.com/menopause-library/pelvic-floor-health-during-the-menopause/
National Library of Medicine - Reducing Menopausal Symptoms With Mindfulness-Based Meditation - https://pubmed.ncbi.nlm.nih.gov/38363970/
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