Understanding Perimenopause: Recognizing the Signs & Symptoms

Perimenopause is a natural part of life that occurs during the transitional period to menopause: the time in a woman’s life that marks the end of her menstrual cycle and reproductive years. Irregular or erratic menstrual cycles are usually the first signs of perimenopause, followed by symptoms such as hot flashes, depression, sleep issues, and weight gain. These signs and symptoms occur as a result of changing hormone levels in the female body (or people assigned female at birth/AFAB). 

In this blog post, we’ll discuss all things perimenopause: common signs, symptoms, and complaints — and how naturopathic functional medicine can help to ease many bothersome perimenopause symptoms and make the transition to menopause a lot more tolerable! 

Perimenopause: What Is It?

As the transitional period that occurs before we enter menopause, perimenopause (or pre-menopause) is when the function of our ovaries begins to decline. The ovaries start producing less estrogen, and as ovulation becomes less frequentt progesterone levels also decline. Declining estrogen + progesterone levels (two of our main sex hormones) can cause many of the more commonly experienced perimenopause symptoms (like menstrual irregularities, vaginal dryness, pain during intercourse, sleep issues, and heavy menstrual bleeding). 

Once the body adjusts to these hormone changes (typically after we’ve reached menopause), symptoms tend to subside. We can also manage these hormone changes during perimenopause by using approaches such as bioidentical hormone replacement therapy (BHRT), herbs, and supplements. I use a variety of natural therapies in my naturopathic functional medicine practice to support the body through these hormone changes.

Pregnancy During Perimenopause?

As ovarian function declines in the years leading up to menopause, fewer eggs are released during ovulation. This can make pregnancy more difficult but still very possible during perimenopause. 

How Long Does Perimenopause Last?

The transition to menopause lasts until we’ve gone a year without a menstrual period, which can range from three to four years, five to eight years, or in some cases, 10 years or longer. However, the median duration is said to be four years

The duration typically varies depending on factors such as:

  • Age of onset.
  • Race and ethnicity.
  • Certain lifestyle factors such as smoking.

Once the ovaries stop releasing eggs altogether and we’ve gone a full year without a menstrual period (known as our final menstrual period or FMP), we’ve officially entered menopause.  Menopause marks the end of menstruation and ovulation, which means we can’t get pregnant naturally during this time.

The Postmenopausal Stage

When the perimenopausal stage ends and we officially reach menopause, we enter the postmenopausal period. Many perimenopause symptoms tend to stabilize during this time, though the risk of osteoporosis, bone fractures, and heart disease increases. However, naturopathic functional medicine helps to restore balance within the body, reduce our risk of health complications as we age, and improve our overall health and well-being! 

Perimenopause: When Does It Start?

Most women or AFAB people notice their first few signs of perimenopause in their mid-40s or 50s, with a mean age of 51. However, some will begin the menopausal transition earlier or later in life. For example, those with polycystic ovary syndrome (PCOS) tend to reach menopause about four years later than non-PCOS women. Dietary and lifestyle factors (like regular consumption of fruits, veggies, and tea) can also delay menopause, according to a review article published in the Journal of Mid-Life Health

On the other hand, those with premature ovarian failure may start the menopausal transition before the age of 40. Premature menopause affects about one percent of women under 40 years of age and is often accompanied by other hormonal issues such as infertility, sexual dysfunction, and low mood. Certain lifestyle factors (like vigorous exercise, severe weight loss, smoking, lack of sun exposure, and diets high in polyunsaturated fats) can also accelerate menopause. 

Common Signs of Perimenopause

For many of us, the first signs of perimenopause include irregular or erratic menstrual cycles and changes in bleeding. Menstrual flow may be lighter or heavier than usual, cycles may become longer or shorter, and periods may be skipped altogether. It’s also common to experience the following perimenopause symptoms:

  • Vasomotor symptoms (VMS) like sudden hot flashes/flushes, night sweats, and chills
  • Sexual symptoms like vaginal dryness and atrophy, pain during intercourse, and decreased libido
  • Sleep disturbances like insomnia and night sweats
  • Brain fog, memory changes, and concentration issues
  • Mood changes such as depression, irritability, mood swings, and anxiety
  • Other changes such as headaches, bodily aches and pains, midsection weight gain, heart palpitations, and thinning skin

While most women and AFAB people experience menstrual changes and irregularities during perimenopause, there are certain changes that aren’t considered normal. For instance, spotting between periods, prolonged bleeding, and bleeding that occurs after menopause could indicate postmenopausal hormone imbalances or a gynecological condition. The good news is that many natural therapies are available to manage these symptoms and balance your hormones throughout all stages of life! 

Managing Perimenopause Symptoms

As a naturopathic functional medicine physician, I use a variety of naturally focused and science-based therapies to assist patients in managing their perimenopausal and postmenopausal symptoms. Helpful therapies during perimenopause often include the following:

Herbs & other natural remedies

From phytoestrogens and herbs to nonhormonal therapies such as nutraceuticals, there are a number of natural remedies available to reduce perimenopause symptoms. Phytoestrogens like soybeans and flaxseeds, for instance, are safe choices for many — as they’ve been shown to reduce hot flash frequency without the risks associated with hormone therapy. 

Numerous studies also support the use of other natural remedies during perimenopause, including herbal derivatives such as Actaea racemosa (black cohosh), evening primrose oil, Foeniculum vulgare (fennel), Ginkgo biloba, Glycyrrhiza glabra (licorice), Hypericum perforatum (St. John’s Wort), Medicago sativa (alfalfa), Melissa officinalis (lemon balm), and Vitex agnus-castus (chaste tree). 

Supplementing with magnesium can also be helpful during perimenopause, especially for reducing symptoms such as abnormal sweating, fatigue, and distress due to hot flashes. Additionally, vitamin E supplementation may help with preventing hot flashes, improving sleep quality, and relieving symptoms associated with vaginal atrophy.

Bioidentical hormone replacement therapy (BHRT)

In my naturopathic functional medicine practice, I commonly use bioidentical hormone replacement therapy (BHRT) as an alternative to synthetic hormone replacement therapy (HRT) when patients present with hormonal imbalances. Imbalances in hormones can be a symptom of perimenopause as well as many other conditions that disrupt hormone function throughout life. 

“Bioidentical” or “body identical” hormone Therapy (BHRT) uses hormones that are compounded to look exactly like your own, natural hormones. BHRT substitutes the endogenous hormones our body does not make any longer, or only makes in insufficient amounts. Applied in the right dose and duration, BHRT can be a safe and effective option in alleviating symptoms of perimenopause and restoring the hormonal balance within our bodies.

Synthetic HRT, on the other hand, uses hormones that come from the urine of adult female horses (mares). Synthetic HRT was once very popular due to its effectiveness in reducing perimenopause symptoms. However, the Women’s Health Initiative (WHI) estrogen plus progestin trial, first published in 2002, has highlighted potential increased risks associated with synthetic HRT, including an increased risk of stroke, heart disease, and breast cancer. While this study has brought up many controversial interpretations of the risks and benefits of synthetic HRT, caution about using synthetic HRT is surely advised. 

Navigate Perimenopause with Ease

While the right approaches for you will depend on your unique body’s needs, I offer comprehensive patient intakes and in-depth testing so we can unlock your hormone levels, nutrient status, and dietary needs as you transition from perimenopause to postmenopause. 

Perimenopause is a natural part of life, but it doesn’t have to be the horrible transition we as women have been taught to fear! The right therapies and lifestyle changes can provide our bodies with everything they need to thrive throughout any life stage — including perimenopause, menopause, and beyond.

Ready to start alleviating your perimenopause symptoms?

Connect with me to learn how naturopathic functional medicine can help to restore balance within your body and relieve your symptoms safely, naturally, and effectively.

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