Perimenopause is the stage leading up to menopause when a woman experiences some symptoms but still has her periods. Menopause is a single moment in time when a woman hasn’t had a period for 12 consecutive months.

Some numbers and facts:

• All women directly and men indirectly experience menopause
• At least 75% of women experience some symptoms
• 25% of them say symptoms affect their lives negatively.
• 9 in 10 women fail to recognise the signs of perimenopause
• 1 in 3 women take no action or rely on the Internet rather than visiting a physician
• An estimated 14 million work days are lost a year due to symptoms of menopause
• 1 in 4 women consider leaving their job due to symptoms

Perimenopause can last for up to 10 years, but the average time is 4 years. During perimenopause, levels of estrogen and progesterone in the body start to fluctuate and decline, causing the onset of perimenopausal symptoms. Estrogen and progesterone are the main female reproductive hormones but they also play a key role in regulating mood, cognitive function, bone health, and metabolism. The start of perimenopause usually starts in your 40s, but some women enter perimenopause in their 30s.

Perimenopause symptoms

• Irregular periods or heavy bleeding. You may also experience spotting between periods.
• Hot flashes or vasomotor symptoms (VMS). Fluctuating hormones may affect the hypothalamus, the part of your brain that regulates body temperature.
• Changes in metabolism. Many women will experience weight gain and changes in fat metabolism. After menopause, you are more likely to experience unhealthy blood sugar and blood fat spikes, which can increase the risk of heart disease and type 2 diabetes.
• Mood changes such as anxiety, panic attacks, irritability, low self-esteem, and depression. Estrogens can influence serotonin, dopamine, oxytocin, and noradrenaline. When hormone levels change during perimenopause, these chemicals can become imbalanced, affecting your mood. Also, the physical signs of perimenopause can cause extra emotional distress.
• Vaginal dryness. As estrogen decreases, your vagina and cervix start producing less natural lubrication, and the vaginal tissue becomes thinner and drier, impacting your sex life.
• Brain fog, reduced memory, focus, and concentration.
• Sleep disturbances.
• Incontinence. The pelvic floor can become weaker making you more susceptible to bladder leaks when you sneeze, cough, laugh, or exert yourself physically.
• Osteoporosis. Estrogen helps keep our bones strong and healthy, but as it decreases during perimenopause, it puts you at greater risk of developing osteoporosis.

Perimenopause treatments

1. Exercising regularly: Exercise can improve mood, sleep, bone health, weight management, and risk of cardiovascular disease. In menopause, weightlifting makes a difference especially when it comes to loss of bone density. Lifting relatively heavy weights stimulates bone growth. You also need an adequate intake of calcium, vitamin D, omega 3, and proteins.
2. Getting adequate sleep (7/8 hours per night). If you can’t sleep as long as recommended, try to go to bed 30 minutes earlier. This can prevent blood sugar spikes the following day.
3. Quitting smoking: Smoking cigarettes has consistently been found to increase hot flashes.
4. Using over-the-counter vaginal lubricants or moisturizers: can help improve sexual function by reducing vaginal dryness and discomfort during intercourse.
5. Limiting alcohol intake as much as you can.
6. Your diet should be varied and low in glycaemic index, rich in fiber, good quality fats, and healthy proteins. Sweets and processed food should be eaten only occasionally. Include plenty of high-quality plant foods, such as organic vegetables, fruit, nuts, seeds, legumes, and wholegrain carbs. Especially important are:

• Fibre such as wholegrain bread and pasta, cereals such as barley and spelt, legumes, veggies, and fruit (raw and with the peel/skin on if possible).
• Proteins such as lean-cuts meat, fish, eggs, legumes, and some dairy. Having protein at any meal reduces the loss of muscles that the drop in estrogen can cause. Moreover, proteins support your immune system and the production of neurotransmitters. They also keep you keep your hunger at bay.
• Calcium-rich foods. Women under 50’s need 700 mg of calcium, and women +50 need 1200 mg. Prioritize fortified nut milk, Greek yogurt, cruciferous vegetables, nuts, dried fruits, tofu, and miso.
• Oily fish for their elevated content of EPA/DHA. Have 2 portions a week of salmon or herrings or mackerel or trout. Regular intake of omega-3 fats provides important cardiovascular and cognitive support.
• Phytoestrogens. These compounds have a weak oestrogenic activity and may provide a little extra hormonal support during the menopausal transition. Dietary phytoestrogens may also be responsible for the lower rates of breast cancer observed in Japanese women; it is thought that these compounds may be protective. Dietary phytoestrogens are non-GMO and organic fermented soya products (such as tofu, tempeh, and miso), flaxseeds, kudzu, grains, brassica vegetables, grape skin, and many beans.
• Foods rich in di-indolilmethane (DIM), a phytonutrient present in cruciferous vegetables such as broccoli, cauliflower, cabbage, watercress, and dark green leafy vegetables. The substance has powerful effects on estrogen metabolism and is able to keep the body relatively balanced.

Additional suggestions:

Consider HRT (Hormone Replacement Therapy) if your symptoms have a negative impact on the quality of your life. It can be taken in the form of a pill, patch, implant, gel, or cream. Your healthcare professional will prescribe the best type of HRT for you, based on your symptoms, lifestyle preferences, risk factors, and if your periods are still regular.

Manage your stress! As the ovaries start to produce less oestrogen, our bodies can produce a form of oestrogen from the adrenal glands. Since the adrenal glands also help us to deal with stress, it’s crucial to reduce and support stress during menopause to ensure the adrenals are able to cope with these extra demands. Alternative therapies such as acupuncture, meditation, and yoga may reduce stress and improve sleep.

Cognitive behavioral therapy (CBT) might help manage emotional symptoms.

Supplements:

• Magnesium glycinate may also help to balance the stress response, improve your sleep and support bone density.
• Omega 7 may reduce vaginal dryness, dry eyes, and dry skin.
• Algae-Sourced Calcium, Vitamin D & K2. Vitamin D boosts calcium absorption from the intestines and its re-sorption from the kidneys, thus greatly enhancing levels of available calcium within the body. Vitamin K2 makes sure that calcium is deposited in the bones.
• Vitamin B6, B12, and folate can prevent the build-up of homocysteine which is a known cardiovascular risk factor.
• Ashwagandha root extract (Withania somnifera). It is described as a safe and effective adaptogen and is used to promote stress relief, good sleep, and mental focus

The menopause transition can be a bumpy journey, but we can make it happen in a less troublesome and more comfortable way. Being aware of the changes that happen inside you and providing the right support you need, can make this journey not only smooth but also empowering. Just remind yourself that our body tries constantly to maintain homeostasis and equilibrium and we only need to feed it with the optimal fuel and environment.

@Valentina Orneli Draghi