- Dr. Tania Dempsey
Perimenopause and Menopause: Everything You Need to Know
Perimenopause and menopause are just another stage of life as a woman. But why does it have to be full of so many unpleasant things: hot flashes, night sweats, mood swings, and so on? It doesn’t sound like fun.
What if I told you it doesn’t have to be this way? You can learn to manage and reduce your perimenopause and menopause symptoms naturally with some simple dietary and lifestyle strategies. You can enjoy your life even during your perimenopausal years — without symptoms holding you back. In this article, I want to share everything you need to know about perimenopause and menopause. I will offer my top lifestyle strategies to reduce symptoms of perimenopause and menopause.
What Are Perimenopause and Menopause
Menopause is the end of an era, and perimenopause is the transitional phase leading up to it. When people talk about menopause, they are usually referring to not only menopause but also perimenopause or even the years leading up to perimenopause.
Female reproductive years are divided into three major periods:
The years of active reproduction and fertility: This starts at the person’s first menstrual period.
The menopausal years: This includes perimenopause.
The post-menopausal years: This includes the years after menopause until the end of life.
Perimenopause is the time of your reproductive years that’s leading up to menopause. Sometimes people refer to perimenopause as pre-menopause, though technically, they are not the same. During pre-menopause, your body experiences some hormonal shifts, preparing for perimenopause. But you are not likely to experience noticeable physical symptoms during this time.
During perimenopause, you may start to experience certain symptoms and physical changes. Estrogen levels can swing wildly during this time, often with periods of low estrogen interspersed with periods of high or excessive estrogen, and progesterone levels typically fall, which may lead to changes in your menstrual cycle. You may start to experience irregular periods, shorter cycles, longer cycles, and skipping cycles. You may also start experiencing other physical symptoms, including hot flashes, mood changes, hair loss, weight gain, headaches, and more.
In some females, perimenopause may start in their 30s. I see an increasing number of women experiencing symptoms in their 30s and 40s due to hormonal issues, diet, or other factors. Interestingly, conventional medicine usually reports that perimenopause lasts about 4 years, but there is research suggesting that for some women, it can last 10 years or more, and that is in line with what I see in my practice. Perimenopause ends when your ovaries stop releasing eggs, and you stop menstruating. You officially reach menopause when you’ve gone without a menstrual period for a full year (12 months). At this time, you won’t be able to get pregnant anymore.
The average American woman enters menopause around the age of 51. You may enter it later or earlier. If you had a hysterectomy or oophorectomy, have undergone cancer treatments, have a family history of early menopause, or are a smoker, you have a higher chance of entering menopause early (1, 2). Women with PCOS may enter menopause a couple of years later than average, based on some reports.
Symptoms and Signs of Perimenopause and Menopause
Symptoms and signs that you may experience during perimenopause and menopause may include:
Hot flashes
Night sweats
Fatigue
Insomnia and poor sleep
Brain fog
Trouble focusing and concentrating
Mood swings
Anxiety
Depression
Lack of motivation
Reduction in confidence
Breast tenderness
Bloating
Digestive issues
Weight gain, especially in the abdominal area
Irregular periods then loss of period
Vaginal dryness
Vulvodynia
Urinary pain
Incontinence
Low libido or loss of libido
Urgency to urinate
Muscle aches and/or joint pain
Hormonal acne
Facial hair
Dry skin
Thinning hair
Wrinkles
Dry eyes
Dizziness
Clammy feeling
Osteoporosis
Conditions Associated with Perimenopause Symptoms
Though perimenopause and menopause are natural parts of life, they may also increase your risk of certain health issues.
Heart Disease and Stroke
During their reproductive years, women have a lower risk of cardiovascular disease compared to men. Why is that? It’s estrogen! One of the perks of estrogen is helping your blood vessels to stay relaxed and open. It may also help to keep good and bad cholesterol in the right balance. As estrogen levels drop during perimenopause and menopause, there may be an increased risk of cholesterol building up on artery walls. This means an increase in the risk of heart disease, heart attacks, and stroke (3, 4, 5).
According to a 2023 review published in the Archives of Medical Science, experiencing premature menopause increases the risk of cardiovascular events even further than menopause at 50 or after (6).
Osteoporosis
Lower estrogen levels during the perimenopausal and menopausal period of time may also increase the risk of losing bone mass more quickly than before. This may put you at risk for developing osteoporosis, which is a condition characterized by weak and brittle bones that break easily. A 2015 study published in the Journal of Clinical Endocrinology and Metabolism has found that women with severe hot flashes and night sweat during their menopausal years had a higher likelihood of bone loss and hip fractures than those without severe symptoms (7).
Urinary Incontinence
Urinary incontinence or overactive bladder means that you have trouble holding your urine in and may ‘leak’ by accident. This is a common issue among women at a postmenopausal age, with about 2 in 5 women struggling, according to a 2023 study published in BMC Urology (8). A 2019 review published in Menopause Review suggests that the incidence of urinary incontinence increases with age, and it happens in around 50% of older women (9). One underlying reason behind urinary incontinence is reduced estrogen levels which may weaken the urethra (10).
Oral and Dental Issues
Dry mouth, an increased risk of cavities, and brittle teeth are also more common after menopause. As you already know, a drop in estrogen may lead to weak or brittle bones, which may mean weaker teeth as well. Reduced estrogen levels may also result in decreased saliva flow, which can not only lead to dry mouth but may also alter your taste buds (11). According to a 2013 study published in the Annals of Medical & Health Sciences Research, hormonal shifts may also reduce your body’s ability to fight bacteria, which may increase the risk of cavities and gum disease (12).
Issues That Make Perimenopause Symptoms Worse
Everyone who menstruates will go through perimenopause and menopause either naturally or surgically induced. This process is characterized by hormonal changes that will cause some shifts in your body. But some women have a more difficult time and more severe symptoms than others.
So what makes perimenopause and menopause symptoms worse? Certain health issues, lifestyle choices, and environmental factors may lead to more severe symptoms of perimenopause and menopause.
High Stress
Perimenopause and menopause can be a stressful time. Most women in their 40s and early 50s tend to have a busy schedule. You may be working a busy and stressful job while trying to meet demanding obligations at home as well. Taking on a more demanding role at work or shifting careers is common. You may be dealing with preteens or teenagers living at home, or may even have some college-age children leaving you with an empty nest. Some women during this time are dealing with aging parents or have recently lost a parent. Divorce is also not uncommon at this time. On top of this, you may be experiencing chronic stress from other areas of life.
Unfortunately, high stress and chronic stress may increase your symptoms. Symptoms of chronic stress may be similar to and overlap with symptoms of perimenopause and menopause, such as low energy, fatigue, insomnia, weight gain, mood changes, and concentration issues. According to a 2021 study published in PLoS One, women who experienced chronic stress were 21% more likely to experience vasomotor symptoms of menopause, such as hot flashes and night sweats (13). Researchers found that social support plays a role as well, and having supportive relationships may reduce the experience of stress and symptoms.
Poor Diet and Lifestyle
You knew I was going to talk about diet and lifestyle. What you eat matters. How you treat your body does too. Inflammatory foods may create chronic inflammation, which can lead to or worsen fatigue, pain, chronic symptoms, and the risk of disease. According to a 2021 research published in Nutrients, an inflammatory diet may increase cognitive issues in post-menopausal women (14). Too much sugar and carbs in your diet may lead to blood sugar imbalances, which can result in hormonal fluctuations, weight gain, fatigue, and other chronic health issues. Low-fat diets may also feed hormonal issues and increase weight gain (15). A 2018 study published in the British Journal of Nutrition has found that low-carbohydrate diets lead to less menopause-related weight gain than other diets examined (16).
Poor Gut Health
Your gut health affects everything, including your digestion, sleep, energy levels, mood, brain health, skin, weight, hormonal health, and so on. Gut microbiome imbalance may lead to chronic inflammation and related symptoms. It may also increase the chance of leaky gut syndrome. Leaky gut syndrome may further increase chronic inflammation and increase your risk of chronic symptoms, inflammatory issues, autoimmunity, hormonal imbalances, and a long list of health problems (17, 18).
Chronic inflammation and health issues from leaky gut syndrome and microbiome imbalance can overwhelm your body. It will end up focusing on these chronic issues instead of lowering your perimenopausal symptoms. In fact, chronic inflammation can only make these symptoms of perimenopause and menopause worse, not better.
Moreover, a 2022 study published in the International Journal of Women’s Health and a 2023 study published in Diagnostics (Basel) have found that menopause itself may lead to changes in the gut microbiome (19, 20). Starting with poor gut microbiome health and gut health issues, these menopause-related changes may be harder on your body, causing even further imbalances, and worsening your issues.
Thyroid Issues
During perimenopause and menopause, you are going through some major hormonal shifts. However, hormonal issues don’t happen in isolation. All your hormones are connected. Your estrogen levels may affect your thyroid function. A decrease in estrogen related to menopause may increase your risk of thyroid issues. On the flip side, existing thyroid issues may affect changes in your estrogen levels during menopause (21, 22). According to a 2007 study published in the Journal of Obstetrics and Gynecology, treating thyroid dysfunction may also reduce menopause symptoms (23).
Chronic Toxin Exposure
Unfortunately, environmental toxins are all around us. Non-organic food, conventional household cleaning, personal hygiene, body, and beauty products, plastics, cigarette smoke, our indoor and outdoor air, municipal tap water, medications, and so on: they are all full of chemicals and toxins, which may disrupt your hormonal health.
Xenoestrogens are substances that are very similar in structure to the hormone estrogen. Though they are foreign estrogens, they can still attach to your body’s estrogen receptors, affecting your hormonal functions. Xenoestrogens may increase estrogen dominance, menstruation issues, fertility problems, perimenopause and menopause symptoms, and breast cancer (24, 25).
On top of a high toxin overload, sluggish detoxification may put more fuel to the fire. A poor diet, unhealthy lifestyle choices, stress, toxins, infections, and various health issues may lead to poor liver and kidney function, digestive issues, and problems with elimination. If your body is unable to keep up with the toxin load and eliminate it at a proper pace, it may lead to increased chronic symptoms, including symptoms of perimenopause and menopause.
Lifestyle Management Strategies to Improve Symptoms of Perimenopause and Menopause
So how do you improve your experience with perimenopause and menopause? Here are my best lifestyle management strategies to improve symptoms of perimenopause and menopause:
Anti-Inflammatory, Low-Carbohydrate Diet
One of the most simple ways to improve your health is through dietary changes. Following an inflammatory, high-carb, low-fat diet can increase chronic inflammation and chronic symptoms. To reduce your symptoms of perimenopause and menopause, remove refined sugar, refined carbs, refined seed oils, artificial ingredients, additives, junk food, and overly processed packaged foods. Follow an anti-inflammatory, low-carbohydrate diet. Eat lots of healthy animal protein from grass-fed meat, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game. Include healthy fats, like pasture-raised butter or ghee, coconut oil, and extra-virgin olive oil. Keep your carbohydrate intake low overall, and while my preference is a Carnivore diet, some people do well, including antioxidant-rich greens, non-starchy vegetables, and low-glycemic index fruits. Aim for an organic diet whenever possible
Drink Enough Water
Estrogen fluctuations during perimenopause and decreased estrogen levels during menopause can increase dehydration and dryness. Hydrating your body well may not only reduce dehydration, but may also decrease overeating and emotional eating, increase a feeling of fullness, reduce bloating, and as a result, support a healthy weight. I recommend drinking 8 to 10 glasses of water a day, more if you are exercising, using a sauna, feeling dehydrated, or sick. You may add some cucumber slices, basil, mint, other herbs, or sliced berries for bonus nutrients and taste. I also recommend the addition of electrolytes (without added sugar) to your water, which will have an even greater impact on dehydration.
Decrease Your Stress Levels
As you know, chronic stress may also increase symptoms of perimenopause and menopause. During this time of hormonal and life transitions, stress reduction strategies can come particularly handy. I recommend meditation, breathwork, guided relaxation strategies, and a gratitude practice. You may try journaling to process your thoughts and release emotions. Yoga, Tai Chi, or Qi Gong are great ways to relax your body and calm your mind while getting some low-impact exercise. Spending time in nature, laughter, playing with pets, spending time with loved ones, dancing, coloring, reading, and listening to music are all great ways to lower stress and increase happiness.
Improve Your Sleep
Life is busy, and it’s so easy to fall into poor sleeping habits. But getting enough restorative sleep is so important for reducing stress, improving energy, supporting your mood, maintaining weight, supporting hormonal health, and reducing chronic inflammation. I recommend getting 7 to 9 hours of sleep each night. Avoid stress, using electronics, blue-light exposure, heavy foods, and alcohol before bedtime. Engage in calming activities instead, such as reading, journaling, crossword puzzles, coloring, listening to music, and meditation.
Lower Your Toxin Exposure
It’s impossible to avoid environmental toxins completely, but it’s critical to reduce your exposure. Avoid chemical-filled conventional cleaning, hygiene, body, and beauty products. Avoid endocrine disruptors, xenoestrogens, and carcinogens. Avoid using plastic, especially BPA-containing products. Use an indoor HEPA filter for better indoor air. Drink purified water instead of tap. Avoid using Teflon-coated dishes. If you are a smoker, stop smoking, and avoid second-hand smoke.
Move Your Body
Many women feel too tired or unmotivated to exercise due to symptoms of perimenopause and menopause. Yet, exercise is so important for reducing inflammation, decreasing stress, improving sleep, supporting healthy bones, maintaining weight, losing weight, and decreasing the risk of chronic disease. I recommend moving your body throughout the day and every day, if possible. Choose a form of movement you enjoy. There is so much to choose from: walking, hiking, yoga, swimming, pilates, weight training, and so on.
Estrogen-Balancing Nutrients
There are a variety of nutrients and compounds you may use to help improve and balance your estrogen levels, including:
Antioxidants and epigallocatechin gallate, or EGCG, from green tea (26)
Di-Indole Methane, or DIM, from cruciferous vegetables, broccoli, and various supplements (27)
Try Bioidentical Hormone Replacement Therapy
Bioidentical Hormone Replacement Therapy (BHRT) may also be an option to improve your perimenopause and menopause experience. It is used for supplementing with or replacing your hormones. They are bioidentical to hormones produced by your body hormones. BHRT may be used to decrease menstrual issues, reduce symptoms of perimenopause and menopause, improve sex drive, decrease fatigue and insomnia, reduce the risk of bone and muscle loss, decrease hair loss, and other hormone-related health issues (31, 32).
Next Steps
If you are experiencing symptoms of perimenopause, menopause, any hormonal problems, or other chronic health issues, working with a knowledgeable gynecologist or functional or integrative medicine practitioner is one of the best ways to find the underlying causes of your symptoms and find the right treatment plan.
At AIM Center for Personalized Medicine, we use a personalized approach to understanding your symptoms, finding the root of your health issues, and creating an individualized treatment plan to regain your health. Find out more about AIM here.