Merritt Tracy is a health and wellness coach at The After Cancer. She specializes in hormonal and women's health.
Inevitable physiological changes
As women, when we enter our 40s we start to mentally prepare for the inevitable physiological changes that await us in the upcoming years. We’ve known since we started getting our periods as teenagers that someday down the line, we’d eventually stop getting them. Those with particularly uncomfortable periods may have even looked forward to this day, not realizing that the transitional time of perimenopause can bring on even worse symptoms.
Perimenopause literally means “around menopause,” referring to the time when our bodies prepare to enter menopause, the official end of a woman’s reproductive years. During perimenopause, our periods may become irregular, but it’s not until a woman has stopped getting her period for 12 consecutive months that she is considered to have reached menopause.
Drop in progesterone
Though perimenopause typically begins in our 40’s, for some women it can start earlier. During this time, estrogen (the predominant “female” hormone) can fluctuate, as can ovulation, and we may experience menopausal symptoms such as insomnia and hot flashes. But the first sign of perimenopause is usually marked by a drop in progesterone.
This drop in progesterone during perimenopause can lead to estrogen dominance (this does not mean estrogen is abnormally high, but rather, high in relation to progesterone levels). Estrogen dominance can cause irregular periods, not only in terms of frequency, but also in length and heaviness. Estrogen dominance can cause a host of other unpleasant symptoms and more serious conditions, including cyclical headaches, weight gain, mood swings, brain fog, insomnia, fibrocystic breast tissue, uterine polyps or fibroids, and even an increased risk for breast cancer. [Source: Biomedicine & Pharmacotherapy 102 (2018) 403-411]
It’s no wonder that, for as much as we “can’t wait” to stop menstruating, we quickly begin to dread perimenopause, and for good reason – heavy periods, irritability, and insomnia?! It’s not much fun, and to make matters worse, it can last up to 10 years!
The symptoms of perimenopause are well documented, but the remedies are not. I want you to take comfort in knowing that this transitional time is not something to dread - it can be managed, especially if we care for ourselves and get on top of perimenopausal symptoms.
3 Key Strategies for Perimenopause
Since many of the unpleasant symptoms of perimenopause can be traced back to low progesterone, the key to braving perimenopause is to create a healthy diet and lifestyle that naturally boosts progesterone and helps balance estrogen. To do this, there are three lifestyle factors that are essential to address.
1. Get serious about managing stress
Perimenopause often hits at a time when we are already overwhelmed with our career and caring for children or aging parents (or both). At this stage we are prime for irritability, and the last thing we need is to add more irritability, sleep disturbances, and heavy periods into the mix. Perimenopause can do just that, and stress makes symptoms worse.
Progesterone is produced in both the ovaries and the adrenal glands. Cortisol (our stress response hormone) is also produced in the adrenals, however, cortisol takes priority in the hormonal hierarchy. When we are under stress, the adrenal glands will prioritize the production of cortisol at the expense of progesterone. During perimenopause, when progesterone is already low, stress can cause progesterone to fall even lower.
Taking steps to reduce your stressors, prioritizing self-care, and really looking at your reaction to stress and how you can improve it will make a huge difference here. Working with a trusted Coach can help you identify your stressors, set boundaries, and reframe how you view and handle stress, in turn, helping to reduce stress’ impact on your body.
2. Detox estrogen
When your digestive system is functioning properly and you have a healthy gut microbiome, excess estrogens are metabolized by the liver and excreted from the body. There are many factors that can inhibit this process, however, and cause estrogens to be reabsorbed. This can further disrupt the balance of estrogen and progesterone and lead to more symptoms of estrogen dominance.
Establishing a healthy gut and a diverse microbiome is key to moving estrogens out of the body and keeping them from being reabsorbed. When most people think about a healthy microbiome, they think about taking probiotics. Probiotics can certainly help, but there is often more that we need to do to heal the intestinal lining and create a healthy diet that feeds our beneficial bacteria. Working with a healthcare practitioner or Coach who understands both gut health and hormonal balance can really help here.
It’s also important to reduce your exposure to xenoestrogens - chemicals that mimic estrogen in the body and bind to estrogen receptors. Some xenoestrogens include BPAs, found in plastics, and phthalates and parabens, which are found in personal care products like shampoo, deodorant, lotions, etc.
Exercise can also help remove excess estrogen, while at the same time, produce more beneficial estrogen metabolites that can help prevent breast cancer. Exercise helps toxins move out of the body.
3. Prioritize sleep
Quality sleep is essential for hormone balance. We naturally produce the most melatonin between 11pm and 2am while we’re sleeping, so getting to bed early has great health benefits. Melatonin lowers estradiol levels and helps with the overall balance of estrogen and progesterone.
However, getting more sleep can be a challenge when we’re trying to juggle career, family, and staying on top of our health. There just never seems to be enough time in the day! As a result, many of us may even engage in a form of self-sabotage referred to as Revenge Bedtime Procrastination, forgoing sleep in order to have free, quiet, or alone time. That blissful time after the kids are asleep and all the chores are done may feel like the only time we have to unwind, but when we sacrifice our sleep, for any reason, we wind up doing ourselves a great injustice.
One of the best things you can do for yourself is prioritize sleep. Establishing a sleep routine may be necessary at first, until it becomes a regular habit. Just as children have a “winding down” routine (snack, bath, story book) before it’s time for bed, adults are no different. Your routine may include turning off all electronics an hour before bed, taking a bath, drinking herbal tea, and/or reading a chapter from your favorite book. Start to train your body that it’s time for bed, and pretty soon you’ll reap the benefits of more restful sleep.
What I want you to take away from this is that, while perimenopause is inevitable, the discomfort associated with it is not. Often when we feel there is nothing to be done, we resign to the symptoms and become complacent. However, complacency is an enemy to health. We don’t have to live with all of these symptoms. By proactively making the time and effort to attend to our diet, lifestyle, and supplementation, we are able to navigate and manage perimenopause naturally and smoothly.