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The Ups and Downs of Perimenopause: Tips for a Healthier Transition

April 20, 2021

Anxious, depressed, angry. Bloated, can’t sleep, can’t remember, no period, then full-blown red storm. Anxious, depressed, angry…again! Why don’t more women talk about this? I’m talking about that midlife experience of perimenopause. We are being thrown into this alternate universe where our emotions, menstruation, and hormones are all over the place—and let’s not forget the appearance of male-like hairs. As much as it absolutely stinks, it is normal.

We hear more about menopause than we do about perimenopause, the time of transition into menopause. There are definitely speed bumps during this time of our lives; our female hormones are up and down, causing us to experience issues such as mood swings, sleep disruption, breast tenderness, change in menstruation, incontinence, and vaginal dryness. This period of transition most often occurs in our forties, but for some can begin in their thirties, and it can last anywhere from a few months to 10 years. There are actually two stages of perimenopause: during the early part, the menstrual cycle is more regular and still fairly predictable; during the second and final stage, the time in which we no longer have a period—that is, amenorrhea—becomes more prolonged, lasting for at least 60 days, until the final menstrual period. Perimenopause is not only a time when estrogen is fluctuating, but there are other hormones involved as well.

Inhibin
Inhibin is one of the first hormones to change during perimenopase and is responsible for telling the ovaries to produce less FSH. According to STRAW criteria (Stages of Reproductive Aging in Women), inhibin is at its peak during reproductive years. As the perimenopausal years go on, inhibin decreases until it is no longer detectable during postmenopause.

Anti-Mullerian Hormone
Anti-Mullerian hormone (AMH) is commonly used to assess ovarian reserve when diagnosing infertility, premature ovarian failure, and hypogonadotropic hypogonadism. It is also an indicator in perimenopause/menopause, when during the transition years AMH continues to decrease until blood levels drop after menopause.

Follicle-Stimulating Hormone
One of the hormones commonly tested when we are experiencing symptoms directed toward our hormones is FSH, or follicle-stimulating hormone. FSH is made by the pituitary gland and stimulates the ovarian follicles to produce estrogen. During reproductive years, FSH stays pretty consistent but once we hit the perimenopausal years, FSH levels begin to fluctuate. When it is high, our ovaries are stimulated to produce more estrogen; when it is low, we produce less.

Estradiol
Our estrogen levels are taken on a roller coaster ride throughout our transition into menopause. There are days when there is both hyperestrogenemia and hypoestrogenemia until menopause actually hits and ovarian follicles are no longer responsive. The low levels of estradiol are responsible for the increase in hot flashes and night sweats. Our serotonin levels are affected by the continuous fluctuation of estradiol, resulting in the changes in our sleep and moments of anger that flush through us. As perimenopause continues, eventually estradiol production drops, and we then enter menopause.

Progesterone
Along with estrogen, progesterone is produced by the ovaries. It not only helps with conception and maintaining a healthy pregnancy, but it is responsible for regulating the menstrual cycle and playing a role in our sex drive as well. Naturally, as our menstrual cycle fluctuates, the amount of progesterone that our bodies produce changes; in other words, the less we ovulate, the less progesterone is produced.

Now that we have a snapshot of the hormones involved, what can we do to support ourselves through this normal life transition? Due to the hormonal fluctuations and the symptoms that accompany them, perimenopause can be quite a vulnerable time. The good news is, there are ways we can help ourselves feel better.

Balancing Hormones Naturally
Many lifestyle changes can be made to help keep our hormones more balanced during perimenopause.

  • Avoid simple carbohydrates and refined sugars; decrease alcohol intake.
  • Consume a more plant-based diet rich in antioxidants and phytochemical. I highly recommend cruciferous vegetables, such as broccoli and kale, which have cancer-protective benefits and, due to their sulforaphane content, help guard against cardiovascular disease.
  • Add high-quality, healthy sources of fats to your diet. These include avocados, coconut oil, nuts, and seeds.
  • Avoid exposure to endocrine disruptors, which are commonly found in plastics, cosmetics, household cleaners, and pesticides.
  • Focus on self-care and manage stress. There are many ways you can manage your stress and at the same time balance your hormones. Regular exercise and meditation are two scientifically proven, highly effective ways to balance not only our female hormones, but our stress hormones as well. Creating routines focusing on self-care, walks, Epsom salt baths, and quiet time to yourself are very beneficial to your mind–body well-being. Consider adaptogens such as maca and shatavari, which help with both stress hormones and female hormones.
  • Maintain a healthy microbiome. There are countless studies about how our gut health correlates with our digestive health, mental health, aging, and more. In terms of the gut–hormone connection, the gut microbiome is one of the principal regulators of circulating estrogen. A group of healthy enteric bacteria within the gut, called the estrobolome, is responsible for metabolizing and modulating circulating estrogen. The estrobolome, along with the rest of our microbiome, affects the levels of estrogen within our bodies, which in turn play a role in our hormonal health and mood.
  • Support your liver. The liver is a key player in detoxification and metabolizing hormones. Addressing nutrient deficiencies, along with methylation and digestive issues, is vital to the health and proper functioning of the liver. Milk thistle, artichoke, and NAC are a few supplements that help support liver function.
  • Consider gentle herbs to help manage symptoms associated with perimenopause. Herbs such as passionflower, ashwagandha, and chasteberry are very helpful. My patients especially love tulsi, also known as holy basil, which can simply be consumed as a tea.

When you are going through any hormonal concerns or changes in your health, it is important to evaluate your nutrient and microbiome status, not just your hormones. Everything within our bodies is connected and works together. If you are going through perimenopause, remember—you are not alone. Perimenopause is a normal part of life that women go through, and we are all here to support one another.

Dr. Veena Verma-Dzik, ND, FIAMA, is a board-certified naturopathic physician and certified medical acupuncturist who is highly experienced in treating acute and chronic health conditions. Some of her specialties include women’s health, ADD/ADHD, GI conditions, MTHFR, Lyme disease and co-infections, mood imbalances, allergies, fatigue, and hormonal imbalances. Each patient she sees receives personalized, individual care involving research-based treatments and therapies from her own clinical experience and success.
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