Today, the word “perimenopause” has a lot of emotion, judgment, and misinformation tied to it. The vocabulary used to describe this life transition is that of a medical condition that needs to be “treated,” as opposed to a natural transition in a woman’s (or person with ovaries’) life where they should feel well supported, educated, and informed. Symptoms can differ from person to person, but most will report an overall decrease in their quality of life. Generations before us didn’t have access to resources or education to discuss their experience of perimenopause and had to live with their symptoms and push through. Now, we can get excited about this phase of life, where we can use it as an opportunity to determine our current health status, act preventatively, and get support for our menopause experience and overall long-term health.
A NATUROPATHIC DOCTOR'S ROLE
As integrative health care practitioners, naturopathic doctors (NDs) have the knowledge and resources to help patients understand and become aware of the changes they are experiencing or may experience in the transition to menopause. Not only can we provide recommendations, a strategic plan for lifestyle changes, and supplemental support to address symptoms and improve quality of life, but also help reduce future health risks. We do not need to “regulate” your cycle or impose on this natural phase of life; we also don’t want one of the longest and most influential hormonal times of your life to negatively affect your well-being. We can help you set health goals for this next stage, which may involve informed conversations around contraception and an indication for hormone therapy, counselling patients on the risks and benefits of all scenarios.
HOW DO I KNOW IF I’M PERIMENOPAUSAL?
As you approach perimenopause, your total cycle length will begin to change. A seven-day change in either direction (shorter or longer), when you’ve had regular cycles before, indicates the beginning stages of perimenopause. Cycles often get shorter before getting longer, but every person has a unique experience. You may also notice changes in the volume of blood lost with each period; perimenopausal cycles can be both heavier or lighter than normal. Perimenopause is diagnosed clinically, so if you’re speaking to your healthcare provider, make sure they ask about the following aspects of your health:
- menstrual cycle history
- past medical history
- family history
- new onset of symptoms as well as changes to them
Many people aren’t aware that signs of perimenopause can present themselves in their 40s, way before we start to notice changes in the menstrual cycle. You may start noticing changes in sleep and mood well before changes in your cycle. Some common symptoms include, but are not limited to:
- vasomotor symptoms (i.e., hot flashes, night sweats)
- vaginal dryness, pain, or itching
- trouble sleeping
- low mood, feeling anxious
- brain fog/change in cognitive function
- bladder changes and recurrent UTIs
- joint pain
- fatigue/lack of energy
- reduced libido
- weight gain/loss of muscle
- irregular cycles
When we start to see changes in our menstrual cycle, we may notice:
- shorter or longer cycles
- reduction in bleeding or heavier bleeding
- different patterns every month
Please remember that even if you are experiencing changes in cycle length with no other signs of menopause, other health factors need to be ruled out before we can call it perimenopause. This applies to people below the age of 45.
HOW LONG DOES PERIMENOPAUSE LAST?
The length of perimenopause can vary, but ranges anywhere from four to eight years. Menopause occurs once we have gone 12 months without a menstrual cycle. Then, the person is considered to be postmenopausal.
This is a crucial time to not only address symptoms, but also be preventative for long-term health. A variety of treatment options are available to help reduce cardiovascular risk, bone density issues, cognitive health, and more. Estrogen is protective for these aspects of health, so as estrogen declines, we need to reinforce our foundations of health to support these long-term risk factors.
AM I STILL FERTILE?
It’s important to note that just because perimenopause is occurring, that does not mean you are no longer fertile. With changes in cycle length, the predictability of ovulation becomes harder; that is why contraception is a key piece of the puzzle that must be discussed during this time.
TRACKING YOUR CYCLE
It is important to follow the same principles of cycle tracking as we approach perimenopause. Over the age of 40, the menstrual cycle becomes less consistent; an egg may not be released every single month, and this interferes with the production of hormones like estrogen and progesterone. The initial changes in perimenopausal cycles may be subtle. Knowing if ovulation is occurring can help us monitor changes in cycle length, bleeding, and PMS symptoms. It can also help your healthcare practitioner review your best treatment options, as hormonal fluctuations can influence symptoms and how you feel.
You can track these symptoms against your cycle, as sometimes they occur all month long, or they may occur only during cycle phases. These drastic hormonal fluctuations may be why a patient experiences poor sleep and the hottest flashes at a certain time of the month. You may also notice your PMS symptoms are absent during longer stretches without a period, or if your period arrives early. This may indicate that you did not ovulate, meaning that changes in mood, breast tenderness, bloating, etc. can’t be explained by premenstrual fluctuations any longer.
As always, ask your healthcare practitioner which method of tracking and testing your cycle is right for you.
CAN I GET A LAB TEST TO SEE IF I AM IN PERIMENOPAUSE?
The short answer is that it’s not necessary. Testing hormones through blood won’t indicate anything about where you are in your perimenopausal journey, or explain your symptoms or experience. What it will tell us is if your body can ovulate or not, which can vary from cycle to cycle, especially during this stage. We would be looking for follicle-stimulating hormone (FSH) to be high and estradiol to be on the lower end, but this would only be accurate if we tested it consecutively. Running hormonal lab work does not change your treatment plan or guide your practitioner in a different direction, it will just confirm what we already know.
WHAT YOU CAN DO
This transition doesn’t have to be confusing or overwhelming. With the proper assessment, you can have support to improve your sleep, mood, and PMS experience, and reduce the severity of vasomotor symptoms, vaginal and bladder changes, libido changes, and heavy menstrual bleeding. Due to the loss of estrogen, we also want to consider standard-of-care treatments that can help reduce your risk of bone mineral density loss and cardiovascular changes/disease.
Here are some things you can start doing today if you suspect you might be perimenopausal:
- Eat a Mediterranean-style diet: a diet high in protein (1.2–1.5 g of protein per kg of body weight), fruits and vegetables, healthy fats (olive oil, nuts, and seeds), 2–3 servings of fish per week, and minimal processed/packaged foods.
- Exercise a minimum of 150 minutes per week.
- Limit alcohol and caffeine, especially in the two weeks before your expected period.
- Prioritize sleep and stress management strategies.
- Track your cycle to collect data.
If you’re wondering if you’re in perimenopause and want to get a head start on being preventative, contact your trusted menopause-educated healthcare practitioner. Education about your menstrual cycle leads to empowerment and will bring you a step closer to accomplishing your health goals.
