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What to expect in peri & menopause?

Most women have either NO idea that there is something called perimenopause or think it refers to the three or four months just before menopause. Many confuse "menopause" and "perimenopause", so first, let’s make sure we’re speaking the same language…

Perimenopause is the phase LEADING UP to menopause: it can start as early as 35 for some women, for others it will only start later - this really depends on your genetics and often also on how much stress you’ve had leading up to this period or during, what your diet and lifestyle is or were like. You are starting to feel a bit different and that’s because your ovaries slow down the production of your sex hormones. Go back to my previous article on the stages of hormone transition for more details here. 

Menopause is when you have not had your period for 12 consecutive months. The average age is 51, but I see it getting later and later for women. Some women also are menopausal much earlier. That’s again up to your genetic make up and also the lifestyle you’ve led.  


That probably doesn't sound right to you, given the fact that many women in their mid-30s are just beginning to start a family, but perimenopausal hormone changes CAN and DO begin in the mid to late 30s for many women. And yes, you can absolutely get pregnant if you are in perimenopause.


If you are in your mid-30s, or even early 40s, you probably don’t want to hear any version of the word "menopause" associated with you, even if it is perimenopause. I totally get it!  But I want you to remember that perimenopause is just a medical term: it’s not a disease, a diagnosis, a syndrome or a designation that says you are old.  It’s just the medical term for what’s going on behind the scenes. So we could actually leave it at that and just wait till menopause comes right? 

Well the annoying thing about those hormone changes “behind the scenes” is that symptoms are creeping in until the day you feel something’s off or you feel like a stranger in your body. And that doesn’t have to happen, but fact is that 80% of women DO experience symptoms when going through perimenopause. 

Let’s have a look at possible symptoms that can be linked to your hormones:

  • Cycle changes: irregular periods, shorter periods, less bleed days, mid-cycle spotting, PMS worse than before, cramps with no bleeding, then later heavy bleeding   

  • Sleep issues: waking at 2am and having a hard time going back to sleep, difficulty falling asleep, waking up tired, not sleeping as deeply, snoring, sleep apnea

  • Mood swings, irritability, aggressiveness 

  • Cognitive changes: brain fog, hard to concentrate, anxiety, depression, migraines  

  • Digestive issues: more digestive issues such as bloating, gas, constipation, or diarrhea.

  • Hot flashes and night sweats but also cold flashes

  • Heart palpitations

  • Low energy, feeling lots more fatigue, and less enthusiasm in getting things done, everything feels like a chore 

  • Weight changes: weight gain, belly fat, cellulite 

  • Impact on vaginal tissues: vaginal dryness, vaginal pain, candida infections, recurring UTIs, urinary incontinence or urinary urgency

  • Decreased sex drive, painful to have sex 

  • Joint and muscle pain,  

  • Breast tenderness, fullness, pain, benign lumps 

  • Skin changes: dry skin, itchy sheens, skin thinning, crepey  skin,  acne, skin more sensitive to the sun

  • Hair: hair loss, hair thinning, increased facial hair

  • Decreased bone density, fracture easily

  • Tingling or numbness in hands, feet or other parts of the body

  • Gum bleeding, swelling, inflammation, receding gums, and increased sensitivity, sensitive teeth, cracking teeth, burning mouth

  • Allergies: more allergies or worsened existing allergy symptoms

  • Increased and/or change in body odor

  • Changes in taste and smell: metallic taste in the mouth or a decreased ability to detect certain smells, ghost smells

  • Restless leg syndrome

Most women begin to have some anovulatory cycles (cycles without ovulation) by age 35. So, it makes sense that progesterone starts to decline in our mid to late 30s since progesterone is primarily produced from ovarian follicles after they have released an egg. It means that if you don’t ovulate or your ovulation is not as robust as it used to be, your progesterone levels in the 2nd half of your cycle will be very low. 


As you progress through your 30s and 40s, your ovarian follicles become less responsive, and as a result, your body makes less progesterone. This is because your ovaries are not working at full speed anymore, they start going towards retirement and things are slowing down. That’s why you begin to see a continuous decline in progesterone which is followed later on by a decline in estrogen (and testosterone) as well. 

Symptoms of low progesterone

The most common progesterone-related complaints I hear from clients and friends are irritability, mood swings, anxiety and sleep issues (not sleeping as deeply anymore). You may notice being much more emotional -  those are all  typical signs of progesterone deficiency.  


We need progesterone to balance out the stimulatory effects of estrogen, and since progesterone starts to decline in our mid to late 30s, many women end up with symptoms of what is commonly referred to as estrogen dominance (high estrogen compared to low progesterone) in addition to our low progesterone symptoms. And this doesn’t necessarily mean that your estrogen is too high, it just means that your progesterone is too low in comparison and that the balance is off. 


“Estrogen dominance” symptoms can be: 

  • PMS

  • Heavy periods

  • Bloating

  • Breast tenderness/fibrocystic breasts

  • Weight gain

  • Mood swings

  • Histamine intolerance (this can show up as allergies, post nasal drip, skin rashes and itching especially after exercise or sauna, insomnia, heartburn/acid reflux or other digestive issues)


Unfortunately that’s not everything…. Once you go deeper into perimenopause and get closer to menopause, your estrogen can fluctuate wildly leading to a huge surge in estrogen one minute, followed by a huge dip in estrogen only moments later. 


Studies show that estrogen can surge twice as high as it ever has during perimenopause and then literally fall to almost nothing. It’s a real roller coaster ride! You may feel these fluctuations as memory lapses, migraines, hot flashes or night sweats.  


And that’s still not all: even though they’re not fluctuating much, your androgen hormones are declining too - these include testosterone and DHEA. They affect your vitality, your sex drive, your mood, your bones, your self-confidence and so much more! 

Women in perimenopause most often actually complain about symptoms of high testosterone like thinning hair and acne, which are mostly related to  the fluctuations of your other hormones. A bit like the “estrogen dominance” situation just minus the fluctuations! Read more about testosterone in my previous article here.

Two weeks ago, I wrote about stress in peri and the importance of your adrenal glands and keeping your stress hormone cortisol down in order to ensure adequate output of sex hormones. This is because your ovaries have been the main organs that produced your sex hormones progesterone, estrogen and testosterone… until perimenopause. When you enter perimenopause, your adrenal glands are getting promoted to becoming your main source of  sex hormone output (and fat tissue for estrogen). Go back to my previous article on stress in perimenopause to read more here. 


And that's where most women run into problems: 

  1. Consider how you have treated your adrenal glands all these years (what kind of stress did your body have to go through?) 

  2. In perimenopause, your adrenal glands have taken on a second job (and if you've ever worked two jobs, you know that it can be a difficult balancing act) on top of all you’ve put them through in these past years…

  3. So you see that you’re double punishing your adrenal glands who have to put out all that cortisol and don’t have any more bandwidth to also put out your sex hormones… and as a result, you're feeling depleted.


Your hormones affect one another

This is what makes it so complicated: hormone balance is really delicate and when one hormone gets out of balance, the others will all be impacted. 

As you’ve seen, cortisol is quite an important hormone in peri although it’s not one of your sex hormones that actually declines. 

Your thyroid is one other gland and hormone that gets affected by all these fluctuations and then lastly, your hormone insulin:


  • Thyroid hormones are also impacted: stress, toxins, lack of sleep, too little or too much estrogen, and/or progesterone affects thyroid hormone production. There’s even a term for it: thyropause! As a result, many women end up with a sluggish thyroid that leaves you with stubborn weight gain, fatigue, hair loss, dry skin, …. Read more about how your thyroid is affected in perimenopause here.

  • Then the last hormone that I want to mention is insulin. We often don’t even consider it a hormone, but it is. And it’s very much affected as well in perimenopause. Stress, toxins, lack of nutrients, lack of sleep, and low imbalanced estrogen affect our body's ability to balance blood sugar. Also, our cell receptors are aging and are not as responsive anymore to insulin as they used to be. Insulin receptors that were once sensitive to insulin no longer work as they once did, and insulin levels rise in the body. The result? Insulin is a fat-storage hormone that tells the body to hang on to extra body fat. Most women develop insulin resistance, meaning that your cells are not able to let energy enter anymore and you feel fatigued, experience brain fog, weight gain around the middle, and experience insomnia.  

Our bodies are dealing with many hormonal changes at once, and at the same time, most of us are balancing work and family obligations, aging parents, perhaps a teen or two who are going through puberty, and so much more! It's no wonder that women don't feel like themselves!  


Many women are wondering: will things get better post menopause? Well at least the crazy hormone fluctuations will stop and most women report improvement in memory loss that can be really severe while transitioning into menopause. 

Most women however, continue to suffer from symptoms of low hormones, especially hot flashes, sleep issues, weight gain, depression, dry and crepey skin, urinary incontinence, vaginal dryness, osteoporosis, heart palpitations etc. 

So things are getting a bit better and that again is very individual to each woman. However, most women continue to experience symptoms of low or imbalanced hormones.

I want you to know that you DO have a lot of control over how you experience this chapter of life.

I find that women who haven’t addressed existing and underlying health issues before entering perimenopause will likely have worse symptoms. Book a free clarity call here if you would like help with this.

I often hear clients or potential clients wanting to prepare for menopause when they are already in their late 40s and suffer from severe symptoms. It’s not too late to start then, but ideally, you’d start that preparation earlier to avoid the suffering.

Think about all the books you read before your kids were born and all you did for them, why is it so strange to apply the same energy to your own wellbeing? 

If you are not willing to prioritize yourself and your own health at this time, you will very likely suffer through perimenopause and also after menopause. 


This phase of life WILL REQUIRE your attention and commitment to change things that are not serving you anymore or have actually never served you well.  

It's also important to find a practitioner who really understands menopausal women. 

Here is a list of things you can start doing to support hormone harmony vs hormone chaos:

  • Eat real food

  • Get in your protein (and if in doubt always eat more)

  • Cut out alcohol

  • Detox 2x per year (at a minimum)

  • Get enough and restorative sleep

  • Get outside daily

  • Move your body daily

  • Lift weights

  • Practice stress management techniques

  • Hydrate 

  • Allow yourself to rest

  • Learn to say NO

  • Have fun

  • Supplement with natural hormones or herbal formulas to boost your hormone levels

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