If you are in your late 40s or 50s and don’t feel like yourself anymore and have noticed changes such as irregular cycles, brain fog, irritability, or vaginal dryness, you might have entered perimenopause.

So What Is Perimenopause?Perimeno-what?

Perimenopause sounds like a bad word, but it doesn’t have to be horrible. Our culture has created a bad connotation with getting older and transitioning to menopause. Still, I assure you this can be one of the most freeing and positive journeys of life!

It’s not without challenges, so let’s go over a few helpful things! I will cover:

    • What perimenopause is (and isn’t)
    • Common symptoms of perimenopause
    • Lifestyle strategies for a smoother journey and improved self-care

Understanding how your body changes during perimenopause is really empowering and can help you navigate this transition with grace and ease.

So What Is Perimenopause?

So What Is Perimenopause?

Simply, perimenopause is the period of hormonal transition before your period stops, as ovarian function declines. Perimenopause is typically a period of seven years but can range from two to ten years, depending on the woman.

Often the terms perimenopause and menopause get confused. Menopause is defined as the point where you’ve gone an entire year without a period. And post-menopause is after that year has come and gone and you no longer cycle.

During the fertile years, in a normal menstrual cycle, your estrogen rises, you ovulate, progesterone rises, and then you bleed.

During perimenopause, this becomes less predictable. You may notice irregularities in your cycle, blood flow, and premenstrual symptoms. In some cycles, you may not ovulate (and therefore not produce progesterone) and feel raging PMS or heavy bleeding, while other cycles may still feel balanced. It’s a bit of a rollercoaster, not unlike puberty. In fact, some refer to perimenopause as reverse puberty.

Symptoms Of Perimenopause

While menopause is characterized by low estrogen (and no progesterone), perimenopause is characterized by fluctuating estrogen. So, there may be times, when you experience high estrogen. Then as you get closer to menopause, estrogen levels will decline, and you may experience symptoms of low estrogen, like hot flashes.

Perimenopause symptoms may include:

      • Irregular cycle length
      • Sleep disturbance
      • Heavy menstrual bleeding
      • Breast tenderness
      • Fatigue
      • Irritability
      • Mood swings
      • Anxiety
      • Depression
      • Brain fog
      • Memory loss
      • Headaches and migraines
      • Weight gain
      • Hot flashes and night sweats
      • Low libido
      • Vaginal dryness
      • Increased urinary frequency
      • Urinary tract infections
      • Pelvic floor weakness

Remeber though, many of these symptoms have to do with how the brain and body adapt changing hormone levels. It’s a transition period, and often women feel more grounded, stable, and confident on the other side!

Each woman will experience perimenopause differently, some with only mild symptoms, and for others, symptoms will impact daily life. Certain life factors such as exposure to toxins, stress, poor diet, and sedentary behaviors may exacerbate symptoms.

Here’s the good news. Many of the lifestyle factors influencing perimenopause are largely within our control. Let’s look at concrete action steps you can take to ease the discomforts you may be experiencing.

How To Support Yourself Through Perimenopause

Here at TārāMD, we believe each woman deserves a personalized hormone solution. We use integrative tools to address each woman’s desires as she goes through perimenopause. Here are some of the foundational habits I discuss with my patients to begin putting in place.

    • Customize your diet. The body may become more insulin resistant through perimenopause, so this is a great time to evaluate your metabolic health and implement diet strategies to keep blood sugar stable. Stable blood sugar may mean fewer hot flashes and steadier weight.

In general, ditch processed food. Strive for a diet composed of whole food with limited sugar and refined carbohydrates. Think of colorful veggies, fiber, protein, and healthy fats with each meal. For more personalized guidance work, please reach out to our nutritionists.

    • Move your body. It’s good for your brain, body, and hormones! As we go through perimenopause and into menopause, we lose muscle mass and bone density. We can counter this with strength training. Body weight exercises, yoga, pilates, and weightlifting are good options. And less can be more; even 20 minutes two or three times per week can make a huge impact.
    • Manage stress. Perimenopausal symptoms may worsen during periods of high stress, so start practicing your stress management strategies already now. Meditation and mindfulness can become a grounding anchor with time and practice. We can also add in nutrients, herbs, and use other tools if stress is high and you need extra support.
    • Prioritize sleep. Sleep can be very challenging during perimenopause as one of the most experienced symptoms is insomnia. Take an inventory of the factors that disrupt sleep most; alcohol use, late caffeine intake and screen time are common culprits. Then, adjust your habits to improve sleep: an earlier bedtime, a relaxing evening routine, and herbal teas or supplements are options.
    • Consider HRT. Hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (bHRT) are effective interventions for perimenopausal symptoms and improving quality of life. We have many options, including creams, patches, and oral tablets. Hormone therapy always needs to be personalized and requires a prescription; please reach out for a consultation to determine if it’s a fit for you.
    • Check your mindset. Perimenopause can feel unfair and overwhelming, but it doesn’t have to be. Remember that perimenopause is temporary.

The only way out is through.

As your body recalibrates to the new hormone landscape, it can be a powerful opportunity to practice self-care in a new way. Many of my patients express a sense of freedom and empowerment as they emerge from perimenopause and settle into the next phase of life.

I hope this information makes perimenopause a little less scary and more manageable. Understanding how your hormone shifts explain how you are feeling and are a natural body process is helpful. We have many integrative tools at our disposal to help you feel your most vibrant self, even through perimenopause.

    Suzanne Fenske, MD, FACOG, ABOIM, NCMP

    Suzanne Fenske, MD, FACOG, ABOIM, NCMP

    With a unique combination of both academic and integrative training, Dr. Fenske focuses on treating complex conditions such as hormonal imbalances, perimenopause, menopause, chronic pelvic pain, endometriosis, fibroids, recurrent infections, sexual dysfunction as well as optimizing women’s health and wellbeing during their annual examinations.

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