Perimenopause & Menopause: Your Questions Answered

Throughout a woman's cycling life, hormonal changes and symptoms can occur at any stage for many reasons. As women approach the age of 40, one of the most common questions I am asked is, "Am I perimenopausal?" The term "perimenopause" can evoke fears of aging, but there is nothing to fear about this natural hormonal transformation.

Perimenopause and menopause are often likened to a woman's "second puberty," marking a time of transition. Any symptoms experienced during this period are temporary.

Perimenopause vs. Menopause

Perimenopause is the period during which the body adapts to a new hormone profile, eventually transitioning into a new hormonal realignment known as menopause or post-menopause.

In this article, we will explore commonly asked questions to help you understand what this hormonal transition might look and feel like for you, and how you can navigate it smoothly.

When will perimenopause start (and end) ?

This will vary a lot from person to person but commonly perimenopause symptoms might show from during our mid-40’s.  In saying this, early perimenopause symptoms may begin from our late 30’s or we might not ever feel symptoms until our period stops!

All up, this perimenopause time of hormonal transition might last from 2 – 10yrs (whether we feel the symptoms or not).  As you can see, it varies greatly from person to person.

Once we have ceased having periods for at least a year, we are considered post-menopausal. Transition completed. Age at menopause is most commonly at 45-55 year

 “Peri-menopause and menopause should be treated as the rites of passage that they are. If not celebrated, then at least accepted and acknowledged and honored.” — Gillian Anderson  “Peri-menopause and menopause should be treated as the rites of passage that they are. If not celebrated, then at least accepted and acknowledged and honored.” — Gillian Anderson

 Stages and Symptoms of Perimenopause

 The transition into menopause is typically divided into three stages: Early Perimenopause, Late Perimenopause, and Menopause. Each stage is characterized by distinct hormonal shifts, leading to varying symptoms.

  • Early perimenopause

Marked by fluctuations of decreasing progesterone, early perimenopause is often unnoticed by many women, or they may experience mild symptoms such as changes in PMS symptoms—mood swings, cravings, or period pain—while the length of their menstrual cycle remains the same. However, as this stage progresses, the cycle length may start to change, often shortening, and the flow may become heavier.

  •  Late perimenopause

In Late Perimenopause, menstrual cycle lengths often become longer, and some women may skip periods altogether. Estrogen levels can start to fluctuate greatly during this phase, ranging from unusually high to low, with an overall gradual decrease over time.

Common symptoms of Perimenopause include:

  •           Increased period pain
  •           Sore, swollen, or lumpy breasts
  •           Weight gain despite no changes in exercise routine
  •           Waking during the night
  •           Night sweats
  •           Hot flushes
  •           Migraines, or more frequent migraines
  •           Worsening or new premenstrual mood swings
  •           Brain fog
  •           Increased anxiety or depression
  •           Sensitivity to stress
  •           Fluid retention

  •  Menopause

Technically, Menopause is said to begin 12 months after periods cease. However, before, during, and after that period, women may experience symptoms specific to estrogenic changes, coupled with low progesterone, such as:

  •           Hot flushes
  •           Night sweats
  •           Rashes or allergies
  •           Migraines or headaches
  •           Breast pain
  •           Fluid retention
  •           Stress intolerance
  •           Brain fog

As women settle into their new hormonal profile post-menopause, these symptoms typically diminish.

Why Symptoms Vary

The experience of perimenopause can vary widely from person to person, influenced by a range of factors related to lifestyle, genetics, and environmental exposures.

  • Lifestyle factors

How we have been living our lives leading up to perimenopause can greatly impact how we experience this transitional period. Individuals who have prioritised self-care in their 30s—by eating well, managing stress, getting adequate sleep, and maintaining a balanced lifestyle—often find the perimenopausal transition much easier. Unfortunately for most of us, the 30s are one of the busiest times of our lives with our health taking a backseat!

  • Genetics and Health History

Genetics play a significant role in how women experience perimenopause. The experience of a woman's mother or sister with menopause can provide insights into her own journey. Additionally, personal health history, including conditions like metabolic imbalances, weight issues, autoimmune disorders, neurological imbalances (such as anxiety or depression), digestion issues, or other chronic health problems, can influence the perimenopausal experience.

  • Environmental Factors

Endocrine disruptors, a group of chemicals found in the environment, can mimic hormone-like effects in the body, playing a role in disrupting our hormonal chemistry. These chemicals are commonly found in plastics, flame retardants, "stain-resistant" clothing, and pesticides. Exposure to these substances can contribute to the variation in perimenopausal symptoms experienced by different individuals.

Read more on endocrine disruptors here


How can a Naturopath help?

  • Identifying the Stage of Perimenopause

A naturopath can assist in identifying whether you are in perimenopause and which stage you might be in by exploring your symptoms through symptomatology or using advanced functional hormone or hormone metabolite tests to gain clarity on your hormone levels and how your body is processing them.

  • Hormonal Testing

A naturopath can also recommend  hormonal testing with access to a variety of options to provide further insights into your hormonal health. Click here for more details on testing

  • Supporting and Alleviating Symptoms

Naturopaths utilise a variety of tools to minimise symptoms and support you through the perimenopausal transition. Each person is assessed and treated according to their individual needs, which can vary greatly. Here are some common ways naturopaths can help:

  • Lifestyle and Diet Changes

Making changes to your lifestyle and diet can have a huge impact on your symptoms. Common recommendations may include:

  •        Avoiding alcohol: Alcohol can worsen symptoms such as sleep issues, hot flushes, and anxiety. Try a two-week break from alcohol and notice the difference.
  •        Limiting caffeine: Caffeine is known to exacerbate sleep problems, hot flushes, stress symptoms, and anxiety.
  •        Avoiding restrictive diets: Eating regularly and meeting your caloric needs is important for supporting a healthy metabolism.
  •        Eating a nutritious breakfast: A protein-rich breakfast can enhance metabolism and help control blood sugar levels throughout the day, providing better energy.
  •        Staying hydrated: Drinking plenty of fresh, clean water is especially important for those experiencing hot flushes or sweating.

Talk to your Naturopath about how you can tweak your diet and lifestyle to help alleviate your symptoms.

  • Herbal medicines

There are many amazing and effective herbal medicines that help with hormonal and other symptoms of perimenopause. You may have heard of Ashwagahnda or Vitex?  Different herbal medicines will work for different stages and symptoms. Some help modulate estrogens, some progesterone or support the neurological and adrenal driven symptoms. A Naturopathic can formulate a prescriptive herbal formula to your needs,

  • Nutritional Supplements

While every woman's needs are unique, some common supplements recommended for perimenopause and menopause symptoms include:

  •        Magnesium: Supports stress reduction, tension relief, and improved sleep quality. It is also essential for hormonal pathways.
  •        Choline: Important for brain health and cognition, which may help prevent brain fog and memory issues associated with hormonal changes.
  •        Vitamin B6: Essential for hormone support and maintaining neurotransmitter balance.
  •        GABA (gamma-aminobutyric acid): Known as the calming neurotransmitter, GABA levels may decrease with lower progesterone levels seen in perimenopause.

As with herbal medicine, these prescriptions are most effective when prescribed and therapeutically dose to your needs by a practitioner.


Should I take HRT (hormone replacement therapy) or BIHRT (bio-identical hormone replacement therapy) ?

Hormone replacement or Bioidentical Hormone replacement may be a valid option for people with strong or debilitating symptoms.  You can talk to both your GP and Naturopath to assess the pros, cons and alternatives. Everyone has different needs and it is good to assess this individually.  Either way,  supporting your hormonal health through diet and lifestyle is still very important and should still be addressed alongside any medication choices.

Curious to know more about your hormonal health? Ask me or book online for an appointment 

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