Although blood tests to ‘diagnose’ perimenopause by hormone levels are available, as hormone levels fluctuate on a daily as well as monthly basis, this isn’t an accurate way to establish whether perimenopause has begun. It’s more aptly assessed by symptoms.
Signs of perimenopause
Despite recent media attention and the narrative that the menopause is a life phase marked by deteriorating health and well-being, many people transition through the menopausal years with no issues and minimal symptoms, and there is evidence to suggest that people from different parts of the globe experience menopause in different ways, though more research is needed to better understand this.
Symptoms most associated with the perimenopause include menstrual changes, such as heavier or lighter periods, irregular periods or unexpected bleeding; vasomotor symptoms, such as hot flashes and night sweats; psychological symptoms, such as mood changes, anxiety, brain fog, low libido, memory loss and poor concentration; metabolic changes, such as weight gain and an increase in belly fat; pelvic symptoms, such as vaginal dryness, urinary urgency or incontinence; and musculoskeletal symptoms, such as joint pain.
Can perimenopause be treated?
Many people think that the loss of oestrogen alone is to blame for these symptoms, but this is to misunderstand the nature of the perimenopausal transition. The first hormone to decrease is progesterone, which can be linked to changes in mood, and many people then undergo several years where oestrogen fluctuates dramatically, with some cycles being higher than it would in their reproductive years and others being lower. This is akin to a ‘second puberty’. It is only in the later phases of perimenopause that both oestrogen and progesterone decline, and testosterone can, too. There are also metabolic changes happening here, which can make women more prone to insulin resistance and blood sugar imbalances, making it easier to gain weight around the tummy.
We hear a lot about ‘balancing hormones’ in the women’s health space, but it is important to remember that the hormone shifts that come with perimenopause are very normal and to be expected, rather than pathologised. While HRT is the only way to replace hormones that are naturally declining, there are nutrients that are important in supporting our natural hormone production and metabolism, and in supporting the other systems in the body that can be under strain during this time of turbulence. Though HRT has gained much media traction in recent years, the decision of whether or not to use HRT is deeply personal and should always be done in the most informed way possible.
Alongside all of the hormonal flux happening at this life stage, it is often also a time peppered with significant stressors and strains. Adolescent children, ageing parents, marital breakdowns and high workplace stress can all be contributing factors, which is why having a healthy perimenopause is about far more than just which supplements to take.
What changes can I make to manage perimenopause symptoms?
Differential diagnoses are an important consideration. Symptoms of perimenopause can also be symptoms of other things (for example nutrient deficiencies, thyroid issues, insulin resistance, gut imbalances or inflammation), so it is always worth getting some comprehensive blood work done to help you and any practitioners you might be working with better understand what is going on.
While a 360-degree approach is best, there are some supplements that may complement lifestyle changes, such as eating a nutrient-dense diet, getting regular movement (particularly strength training), managing stress and prioritising sleep.
It is worth noting that our sex hormones are made from cholesterol, so having a diet that includes healthy fats and having sufficient cholesterol levels is important.
Other nutrients to consider in the context of hormone health in the perimenopause include protein and amino acids, B vitamins, magnesium, vitamin D, iron, vitamin C, zinc, iodine, vitamin E, choline, chromium, taurine, glycine, inositol, CoQ10, fibre and omega-3 fatty acids. Each of them are important for different reasons, and whether or not you would benefit from supplementing with them depends on the symptoms that you’re struggling with.
Many ‘perimenopause’ supplements are broad-spectrum multivitamins, some with added herbs. While these may well be helpful for some people, the best approach is a nuanced one, where the systems that are under strain are getting the right support.
IMPORTANT: If you are taking supplements alongside HRT, it is important to make sure that these have been professionally checked for possible interactions and that you’ve had the go-ahead from a safety point of view.
How long does perimenopause last?
The perimenopausal transition can last up to 10 years for some people, and continues until a year after your final menstrual bleed, at which point you are officially ‘menopausal’.
The biggest sign that you might be coming to the end of perimenopause is the time between your menstrual cycles lengthening. Symptoms can persist into the early years of menopause for some people.
Katy is a nutritional therapist, as well as a registered nurse with over 10 years’ experience. She specialises in women’s health including hormones, fertility and pregnancy, as well as menopause and disordered eating. She worked in the NHS for many years and now focuses on her private practice, clinical mentorship, and supervising nutritional therapy students at University of West London. She holds a diploma in naturopathy and nutrition, a degree in anthropology, and postgraduate degrees in medical anthropology, adult nursing, and specialist community public health nursing, and is licensed by the Nursing and Midwifery Council (NMC), British Association for Nutrition and Lifestyle Medicine (BANT), and Complementary and Natural Healthcare Council (CNHC).
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