What is perimenopause?

Perimenopause, or the menopause transition, is a natural progression in a woman’s life when her reproductive system gradually slows until you hit “menopause”; when you have had an absence of periods for 12 months. The length of perimenopause differs between individuals, and can occur over just a few months, or up to 10 years – but 4 years is the average duration.

During our “premenopausal” reproductive years, our levels of the sex hormone oestrogen, made by the ovaries rise and fall fairly predictably throughout the menstrual cycle. In perimenopause, your oestrogen levels begin to decrease, which effects the levels of another sex hormone, progesterone. These hormones are responsible for ovulation and menstruation and start to fluctuate greatly during perimenopause before your ovaries stop producing oestrogen altogether at menopause.  

Perimenopause symptoms

Changing hormone levels through the menopause transition can manifest as a range of different symptoms, and again, this will vary between individuals. Studies show that up to 90% of women will visit their GP for help with their symptoms during perimenopause¹ – which could include:

• Changes to menstrual cycle – these are usually the first notable signs that you are in perimenopause. Your periods may be heavier, lighter, shorter, longer or more erratic.
• Hot flushes
• Insomnia
• Mood changes
• Brain fog
• Impaired memory
• Fatigue
• Sleep disturbance
• Reduced libido
• Joint pain
• Vaginal dryness
• Changes to skin/hair
• Increased fat around the middle

Although this list might sound daunting, not every woman will experience every symptom and there are lots of dietary and lifestyle changes you can make to support you through this natural process.

Dietary changes to support perimenopause

The decrease in oestrogen and progesterone in perimenopause can have knock-on effects on our insulin sensitivity, which can trigger fluctuations in blood sugar levels. This, in turn can affect our energy levels, create inflammation and create a greater tendency to gain fat, particularly around the middle. You can support healthy, balanced blood sugar through diet by following these tips:

• Avoid eating sugary and processed foods and refined carbohydrates (white rice, bread, pasta etc) – these foods are rapidly converted into glucose and raise blood levels very quickly.
• Include starchy carbohydrates such as wholegrains (including brown rice and oats) and potatoes in moderation. In terms of portion size, starchy carbohydrates should not cover more than a ¼ of the plate at any meal.
• Consume plenty of healthy protein sources such as meat and poultry, wild salmon, tuna tinned in spring water or olive oil, eggs, beans and lentils.
  All green vegetables/salads are recommended. Veggies grown above the ground will be lower in carbohydrate (and higher in healthful nutrients) than those that are grown below the ground.
• Be careful with fruit – all berries are great, apples and pears too, but not tropical fruits like bananas, oranges, grapes, and mangoes which are especially high in sugar. Avoid tinned or dried fruit.
• Choose healthy fats such as olive oil, avocado, nuts, seeds and oily fish. Fat in a meal will slow down the release of glucose into the bloodstream.
• Drink plenty of water and avoid fizzy drinks. Even diet drinks have been shown to have a glycaemic effect, and disrupt our microbiome, so best to avoid.
• Nutrients such as cinnamon, chromium and magnesium can also support healthy blood sugar balance.

Lifestyle changes to support perimenopause 

Stress – there is a link between increased severity of perimenopause symptoms and women who experience high levels of stress. Yoga can be a great way to relax, and the breathing exercises can help to reduce hot flushes and mood changes. Other ways to help reduce stress could include meditation, or just getting outdoors and reconnecting with your surroundings.

Regular exercise – the changes in your hormones during perimenopause can negatively affect bone and muscle tissue, so regular physical activity with strengthening exercise during this time can help to prevent the risk of conditions such as osteoporosis and sarcopenia in later life. Exercise can also greatly benefit mood, particularly if you exercise outdoors or with friends, and has been shown to reduce the number and intensity of hot flushes.

Prioritise sleep – sleep is fundamental for health and regeneration and the healthy production and balance of hormones. Fluctuating hormone levels can contribute to insomnia, night sweats and other sleep issues, so you might need to support sleep with nutrients such as magnesium bisglycinate or L-Theanine.  

Avoid environmental toxins - environmental contaminants are a significant source of xenoestrogens; synthetic oestrogens that we are exposed to through pesticides, herbicides, plastics, cleaning products and cosmetics. Xenoestrogens can disrupt our hormonal balance, and you can reduce your contact through choosing organic foods, natural cleaning products and cosmetics and avoiding soft plastics on your food and drinks.  

What supplements can help with perimenopause? 

Essential fatty acids 

Omega-3 fatty acids, found in oily fish or available as a vegan supplement have been associated with decreased inflammation as well as improved mood. Gamma-linolenic acid (GLA), the fatty acid found in oils such as evening primrose, starflower and blackcurrant seed, may reduce the severity of hot flushes and improve overall sense of wellbeing. The unique mix of fatty acids and other phytonutrients in sea buckthorn oil can help in cases of vaginal dryness.

Vitamin D 

When your ovaries no longer product oestrogen, you are at higher risk of developing osteoporosis, so ensuring a great level of Vitamin D during perimenopause can help to reduce this risk. Vitamin D can also help to support healthy mood balance.

Magnesium 

This mineral can support many of the symptoms associated with perimenopause, including sleep disturbance, fatigue, low mood and anxiety. Magnesium is also an essential mineral to support healthy bone density.

Probiotics 

Perimenopause is often associated with gastrointestinal complaints. Oestrogen levels can affect gut microbiota, and in turn, our gut microbiome can affect our oestrogen levels. Probiotics have been suggested as a non-invasive strategy to support hormonal homeostasis and can help to alleviate some symptoms of perimenopause.

Agnus Castus

With a long traditional history of use, Agnus Castus can be a beneficial botanical alternative to address female hormonal imbalances, such as in perimenopause, and a range of symptoms associated with them.

Phytoestrogens

In the later stages of menopause transition, when oestrogen levels fall, supplementing with phytoestrogens, which give a weak oestrogenic effect in the body, can support several of the physical and psychological symptoms experienced in perimenopause.

Multivitamin 

A number of different nutrients, including vitamin E and C, B vitamins and zinc have been shown to be beneficial at managing the symptoms of perimenopause, so a well formulated multivitamin and mineral supplement that helps to provide a therapeutic level of nutrients, in bioeffective forms, is recommended.

Refs:

¹ Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432. doi: 10.1097/GRF.0000000000000389. PMID: 29952797; PMCID: PMC6082400.