I thought I might escape perimenopause, though I’m not sure why I thought I would be immune. Having witnessed the pains of perimenopause in many patients, I am sure I subconsciously knew I was headed down that road. However consciously I was happily but obliviously moving through my days while a hormonal subterfuge was taking place within.
Then suddenly in the middle of my 47th year, I found myself effortlessly ten pounds heavier, not sleeping, and way more interested in cuddling up with my book than my boyfriend. Still clueless I took myself in for a visit to my doctor. She looked me square in the eye and stated bluntly, “You’re going through perimenopause.” Ohhh….yeah… Feeling a little silly, I probed for recommendations, which amounted to biohormone therapy.
While I have had many patients on biohormones, I had never considered the risks and benefits for myself. Estrogen patches? Estrogen and/or progesterone oral drops or creams? What about testosterone? Suddenly I had a lot of questions to explore. Being an herbalist, I elected to start with herbs before biohormones. But before we get ahead of ourselves, let’s make sure we understand this strange new terrain:
What exactly is perimenopause? Perimenopause , or menopause transition, usually begins several years before menopause, but for some women this phase may last only a few months or as long as ten years. Since the age of onset of menopause differs depending on factors such as genetics, constitution and stress, perimenopause could start as young as 35 all the way up to 50 and beyond. Menopause, on the other hand, is defined as the complete cessation of menstrual cycles, when the body is no longer releasing an egg every month. The average age of menopause in the United States is 51, but it can occur anytime in the 40’s and 50’s.
Perimenopause is a phase where the ovaries stop producing as much estrogen. The woman starts to experience anovulatory cycles, or cycles where an egg is not released and there is a subsequent drop in progesterone levels the second half of the cycle. As levels of estrogen, progesterone and testosterone drop, many women experience uncomfortable symptoms, including irregular menstrual cycles that may include less bleeding or more bleeding, worsening PMS, insomnia, fatigue, lowered libido, weight gain, moodiness or depression, poor memory or concentration, joint pain, vaginal dryness and painful sex. Sound fun?
So there I was, suddenly experiencing perimenopause, desperate for sleep and confronted with so many options I didn’t know what to do. I immediately did one good thing: I got my sex hormones tested, so I would have a clear picture of where my hormone levels stood. And I did one not-so-good thing: I started researching intensely on the internet, and then taking a bunch of supplements and herbs all at the same time. With my body now reeling in confusion, I took several deep breaths, cut most of the supplements and herbs back out, and started over again.
One thing to realize right away about perimenopause is that it isn’t going away. It isn’t an illness; it is a natural transitional phase of life. The second thing to realize is that bringing one’s hormonally craved body back into balance is going to take some patience and some time. I would also assume every woman is fairly unique with regard to which strategies are going to work best for her. Therefore, perimenopause should be a labor of self-love.
In the midst of my journey, here are some of the nuggets I’ve gleaned so far. I’m looking forward to many more in the coming weeks and months on the road to my hard-earned position of Wise Elder Woman. And by the way, if you have tips for navigating through perimenopause that you would like to share, please feel free to email me, I’d love to hear them!
1. Try one supplement, herb, or herbal formulation at a time. Give it one to two weeks before you add something else in. Trust me, this is actually a time-saver, so you don’t have to backtrack when new symptoms crop up that could be your body’s way of communicating that a supplement or herb is not taking you where you need to go.
2. Try herbs first. If the herbs don’t work, you can always advance to the realm of biohormone therapy. Herbs are a gentler approach, encouraging your body to balance hormones on its own, or supplementing hormone deficiencies by attaching to hormone receptors (in the case of phytoestrogenic herbs). During perimenopause your ovaries are still producing a reduced amount of hormones, and I think it’s preferable if you don’t have severe hormonal symptoms to try and encourage the body to normalize by itself.
Two of the top herbs for perimenopause include:
Maca: Studies have shown maca increases estradiol in menopausal women and helps with insomnia, depression, memory and concentration, energy, hot flashes, vaginal dryness and low libido. I experimented with a few different brands, and my favorite is Royal Maca by Whole World Botanicals.
Chasteberry (or Vitex). This herb is used to restore normal progesterone levels in the body. Since low progesterone is one of the first indicators of perimenopause, including symptoms such as shortened or irregular cycles, irritability, increased PMS symptoms, and restless sleep, chasteberry is worth a try. The progesterone boost from chasteberry has been demonstrated in blood hormone levels, in endometrial biopsies, and in analysis of vaginal secretions, and has been proven in more than sixty years of clinical research. Though not conclusively understood, researchers believe chasteberry increases the release of luteinizing hormone from the pituitary, which raises progesterone and normalizes the second half of the menstrual cycle. The further along you are in perimenopause, however, the less likely chasteberry is to work. At this time, topical or oral progesterone becomes the preferred choice.
I have found Royal Maca to be helpful for insomnia and low libido, but Chastetree Berry gave me headaches. Everyone is unique, and the only way to know for sure is to experiment on yourself. In fact, there are many herbs and herbal formulas out there for perimenopause and menopause. It can feel overwhelming in the beginning and it might be helpful to schedule a visit with a naturopathic or holistic doctor as a starting point. Or visit your acupuncturist and try some Chinese herbs. We have a wonderful herbal formula for hot flashes called Balance(Heat) that many women have benefited from.
3. Exercise! Exercising at moderate intensity for thirty minutes four times/week decreases PMS. Also high intensity exercise stimulates the secretion of human growth hormone, which puts the body into “fat-burning” rather than “fat-storing” mode. Careful though: exercise helps with low estrogen symptoms only if you are already lean. Women who are overweight can actually increase their hot flashes and night sweats if they do too hard of a workout. Also, it’s important to remember that hormone reduction causes a loss in bone density and in muscle mass; after menopause we have to work twice as hard to maintain our bones and muscle mass as before.
4. Sex hormone testing: to do or not to do? As we enter perimenopause one thing is certain: our hormone levels are going to drop. My doctor told me she doesn’t need to test hormones in order to prescribe biohormone creams--they will be low across the board for everyone. However, I used a dry urine test called DUTCH to test my hormones, and I’m glad I did. It gave me information about exactly where my hormones levels are right now. It also gave me information about my adrenal health and how my body was metabolizing cortisol. As I continue to take herbs and perhaps add in some progesterone, I now have a point of comparison. I might test once a year just to see how I am doing. Also, if you have any question about whether or not you are in perimenopause, the test can help confirm.
5. Take care of your adrenals. Many people do not realize that adrenal health is critical to ovarian health. Apart from cortisol, the adrenals produce both pregnenolone, the mother hormone from which all other sex hormones are produced, and DHEA, an important precursor for testosterone and estrogen. At the time of menopause it is the adrenal glands that should be producing enough estrogen and progesterone to avoid unpleasant symptoms. Unfortunately, many women by the time they reach perimenopause in our stressed out society, have moderate to severe adrenal exhaustion. Stress causes the adrenals to overproduce cortisol which over time becomes depleted, causing the adrenals to “steal” from pregnenolone and DHEA production for more cortisol. Overall stress levels could be the reason why women in other countries--notably China and Japan--experience very few menopausal symptoms compared to women in the United States. In addition, even if cortisol levels are within normal range, it may not be metabolized properly due to liver toxicity or an under-functioning thyroid--two conditions now prevalent in the majority of women reaching perimenopause. Strategies to detox the liver and support both the thyroid and adrenals are important for most women at this stage.
6. Actively practice stress reduction. Speaking of adrenal health, stress reduction is an absolute must. As a woman with a career and a child to raise, this has been a difficult one for me to include. There always seems to be some other looming priority that gets in the way, including laundry, meals, dirty dishes, and child rearing crises. In my case, I had to force myself to exit my established world by signing up for a weekend meditation retreat. And then I had to place meditation, spiritual reading and walks in nature as high on the priority list as daily grooming and bill paying. There are so many great options out there, from yoga or taichi classes, to simply taking a 20-minute walk in the trees or listening to a soothing meditation app before sleep. But it needs to happen at least four or five times a week for the perimenopausal woman with symptoms.
7. Give up or cut back on caffeine. Nobody likes me for this one. However, both caffeine and coffee have been shown to lower estradiol levels in perimenopausal women. Not only that, but while caffeine boosts energy by raising cortisol, high cortisol levels can block progesterone receptors. Finally, regular caffeine consumption stresses already stressed-out adrenals. I was a coffee addict myself, and the thought of giving it up seemed daunting. Apart from a few headaches, however, it surprisingly wasn’t that hard. And I can still enjoy a morning cup of decaf. As an alternative, try gingko biloba extract. The extract works as a wonderful alternative to caffeine, increasing blood flow to the brain and extremities. It energizes, and increases memory and focus. You can even buy the leaf and brew it into a tea, for a nice alternative to coffee in the morning.
8. Attend to any gut issues with renewed vigor. Your gut is home to trillions of microbes. In fact, when taking our cells into account we are only 10% human and 90% microbes living in or on the human body! Many important microbes in the gut help to metabolize and recycle hormones in the body--playing a critical role in maintaining hormonal balance. New research, for example, shows that certain beneficial bacteria increase testosterone in mice! The epidemic in leaky gut and poor digestive health contributes significantly to hormonal imbalances. Daily gut boosting supplements including probiotics and collagen, and low carbohydrate diets are increasingly important as we age.
9. Get Regular Acupuncture. Acupuncture has been shown to raise estradiol levels. It reduces hot flashes and may be effective on its' own as a hormone therapy when combined with Chinese herbs. Another important benefit of acupuncture during perimenopause is its’ effect on mood, including helping with both anxiety and depression. Weekly sessions for eight to ten weeks is generally recommended to achieve symptom relief. Note: acupuncture is not as effective for hormone-related vaginal dryness or bladder infections: for these issues, there are DHEA and estrogen vaginal suppositories we can recommend.
As a final note, I was quite intentional choosing nine tips. In numerology the number nine signals completion, the end of a cycle or phase. There is a great emotional and spiritual component to the perimenopausal and menopausal transition that I am increasingly aware of. In my case, I feel a shift away from more external ambitions, and towards a more internal awareness. I am suddenly much more interested in how fulfilled I am in life, in whether or not I am achieving my spiritual goals as a human being on this planet. I am more focused on what I find most important in life: healthy relationships, effective communication, love, the simple happiness of being together in the moment, being in nature. When we reach menopause, we cross the threshold of adulthood to elder. We realize our mortality, and we realize we only have so much time left to uncover for ourselves our true purpose in this life.