Perimenopause

Perimenopause is the transition phase of declining reproductive hormones. It usually starts in the mid-40’s, but can be earlier. ⁣There is so much that can be done during these years! ⁣ ⁣

It typically begins with changes in the length of time between periods and ends 1 year after the final menstrual period, which is then defined as menopause.⁣ ⁣

In early perimenopause the estrogen levels may increase and progesterone decreases. This can lead to heavier and longer menstrual flow, mood changes, and agitation which is due to estrogen dominance. ⁣There is also the case where estrogen doesn’t necessarily change, but the progesterone levels drop and mimics estrogen dominance as well.⁣ ⁣

It can be hard to test hormones to tell if you’re in perimenopause due to the drastic fluctuations. As FSH (follicle stimulating hormone) rises in perimenopause this may be a good indicator. Working with a provider can help determine what labs to check. ⁣ ⁣

This time can seem like a roller coaster where some months may seem “normal” and other months not so much. ⁣ ⁣ During later Perimenopause a woman may notice cycles becoming shorter in length or frequency. ⁣ ⁣

Addressing perimenopause can help reduce risk of cardiovascular and stroke risk, sleep disturbances, and anxiety/depression to name a few.⁣ ⁣ Addressing the hormone fluctuations in the the perimenopause years can also help how one responds to menopause. ⁣ ⁣ ⁣

Perimenopause signs/symptoms:

  • Irregular periods

  • Hot flashes, night sweats

  • Sleep problems

  • Mood changes ((depression, irritability, easier anger, mood fluctuations)

  • Vaginal and bladder problems

  • Changes in sexual function

  • Increasing fat especially around midsection


Key areas to focus on:

  • GUT-constipation, microbiome, IBS, inflammation

  • ADRENALS -stress, cortisol, low progesterone, DHEA

  • LIVER-total body burden, detoxification, genetics, alcohol

  • S-sensitivity/sugar –receptors, thyroid, insulin, glucose⁣


Diet/Nutrition:

  • Optimize protein intake

  • 1.2-1.5gm/kg of protein a day

  • Aim for 30 grams at each meal

  • supports mood (increases serotonin and dopamine), controls sugar cravings, builds lean muscle, helps with sleep

  • more energy to break protein down than fat/carbs

  • Eating within 30 min of working out lowers cortisol, starts the repair process


Training:

  • Shift focus, instead of RPE of 10, think more in the range of 5-6

  • Lift heavy, higher weight less reps

  • make sure you cool down/stretch

  • on rest days, treat more as active recovery, e.g. walk, swim, yoga

  • no more than 45 min in length

  • HIIT (high intensity interval training)

    • high intensity burst with short recovery

    • in menopause important to step it up with SIT

  • SIT (sprint interval training)

    • 10-30 second sprint intervals, with adequate rest. for 20 min. e.g. sprints, bike, battle ropes, kettle bell swings

    • Tabatas- 20 sec on, 10 sec off, repeat 6-8 times

    • Increases lean muscle mass

    • reduces cortisol

    • creates HGH, increases testosterone

    • boosts immune system by increasing natural killer cells

    • stimulates vascular endothelial growth factor, makes blood vessels more responsive

    • reduced blood pressure, improves cardiovascular health

    • improves brain health


Functions of Progesterone:

  • antinflammatory

  • counterbalances estrogen

  • increases connective tissue stability

  • protects brain

  • helps with pain

  • protects bone

  • helps with HRV


Functions of Estrogen:

Three types E1, E2, E3:

  • E2 is the most potent form of estrogen

  • anabolic hormone- big impact on muscles

  • bit impact on myosin- muscle contraction

  • important for helping mitochondria sweep out free radicals

  • manages blood sugar, promotes insulin sensitivity

  • regulates ghrelin and leptin

  • increases serotonin, good for mood

  • controls cortisol


Functions of Testosterone:

  • muscles

  • protects brain

  • sex drive

  • mood


Progesterone Therapy for Perimenopause:

Benefits:

  • Improves sleep

  • Improves vasomotor symptoms

  • Beneficial cardiovascular effects

  • Improves bone density

  • Decreases menorrhagia (heavy bleeding)

  • Decreases dysmenorrhea (painful periods)

  • Does NOT increase risk of breast cancer, protective

  • Improves anxiety/PMS/mood swings

  • Can help with pre-menstrual headaches/migraines

* NOT synthetic progestins such as MPA or that found in OCP’s


Options:

RX options:

  • Oral micronized progesterone on days ~12-28 (w/ regular cycles)

  • Topical Progesterone on days ~12-28

  • OTC or compounded cream- absorption can vary

*Side effects in a small percentage: fluid retention, irritability, depression


Key supplements (may be helpful especially in early perimenopause):

  • e.g. phosphatidylserine, vitex, dhea, DIM⁣


*not medical advice, always consult with your provider. ⁣ ⁣

Tara Woodland