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.