Perimenopause – what do you need to know?

As women, we go through many life phases. When we enter our mid to late 30’s, through to our mid-50’s we encounter the perimenopause zone.⁽¹⁾ There are so many things to know when it comes to this life stage, and it can sometimes be overwhelming. In this article, we’ll unpack the key things you need to know, and how to get started if you want to optimise your diet and lifestyle to better manage symptoms.

Perimenopause 101 ^(2,3)

We start life with a finite number of eggs, and for most of our adulthood, our ovaries release an egg each month, and we go through the different stages of menstruation. As time goes on, the number of eggs on hand reduces, and slowly our bodies will ovulate less, until it all comes to a complete stop at menopause. While our egg supply is declining, there are also some key hormonal changes to be aware of. It starts with a drop in progesterone, followed by wildly fluctuating levels of oestrogen, and an overall decline in testosterone over time. Oestrogen levels are trending downwards as perimenopause progresses, but levels can go from high to low, rapidly changing as the body adjusts to some serious changes on the inside. These changing hormone levels are what largely cause most perimenopause symptoms, but the body is a complex beast, with lots of other changes occurring at the same time. A hallmark symptom of perimenopause is irregular periods. Once you have not had a period for 12 months in a row, you have officially hit menopause. From that day on, you are in the post-menopause phase.

Main symptoms

While hot flushes and night sweats tend to get all the focus, you may be surprised to learn that they are not the most common symptoms. Many different bodily systems can be impacted in this life phase, and each woman will have a unique set of symptoms – no one case is ever the same as the next. For many women, the most troublesome symptoms are midline weight gain, brain fog, low mood, mood changes, trouble sleeping, low energy levels and low libido. Other symptoms can include frozen shoulder, dizziness, vaginal dryness and joint pain, to name a few. Some women experience what they describe as more intense pre-menstrual syndrome (PMS) or even periods of feeling rage. A good idea is to keep a diary of your symptoms, and show this to your doctor at your next appointment. This helps them see the bigger picture, and can assist in getting a diagnosis. Unfortunately there is no one single blood test to show you are in perimenopause.

What can you do about it

As your body navigates major changes, you can do so many things to support it through to the other side. Your operating system is changing and you need to modify your diet and lifestyle to accommodate for this. And while it may all sound really scary, many of the tactics you can employ are relatively simple, and can be easily weaved into your current day to day. It all starts with your nutrition. Opting for whole foods, increasing plant foods in your diet, and making your plate as colourful as possible will all help nourish your body, reduce inflammation and somewhat balance your hormonal changes. For example, broccoli contains a compound called glucosinolates. When you chew and digest broccoli, these compounds break down to other components, one of which is called sulforaphane. Sulforaphane supports the body to clear excess oestrogen, which may be helpful as levels wildly fluctuate in perimenopause. ^(4,5)

Fibre is also key, as this helps keep your gut healthy, which can support many areas of health, including hormonal balance

Another tip is to adopt a Mediterranean diet pattern – which again is packed full of whole foods, colourful fruits and vegetables, as well as extra virgin olive oil, which can have so many benefits for your health (e.g heart health, sleep health and more!). ⁽⁶⁾
Making sure you eat enough fibre is also key, as this helps keep your gut healthy, which can support many areas of health, including hormonal balance. Whole grains, fruits and veggies are a good place to start when it comes to fibre. ^(7,8,9) And of course, make sure you are eating sufficient high quality protein to help keep your muscles strong – as you will naturally lose muscle with age, accelerated by declining hormone levels. ⁽¹⁰⁾

Then it’s time to assess lifestyle. Are you getting enough sleep and managing stress levels? Self-care and mindfulness is key here. Balancing your exercise with strength, short bursts of cardio, mobility work and rest. Keep an eye on alcohol intake and stay well hydrated.

Supplements can also play a role for some women.

While not every single woman needs creatine, protein powders and the like, there are some targeted supplements that may support you. These can help top up the required vitamins and nutrients in your diet, support your body to manage symptoms and help assist with any longer term health concerns that come with this change. For example, heart disease and osteoporosis are a concern in the post-menopause phase. There is a lot that can be done for these conditions during perimenopause. ⁽¹¹⁾

You can also speak to a qualified health professional to see what medical treatments may be suitable for you. Menopausal Hormone Therapy (MHT), previously known as HRT, may be suitable for some women, and can be very helpful for symptom control and more. Speak to your doctor for more information.

These tips are just the tip of the iceberg, with so many more science-base strategies at your disposal.

Where to find out more?

When it comes to this topic, there is no shortage of information online. Choose your sources wisely, always ensure recommendations are evidence based, and that the person providing advice has adequate qualifications and experience in women’s hormonal health. There is no one-size fits all approach. Each woman is unique, and will need a different blend of diet, lifestyle or medical treatments to help the body thrive through this life stage.

Wrapping it all up

The first step is understanding what perimenopause actually is. Now that you have that under wraps, you can start to think about your own symptoms, and if they could be connected. Then seek medical advice as soon as you can. Changes to your diet and lifestyle are key in this life era, and can probably help you more than you think. With almost 7 million Australian women in perimenopause or menopause, you are not alone. ⁽¹²⁾ Arm yourself with knowledge and surround yourself with experts who can guide you through this change.

You will find more information in my new book – It’s Not You, It’s Perimenopause – Science based lifestyle and supplement solutions to help you thrive in midlife. Leave with your own personalised perimenopause action plan. For more information, visit my website at www.thenutritionpharmacist.com/perimenopause-book

Sarah Gray

Pharmacist & Nutritionist, Founder – The Nutrition Pharmacist

Sarah Gray is one of Australia’s leading dual-qualified health professionals in pharmacy and nutrition, and a certified menopause practitioner with over 25 years of experience in the health and wellness industry. Her holistic approach focuses on supplements and science- based solutions for perimenopause and menopause. A trusted thought leader, Sarah has appeared on Channel 10’s My Market Kitchen and is a recognised voice across radio, print, digital media and podcasts. She is also a regular contributor to leading health blogs and
publications.
@the_nutrition_pharmacist