Sleepless and sweaty nights, irritable days, wacky periods? Aren’t hot flashes, night sweats and insomnia part of menopause? Unfortunately, the process, and very real physical and mental effects of menopause, take shape long before the last period stops. Welcome to perimenopause. This long lead up to menopause usually starts in the mid 40s but can begin as early as the 30s, and typically lasts 3-4 years, but it can go on for as long as 10 years. Although women largely experience similar physiological changes, symptoms can vary widely—with a lucky few sailing right through, and others at the mercy of fluctuating hormonal levels and ups and downs that go along with it.
Here’s what’s actually going on: In childbearing years, women usually have a well-timed ebb and flow of estrogen and progesterone, maintaining a harmonious hormonal status quo. Perimenopause upends that balance, and is a time of estrogen dominance. Progesterone is the first hormone to drop, and starts declining in our late 30s. This is where we start to see sleep issues and anxiety, since progesterone’s metabolite promotes sleep and calms the nervous system. Other symptoms can include heart palpitations, heavy periods, depression, as well as hot flashes and night sweats. By the time we are in our 40s, the ovaries start to sputter, with fewer follicles being released and poor quality control. But sometimes the ovaries come to life and release more follicles. This translates to times of super high estrogen and other times of low estrogen. Periods become irregular—ranging from very heavy to light, shorter to longer time between cycles, and/or shorter to longer days of flow. High estrogen symptoms include breast pain, an irritable mood and heavy periods, while low estrogen symptoms can be vaginal dryness, hot flashes, night sweats, insomnia, and poor memory/brain fog. While this sounds, well, intense, it should be comforting to know that everything you may be feeling can be tied back to a physiological reason.
The good news is that perimenopause doesn’t last forever and the ovaries eventually go offline and a low estrogen state then dominates and hormonal fluctuations level out. Having a game plan for this period of time can be extremely helpful. Taking care of adrenal health can have a large impact. High adrenal output can make hot flashes worse. This means managing stress, eating regularly to avoid low blood sugar, exercising, and limiting sugar, caffeine and alcohol intake. Self care needs to be a priority. Magnesium is a great supplement here - it promotes the brain’s calming neurotransmitter, decreases cortisol, and promotes sleep.
Helping the body decrease the amount of estrogen can also make a difference. Estrogen is detoxified through the liver (there are supplements that can support this) and eliminated in poop--in other words, regularity is key. A healthy gut microbiome promotes estrogen detoxification and alcohol interferes with it. Also, be aware of xenoestrogens—chemical toxins that act like estrogens—that are in many items like personal care products, pesticides, and plastics. They can contribute to the estrogen load in the body. And eating phytoestrogens found in some vegetables, soy and flaxseed can also be helpful. Many people find black cohosh and red clover to help with hot flashes and night sweats. Micronized progesterone, or bioidentical progesterone (not progestins like Provera) can be used to balance out estrogen and treat low progesterone. It promotes sleep, relieves anxiety, improves one's ability to cope with stress, supports thyroid function and can lighten heavy periods.
Perimenopause is a bit of a hormonal whirlwind, but steps can be taken to calm the winds and help this transition into menopause.