Understanding Perimenopause and How to Get Help
What is Perimenopause?
Peri-menopause literally means “around menopause,” meang that when a woman enters into perimenopause she is nearing menopause, when the ovaries stop releasing eggs and her period stops.
There are many symptoms of perimenopause. Some of the more common symptoms include:
• Mood changes
• Irritability
• Anxiety.
• Changes in sexual desire.
• Trouble thinking/concentrating.
• Headaches.
• Night sweats.
• Hot flashes
• Breast Tenderness.
• Vaginal dryness.
• Trouble with sleep.
• Joint and muscle aches.
• Heavy sweating.
• Urinary urgency.
• PMS-like symptoms
• Irregular periods.
• Heavier periods.
• Weight gain
• Feeling bloated.
Despite the many symptoms of perimenopause, it is usually defined by a woman’s cycle. During early perimenopause, a woman’s period begins to vary in length by up to approximately 7 days, and by late peri-menopause, women may begin to skip two or more consecutive periods.
Tracking your cycle and symptoms during this time can be helpful in determining where you are.
Perimenopause occurs when a woman’s regular reproductive hormones begin to change. Hormones are powerful chemical messengers, and it only takes a tiny amount to cause big changes in cells or even the whole body. Too much or too little of a certain hormone can have huge consequences.
During perimenopause, a woman's estrogen and progesterone levels begin to decline, though not consistently. As a result, women may experience irregular periods, changes in menstrual flow, and various menopausal symptoms.
A woman will typically lose 35% of her estrogen and 75% of her progesterone between the ages of 35 and 50.
The amount of estrogen compared to progesterone can vary from cycle to cycle, but generally, peri-menopause is characterized by much more estrogen compared to progesterone, which causes symptoms of estrogen dominance. Many of the symptoms associated with peri-menopause are caused by the imbalance of estrogen compared to progesterone.
FSH (follicle stimulating hormone) levels will increase as a woman's ovaries become less responsive, because as follicle count reduces, the brain has to send a higher signal for eggs to be released.
Since progesterone is only released after ovulation, progesterone levels will begin to plummet.
When this happens, 85% of women will experience symptoms that will have a direct impact on the quality of their lives.
In fact, it is during perimenopause that most women experience the most debilitating symptoms.
Yet more than 30% of women are not receiving perimenopause help and approximately 70% are not being treated adequately.
Often they receive no care at all, as their symptoms are outright dismissed or ignored.
Many medical providers will treat the symptoms rather than see them as a part of a hormonal decline. For example, they will prescribe sleeping pills for insomnia, antidepressants for mood disturbances, and pain medication for musco-skeletal issues.
A better way to experience symptom relief is by starting bio-identical hormone therapy, as this addresses the root cause. This is not old school synthetic non-bioidentical HRT (hormone replacement therapy)and the scary risks that are associated with synthetic hormones, but bio-identical hormones that your body recognizes as “bio-identical” to its own.
Some women begin to gain weight (especially around the belly), and no matter how hard they try, they just can't seem to get it off.
This is because the imbalance of sex hormones may also create sugar imbalances, insulin resistance, and thyroid and adrenal dysfunction.
Lifestyle measures, such as reducing overall inflammation through food by reducing sugar, swapping out processed food for whole foods, and other inflammatory foods such a dairy and gluten. Other lifestyle hacks like intermittent fasting and creating a consistent practice of inner stillness techniques, can often help bring balance back to these hormones.
Implementing a holistic, multi-pronged plan that includes hormone therapy, as well as various lifestyle measures can help alleviate symptoms, balance hormones, and have you feeling like yourself again. Check out the 9 Pillars of Wellness, and my guides to optimal nutrition, fitness, stress management, and sleep during peri-menopause to help with your symptoms.
Build a Strong Foundation of Peri-menopausal Health
Are you ready for personalized support that is tailored to your menopause journey?
With the signature, The Menopause Playbook: Strategies Right for Your Type coaching program, you will unlock the key to your wellness. Because every woman’s perimenopause journey is unique, a “one size fits all” solution simply does not work.
Here’s a more streamlined and engaging way to say this:
Many women think hormone therapy will ‘fix’ their hormones and solve everything. While it might help some, many find themselves frustrated when it doesn’t deliver the results they hoped for. Why? Because they skipped the essential steps needed to prepare their body first.
Before considering hormone therapy, there are five key steps to take that lay the groundwork for its success. These steps focus on optimizing your health and building a strong foundation for hormonal balance. Skipping them is like trying to build a house without a solid base – it just won’t hold up.
In this program, you’ll discover why these foundational steps are so important. You’ll be guided through each one, with full support along the way. This holistic approach not only prepares you for hormone therapy, if needed, but empowers you to take charge of your health and well-being.
By following these six steps to reset your hormones, you’ll be well on your way to feeling balanced, energized, and vibrant. Together, we’ll embark on this journey with a personalized, holistic approach to your wellness.
Step 1: Discover and Understand your Menopause Type
Every woman’s journey through peri-menopause is unique. Their symptoms of perimenopause will be shaped by a variety of factors including genetics, lifestyle, and health history.. While each experience is distinct, certain patterns can be identified and categorized into seven menopause archetypes.
The 7 Types:
1. Estrogen Excess
2. Cortisol Craver
3. Liver Lover
4. Mighty Mitochondria
5. The Broken Burner (Thyroid/Insulin)
6. The Unicorn
7. The Low-Low
You may be a blend of these types, but usually, one or two will be predominant. Your type will determine your action plan for resetting your hormones. Although all types will follow the same six steps, each will have a tailored approach to diet, supplements, exercise, and bio-identical hormones
Step 2: Create a Strategy
When you’re planning a trip from Los Angeles to New York, you wouldn’t buy a bus ticket from Phoenix to Chicago. Sure, he bus heads in the right general direction, but i leaving from where you are, nor is it arriving where you wt to be. It would take forever and leave you frustrated.
The same logic applies to optimizing an imbalance of sex hormones. You need a clear plan to get from your point A to your point B, and you must understand what these points are. Imagine your menopause archetype is a Liver Lover. If you skip the necessary steps to support your liver and jump straight into BHRT (bioidentical hormone replacement therapy) just because that’s where you think you’ll end up eventually, you might feel a bit better initially. But soon, everything could fall apart. Instead of following the proper route from your true starting point, you took a shortcut and ended up far from your intended destination, and not receiving the perimenopause help you desire.
So, just like you’d carefully plan your journey from L.A. to New York, make sure you’re plotting the right course for your hormone reset. Skipping steps might seem faster, but it’ll only delay you in the long run.
So, you create a plan.
1. Understand What Your Menopause Archetype Means for You
Each one requires a different approach during the ReSet steps, so it’s crucial to know yours well.
2. Understand Where You Want to Go
• Define Your WHY. Identify your reasons for starting this journey.
• Create a Vision. Imagine what your life will look like once your hormones are reset. These two elements—the why and the vision—provide the motivation to keep you going from point A to point B.
3. Create a Strategy
Your strategy needs to reflect how you want your journey to unfold.
Questions to Ask Yourself:
• How quickly do I want to move from point A to B?
• How do I want my journey to unfold?
• Do I want to do it alone, or with health partners?
• How clear am I on the path I want to take?
• If not clear, how can I gain clarity?
• Is there an easier or faster way to get there?
Create Action Steps:
Develop steps to start moving forward and methods to assess if they are successful. If a step doesn’t work, adjust your plan.
Consider Professional Support
Having a holistic medical provider or coach can help you achieve faster and more successful results. Navigating your health when you’re not feeling well can be overwhelming. I’ve been there myself, and it took me years to reclaim my wellness.
Step 3: Optimize Nutrition, Digestion and Elimination
During perimenopause it is essential to eat a variety of whole foods consisting of fiber, protein, and healthy fats that help balance hormones, maintain muscle mass, strengthen bones, and avoid the health risks associated with reduced hormone levels and an imbalance of sex hormones.
An optimized digestion is also important because without it, you will not be able to absorb the nutrients you consume, nor will you be able to eliminate the toxins that build up in your system.
Hormonal constipation is a common symptom during peri-menopause and post-menopause that can severely impact the severity of unwanted symptoms. This can be due to an increase in stress hormones (cortisol) caused by the drop in estrogen, loss of colon function due to the drop in progesterone, weaker pelvic floor muscles due to loss of muscle tone, and the possibility of an underactive thyroid that often accompanies menopause.
If you are constipated, rather than evacuating the toxins and hormones your body has used, they will become reabsorbed and recirculated through your body, causing all sorts of havoc. This is why digestion needs to be optimized before initiating a detoxification or hormone balancing plan.
How to Help with Constipation:
- Stool softeners, short term laxatives - like senna, etc.
- Increase fibrous foods (28-40 grams per day).
- Soluble fiber dissolves and creates a gel that attracts water. This helps to form stools that are softer so they are easier to pass. Foods with soluble fiber include oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables.
- Insoluble fiber is not dissolved in water and instead adds bulk to the stool so they are better formed and easier to eliminate fully. Foods with insoluble fiber include wheat bran, vegetables, and whole grains.
- Drink 2 to 4 litres of water a day.
- Get a squatty potty
- Daily frequent movement.
- Pelvic floor physiotherapy.
- Balancing hormones.
- Sound sleep.
A healthy gut microbiome is also essential to feeling your best. It is essential for proper digestion and gut motility, a healthy mood, and optimal vaginal and urinary ph. A change in hormone balance during peri-menopause and post-menopause can change the ph of the microbiome in the gut, which in turn can create unwanted symptoms.
Step 4: Optimize Detoxification
In today’s society we are inundated with toxins. In fact, it is estimated that the average person encounters up to 700,000 toxins a day. It becomes prudent then to reduce your toxin exposure as much as possible.
There are more than 800 endocrine disrupters that adversely affect your hormones. During peri-menopause and post-menopause, when there is an imbalance of sex hormones, it becomes that much more important to reduce your exposure as much as possible. Many of these can be found in everyday products such as metal cans, plastics, pesticides, food, and cosmetics.
The liver has more than 500 functions.
It is responsible for:
- Detoxification of potentially toxic chemicals from both inside and outside the body.
- Production of bile, which helps carry away waste and break down fats in the small intestine during digestion.
- Converting fat soluble toxins into water soluble substances that can be excreted in the urine or the bile.
- Conversion of excess glucose into glycogen for storage.
- Manufacturing cholesterol, which can be used for hormone production.
Ways to Support Liver Detoxification:
- Liver stimulating foods such as arugula, dandelion leaves, beet leaves, lemon juice, and apple cider vinegar.
- Liver processing foods support either phase one or phase two detoxification of the liver. Phase one foods contain quercitin and include apples, parsley, berries, and peppers. Phase two foods contain sulphur such as garlic, onions, and eggs. Phase 1 and 2 foods include cauliflower, broccoli, and brussels sprouts.
- Liver supportive herbs taken in either a capsule or tincture include herbs such as turmeric, dandelion root, ginseng, and shisandra.
- Phase 1 supportive supplements include B6 and DIM (if estrogen is high).
- Phase 2 supportive supplements include glutathione, NAC and methylated B-complex.
Here is some great information on what and what not to do to support liver health and optimize liver detoxification.
Step 5: Incorporate the 9 Pillars of Wellness
Your lifestyle and choices make a big difference to your overall health and well-being. And when it comes to resetting an imbalance of sex hormones, they can make the difference between being successful or not. As you have already learned, what you choose to eat and drink can make a huge difference when it comes to your hormones, but so can other aspects of your life. There are 9 areas that can strongly influence your well-being and can either impede or help optimize your hormones.
1. Optimal Nutrition
2. Fitness and Frequent Movement
3. Sound Sleep
4. Human Connections
5. Inner Stillness
6. Synch with Nature
7. Sense of Purpose
8. Managing Stress
9. Healthy Habits
Step 6: Balance Hormones
Wow, you’ve finally arrived at the point where you thought you needed to start: actual hormone balancing. After following the previous steps, you’re likely already feeling significantly better And have received perimenopause help. Some of you may decide to maintain your newfound wellness without incorporating hormones. However, others might find that while you feel better, you’re not quite where you want to be. In such cases, increasing the hormones that naturally decline during menopause can help you feel your best. Additionally, some may choose bio-identical hormones to mitigate health risks associated with hormone reduction, such as osteoporosis, dementia, and heart disease.
The choice is yours. Whether you opt for hormone therapy or not, you’re already ahead in taking charge of your health and wellness during mid-life.
Hormone Balancing Basics:
1. Peri-Menopause vs. Post-Menopause:
The hormones you need and when you take them depend on whether you are in peri-menopause or post-menopause, and which menopause archetype you belong to.
2. Bio-Identical Progesterone:
Women in peri-menopause typically start with micronized bio-identical progesterone, as it is the first hormone to decline. (Some women might also need testosterone if it declines as well).
3. Bio-identical Estrogen:
As you approach menopause, you may need to add estrogen. This becomes more likely and necessary in post-menopause.
4. Other Hormones:
Depending on your symptoms, you might also be prescribed DHEA, oxytocin, testosterone, and thyroid hormones.
Professional Guidance:
• Medical Providers:
A licensed medical provider specializing in women’s hormones is essential for prescribing and monitoring your bio-identical hormones and levels. While some bio-identical hormones can be purchased over-the-counter in certain regions, and you can order your own tests, professional guidance is crucial.
• Wellness Coaches:
A wellness coach like me, who specializes in holistic menopause coaching, can suggest which hormones you may need. However, a licensed medical professional is required to prescribe and order tests. If you don’t have one, I can recommend a provider for you.
By reaching this stage, whether you choose to proceed with hormone therapy or not, you are significantly more empowered in managing your mid-life health and wellness. Congratulations on making it this far on your journey!
Navigating Peri-Menopause: Illustrative Case Studies
The following two case studies illustrate common scenarios that mid-life women may experience when receiving the perimenopause help they need. These examples are crafted to help you understand potential outcomes and see yourself in similar situations. While the individuals in these case studies are not real, the challenges and solutions presented are based on typical experiences, offering valuable insights into managing an imbalance of sex hormones.
Anne’s Journey:
Let’s dive into the story of Anne, a 46-year-old woman experiencing peri-menopause, who embarked on the Holistic Menopause Makeover Program to regain her health and vitality. Anne identified as Archetype 1: Estrogen Excess, which is characterized by high estrogen compared to progesterone. Here’s how the 6 steps to Reset your Hormones worked for her:
Step 1: Discover Your Archetype
Anne began her journey by discovering her menopause archetype. She experienced symptoms like heavy periods, breast tenderness, and weight gain, which pointed towards Estrogen Excess. Understanding her archetype helped Anne realize the importance of supporting her liver’s detoxification processes to lower estrogen levels and improve elimination.
Step 2: Create a Strategy
Anne needed a clear plan to navigate from her current state of hormonal imbalance to her goal of feeling energetic and balanced. She defined her WHY—she wanted to feel vibrant and maintain her active lifestyle with her teenage children. Her vision included having stable energy levels and reducing her symptoms. Together, we created a strategy that included dietary changes, lifestyle adjustments, and professional support to guide her journey.
Step 3: Optimize Nutrition, Digestion, and Elimination
Anne started by optimizing her diet. She swapped processed foods and sugars for whole foods rich in fiber, protein, and healthy fats. She incorporated more leafy greens, lean proteins, and healthy fats like avocados and nuts. To support her digestion and elimination, she increased her water intake, added probiotics, and ate more fibre-rich foods to help with constipation—a common issue she faced.
Anne replaced her sugary cereal with a breakfast smoothie made of spinach, berries, chia seeds, and almond milk. This not only helped balance her blood sugar levels but also supported her gut health and hormonal balance.
Step 4: Optimize Detoxification
With her nutrition on track, she focused on supporting her liver to detoxify effectively. She incorporated liver-supportive foods like arugula, dandelion leaves, onions, and apples into her diet. Additionally, she started taking liver-supportive herbs such as milk thistle and turmeric.
Anne began her mornings with warm lemon water and Himalayan salt to kickstart her liver detoxification processes (and balance her electrolytes) and included a liver-supportive salad of mixed greens with kale, spinach, beets, sunflower seeds, and an apple cider vinegar dressing for lunch. She also started taking DIM to help decrease the excess estrogen.
Step 5: Incorporate the 9 Pillars of Wellness
Anne embraced the 9 Pillars of Wellness to support her overall health and hormonal balance:
1. Optimal Nutrition: Continued her healthy eating habits.
2. Fitness and Frequent Movement: Started walking daily and added strength training twice a week.
3. Sound Sleep: Created a calming bedtime routine with herbal tea and reading.
4. Human Connections: Joined a local yoga class to meet new people and reduce feelings of isolation.
5. Inner Stillness: Practiced meditation 10 minutes each day.
6. Synch with Nature: Spent time gardening and going for hikes on weekends.
7. Sense of Purpose: Volunteered at a community center, which gave her a sense of fulfillment.
8. Managing Stress: Used deep breathing exercises and mindfulness techniques.
9. Healthy Habits: Established consistent morning and evening routines to support her new lifestyle.
Step 6: Balance Hormones
After implementing the previous steps, Anne felt significantly better but still needed additional support to reach her optimal health. With the help of a licensed medical provider, Anne started using bio-identical progesterone to address her estrogen excess. Her provider also monitored her hormone levels to adjust the treatment as needed.
Anne found that taking bio-identical progesterone before bed not only helped balance her hormones but also improved her sleep quality, making her feel more refreshed and energetic in the mornings.
Meet Marianne.
Marianne is a 44-year-old woman navigating the symptoms of perimenopause. She began experiencing irregular periods, depression, low energy, and histamine intolerance. These symptoms made it difficult to maintain her usual level of activity and enjoy her daily life. Marianne was a vibrant and active individual who loved hiking, socializing with friends, and engaging in creative hobbies. However, her hormonal imbalances left her feeling disconnected from the energetic and joyful person she once was. Here’s how the 6 steps to ReSet your Hormones helped Marianne regain her health and vitality.
Step 1: Discover Your Archetype
Marianne identified her menopause type as Estrogen Excess with a sub-archetype of Liver Lover. Her high estrogen levels and a sluggish liver contributed to her symptoms, including histamine intolerance. Understanding her archetype helped her realize the importance of supporting her liver’s detoxification processes and balancing her estrogen levels.
Step 2: Create a Strategy
Marianne needed a clear plan to move from her current state of hormonal imbalance to her goal of feeling energetic and emotionally balanced. She defined her WHY—she wanted to feel like herself again and reengage in activities she loved. Her vision included experiencing stable moods, having abundant energy, and enjoying her life again. Together, we created a strategy that included dietary changes, lifestyle adjustments, and professional support to guide her journey.
Step 3: Optimize Nutrition, Digestion, and Elimination
Marianne began by optimizing her diet to support her liver and reduce estrogen levels, focussing on foods such as cruciferous vegetables, lean proteins, and plenty of fiber. To manage her histamine intolerance, she also avoided high-histamine foods like aged cheeses, processed meats, and alcohol.
Example: Marianne started her day with a breakfast smoothie made of kale, pineapple, ginger, and a scoop of collagen protein, which helped support liver detoxification and provided essential nutrients.
To improve digestion and elimination, she increased her fiber intake and added probiotics to her routine. These changes helped her feel less bloated and more energized.
For lunch, she enjoyed a large salad with mixed greens, roasted turkey, quinoa, and a variety of colourful veggies, topped with a homemade vinaigrette rich in healthy fats.
Step 4: Optimize Detoxification
With her nutrition on track, Marianne focused on supporting her liver to detoxify effectively. She incorporated liver-supportive foods like beets, leafy greens, apples, lemons, onions, and garlic into her diet. Additionally, she started taking liver-supportive supplements such as liposomal glutathione to enhance her detoxification pathways, as well as DIM to help her liver process the excess estrogen.
Marianne began her mornings with warm lemon water to kickstart her liver detoxification processes, took a tablespoon of apple cider vinegar 20 minutes before each meal and included a liver-supportive salad with beets, dandelion greens, and a lemon-tahini dressing for lunch.
Step 5: Incorporate the 9 Pillars of Wellness
Marianne embraced the 9 Pillars of Wellness to support her overall health and hormonal balance:
1. Optimal Nutrition: Continued her liver-supportive and estrogen-lowering eating habits.
2. Fitness and Frequent Movement: Started with daily walking and light resistance training to build strength and reduce stress. As her energy improved, she began incorporating gradual hikes, which helped her reconnect with her love of the outdoors.
3. Sound Sleep: Created a consistent bedtime routine with relaxation techniques, such as reading a book and practicing deep breathing exercises to improve her sleep quality.
4. Human Connections: Scheduled regular coffee dates with friends, joined a local book club, and participated in a pottery class to stay socially connected and engaged.
5. Inner Stillness: Practiced mindfulness and meditation for 10 minutes each morning to help manage her anxiety.
6. Synch with Nature: Spent time outdoors during lunch breaks, walking in nearby parks to reduce stress and improve her mood.
7. Sense of Purpose: Found joy and fulfillment in having more energy to engage in hobbies and activities she loved, such as hiking and painting.
8. Managing Stress: Used deep breathing exercises and progressive muscle relaxation techniques.
9. Healthy Habits: Established consistent morning and evening routines that prioritized self-care and supported her new healthy lifestyle.
Step 6: Balance Hormones
After implementing the previous steps, Marianne felt significantly better but still needed additional support to reach her optimal health. With the help of a licensed medical provider, she started using bio-identical progesterone to balance her estrogen levels and support her overall hormonal health. Her provider also recommended adaptogenic herbs like milk thistle and dandelion root to further support her liver detoxification.
Marianne found that taking bio-identical progesterone helped regulate her periods and improve her mood, while adaptogens supported her liver function and reduced her histamine intolerance symptoms.
Through a personalized approach, Anne and Marianne experienced significant transformations in their health and well-being. These case studies, though fictional, reflect real-life challenges and solutions that can help you envision your own path to improved health. By addressing their unique needs during perimenopause, Anne and Marianne were able to achieve lasting changes and regain control over their hormonal and metabolic health.