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Perimenopause: the changes before the change

Navigating haywire hormones when approaching menopause can be challenging. Thankfully, there are lifestyle interventions that can help smooth the transition.

Article first published in Nourish Magazine.

Women are born with several million potential eggs in the form of ovarian follicles; what we have at birth is all we’ll ever have. As each month of menstruation passes, we are withdrawing from our ovarian reserve. By puberty, a woman’s egg count might be 1 million, at 25, maybe 300,000. Then, at around 35, the decline starts to get a bit steeper, until all eggs have been depleted. As the number of ovarian follicles containing the eggs drop, the production of oestrogen by the ovaries slows right down. Once the numbers drop to a critical level our periods stop. This is menopause.

A woman is said to be menopausal or post-menopausal when she has not had a period or any bleeding for one full year. The average age for menopause is 51 all over the world, ranging between 45 and 55 years of age. The lower oestrogen levels we experience trigger a response in our brain, increasing our follicular stimulating hormone levels. These hormonal changes are thought to cause the symptoms of menopause and perimenopause.

Perimenopause is the stage of life leading up to your last menstrual period. It usually lasts around four years although it may last anywhere from two to eight. The average age of perimenopause is 47 but it can start much earlier. For example, if you are destined to stop your periods around age 46 it may commence as early as in your late 30s. Perimenopause is a time in a woman’s life that is often marked with hormonal fluctuations, especially oestrogen levels.

Flower

Haywire Hormones

There are no hormone tests that can reliably diagnose perimenopause because levels can fluctuate widely on a day-to-day basis. Avoid blood, urine, and saliva tests as these are unproven, and of little help. Instead, a detailed medical history is usually all that is needed, while blood tests and pelvic scans might be suggested as individually appropriate. For example, a woman having heavy periods or recent onset of painful periods may have other conditions such as adenomyosis, fibroids, endometriosis, or polyps.

Woman silhoutte dusk

The thing to understand is that symptoms of perimenopause may start long before your periods stop, impacting both mental and physical health.

You may notice mood changes, crowding or skipping of menstrual cycles, erratic periods, heavy periods, hot flushes, worsening of premenstrual symptoms, and reduced libido. Sleep disturbances, loss of confidence, panic attacks, and heightened stress and anxiety are also common. It’s a time when many notice unwanted weight gain that is harder to shift, even though exercise and calorie intake remain the same. The intensity and frequency of symptoms varies for each woman as hormones fluctuate, with some months being completely symptom-free.

Unfortunately, the fact that the most common symptoms associated with menopause may be experienced by women in perimenopause is not often emphasised.

Smoothing the transition

Every aspect of health, at every age and stage of life, benefits from nutrition and lifestyle changes. This is especially true during perimenopause, a phase in our lives where we should start paying attention to our body and our metabolism. It’s also a responsibility-laden time of life when we may tend to neglect ourselves while we are taking care of everyone else!

Perimenopause and menopause affect half the world’s population. Yet, even with so many impacted, when it comes to the benefits of lifestyle modifications, with or without menopausal hormone therapy, there is still a lot of misinformation. There is no doubt that making behaviour and lifestyle changes can go a very long way, both in the short term and longer term, helping us to avoid unnecessary medications or surgery that can be associated with reaching the end of our childbearing years.

… when you sleep better, you tend to stress less, and make better food choices.

There are six pillars of lifestyle medicine that can help us make the transition through this phase of life with as few unpleasant symptoms as possible.

  1. Shifting towards a whole food plant-based diet
  2. Regular physical activity
  3. Restorative sleep
  4. Stress management
  5. Avoidance of risky substances
  6. Positive social connection

Start by improving one aspect of your lifestyle as this tends to cascade to other aspects of your life. For example, when you sleep better, you tend to stress less, and make better food choices. Reducing symptoms such as hot flushes and night sweats as well as improving mood and sleep with simple changes such as ensuring a regular bedtime routine, going for a walk outdoors, or doing a simple daily workout is usually achievable.

My advice to everyone is this: don’t wait until you are 50 to make these lifestyle changes. It’s never too early (or too late) to eat healthily, stress less, move more, sleep better, avoid alcohol and smoking, and build positive social networks to help you live your best life.

Woman with kettlebell

The Plant Panacea

Based on what I observe in my patients, the most dramatic positive changes occur when they avoid alcohol and smoking while switching to a colourful, plant-predominant diet. By this I mean adopting a diet packed with whole plant foods, such as antioxidant-rich, nutrient-dense fruits and vegetables that help reduce chronic inflammation. Fibre-rich beans, soy and intact wholegrains, as well as healthy fats from nuts and seeds can all help in reducing menopausal symptoms. Starchy vegetables such as sweet potatoes, potatoes with skin on, mushrooms, and herbs and spices are also excellent health-promoting foods easily included in everyday recipes.

The bottom line is that the same way of eating that helps prevent cancer is also the same one that can help manage perimenopausal symptoms.

WFPB food spread

As plant foods are naturally lower in calories, maintaining an optimal weight may also be a positive side effect of shifting towards plant-based nutrition. Excess weight is commonly associated with more severe menopausal symptoms (especially hot flushes) as well as an increased risk of many other common conditions we should consider as we age, like heart disease, dementia, and certain cancers.

Minimally processed soy should be enjoyed regularly. Soy is a bean packed with healthy plant oestrogens, fibre, protein, vitamins, and minerals. It is particularly good for lowering the incidence and the intensity of hot flushes.

Interestingly, what and how you ate as a child and young adult has an impact on your later years, including how you deal with perimenopause and menopause.

So, if you are parenting a girl, starting these healthful plant foods early in life will set her up for a smooth transition much later on. It is well documented that all long living, healthy societies around the world base the majority of their diet on whole or minimally processed plant foods. There really are no separate diets for different conditions. The bottom line is that the same way of eating that helps prevent cancer is also the same one that can help manage perimenopausal symptoms.

This article is republished with permission from nourishmagazine.com.au.

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