This is the second post in a series about menopause. Read the first post, Empowered Menopause: Rebirth Yourself.
This is about preparing for a smooth and empowered perimenopause, from my personal experience and clinical point of view. Let’s start with some basic FAQs about perimenopause.
What is perimenopause?
Your perimenopause years are the transition years that come before menopause. Your ovaries gradually produce fewer reproductive hormones. This typically starts in your 40s, however it can begin earlier, in your 30s. Menopause itself is when you stop periods entirely, for a full year. The average age for menopause is 51, but like it or not, you can continue having periods until your late 50s!
Your perimenopause years are a natural hormonal transition, not a disease or a condition.”
What happens during perimenopause?
Physiologically your ovaries produce fewer sex hormones, and eventually your menstrual cycles change. You stop ovulating regularly, and your monthly cycles can be longer, shorter, or irregular. In addition, your periods may change, and become heavier, lighter, longer, shorter, easier, or more difficult.
Each of you experiences your own physical story as to when your menstrual cycle changes, and how. It’s unpredictable. And it’s all perfectly normal.
How will I feel during perimenopause?
Studies show that if you view menopause as negative, as women in industrialized societies tend to do, chances are higher that you will be symptomatic. This is probably why many women talk about perimenopause as something dreadful.
Honestly, most women I work with are delighted to stop menstruating. This is especially true if you don’t like having a menstrual cycle – if it’s painful, cumbersome, or symptomatic. Or, it can feel liberating to be free from dealing with the physical process each month, and to never think about birth control again.
Other women feel sad to stop menstruating. This can happen if you have regular, predictable, non-symptomatic cycles, that feel like an important part of your monthly rhythms. Believe it or not, many women do enjoy cycling.
You may feel grief about ending your reproductive years. This may be because you wanted to be pregnant and never were. Or you never fully decided whether or not to have another baby. Or you associate your fertile years with youth and sexuality, and don’t want to lose that.
Another feeling you may experience is fear. Fear of aging. Fear of the dreaded symptoms. Or, simply, fear of change.
What about the dreaded symptoms?
If you do an Internet search on menopause or perimenopause, it’s likely you will come up with symptom lists. In modern cultures where we view menopause as at best annoying and at worst horrific, of course we focus on symptoms. You’ve heard of them. However, symptoms are potential, not a given.
Potential symptoms include hot flashes, sleep disruption, mood changes, vaginally dryness, bladder infections, change in sexual function, bone loss, high cholesterol, and of course decreased fertility.
No wonder we are afraid! This symptom list can feel scary and dreadful. If you approach your conventional doctor with these complaints, your options are not great. It’s very likely you will be offered prescriptions, such as high doses of hormones, antidepressants, and/or sleeping pills.
There are a few things to keep in mind when it comes to perimenopausal symptoms:
- Symptoms are not a given. They are only a potential. They are malleable.
- Many cultures view menopause in a positive light, and women have few or no symptoms. This speaks to the power of your mind.
- In traditional medical systems, perimenopause symptoms are not considered normal. Perimenopause is normal, but symptoms are not. Symptoms are a clue that there is an underlying disharmony. This means you can do something about them!
8 steps to prepare for a fabulous perimenopause
Let’s get to the good stuff. These are my top 8 steps to prepare for perimenopause. There are more, but these are a great foundation.
1. Take charge of your thinking
Stay off the Internet. Don’t Google your symptoms. If you want to read more about menopause, get one of Christina Northrup’s books. Read things that are written from a woman-centric, feminist point of view. Otherwise, you will probably just get dreadful symptom lists and products marketed to cure you. In essence, you are in charge of your perspective, and only you can shape it.
2. Get your adrenals in order
This is first and foremost, from ancient Chinese Medicine to modern Functional Medicine. Why? When your ovaries produce fewer sex hormones, your adrenals secrete them, so you want your adrenals to be healthy! When I talk about adrenals, I really mean HPA function (Hypothalamus-Pituitary-Adrenal axis).
Take a thorough inventory of the stress in your life, how it affects you (how you perceive it), and what you do about it. In addition, take an inventory of your sleep hygiene. Do you get 8 to 9 hours of uninterrupted sleep? What time do you go to bed? Are your sleep habits regular? Are you caffeine-addicted? These are clues to the health of your HPA axis.
HPA dysregulation is something you can test for, and my favorite test is the Dutch Adrenal test. However, regardless of what you find, this is something you can’t simply supplement your way out of. You need to develop healthy and functional ways to reduce and manage stress, and you need to have good sleep hygiene practices. If this speaks to you, this blog series is useful, as well as these two articles:
3. Balance your blood sugar and insulin
Blood labs to assess this include:
- Fasting glucose (80-85 is good)
- Fasting insulin (5 or less is good, and definitely under 8)
- Hemoglobin A1c (4.8-5.1 range is good)
- Triglycerides (50-80 is good, and definitely under 100)
If you don’t have these results, it’s easy to change with diet alone. Basic common sense applies here:
- Eat three times per day
- Eat enough so you don’t need to snack
- Go for 12 hours at night without eating
- Include protein and high quality fats with every meal
- Eat whole food carbohydrates instead of refined flour and sugar
- If overweight, apply carbohydrate appropriate eating until you are at a realistically healthy weight
Every woman I’ve worked with who has applied these principles regulates her blood sugar and loses weight. Some women have more trouble, because of genetics or because of existing metabolic issues (PCOS, insulin resistance, diabetes, hypothyroidism). In these cases, more specific dietary modifications, and specific supplements and herbs can help. Some of my favorites include alpha lipoic acid, chromium, gymnema, and cinnamon.
It’s time to strengthen your spine. If you haven’t developed healthy boundaries with other people by this time, make it a project to do so. You won’t regret it. If you find yourself irritated, annoyed, overwhelmed, or lying awake at night rehearsing events of the day, chances are that you:
- Have not developed healthy boundaries
- Do too much
- Are not true to yourself
Lose the shoulds from your life, and cultivate more wants.”
We women can be such caretakers! Menopause is a time to tap into our wisdom, power, and creativity. Anything that saps that needs to be questioned. What really makes you happy? What fills you up? Add those things to your life, without guilt. Take an inventory of your happiness and how you spend your time. Are you content with your life? Do you have a passion or a purpose? What you do for fun? What you do to relax? Do you have a good support system? Ask yourself these questions, and if there’s work to be done, go for it!
5. Take care of your thyroid
Hypothyroidism and Hashimoto’s autoimmune disease are common during perimenopause. Assess your thyroid and treat if necessary. Make sure you have thyroid nutrients in your diet.
6. Resolve period problems
Contrary to what women tend to think, it’s actually not “normal” to have periods with pain, PMS, sore breasts, bloating, cramping, moodiness, excessive clotting, and irregularity. It’s healthy to have a period every 26-32 days, and to be surprised when you get it – meaning you didn’t have noticeable premenstrual symptoms. It’s healthy to have a bright red flow with few or no clots, no fatigue, and 3-5 days of bleeding.
If you don’t have a healthy menstrual cycle, work on it, with help! Good practitioners to choose include integrative or functional medical practitioners and acupuncturists who specialize in gynecology.
7. Grow a good gut microbiome
Your gut bacteria are essential in metabolizing your hormones, balancing your blood sugar, and regulating your mood. It’s common to have an overgrowth of unwanted bugs (bacteria, yeast, or even parasites). It’s also common to have low bacterial diversity (not good), or not enough good bacteria.
What can you do? I like to periodically do a stool test to assess gut bacteria, such as the GI Map. I recommend this annually for those with digestive issues (IBS, colitis, SIBO, diverticulosis, food intolerances, gas, and bloating are examples) or those with autoimmunity.
Feed beneficial bacteria with fiber-rich prebiotic food like beans and vegetables. Take prebiotic fibers. Eat fermented and cultured foods. Read more about Feeding Your Microbiome Superheroes.
8. Move your body in a fun way!
We all know the benefits of moving our bodies, but sometimes have blocks to doing so. If you are not regularly moving, here are some tips that might work for you:
- Find a way to have fun with movement – do something you actually enjoy.
- Make it a part of your daily routine (like walking somewhere you need to go anyway, or dancing while cooking).
- If you like alone time, and you’re an introvert, then Bingo! You get your alone time by exercising alone, outside if you can.
- If you like groups, take a class or walk/hike with friends.
- With injuries and/or disabilities, get some support from a qualified personal trainer, Feldenkrais® practitioner, or physical/occupational therapist to find things that you can do. Sometimes we need help.
Keep moving to prevent stagnation and sluggishness. In Chinese Medicine, lack of movement causes “qi stagnation” which directly affects metabolism, digestion, moods, and hormones!
I welcome your comments