Guide for Women in their 40s in Perimenopause

Are you in your 40s and still having periods? If so, this post is for you. You are in a unique time of life called perimenopause, a natural period of life when sex hormones and cycles slowly begin to wind down.

Please don’t fret about being in your 40s! Fortunately, nature gives you this decade as a nice long transition from your reproductive years into menopause. You have tons of time to tend to your mind-body health and get things in order to rock your 50s. There isn’t a guidebook for all women in their 40s, so I like to have a “what to expect and do” conversation with the women I work with. Here I cover the six top things to pay attention to for women in their 40s…

1. Harness your mindset

Use perimenopause (your 40s) as a decade of preparation for menopause. Think about how you want to live and feel when you enter your 50s, and don’t let your parent’s experience dictate yours. Do you want to feel strong, confident, fit, healthy, flexible, creative, beautiful, or sexy? You get to be all of these things in your 50s, and more! NOW is the time to shape how you feel as you get older. Your lifestyle shapes how you age far more than your genetics do, and YOU choose your lifestyle.

2. Put yourself first

Self-care is giving the world the best of you instead of what’s left of you

Put yourself at the top of your to-do list, before everyone else – if you have trouble doing this, you need to check out my friend Victoria Albina’s Feminist Wellness podcast. Make healthy food, 8 hours of restorative sleep, and daily exercise non-negotiable. If you don’t yet have these three basics down, now is the time to learn them.

Next, decide which self-care practices are essential for your wellbeing, and book them so they are also non-negotiable. You know yourself best… what do you need on a regular basis to reduce stress and maintain your mind-body wellness? Massage or acupuncture, social dates, alone time, meditation, yoga, therapy, vacations, creative hobbies – you GET to fit in the core things that relax and rejuvenate you.

3. Know your hormones and your options

Expect that progesterone drops first, and it’s usually a very slow change over your 40s. One of the signs is shorter cycles (under 28 days) that start with spotting. You get to decide if you want to supplement bio-identical progesterone during this time – talk to your practitioner about the pros and cons. You can also use herbs and supplements to even out your cycles and reduce any perimenopause symptoms like hot flashes, mood swings, or insomnia.

Then estrogen drops more quickly between age 46-56 (average is 51), and that’s when periods start to dwindle down. You may feel like you’re in puberty again, with irregular or heavy periods and crazy mood swings. Again herbs and supplements can help ease any uncomfortable symptoms, if you have them – not all women do!

Around age 51 (plus or minus up to 5 years), your period stop. At this time you get to consider the use of bio-identical estrogen, as well as testosterone and DHEA if desired. FYI always use progesterone with estrogen. If your doctor gives you estrogen without progesterone, run to another doctor, as this means your doctor is not practicing safe hormone replacement. See a doctor who specializes in bio-identical hormone replacement (BHRT), and go in person as monitoring with physical exams is essential. Discuss the pros (for vaginal tissue, skin, heart, bones) and any risks or cons (like cancer history).

You can also choose not to use BHRT, and instead use lifestyle and herbs/supplements to stay healthy and vibrant as you go through this transition. Or, you can use naturopathic low levels of bio-identical progesterone, DHEA, and estriol (a weak and safer estrogen good for vaginal lubrication). Choose the health practitioners you want on your perimenopause team – and be picky. One resource is the Women’s International Pharmacy to get referrals for BHRT providers.

4. Nurture your adrenals

Adrenal health and resilience get you through perimenopause smoothly. This is because:

  1. As your ovaries stop producing hormones, you rely more on adrenal production and orchestration of sex hormones. So you want good adrenal function!
  2. If your adrenals are imbalanced with high adrenalin and cortisol, then you are more susceptible to vasomotor symptoms like night wakings, hot flashes and sweats.

Test your adrenals with the DUTCH hormone test, and address any adrenal dysregulation. This takes lifestyle changes that improve your stress levels, sleep quality, light and dark exposure, movement types and timing, and diet. Herbs and supplements can also help.

5. Check your insulin and blood sugar

Women in their 40s often experience abdominal weight gain even with no changes in eating or exercise. Then they wonder if it’s their hormones – for they are right. However, the hormone culprit is usually high levels of insulin.

High insulin is common for women over 40 and signifies insulin resistance, which develops slowly over a life of too many refined carbohydrates and sugars. Often this first shows up in your 40s – as stubborn abdominal fat.

You can check insulin with a fasting blood test that includes insulin and glucose, hemoglobin A1C, lipids, and C-peptide. If you show up on the insulin resistant spectrum (an apple-shaped body with abdominal fat is a clue), then it’s simple – you learn how to eat and move to reverse insulin resistance. An efficient metabolism with stable blood sugar also reduces perimenopause symptoms, a win-win.

6. Harness your sexuality

Let’s face it, sexual desire and performance can be complex for women at all ages. As you approach menopause, you may experience less vaginal moisture which can affect comfort and pleasure. Hormone replacement can help, and this is one reason I want women in their 40s to know that bio-identical hormone replacement done right is a powerful option, not only for vaginal tissue and moisture – BHRT also benefits your skin, brain, and bones. Hormone replacement got a bad rep when the 2002 WHI study came out, however, in 2013 the interpretation of this study was hugely revised, and we now know that bio-identical HRT can be used safely, although not for all women. I am a fan of prescription-strength BHRT however it needs to be done safely. Please see an expert who can do physical exams.

In addition, herbs, supplements, and low dose non-prescription hormone oils and creams can help. There are supplements to improve sensation in the clitoris, suppositories that nurture vaginal tissue and moisture, and herbs to get you in the mood.

Here are suggestions for products to enhance sexuality, alone or with a partner (both highly recommended, as the more you use your lady parts, the better shape they are in):

Want help rocking perimenopause? Please reach out! We start with bloodwork to check sugar-insulin, and the DUTCH complete hormone test for sex hormones and adrenals.

I am sincerely hoping for comments from all women on applying these ideas and adding more of their own,

aptos, santa cruz, monterey, acupuncture, functional medicine, herbal medicine,paris healing arts, doctor laura paris, dr. laura paris, dr laura paris

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