- Susan Horgan
Top 5 tips for reclaiming power over your perimenopause
Updated: Nov 1, 2022
Thriving through menopause may be easier than you think
I’ve heard from so many women recently that they feel they have started perimenopause. Their energy is low, mood is all over the place, have gained weight that they suddenly find impossible to shift and can’t remember why they went upstairs sometimes! These are all very common symptoms of perimenopause (and there are many).
What’s interesting is that many of these women just see these things as part of the process and things that need to be “put up with”. But I politely disagree – I know that there are lots of things that can be done through diet and lifestyle change that can have a hugely positive impact on how a woman experiences perimenopause.
So I wanted to share some of my top tips with you so that you can understand what’s happening in your body and how you can take some steps to helping yourself through this next phase of your life. By the time you’re finished reading, my goal is that you will have picked up a couple of practical things that you can do today to help you feel more like your old self.
OK then, what is perimenopause anyway?
Before we go any further, I think it’s important that we understand what perimenopause is and isn’t. Most importantly, perimenopause is not a condition that needs to be managed. It is a very natural sequence of events, driven by the fluctuation of our hormones, similar in many ways to those that happen during puberty. In fact, some refer to it as “second puberty”. Perimenopause is also not about the aging process – it can be happening at the same time as you age, but it’s not caused by aging.
So what is it? Like I said, it’s a series of hormone-driven events that can begin at any stage from around age 35 (but more commonly in your 40s). For some women, it lasts just a few short months and for others it can go on for up to 10 years, with the average being around 7 years.
The word ‘perimenopause’ means ‘around menopause’ and describes the period of time leading up to when your periods finally stop.
You are officially in menopause once you have not had a period for 12 months.
What’s not commonly discussed is that perimenopause is also a time that women have an increased vulnerability to developing new health conditions. Why is this? Mainly because oestrogen and progesterone have such wide-ranging roles in the body and as our levels decline, all of these body systems need to learn how to function with less of them around.
The most important aspects of health that undergo a significant change during perimenopause (and the early years post menopause) are our cardiovascular and immune systems, our insulin sensitivity, our bones and our brain.
All of this puts us at greater risk of things like autoimmune conditions, mental illness, cognitive decline, diabetes, osteoporosis and heart disease. But, to put a positive spin on things, it also provides us with the opportunity to put in place nutrition and lifestyle habits that can help us to manage those risks and prevent their occurrence, which I’ll cover later, so keep reading.
“How will I know I’m in perimenopause?”
That’s a great question. For the lucky few who experience little to no symptoms, it can be that there is no way to tell until your periods stop. However, for the majority of women, it’s usually the onset of perimenopausal symptoms that gives the game away. Every woman’s experience of perimenopause is different and the number and severity of symptoms you experience will be different to your friend and possibly even your sister or mother. However, there are some frequently occurring symptoms that are generally accepted as being driven by the hormonal changes of perimenopause.
Common physical symptoms:
Heavy / painful periods
Aches and pains
Hot flushes & night sweats
Onset or worsening of allergies
Common psychological / cognitive symptoms:
Mood swings / irritability
Brain fog / difficulty concentrating
Why knowing “What’s Going On?” could be key to reclaiming your power through perimenopause
Are you singing Marvin Gaye in your head ;)
Seriously though, I think if you can understand what’s actually going on to trigger all of this change and the associated symptoms, it can make it easier to make sense of it and allow you to focus on the things you can do to support your unique set of symptoms.
While we are all different and how we experience perimenopause varies from woman to woman, the sequence of events that are happening are the same and each stage can mean the onset of new or different symptoms.
Canadian endocrinologist, Professor Jerilynn Prior, describes it in 4 stages (PMID: 24753856) and I find them really useful for helping to figure out what stage you’re likely in and potentially what’s going on with your hormones that’s driving your symptoms. Those stages are:
1. Cycles are regular, maybe a little shorter – low progesterone
In the beginning, you may not notice any changes to your cycle – it’s still regular, although it could shorten to maybe 21-26 days. In this stage, you are losing progesterone, mainly because you are having more anovulatory cycles (i.e. cycles where you don’t ovulate. No ovulation = no progesterone – see my previous blog for why ovulation is important). Producing little to no progesterone when you still have lots of oestrogen floating about can lead to symptoms like heavy periods, migraines, hot flushes and night sweats, breast pain, mood and sleep disturbance.
2. Cycles become irregular, varying by up to 7 days – high or fluctuating oestrogen
As things progress, you move into a phase where your oestrogen will be high or fluctuating like mad. At this stage, you may notice that your cycle becomes more irregular, varying in length by up to 7 days or beyond. Again, your progesterone is low thanks to those anovulatory cycles, but in combination with your wild child oestrogen, symptoms like hot flushes, irritability, heavy and painful periods and breast pain can all get worse.
3. Missing cycles – cycles extend to 60 days or more – fluctuating oestrogen
Ultimately you reach a stage where you are missing cycles (cycles of 60 days or more) – oestrogen is still fluctuating, but at lower levels and the severity of symptoms can begin to decline.
4. Final menstruation – the 12 month period from your last period – low oestrogen
The final stage is where you’ve had what you think (and hope!) is your last period and you’re counting down the 12 months until you can officially say you’re in menopause. It’s now that your oestrogen levels really reduce and many of the symptoms end (although some, like hot flushes can continue for a number of years after). Other symptoms related to your lack of oestrogen can develop including mood and sleep issues, vaginal dryness, increased risk of UTIs, aches and pains in your muscles and joints and weight gain (although this can start earlier too).
But fear not, there is so much that can be done through diet, lifestyle changes and supplements that can help to manage perimenopause symptoms. Your symptoms are not an endurance test to see how long you can just grin and bear it. You don’t have to put up with them or suffer in silence.
5 ways to reclaim power over your perimenopause
1. Remember: you’re sweet enough as you are
Probably the most important thing any woman can do once they hit perimenopause, or even before then so that it’s already habit, is to look at your overall sugar intake and eat in a way that is focused on supporting healthy blood sugar regulation.
Why? Oestrogen has an important role in supporting our metabolic health and in particular, our production of and sensitivity to insulin, affecting our ability to regulate our blood sugars (PMID: 34102108). Postmenopausal women are more likely to develop insulin resistance and diabetes than a premenopausal woman because they no longer have the protection of all that oestrogen.
Insulin resistance is at the heart of most perimenopausal weight gain,
as well as contributing to the hormonal rollercoaster that triggers many other symptoms you might be experiencing.
When I talk about sugar, I don’t just mean sweets, cake, biscuits, chocolate, fizzy drinks etc. - although cutting down on added sugars and finding less sugary alternatives is a great place to start. Before you label me the treat police, I’m not saying to cut it all out forever. Like everything, it’s about balance. I enjoy having an ice-cream with my kids and I love chocolate – but I know I can’t have them all the time.
Sometimes the more important thing to take into account when thinking about sugars and blood sugar balance is carbohydrates – more specifically, your choice of carbohydrates. I’m not a big fan of cutting out whole food groups and carbohydrates are really important for energy, cognition and, in women, for healthy ovulation. During perimenopause, we want to ovulate as much as possible to keep producing progesterone for as long as we can, so we need carbs in our meals.
The key is to start making the switch from ultra-processed, refined carbs, or “white fluffy carbs” as I like to call them, to more whole food sources of carbohydrates. That means ditching things like sliced pans, white pasta, cakes, crisps and processed foods and swapping in things like brown rice, wholewheat pasta, quinoa, bulgur wheat, starchy vegetables, oats, sourdough or wholewheat breads and pulses.
Pairing the carbohydrates that you eat with a good source of protein and healthy fats helps to slow the release of the sugars from the carbohydrates, meaning your blood sugars stay more even and you get a more consistent release of energy from them too. Protein is especially important in the morning time – not only does it set your blood sugars on the right path for the day, but it also helps to regulate your circadian rhythm, supporting improved sleep quality, insulin sensitivity and healthy weight management (PMID: 28830875).
2. Snuff out the flames of inflammation
Inflammation is a very natural, protective response by your immune system to deal with a perceived threat and restore balance to the body. It is only when it becomes chronic that it starts to cause havoc in the body and impact on the different body systems. During the perimenopause years, it can contribute to heavy, painful periods, sleep issues, weight gain and mood swings.
Chronic inflammation can have many drivers, some of which may well be present long before you hit perimenopause – things like food intolerances, high overall stress load, poor diet, lack of sleep, digestive problems, insulin resistance to name a few. When it comes to perimenopause, this inflammation can be exacerbated by the decline in oestrogen and progesterone, both of which have anti-inflammatory properties.
From a diet point of view, there are a few simple things that you can include to make your diet more anti-inflammatory:
Include plenty of Omega 3 fats – oily fish, nuts, seeds;
Eat at least 7 servings of vegetables and fruit every day, including as much colour as possible to get the full spectrum of antioxidants in your diet;
Include herbs and spices, including fresh ginger and garlic in your food;
Reduce your intake of processed foods, including processed meat like ham, sausages and rashers;
Remove foods from your diet that you know cause you digestive or other symptoms; and
Reduce sugar intake to protect your gut bacteria.
3. Eat to nourish your body
There’s no such thing as a “perimenopause diet” and anyone that is selling that to you is only after your money. Food should bring you joy, keep you feeling satisfied and give you the energy to do the things you want to do every day. What that looks like in terms of how you fill your plate, is down to you and what works for you, your family and individual circumstances.
That said, there are definitely some guidelines that I would suggest to any woman heading into her 40s or 50s to help you to ensure you are getting all of the nutrients you need to support your health through perimenopause and far beyond.
Protein becomes really important, especially in the latter stages of perimenopause and after you reach menopause. With lower levels of oestrogen, your body will lose muscle mass and bone density. If you do high intensity exercise, it is vital to ensure you get even more to support your muscle recovery.
Fats are important as they provide fat-soluble vitamins and essential fatty acids that can’t be made in the body. They’re used in every cell in our body and many (Omega 3s in particular) have anti-inflammatory effects.
Carbohydrates provide fibre to feed our gut bacteria, keep you feeling full for longer and support regular bowel movements which allows for healthy oestrogen excretion. Getting them from the right sources is the important part.
Keep ultra-processed foods to a minimum and avoid additives like sweeteners, preservatives, colours etc. Processed oils can contribute to inflammation so it’s best to avoid processed foods that contain vegetable and seed oils as much as possible.
Vegetables should make up a large proportion of all the food you eat each day. Vegetables are packed with vitamins, minerals and phytonutrients that act as antioxidants in the body, keeping inflammation under control and reducing high levels of free radicals.
Include phytoestrogens (food-based compounds) from pulses, seeds, fruit, vegetables and whole grains – during perimenopause they can have an anti-oestrogenic effect, helping to lighten periods and effectively breakdown oestrogen in the body. After menopause, they can have a pro-oestrogenic effect.
4. Move and strengthen your body
During perimenopause and after menopause, the goal of any movement or exercise that you do isn’t to shift those unwanted pounds or to improve your mood after a hectic day (but it will also help with these things). The reason you want to include some form of movement is to improve insulin sensitivity, reduce inflammation and build muscle.
Some degree of muscle loss is a natural part of the aging process in both men and women, but women tend to suffer a rapid decline that has been linked to the loss of oestrogen. Loss of muscle has been directly linked to osteoporosis, reduced cognitive function and depression and also contributes to overall frailty and our risk of falling.
Resistance or strength training is the most effective way to build and maintain your muscle mass. Not only that but it is the best form of exercise for improving insulin sensitivity and has been shown to improve hot flushes and cognition too (PMID: 312391190). Walking and yoga can also be hugely beneficial forms of movement to improve muscle loss.
5. Set your body clock to the right time
Sleep can be one of the first things affected by perimenopause in some women. This can be driven by a few factors. Firstly, the part of your brain that controls your body clock, or circadian rhythm, is very sensitive to both progesterone and oestrogen and so as these hormones start to reduce, that part of the brain needs to get used to living with less of them around. Our ability to cope with stress tends to be affected and this can impact our sleep, as can certain symptoms like night sweats, restless legs and increased need to use the loo! During times of high oestrogen, our body can also release more histamine that can affect sleep. And to top it all off, our production of our sleep hormone – melatonin – naturally decreases with age, so that’s happening alongside too!
That’s not to say that you can’t do things to help you get better sleep, both in terms of quantity and quality. Your body is like a small child – it thrives on routine. The more consistent you can be with the time you get up and go to bed, helps to engrain this routine into your brain and your body comes to expect sleep at certain times. Getting outside in the daylight early in the morning is also a really good way to reset your circadian rhythm if you find that you are waking at cock’s crow all of a sudden. And I don’t need to tell you (coz we all know at this stage but mostly choose to forget it) that avoiding blue light in the hour or so before bed can have a hugely positive impact on your ability to fall asleep and the quality of your sleep.
Before I finish….
I feel it is vital that we, as women, understand what’s happening to us so that we have the information to make the best choices we can to support our health from the onset (and even before) of perimenopause. Not only will it help you to navigate your journey a little easier but will allow you to feel empowered about your health and the decisions you make about it. We’re going to live in perimenopause and post-menopause for decades of our lives and I know that I want to be as healthy as possible for as long as possible. Knowledge is power and I think we all have the right to know about our body in as much detail as we can digest.
This is a topic I am massively passionate about, and I could go on for hours, but I’m not sure how many of you would keep reading for that long! If you’d like to know more about me and how we can work together, you can check out the details here.
Craving some in-person support and the chance to share experiences with other women going through the same?
I'm running a 4 week course, starting Tuesday November 8th, in St Andrew's Parish Centre, Malahide, Dublin. I'll be sharing all my knowledge on how to manage your symptoms so that you can get your old self back and there'll be loads of chats where we can learn from each other too. If you can't make it in-person this time, you can also register your interest for an online version of the course.