Dr Libby: What You Need To Know About Perimenopause (And What Could Be Making Your Symptoms Worse)

In this special series, guest writer Dr Libby Weaver shares her health insights.

Menopause, by definition, is the one-year anniversary of your last menstrual period. So, essentially, it’s one day.

The one to 12 years leading up to this day — known as perimenopause — and the time afterwards — known as post-menopause — can be times when additional biochemical, nutritional and/or emotional support is needed. This is not true for all women, however, whether you are suffering mildly, majorly or not at all, understanding perimenopause and ways to support yourself during this transition, can offer benefits we may not appreciate until we live the experience ourselves.

Across the menstruation years, cyclical ovulation provides us with progesterone, a hormone crucial to carrying a baby to term, as well as one that offers us a host of biological benefits. Progesterone is a powerful anti-anxiety agent as well as a diuretic, so when we don’t ovulate, or if ovarian health is not optimal (and there can be lots of reasons for this), progesterone production can be compromised and we then feel the effects.

When we enter perimenopause, the first stage of this transition occurs when ovulation — and hence progesterone production — becomes irregular. You might ovulate one month, then not for the next three. Then you do again, perhaps for two months in a row, until you don’t again for four months. Not only does this mean periods will likely become irregular, but additional symptoms are commonly noticed such as changes in menstrual flow, breast tenderness, PMS/PMT, hot flushes, night sweats, disrupted sleep, mood swings, mental fogginess, low libido, and fatigue. Some women also notice shifts in body fat.

The next stage of the perimenopausal transition occurs when estrogen levels start to fluctuate. At times they can be problematically high and other times plummeting low. Couple this with the lack of progesterone during the months when you don’t ovulate and it’s no wonder some women find this time uncomfortable or debilitating.

Stage three of the peri-menopausal transition occurs when estrogen production slows and levels remain low. Your ovaries will still produce a small amount of estrogen but ovulation has ceased, meaning your ovaries no longer produce progesterone (you can still make a small amount in your adrenal glands). Periods will have ceased and one year later is deemed “menopause”. By now, there is a natural testosterone dominance, due to the other two sex hormones levels being low. If you are metabolically healthy, this is fine.

What to know if you’re in your 30s

Before we delve further into perimenopause and aspects of metabolic health, as well as ways we can better support ourselves or alleviate symptoms, I feel called to share an observation. Not very long ago, the only people who used the word “perimenopause” and knew what it was, were health professionals. Now, most women have heard of it. This has immense benefits and also some drawbacks.

Yet on the other side, I have met too many women in their 30s who are now dreading this time in their life (you don’t need to), and I’ve met countless women who have no symptoms and don’t speak up because they don’t want those suffering to feel worse. There needs to be space for all experiences. And if you’re not yet perimenopausal, please don’t fear it. The reality is that this transition may or may not offer up some challenges for you — trust that you’ll find your way just like you have with everything up until now.

Hormonal changes

One of the metabolic factors that can drive further and potentially problematic hormonal changes across this sensitive time is insulin resistance. Insulin is a hormone that helps to regulate blood glucose levels. When we make too much insulin in an attempt to keep blood sugar inside the healthy range, that’s called insulin resistance. It drives a host of unfavourable changes inside us, including abdominal body fat accumulation. Many cells in the body can make an enzyme called aromatase but belly fat cells are particularly skilled at this. Aromatase converts testosterone into estrogen and this can be a concerning form of estrogen (some estrogens are protective, some are risky).

So if we go through perimenopause with insulin resistance, we tend to suffer more. It pushes us into a state of “testosterone dominance”, where there are too many androgens (male sex hormones) — one of which is testosterone. Some of the symptoms that might show up in this scenario include head hair loss, skin tags, elevated blood cholesterol and/or fatty liver. When insulin resistance is treated, for some, the symptoms associated with perimenopause ease.

Iron deficiency is also another culprit that can be lurking in the background, making perimenopause symptoms worse. Iron is needed not only for energy but for detoxification processes and healthy thyroid hormone production. Correcting this can also help some women with challenging perimenopausal symptoms.

Body-identical hormones are available and are appropriate for some women and not for others. Your healthcare professional — the one who knows your thorough health history — is best to guide you with this. Everyone responds differently to the use of hormones — some women get their quality of life back, while for others they make no difference or in some cases they make things worse. Notice how you respond.

I also worry that when we simply throw hormones at someone suffering with perimenopausal symptoms, we risk not addressing what might also be there: factors like insulin resistance, fatty liver and iron deficiency, for example, that can create more significant health issues down the road.

Listen to the signals

Perimenopause is a time in life when your body will typically prompt you to take better care of yourself. Even with the basics, like sleep, more nutritious food, and less alcohol — these things really do make a difference. Do your best to listen to the signals and act on them. It might be a time when you explore practices like meditation and yoga, which focus on slow, diaphragmatic breathing, and have been shown to significantly reduce stress hormone output.

It’s also a time when the unique substances provided by the Brassica family of vegetables are more important than ever as they help with estrogen detoxification, something that’s important to ensure is efficient across all life stages.

Remember that, over time, simple things — like eating more broccoli or correcting iron deficiency — consistently done, can have a profoundly wonderful impact on how we feel and function.

Dr Libby Weaver PhD is a nutritional biochemist, 13 times bestselling author and international keynote speaker. To learn more about supporting your peri- or post-menopausal journey, visit Drlibby.com