Perimenopause: Sifting Through What Matters and What’s Hype

3 days ago

8 min read

There is a lot of talk about perimenopause these days. Honestly, I think that’s a good thing. For a long time, women were essentially told to buckle down, push through, and wait for it to be over.

We know a lot more now.

There are lifestyle changes, exercise strategies, supplements, and medications that can help manage many of the symptoms associated with perimenopause. But with all of the information, and misinformation, it can be really difficult to figure out what is actually useful and what is simply hype.

This is still an opinion piece, not medical advice. It is based on medical literature, loads of continuing education courses, and, of course, more than 20 years of working with women in real life. I’m also navigating this stage myself, so I have plenty of personal experience with the joys of it!

Take what is helpful, talk with your own healthcare provider, and hopefully this will help you sort through some of the most important information and figure out what questions to ask next.

First, Let’s Talk About Estrogen

Estrogen helps every organ in your body, but a few really important ones are your heart, your brain, and your bones. As your estrogen levels decrease, so does the health of these organs. Yes, it’s true this also happens with aging in general, but the important part during the 5-10 years leading up to and just after menopause, is there is a drastic change in these levels. What was once there to protect and serve those organs is ripped away rather quickly, leaving your body to figure out how to navigate it and accommodate for it.

During this time, you may experience any of the following:

Brain fog or difficulty concentrating
Mood changes
Difficulty falling asleep or staying asleep
Vasomotor symptoms such as hot flashes and night sweats
Joint and muscle aches
Changes in body composition and weight distribution
Increased visceral fat
Changes in digestion or gut function
New sensitivities or changes in how you respond to foods
Dizziness or changes in balance
Changes in exercise tolerance and recovery

And, of course, the list goes on

The important thing to know is this: You are not alone. You are not crazy. And you do not have to simply suffer through it.

We can't stop aging, but there are absolutely things we can do to support our bodies through these hormonal changes.

And there are three areas in particular that I think deserve a lot of attention: the heart, the brain, and the bones.

Your Heart

Cardiovascular disease is the leading cause of death in women, more so than all kinds of cancer combined, which makes the changes happening around menopause especially important to pay attention to.

Hormonal changes are only one piece of the puzzle, of course. Genetics, blood pressure, cholesterol, insulin sensitivity, activity level, nutrition, sleep, stress, and many other factors all play a role.

This is also where the conversation around hormone replacement therapy (HRT) gets complicated. The research shows it is the most effective way to treat specific heart issues related to a decline in Estrogen, and we know the earlier we can start it, the better.

HRT is not appropriate for everyone, and I am not a physician or recommending that anyone start it based on a blog post. I am recommending that you have an informed conversation with your healthcare provider about whether it may be appropriate for you.

If HRT isn't right for you, or you simply don't want to take that route—there are still plenty of things you can do to support cardiovascular health.

Exercise is a big one.

If you are already doing long-distance running, cycling, or other endurance activities and you feel great doing them, keep going! There is no reason to stop something that works well for your body.

But if you are noticing that your usual long, steady-state workouts suddenly leave you exhausted, aren't producing the same results, or seem to be accompanied by unexpected changes in body composition, it may be worth experimenting with a different approach.

Working on interval training, and especially SIT (Sprint Interval Training) can help to keep your heart healthy during these times. Wight lifting can also be helpful with flushing some of the hormones out and regulating our system a little more. And walking, especially at a faster pace or an incline is always an option. It’s not as effective as interval training, but it’s a safe and easy way to start for most people.

Your Brain

There will be cognitive changes. 1 in 5 women quite their jobs during this time because of cogintive changes. I can’t tell you how many women tell me they were worried they had early onset Alzheimers or dementia as they navigated perimenopause. My brain fog was crazy! There are loads of supplements that can be helpful for this, but cretaine is a big one. We have know it is helpful for muscle building (which by the way, is also exterememly important during this time), but most of the studies were performed on men. They are now starting to do more studies on women during this time period, and have seen wonderful results in coginition with regular use. Other things to prioritize are...

Sleep Quality

Regular Exercise

Proper Nutrition

And, sorry ladies, minimize alcohol intake, and of course, smoking.

Bone changes

Ouch, women loose up to 25% of their bone mass in the 5 years leading up to menopause. We are already at a disadvantage as our peak bone pass occurs in our late 20s, and both men and women steadily loose bone mass following this. Where it gets worse for women, is during the large loss of estrogen, which is when the majority of our bone density is lost, and what’s even worse, is we don’t feel anything. It is called the silent disease because, unfortunately, we don’t know we have it until we fracture a bone. A hip fracture later in life is one of the leading causes of mortality. So, what can we do? Our bones need a significant load or a stress placed on them in order to grow. Ideally, focusing on areas where your bone density is lower, as well as stressing it in all different directions. Research has shown the following combo, together with proper Calcium, Vit D and protein:

*3-4 days of resistance training - ideally “heavy lifting” meaning bigger, compound lifts with 3-5 sets of 6-8 reps of each exercise. This is not where you would start if you have not been strength training already, but it’s a good place to try and get to. If you currently have osteopenia or osteoporosis, it is essential you work with a health care provider to make sure your lifting form is appropriate so you do not get injured.

*2 days/week of 10 min of impact training. This can obviously be running or jumping, but it can also look like toe taps, or even going up on your toes, and coming down hard on the heels. The idea is to get significant impact through the body. If possible, try and add in multiple directions as our bones respond best to

*Weighted vest walking. Start with 5% of your body weight a couple times/week, and work up to 10% of body weight most days of the week.

The above is research-backed. As always, every person is different, so there is not a magic recipe that works for everyone. Each person also has their own past medical history, so it is important to consult with your health care provider prior to changing some of these routines. BUT, the more research you do going in, the better. Even if you are working with a womens health physician, most doctors receive very minimal training and education in perimenopause. 3 out of 4 women who see a health care provider for mental health issues during this time are placed on an anti depressant rather than dealing with the root issue, which is your hormones. Until recently, this area comprises less than 3% of their training during medical school! So, if this is not an area your specific physician has continued to research and take continuing education courses on, it may be something you have to help guide, or at least ask the right questions to get the ball rolling in the right direction.

Now comes the opinion of a physical therapist who has worked with many women navigating this time period over the past 20+ years I have been treating, as well as a special interest in it as I too am navigating this time.

What are the few things I would do:

*If you think you may be entering perimenopause (remember, this can happen 10 years prior to when you actually stop having your menstrual cycle, and is usually early to mid 40s) AND you are starting to have any of the above symptoms, start having the conversation now with your health care provider to see if HRT is right for you. If it’s not, that is totally ok. There are lots of other avenues below to help address it, but it really is the easiest way to address the issue.

Our vision changes, we get glasses. Our hearing changes, we get hearing aids. We tear an ACL, we put a brace on the knee. Why don’t we treat this the same?

*It is always helpful to get blood work. Our insulin levels change, as well as all the other organs in the body, so it’s important to monitor these. But, unless you are doing something like a Dutch Hormone test where you are gathering info multiple times throughout the day for multiple days, the likelihood of you getting an accurate idea of your hormone levels is pretty low. They change so often through the day and from day to day, that this should NOT be the indicator for HRT. It should be based off your symptoms.

*Work with a nutritionalist or functional medicine doctor for diet changes and possible supplements - a few I go for:

Creatine daily
Fiber supplements as needed (21-25g/day is average needed)
Prunes! (Yes, I said prunes. There is research that backs 4-5 prunes/day helps bone density, and can also help with the fiber issue)
Vit D
Possibly Vit C and Ca if needed
Sleep issues - progesterone will help a lot, but you can also use magnesium.
Increase protein amounts (based of weight and other factors, but shooting for close to 25g/meal in a day for a female - and if you are working out, try and get that within 30 min of your work out OR .8 to 1.5g/kg of body mass)

*If you are still running, cycling, or biking long distances and it feels good with your body, don’t stop! But, if you are like a lot of us that all of a sudden struggle with energy and/or are actually gaining weight when we go for longer, sustained cardio bouts, you are not alone! Try and start shifting to interval training, and eventually, SIT training. You may also have to shift away from early morning workouts, as this is when our cortisol levels tend to spike.

*If you are not already weight lifting 3-4x/week, start!!!!! This is so important for everyone, but especially for us females during this time.

If you feel comfortable, work on increasing resistance with a goal of at least 2 days/week of heavy lifting, and adding in some impact training or intervals with 1-2 of the sessions.

*Add in some dark chocolate here and there. It helps with cortisol levels, as well as can be shown to help with depression.

*Lastly, try to laugh yourself through this. This time period can be scary, concerning, frustrating, full on rage - but, if we are aware it is something every female experiences (yes, on different levels for sure), AND there is an end point, maybe we can be a little more light hearted towards ourselves when we can’t remember the word for an every day object like a pen, or we are once again wide awake at 3am for no reason. Take a breath, maybe a chuckle or 2, and know you will get through this!