Understanding Perimenopause: Navigating the Transition with Clarity
Perimenopause can feel like a long road trip—unpredictable, frustrating, and at times, overwhelming. Much like traveling with a restless child asking "Are we there yet?" the experience of perimenopause is often met with confusion and impatience. There are hot flushes that come out of nowhere, night sweats that last all day, the irregular bleeding, brain fog and mood swings that make PMS look like a cake walk. But just like any journey, it has a destination, even if the path there is not always smooth. Here’s what you need to know to navigate the menopausal transition leading up to the final menstrual period.
1. Perimenopause Is Like Puberty in Reverse
Puberty, which takes about 10 years, is a time of change characterized by mood swings, irregular periods, and big changes in height, weight and body structure. Similarly, perimenopause can last 10-12 years, with symptoms like hot flashes, brain fog, and unpredictable periods. I often hear from my patients “I did not change anything and I cannot lose weight, my moods are unstable and I cannot remember anything”. You don’t have to change anything for your body to naturally go through the transition into menopause. Just like puberty, it’s a natural process, and you don’t need to “do” anything to trigger it. Your body is aging and transitioning just as it did when you were a child becoming an adult
2. Hormones Are Fluctuating
Throughout the menstrual cycle, estrogen levels naturally fluctuate. In the first half of the cycle (follicular) estrogen levels are high, follicles are stimulated and our brains are programmed to look for a mate. People tend to feel more outgoing, our jeans fit, we are less bloated, we have more energy. After ovulation when the egg of that month has been selected and has been released our bodies go into the second phase of our cycle. During this phase (luteal) progesterone is higher and our bodies do not know if the egg that was released has been fertilized. Just in case it has our bodies prepare to be pregnant. Our breasts get tender, we are more sensitive emotionally and sensorily. Smell and taste sensations become stronger. As you approach menopause, fewer eggs are available, leading to less estrogen production. This causes erratic periods, heavy or light, and can make the body feel out of sync, contributing to the frustration many people experience.
3. The Impact of Estrogen Withdrawal
During puberty every organ system and cell is bathed in estrogen and progesterone as the body changes from child to adult. Hence it is not a mystery why people feel the withdrawal of estrogen and progesterone in every organ system as the ovaries wind down their production of follicles and hormones. Estrogen withdrawal impacts everything from the temperature control center in the brain to changes in fat distribution, muscle, bone, and sexual organs. These changes are completely normal but they are the beginning of a “new normal”.
4. Treating Symptoms, Not Just Testing Hormones
There are no reliable tests to determine exactly where you are in the menopause timeline. Hormonal tests simply show your levels on any given day and don’t predict when the transition will end. Treatment should focus on symptom management, improving quality of life, and listening to how your body feels. Just because menopause is not easily diagnosable through tests doesn’t make it any less real.
5. Natural Ways to Support the Transition
For those who prefer to manage perimenopause naturally, here are some recommendations:
Be cautious with over-the-counter “natural remedies,” as they may contain unregulated hormones. Be wary of Black Cohosh that can activate estrogen receptors and supplements marked as “menopausal support”.
This is an ideal time to invest in physical health. Strength training (2-3 times a week) and regular cardio ( a minimum of 75 minutes of vigorous cardio exercise (breathless) or 150 minutes of moderate cardio (breathy) exercise weekly) can boost mood, decrease perimenopausal symptoms and support heart health.
Ensure adequate intake of Vitamin D, calcium, and protein to support bone health and overall wellness during this time.
6. Embracing the Change
Perimenopause and menopause can be viewed as a Renaissance, a rebirth characterized by stability and power. As Anais Nin said, “We don’t see things as they are, we see things as we are.” By embracing this change with a positive mindset, you can enter this new phase of life with wisdom, peace, and renewed energy. Perimenopause can be challenging, it’s also a time of incredible personal growth. With the right mindset, self-care, and support, you can emerge from this transition stronger and more empowered than ever.
“The most powerful force in the world is a menopausal woman with zest.” Margaret Meade.