The change, that time of life, whatever you call it.

Perimenopause & Menopause

The change, that time of life — whatever you call it, the biological process of menopause is a time of anxiety and distress. Not to mention confusing and downright frustrating. Saying adieu to your monthly cycle is only a part of menopause, a journey that may take place over many years.

With so many myths and misconceptions about menopause, it is often difficult to distinguish fact from fiction.

Great strides have been made to understand and support pregnant women, however menopausal women feel as if we've been left in the dust or are no longer relevant. Too often we're told that the slew of symptoms we're experiencing is nature taking its course and we should just accept them.

Nonsense. Although common, the symptoms of hormone imbalances during perimenopause through menopause are most definitely not "normal" — they call them imbalances for a reason — and it is unnecessary to accept their unpleasantness and give up without a fight.

The confusion around menopause is exacerbated by the fact that the years prior to the actual event of menopause are fraught with fluctuating and declining hormone levels as your ovaries gradually release less estrogen. Perimenopause can last 2–10 years — up to 15 for the unlucky — and typically begins in your 40s, sometimes as early as your mid-to-late 30s.

Common symptoms of perimenopause

• Anxiety and depression
• Brain fog
• Bone loss
• Changing cholesterol levels
• Dry skin
• Fatigue
• Hot flashes
• Irregular periods
• Insomnia
• Lower sex drive / libido
• Mood swings
• Night sweats
• Thinning hair or hair loss
• Urinary urgency
• Urine leak when coughing or sneezing
• Vaginal dryness or discomfort during sex
• Weight gain
• Worsening PMS

Your doctor may make a diagnosis of perimenopause based on your symptoms. Hormone blood tests exist but are often inconclusive due to fluctuating hormones. For accurate results, the DUTCH Test is the most complete option — it offers an extensive profile of sex hormones, adrenal hormones, and melatonin along with their metabolites, to identify imbalances.

The type of professional we see can shape the guidance we're given. Symptoms vary so much that even your primary care physician or gynecologist may be stumped. They may be good in their respective areas, but if they don't specialize in menopause, they may not be able to give you good advice — it's just not their area of expertise.

We highly recommend that you find a provider you trust and feel comfortable with, to discuss a plan for preventive health care and any medical concerns you have.

So what is menopause, anyway?

Menopause is literally one day in your life — the 12-month anniversary of the day your menses stopped, meaning your ovaries have completely stopped releasing eggs. The average age of menopause is 51, give or take a few.

Menopause is deeply personal — unique to every woman, and more than just a medical condition. According to WebMD, there are 34 different symptoms associated with menopause. No wonder it's making us a little crazy.

Brain fog, memory lapses, stress, insomnia, mood swings, hot flashes, and night sweats are the result of fluctuating hormone levels. Why do hormones cause such dramatic changes? Estrogen plays a role in almost every major part of the body — heart, skin, hair, bones, breasts, brain — all influenced by estrogen to some degree.

In addition to estrogen, progesterone — all our hormones, really — impacts not only the reproductive system but many other parts of the body. The dip in hormone levels often results in emotional symptoms that may trigger anxiety, sadness, loss, anger, and frustration. Often misunderstood and underdiagnosed, migraines can be another debilitating symptom.

Additional symptoms (any of these look familiar?)

• Anxiety
• Vaginal dryness
• Hot flashes
• Chills
• Night sweats
• Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair / hair loss
• Loss of breast fullness

With over 37.5 million women going through menopause, most of us will experience symptoms — from perimenopause to the end of menopause — for half of our lives. Life expectancy for women is around 80, and perimenopause typically starts in our 40s. Any way you do the math, that's way too long to deal with menopausal symptoms wreaking havoc on our bodies, clouding our minds, and disrupting our lives.

5 things you can start today to ease symptoms

1. Eat real food
2. Maintain a healthy weight
3. Exercise regularly — strength, cardio, flexibility, balance
4. Keep your bones strong
5. Prioritize sleep (and consider thoughtful supplementation)

Decreased libido

The physical effects of falling estrogen — hot flashes, night sweats, and vaginal dryness — can undermine sexual desire and drive. Vaginal dryness can make sex uncomfortable or even painful, which further undermines motivation. If that weren't enough, age-related decreases in testosterone — although not directly caused by menopause — also play a role in women's sex drive.

Fluctuating hormones during perimenopause and menopause can also affect mental health, which in turn can decrease libido. There are steps you can take at any age and stage. Healthy lifestyle changes — diet, exercise, stress management — can improve your overall health, ease symptoms, and support your hormones.

Managing symptoms

Many women choose HRT (Hormone Replacement Therapy) to alleviate symptoms. It's proven effective, but it may not be the best choice for someone with a personal or family history of female cancers.

There are many holistic methods to address hormone imbalances during these years — lifestyle changes around diet, exercise, and stress reduction, as well as thoughtful supplementation.

Complementary and alternative (CAM) remedies for menopausal symptoms are more accepted, and for many women the best option. Generally, there aren't many well-conducted studies proving whether specific alternative remedies work — but there are generations of personal stories and testimonials.

Types of alternative and complementary options

• Acupuncture
• Essential oils
• Herbal treatments
• Hypnosis
• Meditation and mindfulness
• Yoga
• Chinese medicine
• Naturopathic medicine
• Holistic medicine
• Integrative medicine
• Functional medicine
• Menopause health coaching

A note on mood, anxiety, and depression

Transitioning into menopause is confusing and turbulent for most women. Our fluctuating hormones cause new emotions and symptoms — hello, hot flashes. The changes can also affect brain chemicals that influence mood. It's not uncommon to occasionally feel emotional, anxious, and even a bit depressed. But feeling depressed and having depression are not the same thing.

When estrogen levels drop, hot flashes and night sweats aren't far behind. When night sweats disturb your sleep night after night, you're left tired, and the lack of sleep can lead to anxiety and mood swings. Sadness or grief in response to difficult life experiences — loss, job change, empty nest — is natural. Being sad is not the same as having depression.

Depression is a common and serious mood disorder that negatively affects how you feel, think, and act. It inhibits your ability to experience normal moods and live your life. Mood disorders are biological illnesses believed to be caused by changes in brain chemistry, and depression is sometimes inherited genetically.

Symptoms of depression can include

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity
• Feeling worthless or guilty
• Difficulty thinking, concentrating, or making decisions
• Thoughts of death or suicide

While menopause can cause a wave of emotions, severe ongoing panic, anxiety, and depression is not normal. Consult a licensed medical professional.

Managing depression and anxiety

Doctors believe a healthy lifestyle is the first step in preventing mood swings and reducing panic attacks. Regular, gentle exercise can significantly reduce anxiety.

• Avoid caffeine, alcohol, and spicy foods
• Eat a balanced, healthy diet with fruits, vegetables, and whole grains
• Talk to a therapist or counselor
• Get enough sleep