The Transitional Years:  Perimenopause

I have written and lectured for years about the hormonally driven transition to menopause. However, I sometimes forget that there are always women entering these years of transition and the information I have gleaned over 35 years in naturopathic medicine could provide some support during these years.

Perimenopause occurs about 3-6 years before the last period as the body approaches menopause, the complete cessation of menstruation.

During this time the hormones fluctuate, sometimes progesterone is high, estrogen low and visa- versa; times there can be deficiencies of both or imbalances in ratios.

“Oh, fun you” say – but enjoy the ride, and know there are things you can do to make the transition smoother.

Some symptoms include brain fog, insomnia, weight gain, hot flashes, night sweats, mood changes, fatigue and low libido. For some the symptoms may be mild while others, more extreme.

It is difficult not to get caught up in the attitudes fostered by the medical profession and media, that suggest women in this stage of life are drying up, wrinkling and shrinking away resulting in this natural state of every woman being prescribed hormone therapy. Menopause is not a disease required decades of HRT.

The Adrenal Glands and the Hormone connection

The adrenals are the body’s central command post for the body’s response to stress and also play an important role during the more dramatic hormonal changes. When the adrenals are working properly, they produce adequate levels of precursor hormones that are synthesized into estrogens, progesterone and testosterone to counter the diminished production from the ovaries.

Today most women have some level of adrenal insufficiency due to chronic stress and the adrenals are not able to carry the additional load as the ovaries go on a well-deserved vacation. In chronic stress the precursor hormones, specifically progesterone and pregnenolone, are shunted into the stress hormone pathway leading to a deficiency in DHEA, progesterone, estrogens and testosterone.

Adrenal Stress and the Thyroid connection

In Canada a staggering number of people are affected with thyroid conditions and studies indicate that one in 10 people have a thyroid disorder and of those 50% go undiagnosed.

One of the most important functions of the stress hormone cortisol is to act in concert with thyroid hormones. When the adrenals are stressed, they over produce cortisol or when exhausted they underproduce cortisol, both of which affect thyroid function.

Some of the symptoms attributed to perimenopause such as of weight gain, brain fog, insomnia and fatigue can be the result of the adrenal-thyroid connection.

It is important to have the thyroid tested. I would suggest a complete thyroid panel (TSH, T4, T3, and thyroid antibodies). Most doctors simply test the thyroid stimulating hormone (TSH) which is entirely inadequate. A naturopathic doctor or a more holistic oriented MD will run a full panel (there is a small lab cost involved). The testing of TSH only and the current ‘normal’ lab ranges in Canada are the main reasons so many people go undiagnosed. Canada lab norms for thyroid are outdated and there is a very wide range for ‘normal’. (.34 and 5.6 IU/mL). There is a big difference between normal and optimal.

The optimal range for TSH is between 1.0 and 2.0 IU/mL If your reading is for example 3.5 most doctors will tell you that your thyroid function is normal. This is true according to the lab range but it is not optimal, and you will more than likely be experiencing symptoms including fatigue, hair loss, weight gain, mood swings, cold intolerance depression, muscle cramps and more. Sounds a lot like perimenopausal symptoms doesn’t it?

Hypothyroidism (low thyroid function) is the most common thyroid disorder and occurs when the gland fails to produce sufficient amounts of T3 and T4. As a result, the TSH becomes elevated; the pituitary has to put out more TSH in order for the thyroid to respond)

In clinical practice I would always recommend the natural products, lifestyle changes first and then if that wasn’t enough to help with uncomfortable symptoms, I would recommend bioidentical hormones, always starting at the lowest dose and increasing if necessary. Once the symptoms were improved then the hormones would be decreased over time while the women would stay on the natural support supplements. The most recent ‘rule’ for HRT is the lowest dose for the shortest period of time.

Estriol cream can be helpful for vaginal dryness and in preventing bladder infections which plague some women during the transition. Estriol is the weakest of all three estrogens and is considered safe.

General Support during the Transitional years

• Adrenal Support- a combination formula that includes herbs such as rhodiola, Siberian ginseng, and ashwagandha.
• Probiotics- support the gut
• Evening primrose oil- helps overall with perimenopause

Note: if your TSH level is 2.0 IU/mL or over but still under 5.5 IU/mL you could consider adding tyrosine or a thyroid combination formula. If your TSH is above 3 but still below 5.6 UL/mL and you have symptoms, consider prescription thyroid hormone. Most naturopathic doctors will prescribe desiccated thyroid which has T4 and T3. Discuss with your health care practitioner.

Nutritional Support for Hot Flashes

• Menopause specific combination formulas that include herbs such as hops, black cohosh, red clover, chasteberry (vitex), and dong quai provide support for most women.

• Vitamin E: studies confirm that vitamin E helps with hot flashes.

• B Vitamins In 2018, a group of researchers reported that “the role of B vitamins cannot be overestimated in the menopause.”

Vitamins B-6 and B-12 may help support cognitive function and B-6 might lower the risk of depression

Vitamin B-9, also known folate, was effective in reducing the number and severity of hot flashes

Supplement Support for Insomnia

Stress is a common cause of insomnia in all people, but with the added stress on the adrenals during perimenopause, there is added stress on the adrenals.

• Adrenal support during the day such as a combination herbal product or pantothenic acid can help lower cortisol levels which contribute to insomnia.
• Melatonin: An increase in cortisol can cause a decreased production of melatonin.
• GABA: high levels of cortisol inhibit GABA production which acts like a brake during times of stress. Decreased GABA is associated with anxiety depression, and insomnia.
• Combination formulas that include herbs such as skullcap, linden flowers, passion flower and valerian can be very helpful.
• 5-hydroxytroptophan (5-HTP) may be better than melatonin for treating insomnia or for people who have nightmares from melatonin.

Please talk to the knowledgeable staff at the Vitamin Shop for any more information on supplements for relief of your perimenopausal symptoms.

Diet and Lifestyle tips for Perimenopause

• Avoid alcohol. Alcohol in general increases heat in the body and for some very small amounts will cause night sweats. For years patients would tell me that red wine was the worst for causing hot flashes and night sweats.
• Avoid highly spiced foofs
• Exercise regularly. A study of 900 perimenopausal women showed that those who exercised a minimum of 3.5 hours a week had milder and less frequent hot flashes.
• Make time for stress-relieving exercise like massage, yoga, hiking, painting, jogging – whatever helps you unwind.
• Avoid polyester fabrics. Polyesters make you perspire more easily even if you are not going through hormonal changes. Use cotton or natural fabrics for sheets, and clothing.

Remember for everything there is a season. The transitional years are like autumn, rick in colour and they carry a hint of sadness as we leave the hot vibrant days of summer. The autumn years prepare women for the quieter more introspective times of winter – the post-menopausal years.