Perimenopause is the phase of hormonal transition leading up to menopause (the life phase that begins one year after your period). It usually lasts anywhere between 2-12 years before periods stop and has a reputation for being a chaotic and turbulent time for many women.
The growing list of perimenopause signs are wide ranging due to the hormonal fluctuations of progesterone and oestrogen. The list is extensive, and the severity of symptoms can range from mild to debilitating. They include:
- Change in menstrual periods (cycle length, flow volume, PMS)
- Difficulty sleeping
- Temperature changes – hot flushes, night sweats
- Anxiety/ depression or other mood changes
- Bladder or urinary discomfort, vaginal changes
- Changes in brain function e.g. brain fog, poor memory
- Joint aches / pain
- Sore / swollen breasts
- Headaches/ migraines
- Weight gain, especially around the middle
This graphic is taken from Lara Briden’s book “Hormone Repair Manual” (and she cites the original source as Prof Jerilynn Prior’s “Perimenopause lost—reframing the end of menstruation.”)
While it is a conceptual illustration only, it provides a great visual to accompany the language often used for this phase of life – rollercoaster, second puberty, or perhaps more commonly described as a … $h!t-show.
In my own anecdotal experience of working with women in this time of their life – I have noticed that perimenopausal symptoms can often appear like a barometer on how other aspects of health and wellness are tracking. Those with solid self-care practices and a suite of health enhancing habits tend to fare a little better. While diet and lifestyle changes may not eliminate perimenopausal symptoms altogether, it has been suggested that they may delay their development, make them more bearable and everyday life be a little easier.
So, if perimenopause feels like it is affecting your quality of life, there might be few ways to get things running a little more smoothly again.
- Firstly, it’s important to check in with a trusted GP (preferably with an interest in women’s health) to have a chat about any bothersome symptoms. They can assist with ruling out other medical explanations and offer any medical management options.
- If temperature regulation (think – hot flushes, night sweats, generally raised body temperature) is an issue you could try:
o Cutting down alcohol. Some may need to abstain altogether.
o Staying well hydrated to replace any fluids lost with sweating. Some women may benefit from electrolyte replacement if water losses are high. Try and sip fluids across the day to avoid large volumes in the late afternoon / evening as this may increase night waking.
o Sipping on cooling fluids, avoiding hot drinks
o Minimising hot/ spicy foods
- Eating patterns - Eat smaller meals, more regularly to support appetite and glucose regulation.
- Check in with your appetite –are there any sticky points across the day where you are feeling uncomfortably full or hungry? It’s very easy to eat to a well-established routine, eat mindlessly if we are stressed or emotional, or skip meals to accommodate a busy schedule.
- Keep the wholegrains. Don’t cut out carbohydrates in an effort to maintain weight. Wholegrain foods are important for hormone regulation, healthy bowel function, insulin sensitivity and gut health.
o Choose minimally processed wholegrains foods like wholegrain bread/ crackers, rolled oats, quinoa, barley, spelt, rye, brown rice with each main meal.
- Keep the spotlight on protein – important for preserving muscle mass as oestrogen levels decline and supporting energy across the day. Spread protein evenly – include some with every meal. And, keep a particular focus on including proteins from plant sources e.g. soy foods, nuts, legumes.
- Increase foods containing soy or flaxseed. These foods contain phytoestrogens which are (weak) oestrogen-like compounds found in plants. The evidence for this effect isn’t substantial but some studies show that there are effective at reducing hot flush symptoms. Soy foods such as soy milks/ yoghurts, tofu, tempeh, miso and edamame are a great source of plant-based proteins and have benefits for heart health and possibly in the prevention of breast cancer.
- A Mediterranean style diet is going to have so many health benefits. It is anti-inflammatory, high in antioxidants, can help to prevent chronic disease, great for gut and brain health and will support hormone regulation – especially insulin and oestrogen.
o Think a wide variety of fruits, vegetables, wholegrains, legumes, fish, extra virgin olive oil, nuts and seeds
o Small amounts of red meat, minimal processed foods
And of course, there are the non-food related lifestyle behaviours we can undertake to care for ourselves.
- Exercise – Choose something you enjoy most importantly. Something incorporating free weights or against resistance will be helpful for reducing muscle loss associated with reduced oestrogen. Seek out a fab Exercise Physiologist or Physiotherapist with an interest in Women’s Health for some great ideas here.
- Quality Sleep is going to make a huge difference to how you feel day to day. And it’s not just about combating fatigue. Sleep is going to support optimal hormonal balance, prevent chronic disease and help increase insulin sensitivity.
o You know this part already. The routine we undertake before bed (intentionally or otherwise) is going to make a huge difference. You might like to consider:
Eating your evening meal at least 2 hours before bedtime
Drinking fluids earlier in the day to avoid waking during the night to visit the toilet
Relaxing activities in the evening to soothe the nervous system (warm bath/ shower, yoga)
Low lighting, no screens/ blue light in the hour before bed
Cool / dark bedroom spaces
Reduce or avoid caffeine (especially in the afternoon / evening)
References
Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., ... & Várbíró, S. (2023). The Importance of Nutrition in Menopause and Perimenopause—A Review. Nutrients, 16(1), 27.
Briden, L. (2021). Hormone Repair Manual: Every woman’s guide to healthy hormones after 40, Pan Macmillan Australia