Perimenopause is a trending topic these days, and for good reason – in part, people are becoming more aware that the perimenopausal transition is actually up to eight years, taking up a significant portion of a woman’s life, and in part because our modern diets and lifestyles are perpetuating and exacerbating symptoms, so more people are seeking relief. We’re going to go through it all in this post – everything from what perimenopause is, to how it feels, to how to treat and manage the symptoms that go alongside it.  I will specifically focus on 4 things that make perimenopause symptoms worse, and 5 things you can do to make it better.

Overview of Perimenopause

Perimenopause is the transitional phase leading up to menopause. Menopause is when your menstrual periods have stopped for 12 months because the amount of estrogen and progesterone produced by your ovaries has gotten so low that a period is no longer induced.  The average age of menopause is 51, but age ranges – most women experience menopause between 40 and 58 years old. Perimenopause, the transition period that is characterized by fluctuating hormone levels, particularly estrogen and progesterone, lasts on average between 4 and 8 years, meaning that it starts between age 36 and 54, which is a pretty wide range that leaves many people wondering if what they’re experiencing really is perimenopause.

It’s difficult to test whether someone is “in” perimenopause – in my clinic, we test a robust set of hormones well beyond estrogen and progesterone and can get a general sense of where a woman is in the transition, but part of the definition is that hormones are rapidly fluctuating, so as we take a snapshot of hormones on one day, it really doesn’t tell us the whole picture.  We’re much better served to treat the root cause of the symptoms – after all, perimenopause isn’t a disease but a normal bodily process.  Just as you normally have bowel movements, but some people have them more comfortably than others and if yours are not comfortable we can manage with diet and lifestyle, the same applies to perimenopause – it’s a normal process; we just want to make it more comfortable.

So what are the uncomfortable symptoms anyway?  Symptoms of perimenopause vary a lot from person to person, but the most common symptoms include hot flashes, insomnia, night sweats, weight gain, irritability, vaginal dryness, brain fog, and irregular menstrual cycles. These are not directly caused by perimenopause itself but are symptoms of the hormonal shifts occurring in the body. While some women experience severe symptoms, others might go through perimenopause with minimal issues. It is possible to navigate this phase smoothly with the right approach and support.

4 Things that Make Perimenopause Worse

Women often come to me for functional nutrition support in an effort to make the transition more comfortable, and while I know they wish there were just one solution for everyone, there’s not.  I find that women with uncomfortable symptoms of perimenopause tend to fall into one or more of 4 categories.  These are the 4 things that make perimenopause worse, which I’ll review below.

#1: Imbalances of micronutrients, macronutrients, or blood sugar

Hormonal shifts during perimenopause can exacerbate existing nutritional imbalances, leading to more pronounced symptoms. Studies have shown that deficiencies in certain micronutrients, such as Vitamin D, B12, folate, other B vitamins, magnesium, omega-3 fatty acids, and zinc, can worsen perimenopausal symptoms. Blood sugar imbalances can contribute to weight gain and mood swings, making common complaints during this phase even worse.

If you are experiencing unexplained fatigue, mood swings, or weight gain, these could be signs of micronutrient imbalances or blood sugar imbalances. In our practice, we test for micronutrient levels (including all of the above and more), as well as blood sugar markers like A1c and insulin to pinpoint deficiencies and imbalances.

Additionally, imbalances in macronutrients can cause energy fluctuations and cravings, impacting overall well-being during perimenopause. We utilize a comprehensive dietary assessment to evaluate your intake and ensure you are meeting your macronutrient needs. A well-balanced diet that includes sufficient protein, healthy fats, and complex carbohydrates is essential for stabilizing blood sugar levels and maintaining energy throughout the day.

#2: Increased Inflammation and Oxidative Stress

Acute inflammation is helpful; chronic inflammation is not. Chronic inflammation is a longer-term activation of the immune response which is at the root of many chronic diseases.  It activates the sympathetic nervous system (“fight or flight” branch) which makes your body feel stressed all the time, impacts sleep, mood, recovery, digestion, and more.  It is also linked to insulin resistance, which leads us back to blood sugar and weight gain.  In short, chronic inflammation and oxidative stress can intensify perimenopausal symptoms.

Common signs of increased inflammation include joint pain, fatigue, brain fog, bloating, puffiness in face and hands, acne or other skin issues, heightened autoimmune response, and digestive issues. Often, in our practice, we can guess if inflammation is an issue just by talking through someone’s symptoms, but we like to look at three different inflammatory markers – hs-CRP, GGT, and ESR – to help us dive deeper into the inflammation a person is experiencing.

#3: Gut Dysfunction

Gut health plays a crucial role in all aspects of health, but particularly in hormone balance. Research indicates that gut dysbiosis, or an imbalance in gut bacteria, can affect estrogen metabolism and exacerbate symptoms of perimenopause. One marker we like to specifically look at is beta-glucuronidase, which is an enzyme produced by certain gut bacteria that plays a role in the metabolism of estrogen. When beta-glucuronidase levels are imbalanced, it can lead to the reabsorption of estrogen in the gut, contributing to estrogen dominance and exacerbating hormone imbalances during perimenopause. This can be particularly problematic as it prevents the proper excretion of excess estrogen, leading to symptoms such as heavy menstrual bleeding and increased risk of estrogen-related conditions. Additionally, general dysbiosis, or an imbalance in gut bacteria, can worsen mood-related symptoms of perimenopause. Dysbiosis can increase inflammation and disrupt the gut-brain axis, potentially leading to heightened anxiety, depression, and mood swings.  If you’re constipated, you’re definitely not clearing hormones effectively – we’ve got to get your digestion moving to improve your symptoms.

When we can, we like to do a stool test for dysbiosis, pathogens, microbiome imbalances, various inflammation markers, digestive capacity, and markers of intestinal permeability for our clients whose gut issues are exacerbating perimenopause symptoms.  If that is not available, we focus on general gut healing, which we’ll discuss below.

#4: Adrenal Dysregulation

In all of my Functional Medicine training, they really hammer it into our brains that adrenals are upstream of sex hormones, meaning that if adrenals are dysregulated, it doesn’t make sense to focus on patching up sex hormones first, as the adrenals are the root cause. This can be frustrating, as people come into my office looking for fixes for their sex hormones and we have to start by balancing out stress, but it’s the only way to really fix the root of the issue. The adrenal glands produce hormones (mostly cortisol and adrenaline, although they do produce some sex hormones as well!), and all hormones work together like an orchestra, so when one player is off, the rest are often off as a result.  An imbalance in your cortisol (stress hormone) can very likely cause worsened imbalances in sex hormones.

Symptoms of adrenal dysregulation include chronic fatigue, sleep disturbances, weight changes, digestive changes, headaches, blood pressure or heart rate changes, and mood swings. We use tests like the 4-point diurnal saliva cortisol test and the DUTCH (Dried Urine Test for Comprehensive Hormones) to assess adrenal function and create a comprehensive treatment plan.

5 Things that Make Perimenopause Better

#1: Correcting Estrogen Dominance

Estrogen dominance occurs when there is too much estrogen relative to progesterone, and this leads to almost all of the symptoms we’ve discussed. This imbalance can happen due to ANY of the 4 causes above (nutrient or blood sugar imbalances, inflammation and oxidative stress, gut dysfunction, and adrenal dysregulation).  It can also happen due to poor detoxification, stress, or exposure to xenoestrogens (environmental estrogens) and toxins, and it’s one of the most common things we see when we run clients’ labs.

I could (and maybe will) do a whole blog post just on estrogen dominance, because the strategies are quite wide-ranging, but here are a few of the top strategies we use:

• Diet: increasing consumption of cruciferous vegetables like broccoli, cauliflower, kale, cabbage, and Brussels sprouts helps the body excrete excess estrogen.
• Diet: a more Mediterranean-style, plant-forward diet can decrease excess estrogen by up to 40%.
• Diet: reducing refined carbohydrates, added sugars, and alcohol helps reduce insulin resistance and circulating estrogen.
• Diet: increasing foods rich in Vitamin B6 and zinc, like oysters, pumpkin seeds, lentils, salmon, spinach, bananas, and potatoes is helpful to increase progesterone.
• Lifestyle: Managing stress and improving sleep are absolutely essential to help your body correct estrogen imbalances.
• Lifestyle: limiting plastics and xenoestrogens in daily life can stop perpetuating the issue.
• Lifestyle: regular sweating through exercise or sauna can help excrete excess estrogen
• Supplements: we love DIM (Diindolylmethane), which can support estrogen metabolism, and we use a specific product that supports both Phase I and II detoxification, as well as calcium-d-glucarate, but we only use supplements in the right candidates.

One note on estrogen dominance: you really can’t tell if you have estrogen dominance or what your hormones are doing at all if you have an IUD or are on the birth control pill.  This is stopping your body from producing hormones by giving them exogenously, so we really don’t know what your endogenous hormones are doing, and it becomes hard – but not impossible – to measure.  Still, we can manage symptoms and keep working towards the root cause.

#2: Rebalance Nutrient Levels

Addressing nutrient deficiencies can significantly alleviate symptoms of perimenopause.  When we know which nutrients are off balance based on an assessment of a client’s food log or based on lab testing, it becomes easy to focus on replenishing specific nutrients through diet and targeted supplementation.  If we don’t know which micronutrients are off, the best approach is to focus on a whole foods-based diet full of as many different colors and types of vegetables, fruits, and proteins as possible.  Variety is key to ensuring nutrient diversity and adequacy.

For macronutrients, aiming for a balanced diet with appropriate proportions of proteins, fats, and carbohydrates is a great starting place.  In fact, just going for 33% of each in terms of daily intake is a great place to start and will help you identify imbalances. For perimenopausal women, though, focusing on higher protein intake and healthy fats is beneficial.

To balance blood sugar, eating more balanced meals with robust sources of protein, healthy fat, and fiber is a great starting place and will help minimize snacking and blood sugar hits throughout the day.  Avoiding high-sugar foods (especially added sugar), excessive fasting, or carbohydrate-only meals or snacks can also help.

#3: Reduce Inflammation and Oxidative Stress

Lowering chronic inflammation and oxidative stress is crucial for managing perimenopausal symptoms effectively. One of the most effective ways to reduce inflammation is through diet. Incorporating anti-inflammatory foods such as fatty fish rich in omega-3 fatty acids (like salmon and sardines), leafy green vegetables (such as spinach and kale), and berries (like blueberries and strawberries) can significantly lower inflammatory markers in the body. Foods high in antioxidants, such as nuts, seeds, and colorful fruits and vegetables, help combat oxidative stress by neutralizing free radicals. Additionally, reducing the intake of processed foods, sugars, and trans fats can decrease inflammatory responses. Regularly consuming herbs and spices like turmeric, ginger, and garlic, which have potent anti-inflammatory properties, can also be beneficial.  My clients will be very familiar with the infamous inflammation handout we use in practice, which helps people identify their sources of inflammatory foods and assists them in balancing them out with anti-inflammatory foods.

Beyond diet, lifestyle changes play a significant role in managing inflammation and oxidative stress. Regular physical activity, particularly moderate-intensity exercises like brisk walking, swimming, or yoga, can help reduce inflammation and improve overall health. Stress management techniques such as mindfulness meditation, deep breathing exercises, and adequate sleep are vital, as chronic stress and poor sleep quality are known to increase inflammation and oxidative stress. Supplementation with specific nutrients, such as turmeric, omega-3 fatty acids, and specific herbal blends that we prescribe based on a client’s specific situation can provide additional support in reducing inflammation.

#4: Improve Gut Function

If I could write “how to improve your gut” in a few sentences, trust me, I would! Improving gut function involves a holistic approach, including dietary changes, stress management, and the use of specific supplements to restore balance in the gut microbiome and enhance overall digestive health. If we’re fortunate to have stool testing, the process is really personalized and effective. If that’s not available, we can generally assess whether the person is experiencing more SIBO issues or digestive enzyme insufficiency or malabsorption or dysbiosis just based on symptoms, and we have interventions for that.

In general, probiotics could be a great place to start, and may improve cardiometabolic risk factors in menopausal women.  Focusing on adequate fiber and water for gut motility is essential, and we even work on things like bathroom habits with clients to get them having bowel movements regularly for optimal hormone balance.  And don’t forget the connection between gut health, inflammation, and stress  – you can start to see how this is a cycle and many of the factors we’re discussing in this post overlap.

#5: Reregulate adrenals

Remember, adrenals are often the root cause of any hormone imbalance, and sadly, this is the hardest one to fix!  Reregulating adrenal function requires an individual approach to figure out what the main stressors are (emotional, nutritional, lack of sleep, over or under exercise, overwork or lack of purpose, and so much more).

Adaptogens are great for adrenal balance, and we rely upon them heavily in practice (you can learn more about them here or here). However, just taking an adaptogen is not the full solution – finding true lifestyle balance is. This can’t be fixed overnight, but we can take small steps in the direction of balance each day.  If you feel your adrenals may be dysregulated, ask yourself what feels most off balance – do you need more socialization? Sleep? Movement? Vegetables? Water? Connection? Alone time?  Often, we know the answer, and while it can be hard to take the next step, feeling the effects of not taking the step is harder.  Give yourself the gift of honoring what you feel you need!

The Bottom Line

Perimenopause is a natural phase of life that can be managed effectively with a customized approach. By addressing factors that worsen symptoms, such as nutrient imbalances, inflammation, gut dysfunction, and adrenal dysregulation, and implementing strategies to improve overall health, women can navigate this transition more comfortably. At The Lyons’ Share Wellness, we provide personalized assessments and interventions to support women through perimenopause, focusing on root causes and functional medicine based interventions. If you’re wondering whether you’re a fit for our programs, grab your free initial consultation here.

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