Menopause and Perimenopause

Menopause and perimenopause, a transition shrouded in mystery, and yet it affects half the population. Menopause marks the beginning of a new phase in life, where reproduction is no longer the body’s focus. The grandmother theory hypothesizes that humans and some other mammals stop reproducing relatively young so that time and resources can be dedicated to the family unit as a whole. However, shifting through perimenopause into menopause can be an exceptionally trying time and can involve a myriad of unpleasant and even painful symptoms. Let’s take a look at how we can support our own health and that of those we love through this phase.

First, some definitions:

Perimenopause: the 2-12 years (yep that’s right, it can be that long!) before menopause. Involves fluctuating estrogen levels and lowering progesterone. Estrogen’s unpredictable levels mean this is when people are most likely to experience symptoms such as hot flashes, insomnia and increased insulin resistance. Encouraging  healthy estrogen metabolism, reducing inflammation and supporting progesterone levels are key areas of focus during this roller coaster phase. 

Menopause: sometimes called post menopause, this is the  life stage that starts 1 year after your last period and is characterized by low estrogen and progesterone. Symptoms are often reduced or disappear completely. Continuing with the previous focuses from perimenopause while eating high quality protein and exercising for muscle and bone health is crucial.

Estrogen: a hormone family that is responsible for ovulation. It promotes feelings of happiness (when in reasonable amounts) and is required for new bone synthesis and a healthy metabolism. Too much, or too little estrogen can lead to increased insulin resistance. In perimenopause, estrogen levels fluctuate wildly, while once the transition to menopause is complete, estrogen levels will remain quite low but steady.

Progesterone: is a hormone very involved in pregnancy, but is essential in many other ways. Progesterone balances estrogen, boosts thyroid hormone, builds muscles, promotes sleep and protects against heart disease and breast cancer. Progesterone production is linked to ovulation, so as perimenopause progresses into menopause, levels will lower considerably. 

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It is important to note that many people do not experience symptoms and you or your loved ones may breeze through this transition easily. However, hot flash jokes and menopause memes exist because many people do experience symptoms. So how do we maintain healthspan and optimize recovery throughout this shift in hormonal status?

1. Reduce or eliminate alcohol (yes, even wine):

 Alcohol impairs the healthy metabolism of estrogen which is not at all what we want when estrogen levels are rocketing higher than ever before. It also lowers progesterone levels and affects progesterone’s calming actions in the brain (insomnia anyone?) 

Those two things, coupled with the fact that insulin sensitivity is deeply affected by periods of both high and low estrogen, makes alcohol reduction a crucial step during perimenopause. 

2. Rest and self care:

This is a perfect time to slow down, find ways to reduce and manage stress and learn how to truly take care of yourself. This is different for everyone but finding a way to wind down (without alcohol) is crucial. Set aside some time for yourself, take a bath or a walk, read a book or even just find some mindfulness in activities you are already doing.  If someone you love is going through perimenopause, encourage them to do a bit less and help take some of the stress off their plate. 

High levels of stress also cause chronic cortisol elevation, which is detrimental to long term health in many ways, and can contribute to adrenal fatigue. Estrogen and progesterone both counteract adrenal fatigue, but chronic stress impairs the production of these hormones. You can see why lowering stress levels during a time where hormone production is already affected is key for promoting health and well being.

This is also a great time to create a better sleep routine. Read more about sleep hygiene in our sleep blog.

3. Exercise: 

As progesterone levels lower, it becomes more and more difficult to develop muscle mass while declining estrogen decline impairs new bone growth and insulin sensitivity. Fortunately exercise, particularly strength and interval training, has long been demonstrated to counteract these potential health challenges. Plyometrics, high intensity intervals and strength training are all great things to include in your exercise regime. Plyometrics (jumping) helps maintain bone density, while strength training and HIIT help improve insulin sensitivity and promote muscle growth. Use it or lose it has never been more true!

4. Nutrition: 

As mentioned above, roller coastering estrogen levels cause impaired insulin sensitivity which is why many people struggle with blood sugar levels throughout perimenopause and beyond. Low progesterone levels means a harder time building muscle and recovering from workouts. Nutrition, much like exercise, is a great tool to combat these two challenges.  Ensuring you are getting nutrient dense carbohydrates (resistant starches including tubers and low inflammatory grains) every meal will help support your remaining hormone levels without causing excessive blood sugar spikes. High quality protein, especially post workout, will help you continue to build muscle and recover better from all your hard work. 

Cutting back on foods that drive inflammation, such as most grains, A1 dairy, factory farmed animal products, processed foods, legumes and nightshades can also reduce symptoms often experienced during perimenopause. The menstrual cycle is heavily influenced by inflammation. In fact, the monthly bleed is started by prostaglandins (hormones that are also involved in healing and immune response) causing an inflammatory response. This is fine when inflammation is in balance throughout the body, but if inflammation is high in general, the short term burst from prostaglandins can develop into a longer term chronic inflammatory response. During perimenopause, lowering progesterone levels makes you more vulnerable to inflammation and the combination of low progesterone, high or low estrogen and high inflammation can lead to many classic symptoms such as hot flashes, insomnia, and increased muscle, joint and breast pain. Once you are in menopause, low progesterone means less protection against inflammatory diseases such as heart disease and cancer so continuing to eat with long term health in mind is still essential.

5. Seek help:

Perimenopause/menopause are often treated as awful experiences people just have to get through, largely because they are not widely studied. However, help is out there. Bioidentical hormones, specific supplementation, counselling and treatment are all available, so waiting it out is not necessary. Talk to your doctor, consider getting your thyroid levels checked (thyroid issues can sometimes contribute to, or be masked by perimenopausal symptoms) and advocate for your well being. Suffering through this silently will not support your health in the long term. 

Hopefully this has provided some insight and tools to make this transition feel less isolating and impossible. Some great studies are now being run and the health of women and ovulating people is finally being researched in ways it never has been before. Dr Stacy Sims, an exercise physiologist who is leading the charge on ovulating and menopausal athletes and Dr Lara Briden, a naturopathic doctor with a passion for menstrual health both offer excellent books for continued reading. By the year 2030 there will be 1.2 billion menopausal people in the world. It is time we start to empower and support people going through this change.