Holistic Approach to Perimenopause

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Empowering Women through a Holistic Approach to Perimenopause

Perimenopause is finally being talked about more and more, thankfully! I guess it’s also perhaps because I am in my 40s and becoming more curious as well as being a naturopath, attracting many female clients feeling like they’re going crazy, only to be told by their GP that everything looks fine and perhaps prescribe antidepressants.

Menopause is talked about more, i.e. the end of your cycle, but the symptoms can start 10-15 years prior to this!!

I think the more education there is around this time in our lives, the less alone and crazy we will feel.

So, what exactly is perimenopause?

It is the term used for when hormones start to change and decrease, causing a range of symptoms that can start from as young as 35 years old in some women. It can last 4-15 years.

It is, clinically, the transitional period between the reproductive and non-reproductive phases of your life (regardless of whether you’ve had children).

The defining symptom of perimenopause is irregular menstrual cycles, but you may also start to experience mood swings, hot flashes and more as the main hormones, progesterone and oestrogen, decrease as well as many other hormones.

Phases:

Perimenopause from 35 +
Menopause is 1 year without a period at around 45-55 years old (51 on average)
Post menopause is the period after menopause, after you’ve been without a period for 1 year

Some may go into early menopause due to genetic factors, autoimmunity, infections, certain medications, or other underlying mechanisms. Cancer treatments, including chemotherapy and radiation, may induce menopause prematurely, called premature ovarian insufficiency.

We will focus on perimenopause for this article, of which there are 4 stages in itself:

Very Early perimenopause: When periods are still regular, but symptoms are just starting to appear
Early perimenopause: transitioning into irregular menstrual cycles
Late perimenopause transition: cycles are exceeding 60 days
Late perimenopause: even more sporadic menstrual cycles, missed periods, and increased symptoms (as described below) and is the final 12 month stretch before you enter menopause.

What Are the Common Symptoms of perimenopause?

Perimenopause symptoms may include:

Irregular menstrual cycles
- More frequent as progesterone drops
- Heavier as low progesterone often means oestrogen dominance
Increased PMS symptoms
Brain fog
Mood swings/ low mood
- Anxiety & depression, irritable and frustration, overwhelm
Night sweats
Hot flashes
Insomnia
Vaginal dryness
Headaches and migraines
Weight gain
Inflamed joints and aches & pains
Gut issues, bloating

These symptoms start to appear due to the reduction in oestrogen and progesterone and the effects these have on our insulin resistance, blood sugars, cortisol, brain and thyroid function, among others.

These hormones, when in balance, can really help balance the body and mask any areas where we haven’t been fully taking care of ourselves. Everyone will be present very differently with their symptoms depending on their weak spots that are not being highlighted.

This can be a tricky time for many women especially these days with all the stress these days, from working hard, being mums, and all the toxins and the stimulation and need to always be busy!

This has played havoc on our bodies and adrenals & stress hormones and the effects can start to play out during this time.

Attitude is everything. It’s important to be kind and take care of ourselves and also accept ourselves and our changing bodies and minds and to adapt. Perhaps we won’t be able to tolerate certain things as well as we once did, and there can be grief around that. It’s a time for introspection, self care and slowing down.

I find that this time of life is almost highlighting to us some areas that perhaps we haven’t been looking after properly and were being masked by the protective effects of oestrogen and progesterone. When these hormones start to decline, often we start to get symptoms that we never felt before and start to tolerate a lot less.

This time of our lives therefore often requires a lot of love, compassion and acceptance for this change in our lives, and we can also experience grief of our old selves. This is natural and it’s important to be kind and compassionate. The more we talk about this phase of our life, and how it's normal to feel more anxious and angry, irritable etc. the less shame women will have and the more they can talk about it with family, friends and partners and seek help.

Why Consider Natural Remedies? Hormone Replacement Therapy vs natural therapies?

Due to the above symptoms, many might want to avoid any suffering and take anything to help the pain go away.

Many women decide to take antidepressants if their mood is all over the place, or take medications for migraines/ headaches and steroids for joint pain or go straight onto hormone replacement therapy (HRT).

Everyone is different and there is certainly a place for pharmaceutical help, especially when there is a lot going on in your life - kids are growing up, doing big final exams, working hard, being successful - and there’s no time to be cranky, overwhelmed, tired and in pain!

I am simply offering some other natural remedies, as an alternative, that you may have not heard about. Often the above symptoms are due to hormone imbalances. Natural remedies can be amazing to bring our bodies back into balance and harmony. They might just take a little longer, especially if we’ve been overburdening our bodies for some time now.

However, there are less side effects with natural remedies and we are treating the underlying causes and helping the body to come into balance naturally.

Pharmaceuticals often work more quickly, but they often do not deal with the underlying issues, and therefore often just delay the onset of symptoms.

Natural versions of HRT

There are more natural HRT treatments that use less synthetic hormones and are bioidentical, which the body recognises and therefore have less side effects, which are also a great alternative. Natural progesterone is much kinder than synthetic progestins.

Otherwise, there are also some great natural therapies according to the symptoms and history.

Natural remedies

When treating perimenopause, I will look at each client individually and holistically, perhaps using my breathwork, yoga, energy healing tools as well as nutrition, diet, lifestyle and herbs and supplements.

I might do some testing to see where the imbalances are with the hormones, but also look specifically at what is going on for that client and how it’s affecting them day to day.

Diet and Nutrition

Of course everyone is different but diet can really help in perimenopause. Often we want to look at decreasing inflammation, bloating, weight gain and increasing nutrients like calcium and phytoestrogenic foods to help during this phase. We also want to avoid foods that we might have once tolerated, but potentially weren’t great for us, but we’re only seeing the impacts now.

Restrict:

Alcohol, dairy and gluten
- These can be inflammatory and play havoc with our hormones, especially thyroid and cause bloating
Coffee
- We really need to look after our adrenals and cortisol levels during this time, and coffee can just increase anxiety, insomnia, irritability and hot flashes.
Sugar & processed foods
- Insulin resistance can be rife during this time, so we need to look after our blood sugar levels and also or adrenals
- They can also worsen hot flashes
- It’s hard as often we crave more sugar as we’re exhausted, so eating more protein to feel satiated is key
Toxins
- Eat organic where you can especially for the Dirty Dozen to reduce toxins and help liver health

nutrition

Include:

Nourishing foods full of essential nutrients for hormones, bone health, and metabolic regulation
Lots of green leafy veg and colourful fruits & vegetables for antioxidants, fibre & prebiotics
- linked to fewer hot flashes, sleep problems and better concentrating
- Fibre is essential for good gut microbiome, weight loss, blood sugar regulation & a healthy metabolism
Good quality, grass fed meat
High protein foods at every meal with fat & carbs (1-1.5g/ kg body weight/ day)
- Help muscle mass, blood sugar levels, neurotransmitters for mood & metabolism
- E.g. wild fish, shellfish, eggs, grass-fed beef, bison, grass-fed dairy, organic chicken, organic turkey, beans, lentils, nuts, and seeds
Whole, plant foods like vegetables, fruits, beans, lentils, whole ancient grains, oats
- High in vitamin B6 & magnesium to keep healthy oestrogen levels
- I.e. chickpeas, spinach, bananas, potatoes, liver, organ meats, fish, poultry, egg yolk, dried beans, walnuts, prunes, cauliflower, cabbage, avocado
Polyphenol rich foods for heart health
- Nuts and seeds, avocado, virgin olive oil, chia seeds
Phytoestrogen rich foods for hormonal balance
- Flaxseeds, fermented soy, tempeh
Omega fatty acids
- Help inflammation and joint pain.. algae based
Healthy fats
- Keep satiated, reduce sugar cravings and maintain blood sugar balance
- E.g. avocado, cold pressed olive oil, hemp seeds, goats cheese, greek yogurt, coconut oil, nuts, sardines, eggs, olives (also high in protein)
Good quality wild fish, not farmed
Vegetables rich in liver antioxidants
- Sulphur rich cabbage, cauliflower & broccoli to balance oestrogen
Seaweed, kelp & nori flakes
- Minerals supporting bone health and iodine for thyroid health
Calcium rich foods to protect from osteoporosis and mood swings
- Tahini, sesame seeds, green leafy veg
- Good quality dairy

Fasting

A quick note on intermittent fasting which has a lot of buzz around it.

Some clients really find this works for them by eating only in a small window of time, i.e. 12pm - 6pm.

Some benefits:

Can help regulate hormones, build resilience, metabolically burn fat (ketones) for energy
Helps regulate sugars & great for detoxification of the liver as we give the body a break from eating
Help reduce inflammation

However, do fast with caution during this phase of your life. Most studies are done on men, and if you are at all stressed or your adrenals are a little frayed, it can send you into more stress!

The body can go into survival mode and the body will store more fat around your belly and you will feel ‘hangry’, undernourished and exhausted.

This is a time to nourish and slow down and fill yourself up with nutrient dense, protein & fat rich foods to keep you satiated and nourished. You could try stopping eating at 6pm and not eating again til 6am and start with 12 hours. This also helps sleep as the body digests food earlier. Eating before bed is not recommended. If this feels good, you could extend to 10am or even 12pm eventually and fast for 18 hours, but watch stress levels and adrenal exhaustion.

Herbal Remedies & supplements

There are so many beautiful herbs and supplements for perimenopause, each so unique in what they treat.

Key herbs:

Black cohosh
- Helps with night sweat and hot flashes as balances oestrogen levels
Zizyphus
- Helps hot flashes and great if it also affects sleep
Passionflower
- Great for its calming effects and great for restful sleep and anxiety
Ashwagandha (Withania somnifera)
- One of my favourite adaptogen herbs, an ayurvedic herb, it helps stress, overwhelm and is like a mother’s hug!
- Reduces neuroinflammation, reduces anxiety and promotes sleep
Rhodiola
- Great adaptogen herb supporting mental and physical endurance
  - Brain fog, fatigue, and decline in exercise tolerance
Holy basil tea great for anxiety

Supplements:

Probiotics
- are key to good microbiome that can help most symptoms and underlying causes as most disease comes from our gut
Omega 3s ~ Evening primrose oil / fish oils
- Great for period pains, hot flashes, sleep disturbances and mood swings, as well as protecting the brain against inflammation and damage
- Help prevent heart disease and support a healthy inflammatory response, which could help women better support their hormones
Magnesium is amazing for everything!
- Sleep, cramps, PMS, progesterone balancing, anxiety, stress
- Boosts GABA, reduces adrenaline, cortisol regulation, promotes sleep & helps nervous system
- Helps blood sugar regulation, thyroid health & inflammation
- Increases progesterone reducing stress and headaches/ migraines
- Activates vitamin D
Taurine is great in combination with magnesium
- An amino acid great for sleep and calming the brain by increasing GABA
B vitamins (B6 especially)
- Precursors for so many functions in the body and stress depletes them quickly
- Serotonin and mood regulation
- Helps liver to balance hormones and increases progesterone
- A healthy stress response, energy production and adrenal support
Vitamin D
- Vital for bone health and keeping them strong
- Also hot flashes, vaginal dryness and helps breast cancer risk
Turmeric
- Inflammation, osteoporosis, high blood pressure, gut health, iron chelation, fibroids, and bone loss
NAC (N-Acetyl-Cysteine)
- Supporting your body’s natural detoxification process
- Precursor to glutathione, the mother of all antioxidants, reducing free radicals and is protective in both the brain and ovaries
Zinc
- PCOS, thyroid hormone production, and it supports a healthy immune system
- Zinc can help with optimising testosterone levels, and thus hair loss

Lifestyle Changes

As mentioned above, this can be a big change for many and adapting and accepting changes can really help us to transition this huge rite of passage.

As we put on weight, we fret and start to eat less and exercise more, but this just increases our stress and cortisol levels and causes the body to store more fat around our bellies as it thinks it is in survival mode.

Key to this phase of your life is nourishing, slowing down, self care and moderation! It isn’t easy as nowadays us ladies like to be busy!

Alternative therapies

Meditation, yoga & breathwork are so great for anxiety and overwhelm whilst keeping our bodies moving and healthy and slowing down our busy minds

Acupuncture is also amazing for the nervous system and helps with energy blocks and physical pain and inflammation.

Exercise

As we age, we need more strength, stability and muscle mass maintenance

Weight bearing and training
- Great for strength and bone density and to maintain our muscle mass so we keep our bones strong and don’t lose strength and elasticity as quickly
- Weight & resistance training reduces LDL cholesterol, increases HDL (the ‘good’ cholesterol) ]
- Reduces blood pressure and increases cardio benefits
- Helps blood sugar regulation as optimises how our body processes sugar
- Helps mental health as feel stronger inside & out
- Improves muscle tone/ definition and decreases appearance of cellulite
Tai chi / elastic bands for mental & physical strength and stability
Walking, swimming & surfing ~ do what you love!

Avoid too much high intensity exercise, that can overstimulate our adrenals and increase stress and increase risk of injury and fractures as our bone mass decreases

Self care

Treat yourself for a massage, sauna, spa. Take more time to get in nature and read a book, do a hike, take an epsom salt bath (great for the magnesium).

Safety and Precautions with herbal remedies

Even though the herbs and supplements we use are natural, they also need to be used with care as they can be very powerful. Herbs have some powerful constituents within them and must be respected.

We need to use the right dosage and be aware of any interactions with other herbs, foods and medications. Some herbs are only supposed to be taken for a limited timeframe as well.

I always recommend seeing an experienced, trained healthcare professional to help you so you don’t harm yourself through self diagnosis.

Personal experience

I love helping clients going through this phase of their life.

Many clients have no idea what’s going on and just feel they are going crazy. So it’s really important to educate clients on their hormones and how they can change, causing the symptoms they’re experiencing and give them peace of mind that they’re not alone.

Case studies:

Case 1

My client, Carol, had a lot of stress, anxiety & insomnia. She was experiencing a shorter cycle and often heavier bleeding, plus having so much brain fog, she felt she was going mad, as so forgetful and feeling really scattered.

There can be many reasons for the above, and when we can see how they relate to the different hormonal imbalances going on, we can help rebalance these with natural remedies.

For example, my treatment plan would look at:

Increase progesterone
- This is our happy, calming hormone and when it drops can cause anxiety, insomnia and shorter cycles and also increase relative oestrogen causing PMS and heavy bleeds
Balance oestrogen
- When progesterone drops in the first stage of perimenopause, it can send us into a relative oestrogen dominance, causing heavier periods, tender breasts and PMS
  - Therefore improving liver health is key to detox excess hormones and toxins, causing imbalances
  - Suggest low tox living
  - Reduce alcohol
  - Reduce dairy and other foods affecting oestrogen
Decrease stress
- To help with anxiety I would look at their lifestyle and work/life balance and see where we can decrease stress, using meditation and breathwork techniques and yoga to help
- I would also consider herbs to manage Carol’s tolerance to stress, using beautiful Ashwagandha, which is like a mother’s hug and Magnesium & taurine for sleep, stress and anxiety
Gut health
- Gut bacteria is always a big factor at this stage in our lives and can be the cause of many symptoms as it’s less managed by our hormones as they decrease
NOURISHING!!! Slowing down!!!

Case 2

Christy had put on weight and was very stressed and emotional, more sensitive than usual and was really bloated. She also had lots of inflammation in her joints, especially her feet.

Treatment plan

Balance progesterone
- When this drops, it can cause more inflammation and joint pain, aches & pain
- It can cause more stress as it’s the calming hormone
Balancing hormones including thyroid
- Decreased progesterone and increased oestrogen and declining thyroid all contribute to weight gain
- By balancing hormones in conjunction with diet & lifestyle we were able to help with weight loss
- Gut health to help constipation/ weight gain
Weight loss (12kg)
- Through diet, lifestyle & supplements to balance all hormones affecting weight & improve liver health
- Stress relief is also a big one as cortisol will also increase weight gain
Reduce stress
- To reduce impact of cortisol, insulin and thyroid on weight gain & fluid retention via lifestyle and supplements
- Magnesium
- Adaptogen herbs
Reduce bloating/ water retention & constipation
- Diet, supplements, increase digestive enzymes (decrease as we age/ stressed)
- Improve gut health & absorption of essential vitamins and minerals
Reduce inflammation and painful joints / feet
- Increasing progesterone
- Using turmeric, fish oils and anti-inflammatory diet
Acceptance and love / compassion
- Know we can’t go back to weight before but we can tone and weight training also really helps toning and metabolism
- Intermittent fasting

Case 3

Lindi had night sweats, hot flashes and a feeling of ‘being all over the place’

Oestrogen levels erratic during perimenopause and progesterone decreasing was causing anxiety and brain fog
Adrenals taking over from the ovaries to produce hormones but are frayed so excessive stress
Thyroid not working optimally
Hot flashes/night sweats
- Some women never have hot flashes at all, probably because they are good at making oestrogen from other sources like body fat and androgens
- Hot flashes usually last a few — seemingly interminable — minutes. During this time, skin temperature can actually increase by up to 8 degrees F. Core body temperature stays the same or decreases. Many women find that hot flashes are particularly bad at night.

Sources/ references:

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581591/

2 https://drbrighten.com/7-causes-early-menopause-5-ways-eliminate-symptoms/

3 https://drbrighten.com/vaginal-dryness-and-vaginal-flora/

4 https://drbrighten.com/why-do-i-get-anxiety-before-my-period/

5 https://drbrighten.com/16-natural-remedies-hormonal-headaches/

6 https://drbrighten.com/perimenopause-supplements/

7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116096/

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About the Author

Chrissie Alexander

Chrissie is a Yoga teacher/coach, Rebirthing Breathwork facilitator, BodyTalk & Reiki energy healer and Naturopath. Her passion lies in helping others to regain balance in their life & over all wellbeing, and to importantly; educate on natural supportive tools which allow them to feel vibrant, happy and content. Chrissie offers 1:1 sessions as well as discounted packages both which can be online or in person. Chrissie also offers a free discovery call so head to her profile in the link below to begin your journey in feeling vibrant, happy and content.

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