How to Prepare for Perimenopause: Tips for a Smooth Transition

Perimenopause may seem like a distant prospect, but for some women, menopause can begin as early as age 30. Fortunately, you have a lot of control over the intensity of the symptoms that come with it. Proper preparation can help you better manage hot flashes, vaginal dryness, and other unpleasant symptoms of perimenopause. While everyone experiences this phase differently, certain strategies and adjustments can help you navigate perimenopause more smoothly. Read on to discover what you can do to promote your well-being during this transition.

What are the different stages before, during, and after menopause?

Menopause doesn't come suddenly; your body often signals well in advance that your reproductive years are ending. For some women, this transition lasts only a few months, while for others it can take several years. While every woman experiences this phase differently, research suggests that women who are sensitive to hormonal fluctuations and PMS symptoms may be more susceptible to more intense symptoms during perimenopause. This emphasizes the importance of preparing well and addressing hormonal issues in the years leading up to this transition.

Reproductive phase

During this phase, you're still fertile, and your hormones, such as estrogen and progesterone, are relatively stable. Your menstrual cycle is regular, and symptoms are often minimal. While this period can feel carefree, it's important to take good care of yourself and optimally prepare your body for the next phase, especially if you experience PMS.

Perimenopause

After premenopause comes perimenopause. This phase can last a few months or even a few years and involves significant hormonal changes. Two hormones play a major role during perimenopause: estrogen and progesterone. We'll explain exactly what they do later.

Menopause

You're officially in menopause when you haven't had a period for twelve consecutive months – menopause is the specific time of your last period. Your ovaries then completely stop producing estrogen and progesterone.

Postmenopause

Postmenopause begins after menopause, and this is the phase you remain in. While most symptoms have likely subsided, your hormone levels remain low, putting you at greater risk for health problems like osteoporosis and cardiovascular disease.

The main hormonal changes during perimenopause

Perimenopause is a period during which progesterone levels gradually decline and estrogen levels can fluctuate significantly. This is often accompanied by symptoms such as hot flashes, night sweats, migraines, and heavy periods.

Estrogen fluctuations

During perimenopause, one of the most significant changes in your body is the fluctuation of estrogen levels. Unlike menopause, where estrogen levels gradually decline, perimenopause is characterized by unpredictable peaks and troughs in estrogen levels.

You may experience high estrogen levels during this phase, which may seem counterintuitive given that estrogen levels are generally declining. These spikes can lead to symptoms like breast tenderness, bloating, and even more intense PMS symptoms. These high estrogen levels (also called estrogen dominance) can occur because your body is trying to compensate for the irregularity of ovulation, with progesterone production decreasing while estrogen levels remain high or fluctuate significantly.

At other times, you may experience sharp drops in estrogen , often accompanied by classic perimenopausal symptoms such as hot flashes, night sweats, vaginal dryness, and mood swings. These hormonal fluctuations can make the symptoms unpredictable and difficult to manage.

This instability in estrogen levels can also affect your mood, leading to irritability, anxiety, or even depression. The fluctuations between high and low estrogen levels contribute to the variety of physical and emotional symptoms women experience during this period.

Understanding that estrogen not only declines gradually but can also fluctuate with high peaks and low troughs can help you better understand these symptoms and take appropriate steps to manage them.

Decrease in progesterone

Progesterone is a hormone produced primarily by the corpus luteum , which forms in the ovaries after ovulation. This hormone plays a crucial role in regulating the menstrual cycle by preparing the uterine lining for a possible pregnancy. Progesterone production occurs only after ovulation , during the second half of the menstrual cycle, known as the luteal phase .

As you enter perimenopause, ovulation becomes less frequent and more irregular. Without regular ovulation, your body produces less progesterone, leading to a decrease in this important hormone. This decrease can cause a range of symptoms, including:

• Irregular Periods : Without enough progesterone, the timing of your period becomes unpredictable.
• Anxiety and Mood Swings : Progesterone has a calming effect on the brain, so lower levels can increase feelings of anxiety, irritability, and emotional instability.
• Sleep disturbances : Progesterone also promotes restful sleep. As progesterone levels decrease, you may have more difficulty falling asleep or staying asleep, leading to poorer sleep quality.

Why is progesterone important for menopause?

Before menopause, it's essential that your body produces progesterone naturally to maintain hormonal balance with estrogen. Progesterone offsets many of estrogen's effects and helps with problems such as:

• Estrogen dominance : When estrogen levels are high but progesterone levels are low, a condition called estrogen dominance can develop. This hormonal imbalance can lead to worsened PMS symptoms, heavy periods, breast tenderness, and an increased risk of endometrial hyperplasia (thickening of the uterine lining).
• Emotional Well-Being : Progesterone's calming effect on the brain can help regulate mood and stress, making the emotional swings of perimenopause more manageable.
• Bone and Heart Health : Progesterone also plays a role in maintaining bone density and cardiovascular health, which helps prevent conditions like osteoporosis and heart disease as you age.

Ensuring your body has a good balance of both estrogen and progesterone during perimenopause can help ease some of the challenging symptoms as you transition into menopause.

Hormonal contraception and menopause

Women using hormonal contraception during perimenopause may not notice they are approaching menopause because the synthetic hormones in the pill, Nuvaring, or hormonal IUD can mask natural hormonal fluctuations. Contraception contains synthetic versions of estrogen and progesterone (or sometimes just progestin), which externally regulate the menstrual cycle, prevent ovulation, and keep hormone levels stable.

What you need to know when taking hormonal contraception:

Uncertainty about the onset of menopause

Hormonal contraceptives can make it difficult to determine when you've reached menopause. Contraception suppresses the natural production of estrogen and progesterone, reducing or even eliminating typical symptoms such as irregular periods, hot flashes, and mood swings. Furthermore, women often continue to experience breakthrough bleeding during the week off the pill, giving the illusion of a regular menstrual cycle, even after they've already reached menopause. This makes it difficult to recognize when your body has begun the natural transition to menopause.

Sudden onset of symptoms

If you're already in menopause and decide to stop taking the pill, this can lead to more intense menopausal symptoms as your body adjusts to the loss of the synthetic estrogen you received through the pill. Symptoms like hot flashes, night sweats, and vaginal dryness may feel more severe because you haven't experienced the usual, gradual hormonal decline that normally occurs during perimenopause.

The pill cannot prevent menopause

While hormonal contraception can reduce or mask menopausal symptoms, it cannot delay or prevent menopause itself. Menopause is a natural process that occurs when the ovaries stop producing eggs and hormones. As soon as you stop taking birth control, it becomes clear that menopause has already occurred or is approaching. It's important to understand that while the pill suppresses symptoms, it does not affect the biological process of menopause. Therefore, it's crucial to talk to your doctor if you think you're approaching menopause, especially if you're using hormonal contraception.

Preparing Your Body for Perimenopause: 6 Lifestyle Changes for a Smooth Transition

As we mentioned earlier, you can prepare your body well for menopause and thus alleviate those familiar and annoying menopausal symptoms. Here are six important lifestyle changes you can implement immediately:

1. Stay hydrated and limit alcohol during perimenopause

Did you know that our brains are made up of approximately 75% water? Adequate hydration is essential for your overall health and helps support your cognitive function. A lack of fluids can lead to symptoms like headaches, dizziness, and difficulty concentrating, which can be further exacerbated by hormonal fluctuations during perimenopause.

It's important to keep your body well-hydrated, but not over-hydrated. Listen to your thirst and ensure you drink regularly throughout the day. The exact amount of water you need varies from person to person and depends on your weight, activities, and circumstances. Furthermore, alcohol can worsen perimenopause symptoms, such as hot flashes and sleep problems. Alcohol is also dehydrating and can further disrupt your hormone balance. Drinking enough water and moderating your alcohol intake can improve your well-being during perimenopause.

2. Nourish your body and brain

A balanced, nutrient-rich diet can reduce perimenopause symptoms and support brain health. Consider:

• Omega-3 : You find this in oily fish like salmon. DHA in omega-3 contributes to the maintenance of normal brain function.
• Antioxidants : Foods rich in antioxidants, such as berries, nuts, and green leafy vegetables, protect your brain cells from damage and support overall brain function.
• Lean protein : essential for maintaining muscle mass and your overall energy levels. You can find it in chicken, tofu, and legumes. As you age, protein intake becomes even more important to prevent muscle loss and maintain a healthy metabolism.
• Collagen : Collagen supports skin elasticity, healthy joints, and muscle recovery. Your body produces it, but you need to consume the right nutrients to get it. You can also find collagen in meat, oily fish, and bone broth, among other foods.
• Fiber : Helps regulate hormones and supports digestion. Whole grains, fruits, and vegetables are good sources of fiber.

3. Exercise regularly and consider strength training

The main goal of exercise isn't weight loss, but reducing inflammation, improving insulin sensitivity, and building muscle mass. This is especially important during menopause, when estrogen levels are low, as estrogen is a muscle-building hormone. Estrogen loss can lead to muscle loss, making regular exercise essential for maintaining muscle strength.

That's why it's important to build sufficient muscle mass before menopause, particularly through strength training. This not only helps you become stronger but also prepares you for the natural loss of muscle mass during menopause. Exercise also has significant benefits for your mental health and heart. The different types of exercise each have their own advantages:

• Cardiovascular Exercise : Activities like walking, running, and swimming support heart health and help maintain a healthy weight.
• Strength training : Lifting weights or working with your own body weight helps maintain muscle mass and bone density. Strength training is especially important for preventing osteoporosis (bone loss).
• Flexibility and mind-body exercises : Yoga and Pilates increase flexibility, reduce stress and improve mental well-being.

4. Get enough sleep

Hormonal changes can cause sleep problems. Good sleep habits can help:

• Regularity : Go to bed and get up at the same time every day.
• Relaxation routine : Do relaxing activities before bed, such as reading or taking a warm bath.
• Sleeping environment : Keep your bedroom cool, dark and quiet.

Read more about perimenopause and sleep here.

5. Keep stress under control

During perimenopause, your body's ability to cope with stress changes significantly, primarily due to fluctuations in hormones like estrogen and progesterone, which normally play a key role in regulating stress responses. Here's a concrete explanation of what happens:

Estrogen and Stress

Estrogen has a direct effect on the production of cortisol, your body's primary stress hormone. Under normal circumstances, estrogen helps your body better regulate its stress response. It ensures that the hypothalamic-pituitary-adrenal (HPA) axis—the system responsible for cortisol production—remains balanced. During perimenopause, estrogen levels begin to fluctuate, meaning the HPA axis becomes less well-regulated. This can lead to an overproduction of cortisol.

When your cortisol levels are elevated for a long time, the following symptoms may occur:

• Increased irritability and anxiety : Cortisol increases alertness and can put you on edge, which when elevated for long periods of time leads to feelings of anxiety and irritability.
• Less effective stress regulation : Without enough estrogen to keep cortisol in balance, your body reacts more strongly to stress, causing you to remain tense longer after a stressful situation.

Progesterone and rest

Progesterone is known as the "calming" hormone. It has a natural, calming effect on the brain and contributes to relaxation and a sense of well-being. During perimenopause, progesterone levels gradually decline due to irregular ovulation, meaning you experience less of this calming effect. This can make it harder to relax, even after minor stressors.

At lower progesterone levels this can happen:

• Sleep disturbances : Without the calming effect of progesterone, you may have more difficulty falling asleep or staying asleep, contributing to fatigue and stress.
• Increased sensitivity to stress : The decrease in progesterone makes it harder for your body to suppress the mental and physical effects of stress, making you feel overwhelmed more quickly.

Changes in cortisol regulation

These hormonal fluctuations (lower estrogen and progesterone) disrupt cortisol regulation. This means your body not only produces more cortisol but also takes longer to return cortisol levels to normal after a stressful situation. This makes you more vulnerable to chronic stress, which can have negative effects on both your mental and physical health.

4 tips to deal with stress

Managing stress is essential, especially because high stress levels can worsen your perimenopausal symptoms. Here are four practical tips to get started right away:

1. Mindfulness and meditation : Regular mindfulness and meditation practices can help calm your mind and reduce anxiety. By consciously focusing on the present moment, you create more mental space and calm, which contributes to better stress management.
2. Deep breathing exercises : Simple deep breathing exercises can do wonders for calming your nervous system. Slow, conscious breathing helps your body relax, reducing stress and tension. It can also lower your heart rate and help you better cope with acute stress.
3. Regular exercise : As mentioned, physical activity is an effective way to reduce stress. It stimulates the production of endorphins, also known as "happy hormones," which promote a positive feeling and naturally lower your cortisol levels (the stress hormone). Furthermore, exercise helps relax your muscles and improves your sleep quality.
4. Spend time in nature : Spending time in nature has a powerful effect on your stress levels. The fresh air, natural sounds, and green surroundings help your brain relax and reduce stress. Studies show that walking in nature reduces cortisol production, allowing your body to recover more effectively from stress. It also increases your concentration and gives you a sense of well-being. Even short walks in a park can have a positive effect on your mood and mental health.

6. Visit your doctor or a specialized health care provider from time to time

Visit your doctor periodically to monitor any changes in your health. Discuss any new symptoms and explore treatment options, including hormone therapy if needed.

Consider medications, hormone therapy, or alternative therapies

Hormone therapy can alleviate menopausal symptoms. It's always best to discuss hormone therapy with a doctor and consider it while you wait for natural treatments to take effect.

• Hormone therapy : Estrogen or a combination of estrogen and progesterone can relieve symptoms such as hot flashes. However, its use carries certain risks, including an increased risk of breast cancer, heart disease, and stroke. Furthermore, these treatments are often associated with side effects, making them unsuitable for everyone.
• Non-hormonal medications : Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs), can help reduce hot flashes and mood swings. Like hormone therapy, these treatments often come with side effects. Other medications, such as gabapentin and clonidine, may also be prescribed to relieve symptoms, but it's important to be aware of potential side effects.
• Alternative therapies : Natural remedies such as sage, maca, red clover, and phytoestrogens may provide relief.

By focusing on these pillars – hydration, nutrition, exercise, sleep, stress management, doctor visits – you can better prepare for perimenopause and navigate this challenging phase with flying colors.

PS. I hope this blog has been helpful. Just a quick note to close. Why are we sometimes so cautious with our wording? Because we want you to understand that there's no magic pill that solves everything (unfortunately!). Supplements can help support your health, but other factors also play a role, such as genetics, sleep, exercise, and diet. Do you have questions about your specific situation? Chat with us – we're happy to help, with no obligation!