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Perimenopause is often overlooked, with standard medical treatments and recommendations, such as hormonal treatments, being offered and promoted after menopause, when it is often too late to offer symptom treatment. In reality, perimenopause, also known as ‘the second puberty’, is the time of greatest symptoms, occurring two to ten years before menopause. Symptoms include heavy periods, sleep disturbance, increased menstrual cramps, night sweats, migraines, premenstrual mood swings, weight gain (especially abdominally and viscerally), and increased cravings. These symptoms, which are largely neurological, are related to a drop in progesterone. Initially, oestrogen increases, rather than decreases, and combined with decreased progesterone (which usually stimulates thermogenesis), periods can become heavier and uncomfortable, similarly to what commonly occurs during puberty. Further hormonal changes include testosterone dominance, a drop in oxytocin, and an eventual shift to lower oestrogen, which when combined, can increase insulin resistance, increase appetite and irritability, as well as result in the genitourinary syndrome of menopause.

While there is a gradual increase in awareness in the area of perimenopause in healthcare, Naturopathic Doctor and author Lara Briden is a strong advocate for perimenopause education and safe and effective treatment. She explains how menopause is not a mistake of living too long, but rather an evolutionary process which has taken place over time. Lara clearly outlines the physiological processes of perimenopause and menopause, with the integration of evidence-based research for individual client management.

In enhancing quality of life during perimenopause and in reducing symptoms, a thorough dietary assessment should be conducted, including the integration of quality dietary sources of magnesium, taurine, and choline, to enhance sleep quality and insulin sensitivity respectively. A diet high in polyphenols can also play a crucial role in naturally sequestering androgens to assist with hormone regulation. Overall, conducting a thorough dietary and lifestyle assessment is key, with the integration tailored evidence-based recommendations, to assist clients to feel heard and have a reduction in symptoms, during this often uncomfortable and anxiety-provoking time.

Summary:

• Perimenopause is often overlooked, with most treatments being offered after menopause (a life phase that occurs one year after the final period), when symptoms have often settled.
• Perimenopause occurs 2-10 years before menopause and is triggered by a drop in progesterone; it is often accompanied with distressing symptoms such as premenstrual mood changes, heavy periods, sleep disturbance, migraines, night sweats, and weight gain.
• During perimenopause, oestrogen is initially high, causing histamine and mast cell activation, testosterone is elevated, resulting in insulin resistance, and oxytocin is reduced, impacting mood.
• It is key to conduct a thorough dietary and lifestyle assessment to best assist clients in managing these symptoms during this evolutionary time of ‘recalibration’.

Lara Briden BSc, ND is a naturopathic doctor and author of the bestselling books Period Repair Manual and Hormone Repair Manual. She has 25 years’ experience in women’s health and sits on several scientific advisory committees including The Centre for Ovulation and Menstruation Research (CeMCOR) at the University of British Columbia. She currently has consulting rooms in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems.

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