“Navigating Perimenopause: Managing the Transition with Grace” in against a navy background adorned with elegant gold geometric lines.

Navigating Perimenopause: Managing the Transition with Grace

By George Gillson MD PhD CCFP

Perimenopause is the natural transitional phase that precedes menopause. During this time, typically starting in the late 30s or early 40s, a woman’s body undergoes hormonal changes, including fluctuations in estrogen and progesterone levels. By understanding and managing perimenopause effectively, individuals can navigate this phase with grace and vitality.

Understanding Perimenopause

Estrogen and progesterone are the primary reproductive hormones in individuals assigned female at birth. Although they have distinct roles, they work in harmony to regulate various aspects of reproductive health. During perimenopause, the body is preparing to shut down it’s reproductive abilities. This leads to fluctuations in estrogen and progesterone levels which can significantly impact the body.

About Estrogen

Estrogen influences the development of female reproductive organs, breast growth, and hip widening during puberty. It plays a role in mood regulation, bone health, and cognitive function.

There are three main types of estrogen:

  • Estradiol: The most prominent type before menopause, produced by the ovaries.
  • Estrone: The primary type after menopause, produced in adipose (fat) tissue.
  • Estriol: Present during pregnancy and produced by the placenta.

Estrogen initiates the menstrual cycle, supports metabolism, and protects cardiovascular and skin health. When estrogen fluctuates, it leads to symptoms such as:

  • Hot Flashes: These sudden waves of heat can cause intense sweating and discomfort. They result from estrogen imbalances affecting the hypothalamus (the body’s temperature control center).
  • Vaginal Dryness: Estrogen decline leads to reduced vaginal lubrication, causing discomfort during intercourse.
  • Bone Health: Estrogen plays a crucial role in maintaining bone density. Its decline increases the risk of osteoporosis.

Fun Fact: males produce estrogen too and much lower levels. For them, it regulates bone density and libido.

About Progesterone

Progesterone is produced primarily in the corpus luteum during each menstrual cycle. It balances estrogen levels and aids in producing testosterone. Progesterone’s main functions include:

  • Thickening the uterine lining for possible implantation.
  • Maintaining pregnancy by preventing uterine contractions.
  • Preparing breasts for lactation during breastfeeding.

When progesterone fluctuates it can present as:

  • Mood Swings: Progesterone affects neurotransmitters, impacting mood stability. Fluctuations can lead to irritability, anxiety, and depression.
  • Irregular Periods: Progesterone decline results in erratic menstrual cycles—sometimes heavier, sometimes lighter.
  • Sleep Disturbances: Progesterone influences sleep quality. Insomnia or disrupted sleep patterns may occur.

These hormonal shifts during perimenopause contribute to a range of symptoms, affecting physical, emotional, and mental well-being. Recognizing these changes empowers you to manage them effectively.

Managing Perimenopause

Managing perimenopause involves a holistic approach that combines medical guidance, lifestyle adjustments, and targeted supplementation. An essential first step in getting your hormones under control, is to consult with your healthcare provider. At EvolveWell, we like to assess your symptoms, in conjunction with relevant testing to provide you with personalized guidance and treatment options.

Every person experiences perimenopause differently, so personalized advice is crucial. Testing helps us to get you on the right track and identify where we can make the greatest impact for your unique needs. The Dried Urine Test for Comprehensive Hormones (DUTCH) is a comprehensive option. It assesses sex hormones, adrenal function, and metabolites. These test results will guide treatment decisions.

Treatment Possibilities

There are a variety of therapies and lifestyle modifications available that can support you through this period of transition right into menopause. One of the more popular options is bio-identical hormone replacement therapy (BHRT). BHRT uses hormones identical to those naturally produced by the body to help alleviate symptoms such as hot flashes, mood swings, and sleep disturbances.

Lifestyle factors can also play an important role in how you fair through perimenopause and menopause. Factors such as stress, weight, activity levels and nutrition all influence your hormone balance. For instance, maintaining a healthy weight can help reduce estrogen-related symptoms.

Stress triggers the release of cortisol. High stress levels can cause your body to “steal” progesterone to produce more cortisol and can exacerbate estrogen-related symptoms like mood swings, sleep disturbances, and irregular periods.

Additionally, dietary choices can determine if your body has the nutritional building blocks needed to support hormone production. Opting for whole foods, limiting processed sugars, and including phytoestrogen-rich foods (soy, flaxseed) are all steps you can take to maintain your hormonal equilibrium. In some cases, we are unable to get all the nutrients we need from our diet. This is where supplements can really shine. Some examples include:

  • DIM (Diindolylmethane): A compound found in cruciferous vegetables such as broccoli, DIM supports estrogen metabolism and balance.
  • B-Complex Vitamins: Aid energy production and mood stability.
  • Omega-3 Fatty Acids: Anti-inflammatory and beneficial for heart health.
  • Magnesium: Helps with muscle relaxation and sleep quality.
Image of two women in their mid-forties hiking in a forest in fall with the text ‘Embracing the transition’ overlaid in an elegant cursive font.

Embracing the Transition

Moving through perimenopause to menopause is an empowering journey. As the seasons of life change, so do our bodies and experiences. With resilience, self-care and a positive mindset, you can thrive in every stage of life.

Recognize your inner strength. You’ve weathered storms and celebrated victories. Perimenopause and menopause are no different. Embrace the resilience that has carried you thus far.

Prioritize self-care. Listen to your body’s whispers—the need for rest, nourishment, movement, and connection. Nurture and cherish yourself.

Shift the narrative. Menopause isn’t an ending; it’s a new beginning. Celebrate wisdom, laugh freely, and explore uncharted territories. Your mindset shapes your reality.

Remember, perimenopause is not a hurdle—it’s an opportunity for growth and transformation!

George Gillson MD PhD

Author: George Gillson, MD, PHD, CCFP
EvolveWell Medical Director