How to navigate every stage of menopause with as few symptoms as possible

Menopause is a fact of life for women, but when and how strongly it affects you can vary greatly from person to person. There are several factors that come into play with each stage of menopause, so whether you're already experiencing symptoms, or want to be better prepared for the future, we're breaking down all of the facts and natural remedies with the help of Naturopath Natasha Turner. 

Perimenopause

Perimenopause, or menopause transition, begins several years before menopause. It's the time when the ovaries gradually begin to make less estrogen, but it is progesterone that declines first during this stage.  It usually starts in a woman's 40s, but can start in her 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

How Long Does Perimenopause Last?

The average length of perimenopause is 4 years, but for some women this stage may last only a few months or continue for 10 years.

What Are the Signs of Perimenopause?

Women in perimenopause have at least some these symptoms:

• Hot flashes
• Breast tenderness
• Worse premenstrual syndrome
• Lower sex drive
• Fatigue
• Irregular periods
• Vaginal dryness; discomfort during sex
• Urine leakage when coughing or sneezing
• Urinary urgency (an urgent need to urinate more frequently)
• Mood swings
• Trouble sleeping

Are My Perimenopausal Symptoms Normal or Something to Be Concerned About?

Irregular periods are common and normal during perimenopause. But other conditions can cause changes in menstrual bleeding. If any of the following situations apply to you, see a doctor to rule out other causes:

• Your periods are very heavy, or they have blood clots.
• Your periods last several days longer than usual.
• You spotting before your period
• You have spotting after sex.
• Your periods happen closer together.

How Is Perimenopause Diagnosed?

Often your doctor can make the diagnosis of perimenopause based on your symptoms. A blood test to check hormone levels may also help, but your hormone levels are changing during perimenopause. I recommend testing on day 3 of your cycle – FSH. LH, estradiol and then on day 19 -21 estradiol and progesterone. Day 3 tells you ovarian reserve, y9our estrogen should be about 100  and FSH less than 10 to indicate you are NOT in perimenopause. Day 19 – 21 progesterone should be about 20 – 30.

Recommendations for perimenopause support

• Adrenal gland support – as once you are into menopause your adrenals and your fat cells are the only source of estrogen. So you can assess your stress hormone cortisol in the blood and you can also do the orthostatic BP test to indicate how well your adrenals are working. The sooner you start treatment, the better your menopause will be.  So consider herbs like ashwaganda, rhodiola, or relora,
• Add in natural progesterone cream to balance the hot flashes, reduce anxiety, headache, improve sleep and reduce spotting and PMS. You can see an ND for this or a MD that practices bioidendical Hormone replacement, which can be used in a cream or pill form and it is best taken at night. You can also use the herb vitex to regulate periods and improve progesterone with evening primrose oil. Red clover can also help to lower FSH and keep healthy estrogen levels.
• Diet: Think of eating for cortisol balance – so always eat a protein rich breakfast within 45 mins of rising and never miss the 2 – 4 pm meal these are the two most important times for balancing adrenal gland function.

Menopause

Menstruating woman between the ages of 40 and 55 are naturally approaching menopause. Lowered production of the female sex hormones estrogen and progesterone cause these signs of menopause. Menopause is defined after a period of 12 months without any menses.

Signs and symptoms

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your periods have stopped for at least one year
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness. Sex may be uncomfortable or painful.
• You may have less interest in sex. It may take longer for you to get aroused.
• You may experience increased abdominal weight gain – thickening of the waist.
• Your skin may thin and change due to the lower estrogen.
• Your memory may change due to lower estrogen – especially for names and items.

Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen, increasing the risk of osteoporosis. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease ad stroke and the lowered levels of estrogen and are also linked to increased risk of Alzheimers diseae.  

One note of concern – if you develop uterine bleeding after one year period free, go to your doctor for a pelvic ultrasound as this is considered abnormal uterine bleeding.

Recommendations for menopause support

• Essential recommended testing: cholesterol panel, complete thyroid panel, breast ultrasound, pelvic ultra sound and the sooner you do your bone density test the better – studies show if you are losing bone mass the faster you start hormone replacement, the better – don’t wait until you are 65 to get this test done which is what most doctors recommend, We want to be proactive – not reactive. I also recommend testing for the harmful estrogen estrone – as if it is elevated it can increase breast cancer risk.
• Deal with the declining levels of estrogen and progesterone with Bioidentical Hormone replacement in the form of estrogen cream, progesterone cream and vaginal suppositories of estrogen can also be very helpful for dryness and urinary urgency, if you do not want to use hormones, herbs like Red clover, Hops, Black Cohosh, Don Quai and Sage.
• Strength Training is a must here to maintain your bones – ½ three times a week and I have a workout on my blog for you. Walking should be combined with this – one hour a day 4 – 6 days a week.
• Diet – you must change your carb selections as your ability to metabolize carbs decreases with menopause – so go for beets, carrots, peas, quinoa, squash as your choices rather than rice, potatoes, and sweet potatoes, and have only one serving a day at dinner.  I have also put a list on my website for you. AND – protein is a must! You will loose muscle as you age so you must consume at least 30 grams or 4 to 5 ounces cooked four times a day to maintain your muscle, bone and to prevent diabetes.  Even if you do not strength train the protein wll maintain your muscle. And the same rules for meal timing in perimenopause apply here.
• Use a plant-based omega – like Pure Form Omega – it maintains hormone balance and unlike fish oil, preserves bone density.  Combined with vitamin D.
• Take a formula for bone health – I made my own that contains all the nutrients for bone health including:
• Add extra B12 for brain and bone health. University of Toronto researchers found that B12 should be well into the high end of the reference range for brain health so I strive to get my patients levels between 600 – 1200.
• Take Melatonin for sleep, breast health and bone health.