Practices and herbs for Perimenopause
Perimenopause is the period when your hormones start to fluctuate due to age prior to menopause (which is a date – 1 year from the last time you had a period).
During our reproductive years, the amount of oestrogen in circulation rises and falls predictably throughout the menstrual cycle. Basically oestrogen levels are controlled by two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles — the fluid-filled sacs in the ovaries that contain the eggs — to produce oestrogen. When oestrogen reaches a certain level, the brain signals the pituitary, a gland in the brain to turn off the FSH and produce a surge of the other player- LH.
This in turn stimulates the ovary to release the egg from its follicle (ovulation). The leftover follicle produces progesterone, in addition to oestrogen, in preparation for pregnancy. As these hormone levels rise, the levels of FSH and LH drop. If pregnancy doesn't occur, progesterone falls, menstruation takes place, and the cycle begins again.
By our late 30s, our progesterone levels dip. As the number and quality of follicles diminishes, we get a decline in estrogen production and fewer ovulations. So, by our 40s, cycle length and menstrual flow may vary, and periods may become irregular. Oestrogen may drop quickly or spike higher than normal. Over time, FSH levels rise in a vain attempt to get the ovaries into producing more oestrogen 1.
I kind of liken perimenopause to puberty. Its not something that is unhealthy or wrong or something to be battled. That said, it can be uncomfortable and upsetting while the body takes time to adjust to the lower levels of hormones. And dont get me wrong, you can help support the body to adjust more quickly and the health and vitality you have coming into this phase can really make a difference.
SYMPTOMS OF PERIMENOPAUSE
Irregular cycles & heavy periods As the production of oestrogen and progesterone become less reliable and fluctuate it can mean that women may get their periods more frequently than previously experienced. As there may be more oestrogen circulating around for longer periods of time, the endometrium may become thicker and then periods may become heavier, endometriosis and fibroids may become worse at this time. More frequent periods and heavier flow can lead to iron deficiency and anaemia which in turn makes blood vessels in the endometrium more fragile and leads to even more blood loss.
Mood symptoms Many women find that PMS type mood swings can become more prevalent during perimenopause. There is the idea that progesterone has a calming and relaxing action on the brain through its GABAnergic actions. Thus, when ovulation starts to become more erratic, it is thought that it may exacerbate feelings of anxiety, irritability and anger. Similarly, oestrogen has an action on serotonin production so is sometimes associated with low mood and lack of motivation.
Sleep disturbances Perimenopause can bring about sleep disturbances in people who have never experienced them. Often night sweats are a contributing factor but it also seems to be a standalone issue experienced by many women. It may be related to lower serotonin production which is a precursor for the gentle circadian rhythm hormone – melatonin.
Hot flashes and night sweats Hot flashes and night sweats can be one of the most troubling of the menopausal symptoms. They often feel like radiating heat, in the upper body and face area and can be bought on by slight changes in temperature, stimulants such as coffee, alcohol and stress or sometimes nothing! There are varying ideas about what causes them from immune responses to LH surges but whatever causes them they can be uncomfortable and embarrassing. When they occur at night, they can cause disrupted sleep cycles which exacerbate mood and energy fluctuations.
Vaginal dryness During late perimenopause, falling estrogen levels can cause vaginal tissue to become thinner and drier. Vaginal dryness can cause itching and irritation and infection and may be a source of pain during intercourse, contributing to a decline in sexual desire at midlife.
Practises and herbs to support during perimenopause
Shatavari
Try phytoestrogen containing herbs –There are lots of phytoestrogen containing herbs out there - black cohosh, red clover, tribulus, wild yam, dong quai and one of my favourites shatavari ( The main herb in our Lovers Potion) . The mechanism of action is quite complex but basically the phytoestrogen molecule fits loosely into the bodies oestrogen receptor. This means that phytoestrogens can jam up the receptor exerting a weak effect. This is of benefit when there is too much potent unopposed oestrogen circulating around causing sore boobs and heavy periods. On the other hand phytoestrogens can stimulate the oestrogen receptors a little when there isn’t enough oestrogen circulating which benefits things like thin skin, flashes, vaginal dryness, brainfog and the heart protection and mood issues that come with low oestrogen as you inch closer to menopause.
Support your adrenals It’s super important to support the healthy functioning of the adrenal glands coming into this phase ( and all the time really!) This is for a few reasons – the adrenals produce androgens which convert in fat tissue into a type of oestrogen after your ovaries shut up shop. This is also a good reason to eat some carbs and have a decent amount of body fat heading into this phase. Secondly reproductive hormones are made from the same starter materials as stress hormones like cortisol. As the stress response is a survival response, stress hormones are preferentially made instead of sex hormones ( as reproduction isnt really life or death). This is a great reason to get into the adaptogens and adrenal tonics which help to minimise the levels of cortisol associated with long term stress. I like shatavari, ashwagandha or reishi for this period as they both have calming actions and are potent adaptogens. Cordyceps I also might think of here as it has an antifatigue action and has been used for low libido which suggests an action on androgens. I also like maca, licorice and rehmannia alongside vitamin C for adrenal support during this period.
Zizyphus
Get a good nghts sleep –Night sweats and the resulting sleep disturbance are one of the most troubling issues associated with the perimenopause. Zizyphus and ashwagandha are the dream team for menopausal sleep issues as they work synergistically to calm while ziziphus is specific for night sweats. Reishi is also perfect here as it not only improves sleep quality but also has a positive action for liver health. I also like other sleep herbs like vervain, valerian etc. Our Moon Potion is perfect for perimenopause sleep issues as it addresses night sweats and adrenal health. Sage is also not just for smudging! It’s called an antihidrotic which means it can reduce sweating both during the day and also for night sweats. Drink the tea a couple of time as day for about 10 days. Also check out these basic tips for a good nights sleep.
Address anxiety and mood swings– Hormonal fluctuations can lead to a whole new level of anxiety and mood issues. This is in part as progesterone stimulates the brain's GABA receptors, the feel-good, calming neurotransmitters. Whilst oestrogen and serotonin are also intrinsically linked so, it is easy to understand why anxiety and mood swings can surface when your hormones are fluctuating. Of course there are other contributing factors such as major life changes and pressures which arise at this time. So you have to make sure to look after the nutritional needs of your nervous system with adequate protein, B vitamins, magnesium and EFAS. Rejuvenate and restore a frazzled nervous system with lion’s mane and mucuna and try calming adaptogenic herbs like ashwagandha, reishi and calming teas like chamomile, lavender, lemon balm and passionflower. Im also a big fan of St Johns Wort if low mood and anxiety is prevalent but its only suitable for those that are not on medications.
Improve your libido – Low libido can be really problematic for relationships when entering this phase. Of course low libido can also be associated with changes in relationships or now really liking your partner anymore! If thats mnot part of the issue then I like to recommend tonic herbs like cordyceps , shatavari, ashwagandha, maca alongside alongside nervines like damiana (key herbs in our Lovers Potion). Shatavari has a weak oestrogenic action and is thought of as a moistening adaptogen so is helpful dry mucuous membranes that can contribute to low libido and increased risk of genitourinary infections. Maca is an adrenal tonic and is traditionally used for enhancing libido while feel good nervine herbs like damiana can help to stimulate the body while relaxing the mind which is helpful for getting not the mood.
Address nutritional deficiencies – Iron depletion can be quite common at perimenopuase as it can often be accompanied by heavy periods and an exacerbation of endometriosis. This can come about as the endometrium may be exposed to oestrogen for longer periods causing proliferation and heavy periods. Assessing and addressing iron deficiency is really key and maintaining a dietary intake is also important. I also love to recommend nettle tea in conjunction with any supplementation. If your periods are particulalry heavy, your naturopath can recommend you a styptic formula containing herbs like yarrow, shepherds purse and raspberry leaf to help to slow blood flow.
Magnesium is also a key herb to think of as deficiency is associated with PMS symptoms, mood disorders, muscle spasms and is intrinsically involved in progesterone production. Cacao is a good source and green leafy veges are high in magnesium so if you don’t like supplements, get into your green chocolate smoothies!
Legumes, nuts and seeds are also a valuable source of phytoestrogens, vitamins, EFA and minerals and should form a part of your diet. Try having some LSA in those daily green chocolate smoothies alongside some gut healing probiotics!
Be gentle with yourself – The time frame when we start to experience perimenopause coincides with a few other huge stressors. Teenage children, kids leaving home, aging parents, high stress jobs and maybe even starting to reassess your life and the role you are in. So be gentle with yourself. Take some time just for you, get some hobbies, delegate and talk to someone you trust if you are struggling. Make sure to protect and open your emotional heart if you are experiencing grief or feel stuck or emotionally stagnant - i like the flowers of rose, hawthorn, mimosa and linden for this kind of spiritual heart support
Try and minimise stress- Keeping on top of stress levels has multiple benefits for everyone and there are some basic steps to help keep stress in check and improve your physicological function. Check out these tips for when you are under pressure.
Get more exercise Not only does exercise help to dissipate stress hormones, it’s also helps release endorphins and makes your cells more sensitive to insulin and other hormones. Note here though – moderate exercise is great for stress – go too hard, too often and you are making those cortisol levels higher. Maintaining lean muscle mass and doing weight bearing exercise is super important as you age at it helps to maintain bone density and reduce the risk of osteoporosis.
Ditch the booze- Okay - I may have lost you here as many women use alcohol as a support during this stressful time but it doesnt help the symptoms. In fact, it can trigger hot flashes, allow the recirculation of toxic hormonal metabolites, mess up blood sugar and sleep cycles and just generally make matters worse long term.
Think about the positives- It might not seem like it but this stage of life brings with it gifts as well as challenges. A greater sense of self, deepened relationships, harvesting the fruits of your career, more time as children grow up, greater wisdom, mastery and not having to worry about getting pregnant! Whatever your positive may be - keep it top of mind. Walk on the bright side of the road.
You dont get a medal for putting up with serious symptoms - If you are really suffering with severe hot flashes and any other symptoms that impact significantly on your wellbeing and quality of life then visit your doctor and dont feel bad about taking medications if you need them. Be kind to yourself, remember.
1. https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause