This information is for educational purposes only and not intended to diagnose or highlight imperfections. You've likely landed here following your results of my quiz at YourHormoneQuiz.com. No matter what you discover in these results, you're beautiful and perfect as you are. You're good enough and trying hard enough. We're all unique and will experience hormonal shifts differently. This information is here to highlight that, despite what we've been told, we're not just little men — our bodies work differently — and if our hormones have us feeling less than our best, we absolutely can do something about it. My aim is to support and empower you on your journey, where you need and want it. Take what you need, leave what you don't. No judgement here, just good honest support.
Perimenopause is the transition into menopause that comes, on average, 4 to 10 years before menopause, and usually after the age of 42. You’ve reached menopause when you’re of the menopausal age and you’ve gone without a menstrual cycle for at least 12 months. Some medical professionals even consider it menopause after 14 or more months.
The average age to go through menopause is 51 and for most women it will happen between the ages of 45 and 55, but it can also happen earlier or later.
Certain lifestyle factors such as stress, diet or smoking can affect the onset of menopause or perimenopause, and even cause an early onset.
How your hormones shift during perimenopause
Beginning in your late 30s or early to mid 40s, your hormones begin to shift and your female sex hormones — namely estrogen, progesterone and testosterone — will begin a natural decline as you approach perimenopause and menopause. This decline is natural and normal. The closer you get to menopause the lower these levels begin to drop.
Some woman will find this shift unremarkable in terms of symptoms while other women struggle with symptoms affecting one’s mind, mood, sleep, energy, waistline and more.
There are numerous symptoms of perimenopause and each woman will experience perimenopause differently — no two experiences are the same. We’re all wonderfully unique.
Common symptoms of perimenopause include but are not limited to:
- weight gain, especially around the waistline
- insulin resistance and blood sugar issues
- difficulty sleeping, including night sweats, trouble falling or staying asleep, or insomnia
- mood changes, including irritability, depression and anxiety
- feeling emotional or crying more than normal for similar situations
- dry, flaky or thinning skin
- dry eyes
- headaches or migraines
- hot flashes
- brain fog and forgetfulness
- difficulty concentrating
- low libido
- increased UTI’s
- thinning, drying or inflammation of the vagina
- painful sex
- heart palpitations
- tender or drooping breasts
- joint pain
- decreased strength of pelvic floor
- urinary incontinence
- increased cholesterol or blood sugar levels, or both
As your hormones begin to shift in perimenopause, you’ll likely also notice a shift in your menstrual cycle as well.
These changes could look like:
- light menstrual flow
- Heavy menstrual flow
- fluctuating periods — heavy one month, light the next
- shorter or longer menstrual cycles
- fluctuating menstrual cycles — short cycle one month and long the next
- absent periods
Please Note: If you’re getting your period more often, more regularly than an average cycle length of 24 to 30 days, it’s important to check with your doctor to rule out any another reason that could affect your bleeding.
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What can you do about it?
Perimenopause doesn’t have to be a dreadful, miserable experience. Thankfully, there are things you can do to improve the experience and ease common symptoms.
Here are a few ways to get started:
- Keep stress hormones in check by balancing or reducing stress. Stress is a big one! When the work of our stress hormones is chronically in demand, our sex hormones can suffer. Keeping stress in check can help support better hormone balance and less suffering all round.
- Reduce inflammation (this also helps reduce stress levels). This can be done with by:
- reducing known (and even unknown) food allergies or intolerances,
- reducing exposure to known environmental toxins and endocrine disruptors (check foods, home and beauty products),
- Prioritize sleep. This can often be easier said than done in your perimenopausal years, however with a bit of effort and sometimes trial and error, it can be done. Seek support if sleep is an issue. I’m also happy to help here.
- Opt for a daily diet rich in anti-inflammatory foods while reducing refined sugars or processed foods. Many women will require a reduction or shift in carbohydrate intake as a drop in estrogen will impact blood sugar control. A hormone-supportive diet can also help balance stress, reduce inflammation, improve overall hormone balance and help you feel and look your best.
- Choose exercise that’s a good fit for your current hormone status — this will look different from your 20s or early 30s. Appropriate exercise for your hormones will also help reduce stress and inflammation.
- Reduce alcohol. This is a rather unpopular suggestion though one I have to mention as it can greatly reduce your body’s stress levels as well as inflammation. Reducing alcohol can help keep the hormone insulin in check, reducing blood sugar issues and helping you burn fat when you want as well as minimize fat gain, especially around your waistline.
- Improve gut motility. If you tend to be on the constipated side, or the opposite, it’s important to get things moving one to three times a day to support hormone balance. Daily bowel movements should mostly be solid, firm but not hard, well formed, brown and easy to pass. If not, there could be digestion and absorption issues impacting your hormones.
- Targeted nutritional supplementation. It’s important to get adequate nutrients to support hormone balance as well as your unique situation and symptoms. Genes, environment and lifestyle all have a part to play and most often, diet is not enough at every moment to support optimal hormone health. Working with a knowledgable practitioner can help restore nutrients to optimal levels and fill in any essential gaps.
When is hormone replacement therapy helpful?
Sometimes balancing hormones and managing symptoms is not enough to feel your best, but also to reduce risk of disease. Estrogen plays an important role in nearly 400 functions in the body, impacting our heart health, bone health, and metabolism (this means fat stores, blood sugar, cholesterol, blood pressure, and more). As estrogen (in addition to progesterone and testosterone) declines to its lowest point, you’ll likely notice.
Women have the option of restoring hormone levels with either traditional hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (BHRT). I strongly suggest educating yourself on the various options as well as the benefits and risks to be able to make a well-informed decision that best suits your body and needs.
Some women find that their traditional doctors dismiss the idea of hormone replacement therapy in menopause or only mention risks from outdated research, without informing themselves on recent developments in hormone therapy research. I recommend educating yourself on the research so that you’re very well informed. There’s a lot of information out there and it definitely pays to seek out an expert in women’s hormone replacement therapy.
Hormone Therapy Options
Hormone therapy comes in many different forms — including a pill, transdermal creams or gels, injections, sublingual drops, lozenges, a patch — and can have various combinations or types of bioidentical or synthetic estrogens (estradiol, estriol, or both). Not every type or form of estrogen will have the same affect on every woman.
If you choose to try hormone therapy, it’s helpful to have options to find what works for you.
There are many benefits to choosing hormone therapy and it can be health supportive while reducing the risk of certain age-related disease. Working with a knowledgable, well-informed practitioner can help support you in making the best choice for you.
In addition, taking estrogen alone without the supplementation of progesterone can also pose risks — or reduce the efficacy of (B)HRT — for many woman. Some women might find they also feel better with a combination of hormone replacement, including testosterone and even DHEA. Be sure you seek a practitioner who’s highly knowledgable in the different types of options, combinations and what’s required to maximize benefits and reduce risk. This will vary from person to person.
When is it a good time to consider hormone replacement?
- When you’re between the ages of 45 and 50 and having irregular or anovulatory cycles, and no later than 10 years post-menopause. Within the first 5 years of menopause is often ideal.
- Women with primary ovarian failure, primary or secondary amenorrhea
- Your FSH is > 10 IU/L at day 3 of your menstrual cycle
- Estradiol is less than 50 pg/ml mid-cycle
- AMH < 1.5 ng/mL
- Progesterone is < 2 ng/mL during your midluteal phase
How to best support hormone therapy
Hormone replacement therapy is not a magic pill and in order for it to work well for you, diet and lifestyle are an important consideration.
Optimizing hormone health is the way to feeling better, younger, healthier longer and this starts with your diet and lifestyle. There’s no escaping that even with the support of well-planned, well-considered hormone therapy.
Not sure where to start?
I get you. There’s a lot to consider. If you need additional support or direction (no need to go it alone!), I’m more than happy to help. Get started by filling out the application below.
Check out this post for even more ways to get your hormones back in harmony.
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This information is for educational purposes only and is not intended to diagnose, manage, or treat disease or serious conditions. Always check with your doctor before making any changes. It's important to consult a well-informed health practitioner for personal advice about your situation before relying on general information — we're all wonderfully unique.
Laurie Villarreal, CHWC, CFNS, LMC, CPT, RYT
As a functional nutrition practitioner and fitness expert specialized in women’s hormones, I help active, driven women, like you, get back to feeling, performing (heck, even looking!) your best when nothing else has worked. From personalized nutrition and lifestyle guidance to doing the deep, much needed inner work of coaching, I help you soar to new heights — to show up and play bigger (and brighter!) than you’ve ever imagined. So you can get back to living your best life and chasing your dreams — with much more joy and ease.
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