Are You Having A Hidden Perimenopause?
Sleeping badly? Weight creeping on? Anxious? Or just a little more stressed than usual? If this is you, you might put it down to being tired looking after your family or busy with your ageing parents or overstretched at work, or a combination of all three. But in fact, you could be at the very start of the perimenopause.
Hormonal changes can begin ten to 15 years before the menopause. And so for a lot of clients I see, their symptoms started as early as their late 30s. I call this the Peri Grey Zone, because these early symptoms aren’t obviously menopause related, like hot flushes or irregular periods, but more subtle and non-specific.
That’s why it’s so easy to blame them on life, not hormones. One client’s insomnia was so bad, she was signed off work, but she still didn’t realise it was hormone related. It’s such an easy mistake: despite having learnt about all the subtle, very early signs of menopause, it even took me a few months to realise it was happening to me. And I had the classic signs of the Grey Zone: my sleep had got a little worse, I’d become more anxious, I felt a little less resilient to stress, slightly more tired.
Sometimes women blame the Grey Zone on hormones, but not the menopause. And so a woman who’s had a baby in her late 30s or early 40s might think her hormones are off because she is still adjusting from the pregnancy, not because she’s going into the the next hormonal stage of life.
What’s happening to my hormones?
There are two hormones that need to be in balance for you to feel well: progesterone and oestrogen. As a general rule, progesterone is the first hormone to start declining in women, and this is responsible for the Grey Zone symptoms. It’s often (but not always) slightly later in the perimenopause that oestrogen begins to fluctuate.
When progesterone drops, hormones go out of balance, and you can get the symptoms of Oestrogen Dominance. That is, too much oestrogen compared to progesterone. The symptoms of this to watch out for are:
Not being able to lose weight. A lot of women come to see me for their weight because it’s a major symptom of oestrogen dominance, only to find out their hormones are to blame.
Anxiety and not being able to relax. This is because progesterone is pro relaxation.
Bloating. As progesterone is a diuretic, you may feel more bloated.
PMS, or PMS is getting worse.
Gynie symptoms such as fibroids and cysts. And also lumpy breasts.
Night sweats more than hot flushes during the day, and/or your sleep is disturbed so you wake up more frequently.
You may notice any symptoms especially in the second hard of the cycle (the two weeks leading up to your period).
‘Testosterone Dominance’
With the imbalances between oestrogen and progesterone some women may experience a relative testosterone dominance. This is because testosterone may not be declining yet so it feels higher. This can result in androgenic symptoms such as new adult acne or hair loss or you may find that you get the odd chin hair. The great news is that some herbal supplements can work very well. But it’s always best to look the whole hormonal picture.
The stress effect
If you don’t regularly think about what you can do to reduce stress, now is the time. Because if you’re stressed, any hormonal changes will be magnified. This is down to an imbalanced called the Progesterone Steal. It happens because stress hormone cortisol and progesterone are both made from the same hormone, pregnenolone. There’s not really any stealing going on, but it describes that effect that when you are stressed, your body will always prioritise making cortisol rather than progesterone.
There’s another reason to cut stress: to look after your adrenals. This is where stress hormones including cortisol are made. But they’re also the back-up system that is supposed to continue making small amounts of oestrogen when our ovaries stop. However, if you’ve been stressed for a long time, overworking your adrenals, they won’t have the capacity to do this.
Long-term stress can have a negative knock-on effect, one that makes it even harder to stop feeling stressed: dysregulation of the Hypothalamic-Pituitary-Adrenal axis (aka the HPA axis). This is the system by which the brain and adrenal glands communicate. It’s supposed to feed back that the body can stop making cortisol. But what I see in a lot of clients, is that the HPA axis becoming overwhelmed by too much cortisol and stops feeding properly. This has the negative result, that the pituitary keeps sending the message to pump out even more cortisol!
What can you do to get hormones back in balance?
Believe in your body; you know when something doesn’t feel not right. I’ve seen HRT make a huge difference to how clients feel. However, you may not yet be low in oestrogen, and so HRT that contains oestrogen may end up making you feel worse. Ideally, before you start any medication, find where your hormones are at. You can ask your GP to give you a blood test between days 19 to 22 of your cycle. In clinic, we use DUTCH hormone testing which maps your cycle over the month to give a complete picture of what your hormones are doing. Find out more
Eat to detox your hormones and reduced Oestrogen Dominance. When hormones are used up, in particular oestrogen, you need to get rid of them. That includes your own hormones as well as HRT. A lot of this work happens in the liver, and you can help your liver do its work by eating the following foods.
Cruciferous vegetables: Broccoli, cabbage, cauliflower, kale, Brussels sprouts, red cabbage, bok choy, collard greens, watercress, sauerkraut, Romanesco, mustard greens, turnips, kale, rocket and radishes. Best of all are broccoli sprouts. Buy them from the supermarket, or you can sprout them yourself too.
Sulphur rich vegetables: in cruciferous vegetables but also garlic, onion, spring onions, shallots, beetroot, asparagus.
Bitter foods: chicory, rocket, watercress and dandelion, radishes, mustard greens, artichokes, turnip greens and chicory.
Good fats: extra virgin olive oil, avocados, nuts and seeds and oily fish such as salmon, sardines or mackerel.
Proteins: Eat protein at every meal. This is particularly important for hormones because the building blocks of protein – amino acids – are needed to make all our hormones.
Helpful herbs and spices: Turmeric and rosemary both help detoxify oestrogen.
More self care and sleep, less stress. Regularly, consciously switch off your stress system by having proper rests. It doesn’t matter what you do, simply choose the things that reduce your stress and do them more. It can be walking outside, journaling first thing or before bed, meditation, chanting… whatever keeps your boat happily afloat. Switch away from endurance and hard cardio, which are stressful to your body, to strength training, Pilates, yoga, walking and swimming. New research suggests that cleaning ourselves is linked to reducing stress too, so take a warm shower or an Epsom salts bath.
Have your thyroid function checked. Each hormone is part of an intricate feedback system, so they all affect each other. Specifically, perimenopause and Oestrogen Dominance can trigger low thyroid function, which can leave you feeling exhausted, as well as feeling the cold, puffiness around the face and eyes and sometimes a low sex drive. The symptom that almost everyone experiences is extreme tiredness. You can check your thyroid symptoms here.
Eat phytoestrogen foods: Phytoestrogens are compounds in plants that regulate levels of oestrogen in the body. Great sources are flaxseeds, fermented soy foods, such as miso, tempeh and tofu, and also edamame. One of the most powerful is sage. A review of clinical trials during menopause found that sage helped treat hot flashes, reduce sweating, and had positive effects on the nervous system, including improved memory.
Try seed cycling. Seed cycling is a naturopathic remedy that can help balance hormones. The idea is that eating flaxseeds and pumpkin seeds in the first half of your menstrual cycle will regulate oestrogen, and eating sesame and pumpkin seeds in the second half will regulate progesterone. It does have its roots in science, but it’s not a magic bullet so it’s best done as part of a healthy eating plan.
Days 1 to 13/14: Eat one tablespoon each of freshly ground flax and pumpkin seeds per day. Days 13/14 to day 1 of your next period: Eat one tablespoon each of ground sunflower and sesame seeds per day.
Magnesium- magnesium is needed for hormone production. Magnesium and taurine found in my PCH Magnesium Complex is my favourite combination for women in Perimenopause.