Perimenopause: Making Sense of the Transition

Hormone Health, Perimenopause + Menopause, Uncategorized

Perimenopause is a time when women face symptoms that can be unpleasant or confusing. From cycle length to skin changes, this is a time when we question what is happening with our body and what we can do to make the transition better. From acupuncture and evidence based nutraceuticals to BHRT and proper excerice, this is a time when we often we must put ourselves as a priority to start feeling like our old selves again.


Menopause is a major transitional period in a woman’s life. It officially refers to the cessation of the menstrual period, confirmed after one year of no menstrual bleeding. The Centre for Menstrual Cycle and Ovulation Research (CeMCOR) at UBC reports that most women enter menopause between the ages of 45-50, but in clinical practice, this range seems much broader. Menopausal changes often begin much earlier, in the mid 30’s for some women.


Perimenopause refers to the extended transitional state leading up to menopause that can last from 2-10 years. This time often correlates with more intense and variable symptoms than menopause. While a normal process of aging, symptoms are varied, unpredictable and often go unrecognized in the early stages.

Symptoms commonly associated with perimenopause include:
hot flashes, night sweats, heart palpitations, sleep disturbances, anxiety, rage, heavy periods, irregular cycles, fatigue, stress incontinence, skin and hair changes, histamine intolerance, weight gain, cognitive changes, joint pain, low libido, HPA axis dysfunction and thyroid imbalances.

What is happening with hormones at this time?
The physical changes of perimenopause are rooted in hormonal changes, particularly variations in the level of circulating estrogens.


Estrogen levels are fluctuating widely, from very low to very high, and seemingly without rhythm. Many women who experienced very regular, predictable cycles feel as if they are riding a roller coaster. High estrogen is associated with breast tenderness, irritability, heavy periods, and water retention. Low estrogen is associated with weight gain, hot flashes, night sweats, vaginal dryness and generalized stiffness.

Some women experience low estrogen perimenopause, which tends to be a gentler experience; periods get lighter and lighter and seem to fade away. There may be mild sleep disturbance, but rarely the extreme highs and lows of the more typical experience of perimenopause. This type of perimenopause may be associated wth a higher risk of dementia and osteoporosis particularly if early onset.


Progesterone is on a slow and steady decline, which makes the estrogen fluctuations even harder to manage. Progesterone calms the nervous system supporting better coping, stress management and deep restorative sleep. It stimulates the thyroid for optimal metabolism and thins the uterine lining resulting in lighter periods.

Other hormone levels such as DHEA, Testosterone, Insulin and Thyroid hormones are also shifting

The perimenopausal period can be really challenging. In addition to the intensity and variability of physical and emotional symptoms, spiritually women are navigating change, loss, grief and fear as they transition to a new and as of yet unknown rhythm and deep connection and expression of their inner crone or wise woman.

The goal of ‘treatment’ is to provide support for women physically, emotionally and spiritually as they navigate this transition; and to prevent diseases associated with aging such as osteoporosis, Alzheimer’s disease, cardiovascular disease, autoimmune conditions and cancer. Here are some basic suggestions to implement:

  • Support estrogen metabolism with diet – increase brassicas and seaweed, limit coffee, alcohol, sugar, and BPA exposure. Ensure healthy and balanced intestinal flora and optimize hepatic function to manage the estrogen surges.

  • Support ovulation and progesterone production with specific vitamins/minerals/botanicals, sufficient nutritional intake of good fats to reduce inflammation and support ovulation.

  • Consider bio-identical hormone replacement to support and correct imbalances and deficiencies.

  • Exercise to improve insulin sensitivity, elevate mood, eliminate excess estrogen, prevent bone loss and maintain muscle mass.

  • Rest, meditate, spend time in nature, take space when needed, talk to your friends/partners/families about what you are experiencing and make space to connect with your creative energy – write, draw, paint.

  • Find a way to honour and personally recognize this transition and the gifts it brings – release, surrender, freedom, clarity, power, a deeper connection to your voice and creativity.

At West End Women’s Health, we have a number of solutions from testing to BHRT prescriptions as well as diet and lifestyle recommendations that can help you feel better. Reach out today to schedule a consultation.

Recommended Resources for Additional Support

  • The Centre for Menstrual Cycle and Ovulation Research, UBC

  • My wise colleague Dr. Lara Briden, ND’s Blog

  • The New Menopausal Years, Susun S. Weed

  • The Wisdom of Menopause, Dr. Christiane Northrup, MD

Reach out today to book your appointment today.

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