Are you in your 40’s and feeling off? You may need to start navigating the mystery of perimenopause  

Perimenopause is a bit more mysterious than the infamous menopause when it comes to knowing what to expect when the time arrives. This seems absurd when research shows that women commonly experience more symptoms in perimenopause than menopause (Santoro, 2016). Especially when considering there are around 1 billion women across the world who have lived it (Zhang et al., 2021).

The time is nigh for more conversations about this phase of life so women know what to anticipate and how they can help alleviate their symptoms.

Have you been noticing changes with your cycle, had more trouble sleeping or been feeling moodier lately (Santoro, 2016)? What about brain fog (Gava et al., 2019), unexplained weight gain (Chopra, et al., 2019), fatigue (Ahsan et al., 2015), hot flashes or low libido? These are some of the most common symptoms of perimenopause.

 The good news is there are natural scientifically proven ways to lessen the impact of this transitional period. The severity of your symptoms can depend on a number of factors, including health status, hormone levels, diet and lifestyle. Hormone changes are a big part of the equation but altering them with medication is not the only solution.

What is perimenopause?

Perimenopause is a transitional period when hormones fluctuate wildly in the lead up to the final years of reproductive life. It is usually initially characterised with irregular periods, however there are a number of other symptoms that can vary from person to person (Allshouse, et al., 2018). When a menstrual period has been absent for 12 months then you have officially entered menopause. In menopause hormone levels, namely progesterone and estrogen are at a constant low. It can be a breeze for some and a living nightmare for others. Usually, it is somewhere in between for most.

For some women, perimenopause can begin as early as their 30’s or as late as their 50’s, most women enter perimenopause between the ages of 40 to 44. This phase of your life may last for 4 to 8 years, it is officially over when you enter menopause. The average age of menopause is 51 (Dunneram, et al., 2018).

Perimenopause symptoms

Just like the age you might enter perimenopause there is also a lot of variability in the symptoms you might experience. However, usually one of the first symptoms of perimenopause is the lengthening and/or changes to your menstrual cycle.

Some of the most common perimenopause symptoms include:

• Insomnia (Santoro, 2016)
• Depression (Santoro, 2016) (Ahsan et al., 2015)
• Anxiety (Santoro, 2016) (Ahsan et al., 2015)
• Irritability (Santoro, 2016)
• Menstrual changes (Allshouse, et al., 2018)
• Hot flashes
• Fatigue
• Brain fog (Gava et al., 2019)
• Sexual disturbances (Ahsan et al., 2015)
• Weight gain (Chopra, et al., 2019)
• Headaches
• Musculoskeletal pain (Allshouse, et al., 2018)

Perimenopause can be Worse than Menopause

A couple of studies have found that symptoms can actually be worse in perimenopause than menopause (Santoro, 2016) (Imhann et al., 2016). One study which surveyed over 3,000 women showed that hot flashes affected 79% of perimenopausal women and only 12.5% of menopausal women. Perimenopausal women were also more likely to suffer from insomnia with 56.6% reporting this symptom whereas 50.7% of menopausal did (Santoro, 2016). This study also showed that symptoms of depression and anxiety are more likely to be reported in perimenopause than menopause (Santoro, 2016).

Is there a Test for Perimenopause?

There is no test to determine if you’re in perimenopause, it is diagnosed from a collection of symptoms. Hormones can fluctuate on a daily basis during this time which is why testing hormones is unreliable.

Optimising Your Nutrition for Perimenopause

A decline in metabolic health often accompanies perimenopause and menopause, this is why it so important to optimise nutrition during this transition. It is common for blood sugar and lipid levels to increase and adipose tissue to accumulate around the abdomen, even if your diet and exercise routine has remained the same.

Diet can be a surprisingly powerful way to help with perimenopausal symptoms. Research shows there are a number of different ways to improve symptoms and delay the onset of perimenopause through nutrition. Some studies show increasing protein and omega -3 intake helps whilst other studies show following a plant-based diet is beneficial.

Increasing Protein Intake

Researchers from the University of Sydney have indicated that optimising protein intake can assist with weight gain that can occur during perimenopause. Protein helps with regulating blood sugar levels and appetite. The study found that those with higher protein intake had a lower body fat percentage, lower BMI and higher muscle mass (Simpson et al., 2022).

Requirements for protein increase during perimenopause because hormonal changes accelerates loss of muscle mass, increasing protein can help minimise this (Simpson et al., 2022).

Good sources of protein:

• Chicken
• Beans
• Fish
• Eggs
• Organic soy beans
• Lentils
• Quinoa
• Grass-fed beef
• Hemp seeds

Blood sugar regulation

A number of studies show that reducing simple carbohydrates can assist with perimenopausal symptoms (Hyvärinen et al., 2022) (Simpson et al., 2022). In fact, a higher intake of refined carbohydrates was associated with menopause commencing 1.5 years sooner (Dunneram, et al., 2018).

Fluctuating hormones during perimenopause can interfere with blood sugar regulation. Estrogen facilitates the metabolism of glucose and insulin secretion (Alemany, 2021). Refined carbohydrates such as white rice, white bread, fruit juice and potato chips significantly increase blood sugar levels, therefore minimising these foods will help keep blood glucose levels steady.

Increasing muscle mass and decreasing chronic inflammatory markers can improve metabolic health (Hyvärinen et al., 2022).

Omega-3 fatty acids

There is some good evidence that omega-3 can help with perimenopausal symptoms associated with mood and inflammation.

A small single blinded placebo-controlled study found that 2 grams of omega-3 fatty acid capsules significantly reduced symptoms of major depression and hot flashes in women transitioning to menopause (Freeman, et al., 2011).

A diet rich in oily fish along with legumes was directly correlated to a delayed onset of menopause by 3.3 years (Dunneram, et al., 2018).

Good sources of omega-3:

• Fish roe
• Wild caught salmon & trout
• Sardines
• Mackerel
• Oysters
• Flaxseed

Correcting nutrient deficiencies

Correcting nutrient deficiencies has been shown to delay the onset of menopause. In particular optimal intake of vitamin B6 and zinc was also associated with going into menopause later (Dunneram, et al., 2018).

Increasing plant foods

We are always told that eating our fruit and vegetables is good for us, and there is no exception for perimenopause. A study conducted in 2021 found that hot flashes decreased by 79% when post-menopausal women followed a low fat, plant-based diet rich in whole soybeans for 12 weeks (Barnard et al., 2021).

Physical activity

Regular physical activity can help reduce perimenopausal symptoms such as anxiety, depression and insomnia, according to a large study published last year. This study had over 3,000 participants and found that aerobic exercise twice a week over 8 weeks had a 83.2% improvement in anxiety, 84.08% had improvement in depression symptoms and almost 90% were sleeping better (Zhao et al., 2022).

Another study showed that perimenopausal and menopausal women had a significant improvement in mental health and vitality after exercising three times a week. Each session went for 60 minutes over a 12-week period and consisted of walking, stretching and strengthening exercises (Dąbrowska, 2016).

References

Ahsan, M., Mallick, A., Singh, R., & Prasad, R. (2015). Assessment of menopausal symptoms during perimenopause and postmenopause in tertiary care hospital. Journal of Basic and Clinical Reproductive Sciences, 4(1), 14. https://doi.org/10.4103/2278-960x.153516

Alemany M. (2021). Estrogens and the regulation of glucose metabolism. World journal of diabetes, 12(10), 1622–1654. https://doi.org/10.4239/wjd.v12.i10.1622

Barnard, N. D., Kahleova, H., Holtz, D. N., Del Aguila, F., Neola, M., Crosby, L. M., & Holubkov, R. (2021). The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause (New York, N.Y.). https://doi.org/10.1097/GME.0000000000001812

Dąbrowska, J., Dąbrowska-Galas, M., Rutkowska, M., & Michalski, B. A. (2016). Twelve-week exercise training and the quality of life in menopausal women – clinical trial. Przeglad menopauzalny = Menopause review, 15(1), 20–25. https://doi.org/10.5114/pm.2016.58769

‌Chopra, S., Sharma, K. A., Ranjan, P., Malhotra, A., Vikram, N. K., & Kumari, A. (2019). Weight Management Module for Perimenopausal Women: A Practical Guide for Gynecologists. Journal of mid-life health, 10(4), 165–172. https://doi.org/10.4103/jmh.JMH_155_19

Demel, S. L., Kittner, S., Ley, S. H., McDermott, M., & Rexrode, K. M. (2018). Stroke Risk Factors Unique to Women. Stroke, 49(3), 518–523. https://doi.org/10.1161/strokeaha.117.018415

Dunneram, Y., Greenwood, D. C., Burley, V. J., & Cade, J. E. (2018). Dietary intake and age at natural menopause: results from the UK Women’s Cohort Study. Journal of epidemiology and community health, 72(8), 733–740. https://doi.org/10.1136/jech-2017-209887

Freeman, M. P., Hibbeln, J. R., Silver, M., Hirschberg, A. M., Wang, B., Yule, A. M., Petrillo, L. F., Pascuillo, E., Economou, N. I., Joffe, H., & Cohen, L. S. (2011). Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: a preliminary open trial. Menopause (New York, N.Y.), 18(3), 279–284. https://doi.org/10.1097/gme.0b013e3181f2ea2e

Gava, G., Orsili, I., Alvisi, S., Mancini, I., Seracchioli, R., & Meriggiola, M. C. (2019). Cognition, Mood and Sleep in Menopausal Transition: The Role of Menopause Hormone Therapy. Medicina, 55(10). https://doi.org/10.3390/medicina55100668

‌Hyvärinen, M., Juppi, H.-K., Taskinen, S., Karppinen, J. E., Karvinen, S., Tammelin, T. H., Kovanen, V., Aukee, P., Kujala, U. M., Rantalainen, T., Sipilä, S., & Laakkonen, E. K. (2022). Metabolic health, menopause, and physical activity—a 4-year follow-up study. International Journal of Obesity, 46(3), 544–554. https://doi.org/10.1038/s41366-021-01022-x

‌‌Perkins, M. S., Louw-du Toit, R., & Africander, D. (2018). Hormone Therapy and Breast Cancer: Emerging Steroid Receptor Mechanisms. Journal of molecular endocrinology, 61(4), R133–R160. https://doi.org/10.1530/JME-18-0094

Santoro N. (2016). Perimenopause: From Research to Practice. Journal of women’s health (2002), 25(4), 332–339. https://doi.org/10.1089/jwh.2015.5556

Simpson, S. J., Raubenheimer, D., Black, K. I., & Conigrave, A. D. (2022). Weight gain during the menopause transition: Evidence for a mechanism dependent on protein leverage. BJOG: An International Journal of Obstetrics & Gynaecology, 130(1), 4–10. https://doi.org/10.1111/1471-0528.17290

 Zhang, G.-Q., Chen, J.-L., Luo, Y., Mathur, M. B., Anagnostis, P., Nurmatov, U., Talibov, M., Zhang, J., Hawrylowicz, C. M., Lumsden, M. A., Critchley, H., Sheikh, A., Lundbäck, B., Lässer, C., Kankaanranta, H., Lee, S. H., & Nwaru, B. I. (2021). Menopausal hormone therapy and women’s health: An umbrella review. PLOS Medicine, 18(8), e1003731. https://doi.org/10.1371/journal.pmed.1003731

Zhao, Y., Niu, H., & Liu, S. (2022). Effects of aerobics training on anxiety, depression and sleep quality in perimenopausal women. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1025682

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By nutritionist Chrissy

Chrissy is a university qualified nutritionist who graduated with honours at La Trobe University in Melbourne. One of her favourite hobbies is to read the scientific literature on how to optimise health. When she’s not reading, writing or working she’s with her 3 children outdoors, practicing yoga, jogging or cooking up a storm in the kitchen. Chrissy has overcome some debilitating chronic health issues (low mood, adrenal fatigue, insomnia, very bad acne to name a few) with the power of nutrients and correcting gut health, at 39 she now feels better than she did in her 20’s.