Perimenopause can be a frustrating time. Many women dealing with changes in their bodies often don’t know what’s happening. Perimenopause can occur anywhere between 2 to 10 years before menopause. The average age of menopause is about 45 to 55 years old, which means women can experience perimenopause as early as 35. Common symptoms are hot flashes, night sweats, insomnia, fatigue, mood changes, forgetfulness, weight gain – especially around the midsection and changes in periods. You may find that your cycle is extending or, perhaps, shorter. While these symptoms are common, you don’t hear about them often because women don’t know that it is linked to their hormones or perimenopause. Instead, they often get tested for joint pain, urinary tract infections or yeast infections. These, however, are symptoms of a decrease in estrogen in our bodies. Other symptoms include loss of breast fullness, decreasing restfulness, changes in body odour, bloating, and reduced muscle tone.

Visit a medical professional and talk with them about what you’re experiencing. They will likely recommend getting tests done, like checking the blood for estrogen, progesterone, testosterone and cortisol levels. High amounts of cortisol (the stress hormone) or a nutrient deficiency can worsen perimenopausal symptoms, making them more severe. The Dutch test is a fantastic testing panel—hormone metabolite testing shows how your body processes your hormones and what’s happening with them.

It is important to remember that during perimenopause, your hormones are all over the place. So, if your blood test comes back within normal ranges, it doesn’t mean the symptoms you’re experiencing aren’t real. Taking the same test a few weeks later might show different results.

Diet: Women who eat fruits, vegetables, lean proteins and healthy fats show reduced symptoms compared to women who have a diet with highly processed foods. The Mediterranean diet is a great place to start and can be modified based on your lifestyle. Healthy fats like avocados, fish, nuts and seeds are essential for hormones. Green leafy vegetables, especially cruciferous vegetables like broccoli, cauliflower, and kale, are important. Look at foods that contain ISIL flavonoids, which is plant estrogen found in soybeans, chickpeas, lentils, and flax. These foods are beneficial for perimenopausal symptom relief. Women who eat these isoflavonoid foods see a 19% decrease in hot flashes. Choose organic foods as much as you can. It limits exposure to Xenoestrogens (estrogen imitators), which are not necessarily good. Avoid caffeine, alcohol, sugar, and even charred meats. As we get older, we need to ensure that we’re getting enough protein. Consuming one to two meals with 30 to 45 grams of protein daily is vital to maintaining lean muscle.

Sleep hygiene: Going to bed on a regular schedule, ensuring that your room is dark, turning off those devices, and not drinking caffeine past three o’clock are all essential.

Exercise: Exercise, in general, is essential to maintain muscles and muscle mass. It also aids in maintaining future bone health. Make sure you’re getting in both aerobic exercises and weight training.

Mindset: Studies show that women who dread perimenopause and menopause and talk about it in a negative way experience more hot flashes and negative symptoms during those years. Change is inevitable. Try to keep a positive outlook.

Supplementation: While getting all nutrition from your diet is preferable, sometimes, you need additional support. Certain vitamins like D3 and K2 are difficult to get for which supplementation can help. Taking magnesium or melatonin for sleep, vitamin B for stress and omega supplements for hormones can help relieve certain symptoms. Herbal options like ashwagandha and Rhodiola are adaptogens that are great for supporting stress levels. Black cohosh and Chaste tree are herbs that can help with hot flashes and breast tenderness. Valerian passionflower can assist with reducing anxiety and promote relaxation and sleep.

In cases where nutrient and herbal supplementation isn’t enough, we recommend bioidentical treatments and therapies. The type of hormone replacement therapy that naturopaths use is BHRT (Bioidentical Hormone Replacement Therapy). There’s a misconception that it’s not consistent with benefits. But, in BHRT, the estrogen is made from soy and progesterone from wild yam. The creams are naturally made and prescribed by a compounding pharmacist. My patients like using bioidentical creams as it’s easy to stay consistent with the treatment. The other misconception is an increased risk of estrogen-related cancers. Traditional medical doctors don’t use hormone replacement therapy because a study showed an increased risk of breast cancer. However, this study does not pertain to BHRT because the ingredients used differ from other HRTs. The difference is putting good or bad estrogen into your body. BHRT, being natural, binds to estrogen receptors differently, so there isn’t an increased risk, unlike traditional hormone replacement therapy.

Regardless of treatment, doing consistent lab tests is essential. Our hormones are constantly changing. At a minimum, I recommend repeating tests yearly for a perimenopausal stage. If you’re on BHRT, initially, run tests every two months for about six months to a year to ensure everything is at the right level. The other factor to consider is how the patient is feeling. You should be feeling good. The BHRT dosage should align with what one needs in terms of how they’re feeling.