By Dr. Shawna Darou, ND
Let’s talk. Hormone changes in the 40’s and 50’s affect everything from mood to energy, and also weight, cognition, bone density, cardiovascular health, and athletic performance. This is also an essential time to reverse disease processes that are starting to become evident as we age, and get the foundations in place for a more easeful menopause transition. The hormone changes that occur before menopause are called “perimenopause” which can last anywhere from 2 to 8 years. It’s important to note that there is not one way to go through perimenopause – some women get really heavy and long periods, some have disrupted sleep, some experience weight again, and others have mostly mood symptoms.
To help with treatment, I have categorized periomenopause symptoms into 5 types. Most of us have one dominant type, and another secondary one. Take a look at the categories and see which fits you closest – by addressing the underlying imbalance related to the perimenopause symptoms we can not only help you to feel better during this time, but also have a better understanding of potential issues to be on the alert for prevention.
5 Perimenopause Types
1) Estrogen storm
Key symptoms: When estrogen surges during perimenopause, the main symptom is VERY heavy periods, sometimes with fibroids or adenomyosis. Other symptoms are gaining weight on the thighs, hips and upper arms, and stronger PMS symptoms like mood swings and irritability especially. The estrogen storm typically happens before periods become irregular and estrogen drops.
2) Low estrogen / low hormones
Key symptoms: When estrogen is dropping and gradually tapering off, you would experience much lighter periods than before, and maybe starting to become irregular. Other common symptoms are night sweats, more anxiety sleep disruption. The gradually dropping estrogen is actually less common than the estrogen storm.
3) Stressed & anxious
Key symptoms: Some women’s perimenopause is mostly characterized by reduced stress tolerance and overwhelm in the years leading up to menopause, with or without an obvious change in the menstrual cycle. It’s as if you can’t handle the everyday stresses as well as you used to. Overwhelm is more common in the PMS window, and there may also be more anxiety, sleep issues, and sometimes abdominal weight gain too.
Key symptoms: Another very common presentation in perienopause is an increase in inflammation – waking up achy and stiff, more joint pains and body aches, and possibly more headaches and migraines. You may find that workouts are getting more difficult because of injuries or joint pains, and you’re stiff when you stand up after sitting for a while. Changes in hormones may be contributing to these changes, as well as underlying inflammation.
5) Blood sugar issues
Key symptoms: Blood sugar issues, specifically insulin resistance also tend to show up strongly in the 40’s and early 50’s, along with the hormone shift. Signs of blood sugar issues are mostly a significant weight gain (usually about 15lb), carrying weight especially in the central abdomen, cravings for sweets, carbs and possibly alcohol. Blood sugar issues through abdominal weight gain can also contribute to heavier menstrual cycles, and can also contribute to sleep disruption.
Once you have identified your perimenopause type or types, there may be testing recommended to confirm, or understand the imbalance further. For example testing estrogen and progesterone in the luteal phase, measuring fasting blood sugar and insulin levels, testing for adrenal hormones (cortisol and DHEA), and measuring inflammatory markers. Testing can give us a baseline, and confirm the imbalance.
There are of course treatments for each type – ranging from herbs and nutrition to support estrogen detox pathways, to supplements to lower cortisol levels, to anti-inflammatory nutrition plans, and strategies to reverse insulin resistance. Identifying your perimenopause type(s) allows us to personalize your treatment plan.
Using perimenopause signs for prevention
How you experience perimenopause also gives us significant clues about what issues we need to focus on preventatively as you age. Let’s go through each of the types, and how to follow-up.
1) Estrogen storm
Prevention: With signs of high estrogen, or slower estrogen detox pathways, uterine fibroids are more common, as are breast cysts. As you know, estrogen can feed certain cancers, so breast screening and pelvic ultrasound is a good idea. It is also essential to keep an eye on iron and hemoglobin levels – severe anemia can result from ongoing heavy periods.
2) Low estrogen / low hormones
Prevention: If estrogen is dropping early, bone density is a concern especially, as well as brain health. For bone density, ensuring that you are getting enough calcium, vitamin D, doing strength training exercise, and watching coffee and alcohol intake are important. A bone density test may be recommended before the typical age of 50. Low estrogen can also contribute to age-related memory changes happening a little earlier. If your periods are tapering off, and you’re also experiencing a change in your memory or word-finding, a cognitive prevention plan is recommended. (https://drshawnadarou.com/courses/steps-you-can-take-now-for-cognitive-wellness-alzheimers-prevention/).
3) Stressed & anxious
Prevention: If high cortisol is the underlying imbalance causing an increase in stress and anxiety during perimenopause, this is important to address as it can contribute to high blood pressure, high blood sugar, increased cardiovascular risk and also low bone density with menopause. In fact, having high cortisol as you go through menopause, especially when estrogen finally drops is a major risk factor for early development of osteoporosis.
Prevention: If inflammation and body pains are beginning in the 40’s, a preventative plan with an anti-inflammatory nutrition plan, supplements, stretching and regular gentle movement are recommended to reduce risk of arthritis and autoimmunity. As you know, inflammation is at the root of many chronic health issues, so addressing it when it first shows up is key.
5) Blood sugar
Prevention: If fasting insulin levels are climbing with insulin resistance, or pre-diabetes is found, clearly we need to reverse these changes to prevent future diabetes and heart disease. Remember that insulin resistance is 100% reversible with nutrition and exercise – it’s good to address this early. As mentioned above, insulin resistance typically shows up along with hormones shifts in the 40’s, and it can compound the symptoms you experience during this time.
I hope this short article has shown you how important it is to pay attention to your perimenopause symptoms, because they give us many clues about your overall health, and get us on a plan for prevention. Don’t ignore the signs!
If you would like to investigate or treat your perimenopause symptoms, please ask at your next appointment. There is so much we can do to ease the hormone changes that are occurring during this time, and as you can see, women go through this transition in different ways.